Per- and polyfluoroalkyl substances (PFAS) represent an emerging concern for male reproductive health. Epidemiological studies have reported associations between increased PFAS exposure and reduced semen quality parameters, lower sperm counts, and potential alterations in reproductive hormone levels. Toxicology research has revealed possible mechanisms including blood–testis barrier disruption, oxidative stress, interference with testicular cell function, and epigenetic changes. However, significant uncertainties remain regarding definitive exposure–response relationships, developmental windows of heightened vulnerability, combined mixture effects, and causality interpretation, given limitations inherent to observational studies. Ongoing investigation of short-chain and replacement PFAS compounds is also critically needed. Additionally, directly connecting the mechanistic insights from animal models to human fertility impacts remains challenging. While controlled toxicology studies have described pathways by which PFAS could impair cellular functioning in the testes, uncertainty persists in extrapolating these experimental effects to real-world human exposures and sperm parameter declines reported epidemiologically. Overall, current findings suggest PFAS may contribute to declining male reproductive function, but additional clarification through well-designed longitudinal cohort studies integrated with mechanistic animal work is still warranted to confirm exposure–fertility links across a range of PFAS types and inform evidence-based public health mitigation strategies.