Currently most infertile men cannot be given an aetiology. This reflects a lack of knowledge around gamete production and how they are impacted by genetics and environment. There is a failure to recognise the burden of male infertility and its potential as a biomarker for systemic illness. The absence of such knowledge results in patients generally being treated as a uniform group, where the strategy is to by-pass the causality, by medically assisted reproduction (MAR).In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR shifted to the female partner.To advance understanding of male reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programs must allow for an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health.There is a need to define what these consequences of MAR are for conceived children, and where possible to ameliorate them. Inherent in this statement is the necessity to promote fertility restoration, and/or use the least invasive MAR strategy available. To achieve this, protocols must be rigorously tested and the move towards personalised medicine encouraged.Equally, there is a need to educate the public, governments, and clinicians on the frequency and consequences of infertility. Health options, including male-based contraceptives, must be expanded, and the opportunities encompassed in such investment understood.The aim of this opinion piece is to identify the pressing questions related to male reproductive health, spanning the spectrum of andrology.