April is turning out to be Testosterone Month, which is swell coming as it does on the heels of Women's History Month. Cover stories in the New York Times Magazine ("Why Men Are Different") and Time ("Are You Man Enough?") trumpeted the rising popularity of the hormone, which is fast becoming the new panacea for the ills of aging males.
Now that male baby boomers are beginning to close the long-standing life-span gap with women, they're demanding that doctors meet their desire for everlasting potency and youth. But amid all this hype -- from Andrew Sullivan's soul-searching quest to define masculinity to the brave new medical treatments -- there lurks a foolhardy notion which ignores much of science and a lot of common sense: Testosterone equals male essence.
More than 4 million men already receive prescriptions for low testosterone disorders caused by diseases (such as HIV-wasting), exposure to heavy metals, alcohol abuse, tumors, radiation or chemotherapy. Men with low levels of the hormone are routinely treated with testosterone to restore libido, lift depression, fight fatigue and strengthen bones. Until now, treatment has been limited to irritating dermal patches (sometimes attached to the scrotum) or painful intramuscular injections. But this summer the hormone will arrive in a user-friendly form called AndroGel, i.e. testosterone in a tube.
A huge potential market looms: Fifty million men in the United States are between 40 and 80; a full 20 million are in their 40s and 13.6 million are in their 50s. The constellation of symptoms associated with low testosterone levels -- declining energy, flagging sex drive, weaker bones -- sounds remarkably like ... well, aging. In that sense, the burgeoning testosterone fixation is a kind of declaration of war on the effects of a lengthening life span.
"The baby boom is going to turn 54 this summer," says Dr. Louann Brizendine, whose clinic at the University of California in San Francisco has been deluged with phone calls from men seeking testosterone treatments in recent weeks. "These men are very identified with their sexuality. They are used to being able to control their lives. And they expect to push right through this (next) phase of life with the same level of control."
Androgel's makers, Unimed Pharmaceuticals is counting on a big seller. The colorless compound that can be spread on the chest will be available only by prescription. But faster than you can say hypogonadism, we can expect a new wave of previously undiagnosed (or noticed) cases of low testosterone disorders once the topical T gel arrive at your corner pharmacy. That's not to mention the horde of teenage boys and younger men who will get their hands on black market testosterone -- as they do already with anabolic steroids
Some of the bolder advocates of testosterone are asking why easy-to-rub testosterone should be accessible only to the certifiably ill. "If you're a woman, and you're having a crying jag, they'll give you estrogen. If you're a guy and you ask for testosterone, you'll get turned in to the police," complains Tim Patterson, who publishes Testosterone magazine online. Nothing on the Web will make a middle-aged man squirm more than Patterson's site, which claims 7 million hits per month. Unless you visit, you can't imagine how many nose sprays, big horse pills and compound powders will be needed to restore your flagging confidence, aggressiveness, physical prowess and erotic ardor. Iconic models, on this site and a host of others, are hairless, blemish-free, bionic, with celestial light gleaming off polished bulges. Patterson says that he'd jump at the opportunity to market T "in a heartbeat."
Testosterone use carries significant risks, but don't imagine that this will dissuade the man in search of his inner stud. In this testosterone-saturated environment, potential hazards of treatment will receive short shrift even as doctors and manufacturers freely disclose them. Elevated risks of prostate cancer, cardiovascular trouble, sleep disorders and liver damage, among others, are all linked to testosterone. "This is not a tonic for what ails you. It's not a global treatment for depression or for people who feel they don't have enough energy," cautions Dr. Ronald Swerdloff, a UCLA medical professor who conducted tests on AndroGel.
Among its other risks, testosterone can balloon the pectorals of men into buxom breasts and trigger male pattern baldness. AndroGel will come with a warning about what its manufacturer calls "sessions of vigorous skin-to-skin contact" between treated men and their female partners. Results of Unimed's studies show that female partners of men being treated with AndroGel ended up with double the testosterone they had before their vigorous rubbing sessions started.
It may be that you are already hairless, bionic, bulgy and firm, and therefore won't be attracted to these appeals concerning testosterone. If so, good for you, bud. But, still, you might want to know that T is more than a means of beefing up your biceps; it's the very essence of your sex. In "The He-Hormone," the cover story published in the New York Times Magazine (on the day after April Fool's Day), Sullivan argued that testosterone defines the essential difference between genders. Linking it to a range of behaviors and feelings, he wrote: "It is about the ability to risk for good or bad; to act, to strut, to dare, to seize. It is about a kind of energy we often rue but would surely miss."
Some readers may be hesitant to embrace this notion because of a nagging, distinctly nerdy impression that no single hormone could be the sole cause of such profound effects. Reducing biology to the idea that a single chemical has the power to determine behavior has fallen out of fashion, thanks mostly to pesky science writers who like nothing better than referring to the teeny-tiny print in the footnotes of research studies and the pinheaded researchers who write those footnotes.
In her most recent book, "Woman," the New York Times' Natalie Angier complains: "Testosterone has been accorded vast powers, as the libido hormone, the aggression hormone, the dominance hormone." But if testosterone has such a profound effect, she wonders, how do we explain randy, aggressive, dominant behavior by women, who have 10 times less T than men? Casting doubt on "the persistent presumption ... that the female brain is comparatively less primed to aggressive, dominant behavior," she points out that testosterone is transformed into estrogen before "the sexual architecture of the brain" is established in male fetuses. "Yes," she crows. "Only as a 'female' hormone can the male hormone masculinize the brain." Now can you see how troubling it is to rely on people who can't seem to get over nuance?
In "The Trouble with Testosterone," neurobiologist Robert Sapolsky throws another curve, noting that hormone levels, in primates as in humans, are exceedingly crude markers. (Among male humans, the normal range is from 300 to 1000 nanograms of testosterone for every deciliter of blood.) What's more, Sapolsky points out, behavior nearly always flows from a mix of chemical stimulus, social context and environment. Often, it's behavior driving hormone levels rather than the other way around. Sapolsky cites experiments on castrated baboons that show the complexity of the link -- in this particular case, the long-vaunted connection between testosterone and aggressiveness. "The more social experience an individual had being aggressive prior to castration, the more likely (his) behavior persists sans cojones," Sapolsky reported. "Social conditioning can more than make up for the hormone."
But what does he know? Whatever you ask, scientists like Sapolsky will tell you it's all more complicated. This is not helpful if you're engaged in a primordial hunt for the essential male trapped inside and considering freeing him by strutting, seizing, daring -- or whatever surging lurch overtakes you as you reach for a good strong dose of T.
Once your hormones are raging and you feel appropriately bionic, bulgy and firm, forge on. Lifeextension.com recommends considering hormone replacement therapy -- including recombinant human growth hormone, testosterone, estrogen, progesterone and DHEA -- at age 35. And how long should we be prepared to follow the protocol? "It will be a lifetime commitment" is the comforting answer.
For prime candidates like myself (read: boomer men), testosterone replacement is a seductive idea, promising, as it does, the opportunity to age without losing a sense of mastery over our lives. It's the understandable dream of carrying on good sex lives and optimum health from our young and middle-aged years onto an ever-extending life span. Getting a prescription filled, and continuing in this way, is far easier than asking oneself how the additional years might be used most meaningfully.
So sign me up. In the midst of the national swoon over testosterone, it's too confusing to weigh health risks against benefits or pose such big questions. Just thinking about testosterone this week, I've begun to feel less aggressive, confident, dominant and ardent -- not to mention bionic, bulgy, firm and anchored in my male essence -- by the nanosecond. I'd hate to have to drive in this condition.