The hard stuff

The Guardian:

A ripple-bodied sprinter explodes from his starting block, radiating aggression and power, a politician philanders, a business chief drives a hard bargain, a soldier goes snarling to war: we reach for a word to explain what it is that makes men — mostly, it is men — behave this way, and choose “testosterone”. Guystuff, some call it, the He Hormone, the Big T. The molecules manufactured in a man’s testicles explain his urge to fight and win.

Consequently, testosterone is both envied and feared. Those priapic, pumped-up fellows who seem to have more of it than most fill many with admiration, but also with disquiet. A random selection of recent newspaper reports variously suggest that a fast car, badly-driven, is the last refuge of the “testosterone-flooded” male, that male travellers, unlike women, prize distance covered over cultural knowledge absorbed because they are “testosterone-fuelled”, and that men’s predominance in parliament means that it is “testosterone-driven”. Risky stuff, this male hormone.

But just as the word testosterone — “T” for short in the trade — has become shorthand for maleness of a certain kind, so the craving for more of it has grown. Testosterone has been used for decades as a treatment for certain hormonal disorders, and in sport, sprinters, throwers, lifters, distance cyclists and others have called on it illicitly for decades. Now, however, the demand for boosted testosterone levels is no longer limited to such cases. Increasingly, the treatment known as testosterone replacement therapy is entering the mainstream of men’s healthcare, the supposed cure for what has controversially been dubbed the “male menopause”, a collection of complaints from 50ish chaps that typically include loss of energy and libido. Annual sales of TRT preparations in the US now exceed $400m, with hundreds of thousands of men of a certain age turning to them to recover their appetite for life and sharpen their competitive edge.

TRT is becoming more common in the UK as well. And it is not only among men that added testosterone is proving popular. The hormone is also present in women’s bodies, though in lower levels than in men, and testosterone supplements, argue its proponents, can also give women a feeling of extra oomph. Last year another London doctor raised eyebrows by disclosing that his clients included a number of female MPs, whom he provided with T implants because they wanted to be more combative.

It is now part of our culture’s fund of common knowledge that the more testosterone you have in your system, the more lead you have in your pencil, the more tiger in your tank. What, though, are the deeper implications? What does it say about us that testosterone has secured such a status? And what if a seductive T-mythology is obscuring the T-facts? Testosterone’s history as health corrective goes back 70 years. It was named in 1935 by the Dutchman Ernst Laqueur, who was the first to isolate it, extracting a few crystals from a job lot of bulls’ testicles (another version says mice’s testicles). In the same year the German Adolf Butenandt took a great leap forward from his previous technique for obtaining T - salvaging tiny portions from gallons of policemen’s urine - by deriving it from cholesterol in a lab. Almost simultaneously in Switzerland, the Slav chemist Leopold Ruzicka secured a patent for T-production by the same means. In 1939, Butenandt and Ruzicka were awarded the Nobel prize. In no time, testosterone was being successfully given to men whose testicles were not functioning properly. Supplements of T are a long-established treatment for hypogonadism, where testosterone production is severely impaired and can disrupt the development of boys at puberty as well as enervating adult males. In clinical circles, a quiet debate is taking place about whether its definition should be broadened. But the appetite for TRT is racing ahead regardless. Testosterone can be taken by injection, by pellet implant or in pill or patch form, and last year saw the launch in Britain of Testogel, the first TRT in a sachet. The user rubs it into the shoulders or upper arms, just like a lotion or a cream.

The notion of a male menopause is, however, contentious. Carruthers is fighting for recognition of what he prefers to call the “andropause”, androgens being the collective term for hormones found in higher quantities in men. There’s “no doubt”, he says, that “30, 40, even 50 per cent of men over 50” would benefit from the wider application of TRT, but when they go to their doctors, “they’re told, ‘What do you expect at your age?’ But these are not just the symptoms of natural ageing. Many can be reversed.” Other doctors, though, believe the “andropause” is, at best, misleadingly named and, at worst, owes its existence more to a public appetite for TRT products than the other way round. Howard S Jacobs, formerly professor of endocrinology at the Royal Free Hospital in London, has argued in the ‘British Medical Journal’ that the concept of the male menopause risks harming more men than it helps. He thinks the term unhelpful because hormone fall-off in men is “gradual, not precipitate”, as in women. Now retired, Jacobs remains a trenchant sceptic, describing the male menopause as “a construct” nurtured by naive “enthusiasts”. Most seriously, he says, the long-term side-effects have not been properly assessed, while the claims made for TRT as a rejuvenating panacea he describes as “absurd”. In April 2000 the commentator Andrew Sullivan wrote an essay about testosterone for the ‘New York Times Magazine’. He described injecting it (on medical advice) to correct the fatigue and weight lost attributed to his being long-term HIV positive, and wrote of experiencing “a deep surge of energy”, a shortened attention span, a need to exercise more. “My wit is quicker,” he continued, “my mind faster, but my judgment is more impulsive.” Also, there was lust and unaccustomed bursts of aggression. Sullivan was confident that these changes could be substan tially attributed to his “biweekly encounter with a syringe full of manhood”.

“Placebo effect,” says John Archer, professor of psychology with the aggression research group at the University of Central Lancashire, of the experiences Sullivan describes. Trials of the various “love drugs” have produced a lot of this: men with poor erections describing glorious improvements when they had in fact been given a dummy treatment. It was as if the mere idea of popping such a pill had been enough to trigger tumescence.

Archer’s view is that the association between testosterone levels in men and aggression is “weak”. Several studies have appeared to show associations between high T levels and anti-social behaviour, lower status jobs, a propensity for drug abuse and larger numbers of sexual partners. But Archer cautions that an association does not prove cause and effect.

To complicate the picture further, a rise in testosterone levels has also been linked with greater tranquillity in men. Researchers have found that although T-levels rise in men prior to competitive events, they also do so afterwards if they win. The same goes for men both before and after sex. This suggests some connection with relief and satisfaction rather than raw hunger for conquest.

Archer cites the results of a recent study he conducted into the effects of injecting young men with the amounts of testosterone that would be used in any future chemical contraceptive for men. They found “significant minor effects on mood but none on aggressive tendencies - assertiveness, irritability, self-esteem or sexual function”. Some participants said they felt less tired, though none said they wanted sex more or derived greater pleasure from it. In short, not a lot changed.

What does it all mean? Clearly testosterone’s precise role in shaping how men are - and how women are, too - is harder to define than we presently seem disposed to assume.

Lynne Segal, professor of gender studies at Birkbeck College London, sees the buoyant profile that testosterone today holds as being of a piece with a “quasi-religious” overexcitement about molecular biology, and a related market for quick-fix wellbeing. Furthermore, she sees the willingness to equate a complex social concept like masculinity with a single chemical as not only mistaken but also a depressing sign of conservative times.

“Our lives have moved so far from the old gender stereotypes,” she says, “but the desire of many men to stay forever upright and forever young discourages us from re-thinking how we might live as women and men. It reminds us of the continuing fear of the supposedly softer, gentler, calmer life associated with ‘the feminine’. It is both dangerous and sad.” Even its champions insist that the “He Hormone” should be handled with caution. The same might be said of the mythology that is now attached to it.