Editor’s note, October 4, 8 am ET: We’re bringing you some of our best-loved Your Mileage May Vary columns while Sigal Samuel is on parental leave. The one below was originally published last year.

This unconventional advice column offers you a unique framework for thinking through moral dilemmas. It’s based on value pluralism: the idea that each of us has multiple values that are equally valid but that often conflict with each other. Submit your own question here.

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My partner and I did IVF recently and luckily we ended up with several embryos. One of those will be implanted in me so I hopefully get pregnant. But which one?

My fertility clinic is encouraging me to do PGT-A testing, which would screen for things like Down syndrome and would also let me see the sex of each embryo so I could potentially choose whichever I want. (And to be honest, I really want a girl!) I’m also hearing about these new companies that can test embryos for all kinds of things — like how smart the kid might be, how tall they’ll get, and whether they’ll have a lower chance of getting breast cancer, diabetes, mental illness, stuff like that.

I don’t know how to feel about any of this. On the one hand, it feels weirdly eugenics-y to do so much tinkering with embryos, and I can’t help feeling a little pressured into overmedicalizing everything with these expensive tests. But then again, if I could do something to make my baby healthier and happier, don’t I kind of have to do everything in my power? What does a parent owe their child?

Dear Expecting,

This is such an exciting — and also confusing — time. You’re about to have your first kid, and that comes with all sorts of fears and insecurities and hopes and dreams. You want to do the right thing — no, the best thing! — for your child. It’s a beautiful impulse. Unfortunately, it makes it easy for companies to prey on you.

So let me walk you through what these companies can and can’t really provide. After we talk about the science, we can talk about the ethics. 

The simpler test you mentioned, PGT-A, has been around since the 1990s. It can indeed screen for conditions like Down syndrome and let you see the sex of each embryo. Mind you, that doesn’t predict what gender your child will ultimately end up identifying with — more on that soon.

The newer testing you mentioned is called polygenic testing. The conditions it screens for are complex ones, influenced by thousands of genes. We’re talking about everything from breast cancer to depression. Some companies even offer screenings not for disease prevention, but for genetic enhancement — so you can select for a taller kid or a kid with higher IQ.

Polygenic testing companies claim to predict each embryo’s risk for each condition, and the potential reduction of risk you’ll get if you choose one embryo over another. As the statistical geneticist Sasha Gusev explains, it’s very, very easy to be misled by this claim. If the company claims to lower absolute risk of Type 2 diabetes by 12 percent, you might think this means, “The chance of my kid ever developing diabetes just went down by 12 percent — great!” But really what it means is that, all else equal, a kid who would’ve developed diabetes is likely now at the high end of pre-diabetes instead, or just develops diabetes a few years later. The same holds true for other conditions, like breast cancer. Sure, if your kid is going to develop diabetes or breast cancer, you’d rather they develop it later — but it’s not the bill of perfect health customers might imagine.  

“Typical risk reduction estimates tend to exploit statistical assumptions to overstate their benefits and lead to confusion,” Gusev writes.

It’s also important to note that there’s a difference between a physical disease like cancer, which is straightforwardly and universally negative, and a complex mental health condition like depression. For one thing, polygenic scores don’t perform as well in psychiatry, as the psychologist Eric Turkheimer notes. Plus, most mental health conditions come in mild to moderate to severe forms, and it’s not clear that we should want to get rid of mild or moderate manifestations. 

“Sure, it would be nice if no one ever got depressed, but what would that actually mean?” Turkheimer writes. “People are going to be sad, and the most modern models of psychiatric disorders view most of them as extremes on continuous dimensions of normal behavior. I don’t think we want some kind of genetic version of Soma.”

To give a personal example: I have generalized anxiety with some obsessive tendencies. Is that a major pain in the butt sometimes? You bet. But if I could wave a magic wand and get rid of it, would I? No. In my experience, this trait is linked to another trait I deeply value: my creativity. The same thing that propels me down rabbit holes of worry also propels me down rabbit holes of getting super curious about some topic, researching it into the wee hours of the morning, and then writing a novel or children’s book about it.

That brings me to one other scientific issue: pleiotropy. It’s a fancy term for a simple truth, which is that genes can have an effect on more than one trait. When it comes to behavioral polygenic testing, we actually know very little about which genes cause what — a gene that’s correlated with depression or anxiety may also be correlated with a bunch of other things. So, if everyone were to start selecting embryos to try to protect their kids from depression or anxiety, what would happen? We don’t know! 

Pleiotropy is a scientific issue, but it’s also a moral issue, because in trying to protect your kid from a negative outcome, you could also be accidentally barring them from a positive one.

And that’s just the tip of the moral iceberg.

Another issue is the potential psychological harm that can result from commodifying our kids — treating them like consumer objects with selectable parts. Let’s say you use polygenic testing to try to select for high IQ. Even if the company’s predictor is right 80 percent of the time, that means it’s wrong 20 percent of the time. What happens if it’s wrong about your kid, and they end up with a low IQ instead of a high one? How will your kid feel? Unless you hide the truth from them, they’ll know that they are not what you wanted, that they failed to live up to the vision you went out of your way to chase.

The same goes for sex selection via good old PGT-A. I know you really want a girl. But what would happen if you select for a girl, and then your child grows up and turns out to be trans? They may feel an extra sense that they’re letting you down by not conforming to the gender expectations you had for them.

Then there are the ethical questions around unequal access. Polygenic testing isn’t cheap. (One company, Orchid, charges $2,500 per screened embryo. Test 10 embryos and that’ll cost you $25,000.) So, at least in the short term, that raises the specter of entrenching a caste system, where the gap between rich and poor expands dramatically as the rich get smarter and stronger.

Technologies tend to get cheaper over time, so maybe everyone will ultimately be able to afford polygenic testing. But that raises another problem: implicit coercion. If more and more of us make ourselves smarter and stronger, we may create a society in which everyone feels pressure to alter their child’s biology — even if they don’t want to. To refuse embryo selection would mean to put a child at a huge professional disadvantage, or to face moral condemnation for making “suboptimal” kids when optimization is possible. Society may no longer offer health insurance benefits or accommodations for kids with disabilities (or even non-enhanced IQ), reasoning that “it was the parents’ choice.” 

Some philosophers, like Julian Savalescu, already argue that parents have a “moral obligation to create children with the best chance of the best life.” Polygenic testing companies love that argument; Orchid founder Noor Siddiqui tells parents that “the responsible decision” is to “protect their children” from disease, using language like, “What if you could have stopped it…but chose not to?” And we generally live in a culture that’s obsessed with optimization. 

So it’s no wonder that you find yourself asking, “If I could do something to make my baby healthier and happier, don’t I kind of have to do everything in my power?” 

It’s a view that will be very appealing to utilitarians, who believe the right action is the action that maximizes well-being or happiness. But maximizing principles can be dangerous. If we’re laser-focused on maximizing one value, however noble it may be, that can lead us to overlook a host of other important values. Think about diversity, for example; polygenic testing could lead to a less diverse world. 

And it’s not even clear how to maximize well-being given that each embryo will have some downsides: How would you choose between one embryo with a slightly elevated risk for schizophrenia, another with a moderately elevated risk for cancer, and a third with a high risk for Alzheimer’s? You’d have to decide how to rank the importance of each condition, which would require a dizzying bit of moral math: How much weight do you put on the longevity associated with each condition, how much on patient-reported quality of life for each condition, and how much on your own ability to cope with each — and society’s ability (which will change over the years)? Plus, even if the screening does end up optimizing life for your individual child, it could have negative effects on the population level, for the reasons we covered above.

As the Nobel laureate Herbert Simon pointed out, many problems contain way more variables and way too much uncertainty for maximizing along a single axis to be feasible or even desirable. So it often makes sense to just go with an option that’s “good enough.” He coined the term “satisficing” — a portmanteau of “satisfying” and “sufficing” — to describe opting for this good enough choice.

What would satisficing look like in the context of embryos? If there’s a very serious condition that runs in your family — like Tay-Sachs or the BRCA mutation that markedly increases cancer risk — then I do think there’s a strong case for screening for that. These conditions are debilitating and can lead to early death. Nobody wants them. Genetic testing that lets us prevent them is an awesome gift. 

Then there are conditions that can include suffering, like autism, but can also be very compatible with a happy life. Mental health conditions in particular are heavily socially constructed — a lot of the associated suffering comes about because society constructs a certain biological reality as a problem and doesn’t support the people who have it. In these cases, if you want to give your child a “good enough” or even “optimized” life, remember that you don’t have to achieve that by biological means; working to change the social environment can be just as important, and it doesn’t carry the societal risks associated with polygenic testing. 

Ultimately, when considering what counts as a “good enough” life, each parent will draw the line in a slightly different place. And there’s a part of that that can’t be boiled down to objective facts about disease, because this is also about how well-resourced the parent feels — emotionally, socially, and financially — to deal with a certain condition. What feels manageable to one parent may feel crushingly hard to another. 

So, I can’t tell you exactly which screenings to do and which to forgo. What I do want to tell you is to resist being bullied or shamed by others, especially those with a profit incentive to push you in a certain direction.

As the epidemiologist Abby Lippman has noted, genetic testing is supposed to offer parents more choice, but it too often has the opposite effect. When someone like Orchid’s Siddiqui says about a disease, “What if you could have stopped it…but chose not to?” — well, that language preys on parents’ worst fears and insecurities. It holds parents hostage while pretending to be giving them more autonomy. 

You are nobody’s hostage. You are a moral agent free to look at the many different relevant factors, weigh them all in the balance, and then make the choice that works well enough for your family.   

Bonus: What I’m reading

• Silicon Valley is obsessed with IQ, so it’s no surprise that tech execs there are using polygenic testing in hopes of creating supersmart babies. This article shows the kind of mental pretzels customers get into when trying to figure out whether to select the embryo with the highest predicted IQ or that with the lowest risk of disorders. One couple asks: “How much additional risk of ADHD cancels out against 10 extra IQ points?”

• Rereading “The Last Children of Down Syndrome,” Sarah Zhang’s 2020 Atlantic feature on prenatal testing, it struck me that when people think “prenatal testing,” Down syndrome is often the first condition that comes to mind, even though it’s not the most severe or straightforwardly negative (it’s compatible with a happy life). It’s just that Down syndrome was easy to test for, so we started testing for it early. I wonder if that built up the condition as a bogeyman in the expectant parent’s imagination — if the fact that we could screen for it shaped the public’s perception of Down syndrome as something that should be screened for and potentially screened out.

• One trait that many people assume we should select for is a great memory. But I highly recommend the short story “Funes the Memorious” by Jorge Luis Borges. It’s a reminder that having too good a memory is not always a benefit.  

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In 1995, gender studies researcher Judy Chu found herself chauffeuring around her 13-year-old brother and his friend. The boys’ curiosity got the better of them, and they asked what she was learning: adolescent girls’ development, she told them. 

One of the boys looked at her and said, “‘You should study boys. You can start with me,’” Chu recalled. So she did. That fall, she spoke to 13-year-old boys from home for her clinical interviewing class.

In the years since, Chu has researched boys between the ages 12 and 18 — their wishes, their desires, what they wanted from their friendships and romantic relationships — and discovered some felt largely unknown. There was a gap between what the world expected of them — the stoic, strong, independent stereotypes that have persisted for centuries — and how they saw themselves, but had internalized so many messages for so long that they felt like they had no choice but to accept this version of masculinity. Chu theorized that these beliefs must have taken root during their childhood, and she later published a book on the subject.

When toddlers enter school, she discovered, they begin learning the rules of boyhood. “Regardless of what their parents had encouraged or enabled at home, they were learning that at school, if you wanted to be seen as and treated as one of the boys and you wanted to be with the boys, you wanted to play with the boys, be friends with the boys, there were rules you had to follow,” Chu said. “It was kind of like a microcosm of our society, which is if you want people to see you as and treat you as a quote unquote real boy or real man, you need to prove yourself.”

Since Chu’s work on the subject, American culture has changed to address gender inequities — the ones that negatively affect girls. As a part of this movement, girls were empowered to be more autonomous and pursue careers and financial independence to build a life beyond marriage and childrearing. (Though it should be said, women still trail men in earnings, outpace them in household responsibilities, and have higher rates of anxiety, depression, and PTSD.) 

But boys are still stuck in place. 

Across the country, lawmakers have promoted policies and legislation aimed at helping men reach their potential. In California, Gov. Gavin Newsom signed a 2025 executive order outlining education, career, and mental health initiatives targeting men. Maryland Gov. Wes Moore created the state’s Young Men and Boys Initiative, focusing on men’s health, employment, and community connections. But these programs are reactive, attempting to disrupt decades of socialization. At the same time, the rise of the manosphere and misogynist online spaces and increasingly right-leaning voting trends among men signal a cohort of young men at a turning point.

Recent studies have found that boys are less likely to graduate high school on time compared to girls — that gap is even bigger for Black and Hispanic boys — and fewer young men obtain bachelor’s degrees compared to their female peers. And as fewer men graduate from college, fewer participate in the labor force, too. The suicide rate among men is nearly four times higher than that of women. While men and women report similar rates of loneliness and number of friends, men are less likely to turn to their social networks for support. Out of the over 750,000 jobs created since Donald Trump took office in 2025, men have gained none of them. 

So what will it take to help men get unstuck? If we are truly committed to ending the male loneliness crisis, to tackling suicide and gun violence — society has the power to change things for the next generation, experts said. Rather than aiming to reach men after the constraining masculine worldviews have already taken root, we can prevent them from warping boys’ sense of self in the first place: To help men, we must change how boys are raised. 

Reject the myth of the “real boy” 

In 2023, psychologist Michael Reichert conducted a nationally representative survey of more than 2,000 American men, asking them questions about their lives, relationships, internet habits, and sources of social support. One finding was particularly staggering: two-thirds of young men between the ages of 18 and 23 felt like no one really knew them well. (In a follow-up report two years later, in which women were also surveyed, equal percentages of men and women — about 50 percent — said they were not truly known.)

The conclusion Reichert came to, he told Vox, was “boyhood is failing at the most important task.” American society is producing young adults who feel like they’re on their own, “a tragic outcome of a boyhood that’s not preparing our males for a resilient life in a world where things are harder, more complicated,” said Reichert, the executive director of the Center for the Study of Boys’ and Girls’ Lives at the University of Pennsylvania.

Because the idea of what a man looks like and how a man behaves is so ingrained, boys are taught to conform from an early age, experts said. From their earliest years, as evidenced in Chu’s work, boys are taught to adhere to stereotypical gender norms reinforced through comments like “boys don’t cry,” “toughen up,” and “don’t be a girl.” 

“It starts with mothers having a fear of turning their son into a mama’s boy, so they push them away at young ages — 3 and 4 years old. Go play with your dad, go play with your older male siblings,” Joseph Derrick Nelson, an associate professor in the department of educational studies at Swarthmore College, told Vox. Fathers, for their part, tend to emphasize self-defense, goal pursuit, and overcoming adversity with their sons, Reichert said. Black boys in particular are perceived as older and less innocent than their white counterparts, only pushing them further toward rigid gender roles, Nelson said. If they don’t conform, they may be teased by other boys.

A large part of proving yourself as a “real boy” means rejecting anything deemed feminine, including emotional vulnerability and relationships. As babies and young children, boys and girls are equally emotionally expressive, but by the time they start school, boys show fewer emotions and use less emotional language. When boys are taught that showing their feelings or forging deep friendships is girly, they stop prioritizing those relationships. That shift happens during the teen years, when boys go from reporting having best friends with whom they can share their deepest secrets, to feeling like they’ve drifted apart from these very connections by the end of high school. And it’s not for lack of desire, Chu said, or some inherent biological difference: Boys have simply learned not to show their need for affection, to hide their sadness, to not be tender. 

A new paradigm for raising boys, experts said, begins with how masculinity is first presented at home and in school. 

To encourage boys to be better in touch with their emotions means adults should not pit masculinity against femininity, Christopher Reigeluth, an associate professor at Oregon Health and Science University, told Vox. This goes beyond simply telling boys not to conceal their feelings, but making clear that confiding these feelings in a friend and fostering platonic connections isn’t girly: it’s a universal human need. 

In schools, specialized emotional education in curricula can help boys express their emotions and embrace vulnerability. 

Simply talk to them 

One of the easiest ways to do this is to allow and encourage boys to engage in an activity traditionally seen as more feminine: talking.

Reichert, the psychologist, has led an emotional literacy program in a boys’ school for over 30 years. In that time, he’s seen the sentiment among students shift from skepticism to genuine interest. “It has become, by 2026, the most popular program in the school,” Reichert said, due to an increased cultural awareness of emotional health. In the group, students discuss their daily stressors and hardships, and they learn that letting their peers see them for who they are — connecting with them — benefits their well-being. 

Before joining Reichert’s peer counseling group, high school senior Chris Burnetta expressed his emotions on the field. “You’re almost allowed to be emotional when you’re playing sports, and you’re not allowed to be emotional when you’re not,” Burnetta, 18, told Vox. In middle school, he attended a co-ed school and found himself performing aspects of masculinity to impress his female classmates. But once he met older classmates who he respected and wanted to emulate, he discovered many of them attended the counseling group and encouraged him to go, too. “I don’t want to speak for everyone, but I think for guys in general, looking up at people above you gives you a big impression and a big influence on how you want to live your life and what you want to be like,” he said. 

Seeing his peers so enthusiastically discuss their struggles and triumphs helps foster maturity and gives him permission to show his emotions, Burnetta said, an outlet he never had before.

Adolescence, a time when many behavioral health patterns are forged or discarded, is the time to engrain healthy social habits in boys — and for parents to be explicit, Matt Englar-Carlson, a professor of counseling and the director of the Center for Boys and Men at California State University Fullerton, told Vox. Now is the time to have dedicated phone-free time as a family, to give them opportunities to share how they’re feeling without fixing their problems, to listen to them even when they’re frustrating you. When his own son was younger, Englar-Carlson thought he knew all the tricks: showing empathy, trying to help. “Me doing that with him actually was making him feel worse, I think,” he said. Instead, Englar-Carlson took a lighter touch. He would acknowledge when his son was upset, but wouldn’t press a conversation. Whenever his son was ready to talk, he was available.

One easy way to do this? Talk to them when you’re driving. As my colleague Rachel Miller previously reported, not having to make direct eye contact can make it a little easier for kids to be vulnerable. 

And if you’re a man, make sure you’re leading by example: Be willing to share your own moments of embarrassment, disappointment, and sadness, so they know it’s okay for them to do the same.  

Help them foster non-romantic intimacy 

While in school, boys have ample avenues for connection through classes and sports, even if they aren’t interacting with others on a deeper level. It’s when they lose access to these organized outlets for socialization in adulthood that they slide into isolation or start looking to their romantic partners to fulfill all of their social needs. 

The idea that emotional intimacy is reserved for your significant other is how society gets to a point where 15 percent of men say they don’t have any close friends. Those without a partner are even more adrift: Men are less satisfied being single than their female counterparts. “We teach boys to not ask for help…figure it out on their own,” Nelson said. “I don’t know why we’re surprised when they become adult men and struggle with building relationships and close and connected communities, because all they’ve been taught, even since they were young children, was about figuring it out on their own and denying emotions, suppressing emotions, that then leaves you not in relationship and quite lonely.”

In the absence of in-person friendships, digital spaces provide an attractive alternative. While not altogether negative, some online forums — interactive video games, sports gambling, the manosphere — enable young men to further retreat from society. While pursuing community, boys may find their way to adult-centric spaces, which can be rife with misogynistic and patriarchal messages, feeding the belief that the only way to advance is through hyperconsumption, materialism, looksmaxxing, and dominating women, Nelson said. “They’re quarantining themselves to their rooms and their tech devices and these online communities where they play video games, they gamble on sports, and they have conversations with other boys and young men online about somehow feeling disadvantaged as men in our society,” he said.

Burnetta, the high school senior, said he and many of his classmates’ feeds are populated with “super masculine” content that sometimes pokes fun at men who open up about their feelings, which can further add to the stereotype that men should not be emotional. 

Even if boys don’t necessarily agree with these sentiments, they often don’t have other alternatives online. “I don’t think a lot of boys go on to YouTube…and say, ‘I really want to find the most misogynistic content I can find. That’s what I’m looking for,’” said Englar-Carlson, the director of the Center for Boys and Men. They may have simply wanted to watch a video about sports but were fed an ad for betting and then fell down the rabbit hole. Because traditional masculinity content is often fed to boys via their social media feeds, a brief introduction to these themes only leads to more. 

By young adulthood, they will have a fairly concrete idea of what’s expected of them as a man. In a 2017 study, young men largely agreed that the cornerstones of masculinity are self-sufficiency, toughness, physical attractiveness, being a financial provider, heterosexuality, hypersexuality, aggression, and control. Notably, they said they feel external pressure from family, friends, and society to meet these ideals.

If adults start with the understanding that boys are emotional and they have the same social needs as girls, they can encourage them to make friends before they learn otherwise. 

Teachers can recognize the signs of loneliness in young boys (resisting authority, talking back, and challenging boundaries) and use it as an opportunity to connect with their students instead of reprimanding them — because when they feel heard, their behavior softens. “What are these behaviors communicating to me from this boy about a met or unmet need, and how can I be responsive to it in my classroom? How can I help them facilitate close and connected friendships with not only their peers, but also with me as their teacher, like a primary adult in their lives?” Nelson said. When young boys simply get kicked out of class, they might fall behind and internalize a “bad boy” persona, he said, a cycle that enforces stereotypes and comes at the cost of their education. 

The story of masculinity online and from political leaders is that men must be protectors, high earners, and muscular and strong, and when boys fail to meet that standard (which they inevitably do because they are children), they are made to feel inadequate. “They’re struggling in school, they’re having a difficult time finding work, but everything about what they’re learning about to live in America is about the dream, the aspirations, acquiring, hitting these life milestones,” Nelson said.

Demonstrate an alternative masculinity

But for some young men, the most impactful interventions take place while they’re young. Growing up, Michael Dean looked to his father and his friends’ fathers for how to be a man. These men often spoke of the importance of providing for a family, being decisive, and being a stable force. Dean thought everyone was raised with these values and had similar upbringings until he reached high school and joined Reichert’s peer counseling program.

His junior year, one of Dean’s teammates on the football team suggested that some of the young men check out the group to discuss any problems at school, issues with parents, friends, or partners. Dean was frustrated with his performance on the field and decided to attend. Hearing from his classmates — their grief, their struggles — helped give him perspective. He also learned how to be an emotional outlet for the people he loves, including his younger brother. 

“I never felt that I had to be some kind of way or be some kind of man based on traditional values of being that strong, tough guy and to keep persevering through. I could definitely see that through my dad, and I did have that belief for a little while as I was in middle school and in the beginning of high school,” Dean, now 21, told Vox. “I learned that that’s not necessarily what it means to be a man, and I can make my own judgment through my own experiences and listening to other people to help me figure out what it means in my own belief to be a man.”

For Dean, learning how to be a man began when he was a child, but his path to adulthood was punctuated by formative adults — his mother, Reichert, and yes, even his dad — who fostered a safe environment to be vulnerable and emotional. Now, when he’s lonely, he knows he can call his family, friends, or his girlfriend for support. These are the outlets experts hope men feel empowered to call upon.

“If we’re really going to make a bigger difference with having healthier men who have connected friendships, who are emotionally expressive and connected in their friendships,” Reigeluth said, “it’s got to start with boys.”

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