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In conversations caught on hidden camera, New York City’s former COVID czar said that he’d organized a pair of sex parties in the second half of 2020, as New Yorkers coped with peak pandemic social isolation. “The only way I could do this job for the city was if I had some way to blow off steam every now and then,” Jay Varma told an undercover reporter with whom he thought he was on a date. In a video compiled from several recordings taken this summer, the onetime senior public-health adviser to city hall describes the two events that took place in August and November of 2020. He also talked about his work promoting vaccination in the city by making it “very uncomfortable” for those who wanted to avoid the shots.

“I stand by my efforts to get New Yorkers vaccinated against COVID-19, and I reject dangerous extremist efforts to undermine the public’s confidence in the need for and effectiveness of vaccines,” Varma said in a statement to The Atlantic. He acknowledged having participated in “two private gatherings” during his time in government, and said he takes responsibility “for not using the best judgment at the time.” The statement also notes that the taped conversations were “secretly recorded, spliced, diced, and taken out of context.”

It’s not clear whether Varma personally violated any COVID rules. The sex parties involved, by the account he gave to the podcaster Steven Crowder in a companion video, “like, 10 people.” At the time, New York’s guidelines—which Varma was promoting far and wide—limited gatherings to 10 people or fewer in an effort to curb the spread of the virus. Separate city guidance on “Safer Sex and COVID-19” discouraged—but did not forbid—group sex. (“Limit the size of your guest list. Keep it intimate,” the guidance said.) Varma explained that he’d sex-partied responsibly, noting, “Everybody got tests and things like that.” He also said that he’d attended a dance party with hundreds of others in June 2021, after he’d left government (but while he was still consulting for the city on COVID policies).

Still, you might think that a public-health official would do better to skip out on all of these events while other city residents were encouraged to minimize their social interactions. Even if Varma did not personally buck official guidance, others in his family may have crossed the line. He says in the videos that his family traveled to Seattle for Christmas in 2020, and that he didn’t join because the mayor was concerned about the optics: Public-health officials were actively encouraging people to avoid traveling for the holidays to avoid a winter surge. The following January, the U.S. reported a then-record number of COVID deaths.

In June 2021, around the time that he attended the dance party with hundreds of others, Varma wrote an article for The Atlantic about the tricky calculus behind vaccine mandates and related COVID policies. “Many academic public-health experts favor more stringent restrictions than public-sector practitioners, including me, believe are realistic,” he wrote. He argued instead for what he called “a more targeted approach—one that neither requires universal sacrifice nor relieves everyone of all inconvenience.”

Perhaps it would have helped if he’d shared his own struggles with that tension at the time. Social-science research tells us that public-health messaging wins trust most effectively when it leads with empathy—when leaders show that they understand how people feel and what they want, rather than barraging them with rules and facts. Clearly Varma struggled in the way that many others did as he tried to navigate the crushing isolation of the pandemic. In preparation for the holidays, his family was faced with tough, familiar choices, which resulted in his being separated from his loved ones.

The end result may seem hypocritical, but it’s also relatable. (Well, maybe not entirely relatable, but in principle.) “We know that transparency can increase public trust in public health and medical experts,” Matt Motta, who studies vaccine hesitancy at the Boston University School of Public Health, told me. What if Varma had been forthright with the public from the start, even on the subject of his sex parties? Perhaps he could have shown that he understood the need to get together with your friends as safely as you can, in whatever ways make you happy. Even now, his description of that moment strikes a chord. “It wasn’t so much sex,” he told the woman who was trying to embarrass him. “It was just like, I need to get this energy out of me.” So did the rest of us.

Deb Jenssen never wanted her children to suffer from the disease that killed her brother at 28. The illness, Duchenne muscular dystrophy, initially manifests in childhood as trouble with strength and walking, then worsens until the heart or the muscles controlling the lungs stop working. She decided to get pregnant using IVF so that she could select embryos without the mutation for the disorder. But when she ended up with just two viable embryos—one with the mutation—the clinic urged her to transfer both.

The embryos were female, and Jenssen remembers the doctors assuring her that, because the Duchenne mutation is linked to the X chromosome, a girl who carried it would have a backup chromosome, with a working copy of the affected gene, and would be as healthy as Jenssen was. “I had 10 minutes to decide,” Jenssen told me; less than a year later, she had three babies. Both embryos had successfully implanted, then one split into two. Jenssen had a clue which embryo had divided when one of her toddlers stood up by spreading her feet out wide and walking her hands up her legs: She’d seen her brother do that same move, a hallmark of muscular dystrophy, as a child.

Jenssen guessed then that two of her daughters, the twins, had a Duchenne mutation, and she knew in her heart that, for at least one of them, that genetic legacy was already developing into disease. But persuading doctors to test for it took about a year and a half. She said they kept telling her, “Girls don’t get Duchenne.”

Of the hundreds of genetic diseases linked to the X chromosome, Duchenne is among the more common, along with certain forms of hemophilia. Other so-called X-linked disorders include Fabry disease, which can cause life-shortening kidney and heart problems, and types of Alport syndrome, another kidney-destroying disease. In the past, many doctors believed that these diseases affected only men and boys. But what seemed at first like isolated cases kept cropping up, in which women and girls showed symptoms, too. Parts of the medical community and many patients now argue that more women might be affected with symptoms of X-linked disorders than previously appreciated.

Data about what these diseases look like in women and girls, or even how many women are affected, are scarce, in part because researchers are only now taking this problem seriously. For some women, the symptoms appear less severely than in men, but for others they are similarly devastating: Jenssen told me that, at 15, one of her two daughters with the mutation so far has only mild symptoms of Duchenne, but the one who first showed signs of the disease now uses a wheelchair. That they are affected at all, though, goes against what many women were told for years.

Shellye Horowitz, now 51, told me that, throughout her childhood, her wounds never healed well or quickly, and her joints hurt so much that she limped. No one believed what she said about her constant pain. “The doctors told my parents that I was lazy and that I was faking it to get out of PE,” she said. Horowitz’s dad had hemophilia, a blood-clotting disorder that, in severe forms, can cause fatal bleeds if left untreated, but her doctors never took seriously the possibility that she did too.

Still, long after she was done with PE, Horowitz suffered from swelling joints and other tissues, and wounds that wouldn’t heal. As an adult, she had a small mole removed, and bled through an entire roll of paper towels. Finally, the doctors gave her replacement clotting factor, a classic treatment for hemophilia, and the bleeding stopped. Only as she entered her 40s, after a series of medical procedures and follow-ups, did Horowitz learn that she makes just 10 to 20 percent of the amount of clotting factor the body needs. And she finally found a specialist who put her on preventive therapy for hemophilia.

For years, many practicing doctors’ thinking about X-linked diseases has been simple. In their view, men and boys have one X chromosome in their cells and one Y, which carries only a paltry set of genes. So if a genetic error on the X chromosome disrupts production of important proteins in the body, male patients suffer the consequence. According to this traditional logic, women and girls have another copy of the genes in question on their second X chromosome—working genes that can make up for mutated ones. (Women might have two mutated X chromosomes, but that is statistically ultrarare.)

The idea that those backup genes would always shield someone from an X-linked disease, however, has proved untrue, in part because of a special thing that happens with X chromosomes.

In other pairs of chromosomes, those alternative genes can protect against some dangerous mutations. But beginning in the 1960s, scientists began to appreciate that, as female embryos develop, their cells undergo a process known as X-chromosome inactivation. The thinking goes roughly like this: Because cells do not need two of these particular chromosomes to function, they chemically silence one at random. If the X chromosome carrying a mutation for a disease is silenced as the embryo grows, then a woman carrying the disorder will be symptom-free. But if the healthy X chromosome is silenced early in development, then the mutated X chromosome can prevail in many of the body’s cells from that point on, and dominate as the girl grows.

Still, “it is a rather common misconception that women are not affected by X-linked disorders,” Caroline Bergner, a neurologist in the Leukodystrophy Outpatient Clinic at the University Hospital Leipzig, told me. Many doctors still learn that X-linked diseases are essentially restricted to boys and men, but “genetics is a lot more complicated than what we are taught in medical school,” Angela Weyand, a hematologist and professor at the University of Michigan Medical School, told me. The science of X inactivation might not be new, but in her experience, “most of it isn’t well known within the medical community outside of geneticists.” Even if a doctor does understand that a woman could be affected by X-linked disorders, they might think these scenarios are too rare to be applicable to their patients. But, Weyand said, “I don’t believe that people who truly understand the science can say that risks to carriers are negligible.”

The variability of X inactivation likely helps explain why an X-linked disease’s effects on women who do have symptoms can vary widely. With Duchenne, a girl whose cells skew toward the mutated copy of the X chromosome “can develop symptoms that look very much like classical Duchenne muscular dystrophy in boys,” Sharon Hesterlee, the chief research officer at the Muscular Dystrophy Association, told me. But because X inactivation is random and exceedingly difficult to test for, women cannot readily know the pattern of chromosome inactivation in their body or predict the degree to which they will experience symptoms. For example, even though Horowitz’s body produces only 10 to 20 percent of the normal amount of clotting factor, she says her aunt with the same X mutation makes 80 percent of the normal amount, and does not need medication.

When researchers have looked at how women are affected by certain X-linked diseases, they’ve found that symptoms are surprisingly common, though. For instance, a study of women with Duchenne mutations—in which Jenssen participated—found that half of them had evidence of tissue scarring in their heart. Jenssen was among those with signs of this cardiac damage. A study of adrenoleukodystrophy, an X-linked disease that can cause deadly hormonal and cerebral complications in boys and men, indicated that upwards of 80 percent of women with mutations for adrenoleukodystrophy show neurological dysfunction by age 60 or older. These women might not be at risk of death, but they can experience life-altering symptoms, including bowel and bladder issues and mobility issues that cause some to need a wheelchair.

Taylor Kane has the mutation for adrenoleukodystrophy, which claimed the life of her father and his twin brother when she was a child. She has not yet had any clear signs of the disease, but her mutation inspired her to start Remember the Girls, an organization that pushes against the dogma that X-linked diseases rarely affect women. About 1,500 women who collectively represent 50 X-linked disorders have joined, including Jenssen and Horowitz. But many women with X-linked disorders are unaware that they even have an affected gene, Kane said. They might suffer symptoms and discover the cause only when they have a son born with the condition.

Knowing that they’re a carrier of the disease doesn’t necessarily help women get treatment. Data might not exist to prove that a particular treatment works in symptomatic girls; if a treatment is sex-limited, then prescribing it for female patients is considered off-label and not always covered by insurance, says Eric Hoffman, a pharmaceutical-sciences professor at Binghamton University and the CEO of a company that has an approved Duchenne therapy and another that facilitates research on treatments for the disease. A doctor might also prescribe a treatment for a female patient’s symptoms without diagnosing the disease as the root cause, which could also cause an insurance company to balk. A company might also deny coverage because a patient’s record is missing the diagnostic code for an X-linked disease—which some hospital medical systems simply don’t have for girls and women.

Jenssen has struggled to get her daughter treated for Duchenne even after a muscle biopsy confirmed the diagnosis. Being a girl disqualified her daughter from drug trials, even though a respected researcher who was enrolling boys in a gene-therapy trial once allowed that “gene therapy would be perfect for her,” Jenssen told me.

One gene-therapy trial eventually produced the medication Elevidys, which received approval from the U.S. Food and Drug Administration in June. Jenssen’s family cheered when they saw that the agency hadn’t limited the drug to boys. Her daughter’s doctor prescribed the medication, with the hope that it would preserve the autonomy her daughter still has—lifting herself into bed from her wheelchair; dressing herself. The family’s insurance provider initially denied coverage of the treatment, a onetime infusion with a list price of $3.2 million. They appealed, and yesterday the company called Jenssen to tell her that the original decision had been overturned. “I feel like it’s unreal,” Jenssen told me. The data on the treatment have been promising but not definitive (and is lacking for girls in particular). Still, Jenssen had hope in her voice when she talked about getting her daughter’s identical twin—the one with more mild symptoms—the medication as well, before her prognosis has a chance to get worse: “She could maybe be cured.”

Produced by ElevenLabs and News Over Audio (NOA) using AI narration.

For the past couple of months, Donald Trump has been working hard to prove that, as he said during his debate with Vice President Kamala Harris, he is “a leader on IVF, which is fertilization.” And despite the jokes that ensued about Trump’s follow-up claim—“I have been a leader on fertilization”—Trump really has been trying. In August, he pledged to make IVF free to all Americans by requiring insurance companies or the federal government to cover it.

Trump’s debate statement puts him at odds with most of his party on IVF. Only two Republicans—Susan Collins and Lisa Murkowski—voted in favor of the Right to IVF Act, which came before the Senate for the second time this week and included provisions similar to Trump’s promise, requiring employer-sponsored insurance and certain public plans to cover the treatment. The former president’s emphatic interest in IVF also marks a striking pivot for a campaign that has remained mostly muted on reproductive health care, including on the issue of abortion rights. And his focus offers a window into his political calculus as he attempts to retake the presidency. If his party won’t budge on abortion, IVF allows him to signal to swing voters—particularly women—that his populist instincts are still in play.

Infertility is an issue that resonates with a large and growing number of American families, and the treatment has high and consistent support across partisan and demographic groups. One out of every 40 babies born in the U.S. in 2022 was conceived through IVF, compared with about one out of 65 a decade earlier. As awareness and use of fertility treatments rise, demand has begun to far outstrip supply. Roughly one out of every eight Americans experiences some form of infertility, and many LGBTQ couples and single people also turn to IVF to become pregnant. Yet few poor and rural areas in the U.S. have fertility clinics; in fact, 80 percent are in New York City. Even in areas where treatment is available, it can be prohibitively expensive. IVF costs an estimated $15,000 to more than $30,000 per cycle, and the average patient needs 2.5 cycles to become pregnant.

Trump’s campaign has provided few specifics on his IVF plan; his vice-presidential candidate, J. D. Vance, told NPR that “details get worked out in the legislative process.” But legislators in their own party don’t seem keen to make it happen: Several prominent Republican lawmakers expressed opposition to (or at least confusion about) Trump’s proposal, and even some of Trump’s most loyal congressional allies have stopped short of endorsing government-mandated coverage for the procedure.

However half-baked Trump’s free-IVF plan may be, his embrace of fertility rights stands in contrast with his more distant approach to abortion. Since 2022, when the Supreme Court’s Dobbs ruling paved the way for tighter abortion restrictions in 22 states and counting, Trump has faced intense backlash from women’s-rights advocates and health-care groups. In response, he has wavered on supporting a national abortion ban. In March, he voiced support for federal restrictions on the procedure, but during the recent presidential debate, he argued that abortion access should be left to the states. At the same time, he deflected questions about whether he would veto a ban if it came across his desk. But voters haven’t forgotten that “his fingerprints are stuck all over the Roe v. Wade reversal,” Susan Crockin, an adjunct professor specializing in reproductive-technology law at Georgetown Law, told me. Abortion will likely remain a losing issue for his campaign, she said: This spring, about two years after Dobbs, nearly two-thirds of Americans polled by Pew said abortion should be legal in all or most cases.

Read: Kamala Harris’s biggest advantage

With IVF, unlike abortion, Trump is taking a clear stance that contradicts core conservative principles. Leaving abortion to the states at least aligns with the traditional Republican position to limit the federal government’s involvement in health care: Senator Mitt Romney similarly highlighted the importance of states’ rights in abortion during his 2012 campaign for the presidency. Trump’s free-IVF pitch flouts those principles, as well as the push among some conservatives to restrict IVF on moral grounds. To many anti-abortion and abortion-rights advocates alike, Trump’s proposal most resembles the Affordable Care Act mandate for employers to cover birth control and emergency contraception, a policy that Trump’s 2016 campaign derided. “This IVF plan is pure populism. It shows he’s not someone with a conservative worldview,” says Cole Muzio, the president of Frontline Policy Action, a conservative Christian group that has lobbied for anti-abortion measures in Georgia. (The Trump campaign did not respond to a request for comment.)

Whereas Trump’s evasiveness on abortion comes across as an attempt to please moderates and conservatives alike, his IVF stance strongly suggests which voters he’s most desperate to court. This year, the Trump campaign has been pointedly targeting white and suburban women, a crucial voting bloc in his previous presidential bids. College-educated white women, in particular, exhibit strong support for Kamala Harris, and they are also more likely to use fertility services than Black and Hispanic women or those without a bachelor’s degree. Although Trump’s promises are unlikely to sway staunch supporters of abortion rights, they might win back some swing-state voters who feel lukewarm about abortion and firmly support fertility care. Some early signs suggest that this strategy could pay off: In a September poll in Michigan, the battleground state where Trump announced his free-IVF plan, 29 percent of independent voters said they were more likely to support his 2024 campaign because of it.

This advantage might come at the expense of a different, but still key, Trump voting bloc: strong opponents of abortion. Although IVF access has broad support from Christian and self-identified pro-life voters, the former president’s recent statements have angered some anti-abortion advocates, who argue that life begins at conception and that discarding embryos during IVF is therefore akin to murder. His promises could dampen enthusiasm somewhat among white evangelicals, from whom Trump is projected to need overwhelming support in order to win the election. But Trump seems to have decided that he can afford to offend these Americans without losing their votes. As Peter Wehner argued in The Atlantic last month, many anti-abortion voters will likely continue to support Trump, even if begrudgingly. Muzio agreed. “This will be the difference between quietly going into the ballot box and casting your vote for him versus going to Sunday-school class and encouraging your friends to do the same thing,” he told me.

Peter Wehner: Trump’s evangelical supporters just lost their best excuse

Although Harris has linked IVF and abortion access as part of a unified reproductive-rights platform, Trump has attempted to separate the two. He frames his free-IVF plan as its own pro-family issue, even tying it to a proposal for child tax credits. What remains unclear is whether this distinction is meaningful to voters. Last December, less than 1 percent of registered voters ranked abortion as the most pressing problem facing the country. But in an August poll of voters in three key swing states, a plurality of women said it was the single most important issue determining their vote for the presidency. In September, 14 percent of all voters said abortion was their No. 1 issue. Sidestepping it in favor of IVF is a gamble—one whose payout could well determine who moves into the White House next year.

A placenta is, by definition, new tissue: It grows from scratch over nine months of pregnancy. So when a team of researchers found microplastics in every human placenta they sampled, they were a little bit shocked, Matthew Campen, a professor at the University of New Mexico and a researcher on the team, told me. But in hindsight, he thinks perhaps they shouldn’t have been. Microplastics are in the air we breathe, the water we drink, the rain and snow falling from the sky, the food we eat. They are in the dust in our house, the paint on our walls, the cosmetics in our medicine cabinets. They slough off from dental aligners, the toothpaste on our toothbrush, the toothbrush itself. Since his placenta study, Campen has found that microplastic is in human testicles and, detailed in a paper that has yet to be published, in human brains.

Scientists have now been studying microplastic for 20 years, since a paper in 2004 first used the term, and have started on nanoplastics, the vanishingly small versions that build up in organs. In that time, human exposure to microplastic has been increasing exponentially; by 2040, the amount of plastic in the environment could double. A robust body of research now links chemical compounds (such as phthalates and bisphenols) that are shed from plastic to a wide array of human health impacts, including hormone disruption, developmental abnormalities, and cancer. But scientists know far less about what the health impacts of the plastic fragments embedded in our organs and coursing through our blood might be.

They are, however, wary. Sheela Sathyanarayana, a physician at Seattle Children’s Research Institute who studies the effects of plastic on pregnancy outcomes and children’s health, told me that what we stand to learn about microplastic is unlikely to be good—it’s probably at least an irritant that, like the small particles in wildfire smoke, can cause inflammation. A new paper reviewing emerging evidence about microplastics, published today in Science, anticipates that researchers will know more in five to 10 years about microplastics’ health effects. However, that doesn’t mean the world should wait for more damning evidence to emerge, the paper’s lead author, Richard Thompson, a marine-biology professor at the University of Plymouth, told me. Animal models are clearly pointing toward the potential for harm, he said, and we are not, biologically speaking, that different from those animals. “We could spend billions on experiments trying to understand that harm in humans,” he said. “But when we’ve done that, we’re still arguably going to need to fix the problem.”

As it stands, though, individuals are left to mediate their own relationship to plastic, in a world where plastic is the default. Even reducing one’s exposure can take scrupulous research and, often, money. Avoiding plastic in daily life has become essentially a luxury.

I recently went through the painstaking process of finding a couch that wasn’t covered in some kind of polymer “performance” material, eventually settling on a leather option. It was already far more expensive than standard microfiber or polyester-twill options, and I only later realized that the foam cushions within the leather were, like most couches, made of polyurethane foam that, for all I knew, was releasing plumes of microplastic dust each time I plopped down. Couches are available with plastic-free wool cushions, but those were out of my price range. Okay, I thought, I’ve done the best I could. Still, I think about it every so often when I sit down.

You can repeat this type of reasoning with any manner of home good. Purity is impossible, and half measures feel better than nothing but also like failure. And it’s all expensive. If a family is expecting a baby and wants, reasonably, to buy plastic-free baby products—given everything humanity is learning about the possible impact of plastic on fetal and child development—they would have to be relatively rich. You can get an organic, plastic-free crib mattress for $1,379; one made of polyester fiber and wrapped in vinyl costs $35. Or consider your floor. Some 95 percent of modern carpets are made from synthetic fibers—in other words, plastics—which flake off microplastic throughout their life. Vinyl flooring is better than carpeting, because it can more easily be kept clean. But vinyl is also a plastic and can emit harmful compounds including phthalates, which may interfere with children’s development and reproductive health and are associated with allergic conditions such as asthma, Sathyanarayana told me. In recent years, several large retailers have offered phalate-free vinyl flooring options, in which the problematic phthalate was swapped for a different compound which appears to be less concerning. But the least concerning option is either buying natural-fiber carpets, which are more expensive, or installing hardwood floors.

When Sathyanarayana talks with the families she sees as a pediatrician, she tells them to avoid the big things: Don’t use plastic in your kitchen, if you can help it, because ingestion is a major route for microplastics into the body. She suggests that they not eat food out of plastic containers. (Babies can use stainless-steel plates and cups, for instance.) And especially don’t heat food in plastic, to avoid ingesting plasticizers—chemicals added to plastic to make them soft and flexible. But another big one to avoid is heavily processed food, which may be contaminated with more microplastic simply by undergoing more manufacturing steps in modern, plastic-heavy factories. It’s good advice, but it also requires money and time: Wooden utensils are more expensive than plastic utensils, glass containers are more expensive than plastic containers, and so on. Avoiding processed food means making food, which also takes time, a luxury that some families simply don’t have.

Sathyanarayana acknowledged that following her advice is tough. “It puts the burden on the consumer, because our regulatory system has not accounted for these types of chemicals,” she said. “That kind of burden is really tough. When you’re pregnant and trying to think of so many different things, it’s a heavy burden to carry.”

Rather than panic, Campen advised, people should not stress so much about microplastics. Stress, he reminded me, is also a health hazard. And given that we move in a wall-to-wall-plastic world, we know too little to worry, as individuals, over what might be uncontrollable. “Knowing what I know, if I freaked out about it, I would quickly lose my mind,” he said.

Still, despite this breezy advice, Campen admitted that he does stress about the systemic side of the plastics problem. “I worry about the global problem more than my personal health,” he said. “We are in no position to make a change to this exponentially growing problem. That’s what causes me the most stress.” At this point, only major government intervention to limit plastic production could stem the tide, he and both other researchers I spoke with said. Crib mattresses that cost nearly $1,400 are not going to solve it, although they could, in theory, lower the concentration of some of these compounds in your child’s blood. Eventually, Sathyanarayana thinks, companies will catch on, and cheaper plastic-free options will come to market—but that’s a slow process, and few materials stand any chance against the basement-floor pricing of plastic polymers, driven by the profusion of cheap oil and gas used to make it. And if, in a decade, scientists do find that these tiny particles have posed a threat all along, many people will wonder why no one did anything about them sooner. By then, a whole additional generation will have been born into a polymer world, wrapped in plastic since the womb.

Richard Einhorn first noticed that he was losing his hearing in a way that many others do—through a missed connection, when he couldn’t make out what a colleague was saying on a phone call. He was 38, which might seem early in life to need a hearing aid but in fact is common enough. His next step was common too. “I ignored it,” Einhorn, now 72, told me. “Hearing loss is something you associate with geezers. Of course I hid it.” He didn’t seek treatment for seven years.

About 15 percent of Americans, or nearly 53 million people, have difficulty hearing, according to the CDC. Yet an AARP survey found that Americans older than 40 are more likely to get colonoscopies than hearing tests. Even though hearing starts to deteriorate in our 20s, many people think of hearing damage as a sign of old age, and the fear of being seen as old leads people to delay treatment. According to the Hearing Loss Association of America, people with hearing loss wait, on average, seven years to seek help, just as Einhorn did.

When people ignore their hearing loss, they put themselves at a higher risk for social isolation, loneliness, and even dementia. One of the best things you can do to feel less old is, ironically, get a hearing aid. And in the past two years, these devices have become cheaper, more accessible, and arguably cooler than they’ve ever been, even before the FDA approved Apple’s bid last week to turn AirPods into starter hearing aids. This new technology is more of a first step than a complete solution—think of it as analogous to drugstore reading glasses rather than prescription lenses. That, more than anything about AirPods themselves, may be the key to softening the stigma around hearing aids. Creating an easier and earlier entry point into hearing assistance could help Americans absorb the idea that hearing loss is a spectrum, and that treatment need not be a rite of passage associated with old age.

As it stands, one demographic that could especially benefit from destigmatized hearing aids is older men. “Men are at a greater risk for hearing loss early on because they have typically had more noise exposure than women,” says Steven Rauch, who specializes in hearing and balance disorders at Harvard Medical School. But men are also less likely to go to the doctor. (Several men I interviewed spoke about being prodded by their wives to go to an audiologist.) Instead, many hide their hearing loss by nodding along in conversation, by hanging back at social gatherings, by staying home.

Faking it makes the situation worse. Without treatment, hearing can decline, and people become socially isolated. “When you’re sitting in a room and people are talking and you can’t participate, you feel stupid,” says Toni Iacolucci, a communication-access advocate who waited a dozen years before she got a hearing aid. “The amount of energy you put into the facade that you can hear is just exhausting.”

Compensating for untreated hearing loss is so taxing, in fact, that it can have a meaningful impact on the brain. “Hearing loss is arguably the single largest risk factor for cognitive decline and dementia,” says Frank Lin, the director of the Cochlear Center for Hearing and Public Health at Johns Hopkins University. Lin and his colleagues have found that mild hearing loss doubles the risk of dementia, and moderate loss triples it. In this context, a hearing aid can look almost like a miracle device for slowing aging: In that same study, Lin also found that among older adults at increased risk for cognitive decline, participants who wore a hearing aid for three years experienced about 50 percent less cognitive loss than the control group.

Lin hypothesizes that the difference is because of cognitive load. “Anybody’s brain can buffer against the pathology of dementia,” he told me. “But if you have hearing loss, too, a lot of that buffer is having to be used up to deal with hearing loss.”

In many cases, the gap between onset and treatment means years of missed conversations and declining social connection; hearing loss is associated with both loneliness and isolation. For Einhorn, who worked as a composer and a classical-record producer, his declining hearing meant maintaining a constant effort to keep up appearances. He remembers going to restaurants and tilting his head entirely to the left to favor his better ear while denying to his friends that he had any issue with his hearing; he started to avoid going to parties and to the movies. “Phone calls became hellish,” he told me. He eventually had surgery on one ear and finally started wearing hearing aids in 2010, when he suddenly lost all of his hearing on one side. “When I lost my good ear, I fell into an abyss of silence and isolation,” he says. “It was an existential crisis: Either I figure out how to deal with this, or, given the isolation I was already experiencing, it was going to become really serious.” Only then did he realize that the devices were less visible than he’d imagined and that the integration into his world was worth the ding to his vanity. Like many who use the devices, he still struggles to hear at restaurants and parties (carpets and rooms without music help), but the hearing aids have made an enormous difference in his quality of life. He still regrets the years he spent posturing instead of listening. “When you get to 72, you realize you’ve done a lot of dumb things, and not getting treatment was probably the dumbest thing I’ve ever done in my life,” he said.

That anyone is straining this much when a fix exists is a testament to how powerful ageism and the pressure to project youth can be. As long as people see the choice as one between hearing well and looking young, many will opt for faking their ability to hear. Overcoming that association with age may be the last challenge of persuading people to try hearing aids out.

Some of the barriers were, until recently, more basic. Hearing aids were available only with a prescription, which usually requires visits to an audiologist who calibrates the device. Prescription hearing aids also cost thousands of dollars and aren’t always covered by insurance. Pete Couste, for instance, did go to the doctor a couple of years after first noticing he was off pitch when playing in his band, but he decided not to get hearing aids because of the cost. Instead, he dropped out of the band and his church choir.

But these barriers are getting lower. In 2022, the FDA approved the sale of hearing aids to adults without a prescription, opening the technology up to industry for the first time. Over-the-counter options have now hit the market, including from brands such as Sony and JLab. Apple’s hearing-aid feature, compatible with some AirPod Pros, is the first FDA-approved over-the-counter hearing-aid software device and will be available later this fall via a software update. EssilorLuxottica plans to release the first-ever hearing-aid eyeglasses later this year. Learning about the over-the-counter options triggered Couste to address his hearing loss, and he ended up with prescription aids that have made a “tremendous difference” in his confidence, he told me. This year, he went to four weddings and a concert at Red Rocks; he’s even started to play saxophone again and plans to get back onstage within a year.

None of that undoes hearing aids’ association with aging, though. A selling point of the new AirPod technology is simply that “everybody wears AirPods,” Katherine Bouton, a hearing-loss advocate and the author of the memoir Shouting Won’t Help, told me. “The more you see people wearing something, the more normal it becomes.” At the same time, AirPods are typically a signal that someone’s listening to music or a podcast rather than engaging with the world around them: The AirPods might improve someone’s hearing, but they won’t necessarily make hearing loss less lonely. Even if Iacolucci’s hearing loss could be treated with AirPods, she doesn’t think they would fully address the loss’s impact: “I still have to deal with the internal stigma, which is a thousand times worse,” she told me.

The real power of the Apple technology, then, might be that it’s targeted to users with mild to moderate hearing loss. Changing the stigma around hearing loss will take far more than gadgets: It’ll require a shift in our understanding of how hearing works. “Hearing loss implies that it’s binary, which couldn’t be further from the truth,” Lin said. Most people don’t lose their hearing overnight; instead, it starts to deteriorate (along with the rest of our body) almost as soon as we reach adulthood. Over time, we permanently damage our hearing through attending loud concerts, watching fireworks, and mowing the lawn, and the world is only getting louder. By 2060, the number of Americans ages 20 years and older with hearing loss is expected to increase by 67 percent, which means that nearly 30 million more people will need treatment. If devices we already use can help people transition more easily and at a younger age to using hearing assistance, that could make the shift in identity less stark, easing the way to normalizing hearing aids and changing the idea that they’re for geezers only.