24, 2000 VOL. 155 NO. 16
You Man Enough?
can make a difference in bed and at the gym. And soon you'll be able to
get it as a gel. But it's a risky substance. And is it really what makes
By RICHARD LACAYO
Whatever else you may think about testosterone, you can tell it's a hot
topic. Every time you mention that you happen to be writing about it,
the first thing people ask is "Can you get me some?" (Everybody, even
the women.) Maybe that's not so surprising. If there is such a thing as
a bodily substance more fabled than blood, it's testosterone, the hormone
that we understand and misunderstand as the essence of manhood. Testosterone
has been offered as the symbolic (and sometimes literal) explanation for
all the glories and infamies of men, for why they start street fights
and civil wars, for why they channel surf, explore, prevail, sleep around,
drive too fast, plunder, bellow, joust, plot corporate takeovers and paint
their bare torsos blue during the Final Four. Hey, what's not to like?
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now, it was easy to talk about testosterone but hard to do much about
it. About 4 million men in the U.S. whose bodies don't produce enough
take a doctor-prescribed synthetic version, mostly by self-injection,
every one to three weeks. But the shots cannot begin to mimic the body's
own minute-by-minute micromanagement of testosterone levels. So they can
produce a roller coaster of emotional and physical effects, from a burst
of energy, snappishness and libido in the first days to fatigue and depression
later. The main alternative, a testosterone patch, works best when applied
daily to the scrotum, an inconvenient spot, to put it mildly. Some doctors
recommend that you warm that little spot with a blow dryer, which may
or may not be fun.
edition's table of contents
All of that will change later this year when an easy to apply testosterone
ointment, AndroGel, becomes generally available for the first
time by prescription. The company that developed it, Illinois-based Unimed
Pharmaceuticals, promises that because AndroGel is administered once or
more a day, it will produce a more even plateau of testosterone, avoiding
the ups and downs of the shots. Though the body's own production of this
hormone trails off gradually in men after the age of 30 or so, not many
men now seek testosterone-replacement therapy (not that they necessarily
need to) or even get their T levels tested. But replace the needles and
patches with a gel, something you just rub into the skin like coconut
oil during spring break at Daytona Beach, and suddenly the whole idea
Testosterone, after all, can boost muscle mass and sexual drive. (It can
also cause liver damage and accelerate prostate cancer, but more on that
later.) That makes it central to two of this culture's rising preoccupations:
perfecting the male body and sustaining the male libido, even when the
rest of the male has gone into retirement. So will testosterone become
the next estrogen, a hormone that causes men to bang down their doctor's
doors, demanding to be turned into Mr. T? Do not underestimate the appeal
of any substance promising to restore the voluptuous powers of youth to
the scuffed and dented flesh of middle age. If you happen to be a man,
the very idea is bound to appeal to your inner hood ornament, to that
image of yourself as all wind-sheared edges and sunlit chrome. And besides,
there's the name: testosterone! Who can say no to something that sounds
like an Italian dessert named after a Greek god?
But testosterone is at issue in larger debates about behavioral differences
between men and women and which differences are biologically determined.
A few Sundays ago, the New York Times Magazine ran a long piece by Andrew
Sullivan, 36, the former editor of the New Republic, in which he reported
his own experience with testosterone therapy. In two years he has gained
9 kg of muscle. And in the days right after his once-every-two-weeks shot,
he reports feeling lustier, more energetic, more confident and more quarrelsome--more
potent, in all senses of the word.
Looking over the scientific research on testosterone, Sullivan speculated
on the extent to which such traits as aggression, competitiveness and
risk taking, things we still think of as male behavior, are linked to
the fact that men's bodies produce far more testosterone than women's
bodies. His answer--a lot--was offered more as an intuition than a conclusion,
but it produced a spate of fang baring among some higher primates in the
media and scientific world, since it implies that gender differences owe
more to biology than many people would like to believe. Three researchers
wrote the Times to complain that Sullivan had overstated their thinking.
In the online magazine Slate, columnist Judith Shulevitz attacked Sullivan
for favoring nature over environment in a debate in which nobody knows
yet which is which. In the days that followed, Sullivan fired back at
Shulevitz in Slate, she attacked again, and other writers joined in. If
testosterone use becomes a true cultural phenomenon, expect the conversations
about its role in gender differences to become even more, well, aggressive.
So just what does testosterone actually do for you? And to you? And how
does it figure among the physical and environmental pressures that account
for head-banging aggression, or even just the trading pit on Wall Street?
One reason testosterone enjoys a near mythical status is that myth is
what takes over when conclusive data are scarce. Though testosterone was
first isolated in 1935, hormone-replacement therapy is one of the few
areas of medicine where research on men lags behind that on women.
What we do know is that testosterone is an androgen, as the family of
male sex hormones are called, and these hormones, in turn, are made up
of the fat known as steroids. Both men and women produce testosterone
in their bodies, men in the testes and adrenal glands, women in the adrenal
glands and ovaries. But men produce much more--the average healthy male
has 260 to 1,000 nanograms of testosterone per deciliter of blood plasma.
For women the range is 15 to 70. But because men differ on how effectively
their bodies process the substance--for instance, some have more receptors
around their body that absorb it--a man on the low end of the normal range
can still have all the testosterone he needs for normal sex drive and
other benefits. In healthy men, levels also vary during the day, peaking
around 8 a.m., which is why men commonly awaken in a state of sexual arousal,
and dropping as much as half before bedtime.
Testosterone is the substance that literally turns boys into boys in the
womb. In the first weeks after conception, all embryos are technically
sexless. Around the sixth week of gestation, the presence of the Y chromosome
in males triggers a complex set of signals that cause a surge in testosterone.
Among other things, that sets in motion the formation of the penis and
testes. In adolescence, boys undergo another eruption that deepens their
voices, causes hair to form on their bodies and allows their muscles to
enlarge. Testosterone in the blood of teenage boys can jump to as high
as 2,000 nanograms, which helps explain teenage boys.
One possible danger of easy-to-use testosterone is that it might become
a temptation to younger males looking to bulk up at the gym. Not many
of them would be able to demonstrate the diminished T counts that would
allow them to get it legally from their doctors, but the potential for
a black market in AndroGel is not hard to imagine among teens and guys
in their 20s--and older--who hear stories about a new substance stronger
than the supplements available over the counter and easier to use than
anabolic steroids that are injected. For teens in particular, the dangers
of testosterone overload are not just acne and breast development but
a shutting down of bone growth--though they may be at an age that makes
them almost deaf to the risks. For older men, studies indicate that high
levels of T do not necessarily cause prostate cancer but do fuel the growth
of tumors once they occur, which is why chemical castration is one means
of treating the disease in the advanced stages.
Gay men may have been one of the first populations to talk up testosterone
replacement, which is often part of the treatment regimen for HIV-positive
men like Sullivan, author of the New York Times Magazine piece. They produced
a buzz about increased sex drive and better results at the gym, things
that happen to be of interest to a lot of straight men too, especially
middle-age baby boomers looking to put themselves back in the driver's
seat as far as their sex drive is concerned. "These men already come in
asking for [testosterone]," says Dr. Louann Brizendine, co-director of
the program in sexual health at the University of California, San Francisco.
"This generation came out of the sexual revolution. They really identify
themselves as sexual beings. And they don't want to give that up."
At 66, Gene Teasley, who operates a family business that makes banners
in Dallas, is a decade older than the baby boomers, but he gets the idea.
About nine years ago, he went to his doctor complaining of less interest
in sex. Since then, he has been getting testosterone shots once every
two weeks. "I've enjoyed the results not just in the sexual way but also
in a broader way of feeling healthier. I have more of a desire to work
out, be outdoors and do more athletic things," he says. "Everybody wants
to feel like they felt in their 20s and 30s."
Some researchers are taking seriously the still controversial notion of
"male menopause," a constellation of physical changes, including fatigue,
depression and drooping libido, that they believe can be traced to the
decline of hormones, including testosterone, in men over 50. Others are
not so sure. "One thing we have to recognize is that the decline in testosterone
is also intertwined with changes, such as decrease in blood flow, and
psychological and social changes too," says Dr. Kenneth Goldberg, medical
director of the Men's Health Center in Dallas. "Simply expecting to take
men who are androgen deficient and expecting testosterone to fix it all--it
just can't be."
Yet even the passage of time doesn't guarantee that a particular man's
testosterone will decline to a level that much affects how he feels, at
least not by middle age. Middle-age men who preserve the body weight they
had in their 20s may have no falloff at all, while overweight adult men
of any age tend to have lower testosterone levels. This means that a couple
of the mobsters on The Sopranos are probably deficient, though maybe I
should let you be the one to tell them that.
Once you get past the proven links between testosterone, libido and muscle
mass, the benefits of having higher levels of testosterone become harder
to prove, though no less interesting to hear about. Just how much of a
role does this play in producing behaviors such as aggression, competitiveness
and belligerence? Men who take testosterone by injection routinely report
that in the first days after the shot, when their T counts are especially
high, they feel increased confidence, well-being and feistiness--what
you might call swagger. They also describe feeling snappish and fidgety.
Jim--not his real name--is a family therapist who was 40 when he started
taking the shots because of fatigue and a so-so interest in sex, which
had led him to get his T levels tested. The first day or two after the
shot, he says, he's on pins and needles. "My fiancé knows to steer clear.
I tend to be short-tempered, more critical, and I go around the house
looking for problems. I live out in the country, so right after I get
the shot I get out the weed whacker and the chain saw, and I just go crazy."
Gee. Even putting aside for a moment the much increased danger of prostate
cancer, do we really want men to turn later life into a hormonal keg party?
The thought could be mildly exasperating to women, who might be forgiven
for greeting the news with the same feelings china shopkeepers have for
bulls. But this is the point at which the discussion of testosterone veers
into the metaphysical.
Outside the bedroom and the gym, just what does testosterone do for you?
Studies in animals have repeatedly shown that testosterone and aggression
go hand in hand. Castrate species after species, and you get a pussycat.
Boost the testosterone with injections and the castrated animal acts more
like a tiger. In one study of men, when the testosterone levels were suppressed
(in this case by researchers using medications) libido and dominant behaviors
dropped. But when a mere 20% of the testosterone was added back, libido
and domination climbed to the levels where they had started. Which suggests
that men do not need much of the stuff to go on doing whatever it is they
have already learned to do.
Other studies have shown that men with naturally higher testosterone levels
are more aggressive and take-charge than men with slightly lower levels.
When two sports teams meet, both teams will show an increase in testosterone
during the game. "In the face of competition, levels of testosterone will
rise," says Alan Booth, a sociologist at Penn State University. "This
prepares the competitor and may help increase the chances for a win. It
could be that the rise in testosterone has physical benefits, such as
visual acuity and increased strength. But only the winning team continues
to show high testosterone after the game."
For this exercise, you don't even have to picture the Packers vs. the
Vikings. The T boost also happens during nonphysical competitions, like
chess games and trivia contests. Whatever the game, in evolutionary terms
this makes sense. Among the primates from whom we are descended, the victorious
male in any encounter may have needed to maintain high testosterone levels
in the expectation that his position in the pecking order would be challenged
by the next guy coming up.
But here it gets complicated. Does higher testosterone produce more aggressive
behavior? Or does the more aggressive male--whose aggression was learned,
say, at home or in school or in the neighborhood or on the team or in
the culture at large--call for a release of testosterone from within himself
for assistance? And if testosterone really does determine male behaviors
like aggression, then what are we to make of the fact that although testosterone
levels are pretty equal in prepubescent children, boys and girls already
demonstrate different behaviors?
What we know for certain is this: aggressive behavior and testosterone
appear in the same place. And aggressive behavior seems to require some
testosterone in your system. But researchers have yet to show conclusively
that adding a little more in males who already have a normal range of
the stuff does much to make them more aggressive or confrontational. In
one study, Dr. Christina Wang of UCLA found that men with low testosterone
were actually more likely to be angry, irritable and aggressive than men
who had normal to high-normal levels of testosterone. When their testosterone
was increased during hormone-replacement therapy, their anger diminished
and their sense of well-being increased. "Testosterone is probably a vastly
overrated hormone," says Robert Sapolsky, a Stanford University biologist
and author of The Trouble with Testosterone.
All the same, there are social implications connected to the one area
in which we know for a fact that testosterone matters--sex drive. Married
men tend to have lower testosterone. It's evolution's way of encouraging
the wandering mate to stay home. (In newly divorced men, T levels rise
again, as the men prepare to re-enter the competition for a mate.) If
aging men start to routinely boost their testosterone levels, and their
sexual appetite, to earlier levels, will they further upset the foundations
of that ever endangered social arrangement called the family? "What happens
when men have higher levels than normal?" asks James M. Dabbs, a psychology
professor at Georgia State University. "They are just unmanageable."
Dabbs, the author of Heroes, Rogues and Lovers, a book about the importance
of the male hormone, is another researcher who believes that T counts
for a lot in any number of male moods and behaviors. "It contributes to
a boldness and a sense of focus," he insists. It's possible for the scientific
community to come to such disparate conclusions on the stuff, not just
because the research is slim but because the complexities of human behavior
are deep. If we're verging on a moment when testosterone will be treated
as one more renewable resource, we may soon all get to focus more clearly
on just what it does. But if men, in a culture where the meaning of manhood
is up for grabs, look to testosterone for answers to the largest questions
about themselves, they are likely to be disappointed. One thing we can
be sure of is that the essence of manhood will always be something more
complicated than any mere substance in the blood.
Reported by Lisa McLaughlin and Alice Park/New York
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