Does the world really need more testosterone?

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FOR such an uncomplicated chemical arrangement of carbon rings, testosterone's impact far surpasses its molecular simplicity. In sporting parlance, it's a bantamweight puffed up as a Tysonesque heavyweight - which is an apt, really, given it has been romanticised as the essence of man and roundly condemned as the catalyst for carnage.

In itself it is neither, yet its function is crucial to the human condition, male and female. In popular lore, testosterone translates as a catchphrase for everything male, whether noble or iniquitous. Which helps explain why it is so mythologised and misunderstood.

And why not? After all, it does influence an individual's disposition towards altruism, delinquency, criminal violence and suicide. It also has a defining effect on sexuality, profession, character, cognition, emotions, competitiveness, childhood behaviour, facial expressions, relationship aptitude and the colour of the socks you wear. Well maybe not the socks, but its reach is so embracing as to make you wonder what's left.

And that's not much, if the gender wars of the late 20th century were any guide - testosterone became the fulcrum for debate about behavioural differences between men and women, and which differences are biologically determined. If some of the fire had gone out of that simmering dispute in the past few years, the recent announcement by an American pharmaceutical company that it will market a user-friendly testosterone ointment has reignited gender passions.

If you can bottle this stuff, feminists are asking, what are the implications? Will society become even more male-dominated, commerce more cutthroat, criminals more dangerous? Will the guy next door out-hulk Hulk Hogan? And what if, say, a Hitler got hold of some? More aggressive war-mongering, possibly universal annihilation? (Possibly not, if a UCLA study reported in Time magazine is any guide. This found that low-testosterone men were more likely to be angry and aggressive than their high-normal level brethren, and that anger levels diminished and well-being improved when they received hormone treatment. If Adolf had received a testosterone top-up, perhaps history might have been different.)

Nevertheless, the sisterhood is shuddering at the realisation that testosterone may soon be augmented easily and painlessly (important, given that the average male is such a high-class sook when it comes to remedial discomfort). Every woman knows there's too mucho macho already in the world - and the prospect of manufactured testosterone running rampant through the systems of every wannabe superstud and Master of the Universe is considered definitely retrogressive.

As one social analyst (female) shuddered, "testosterone is women's code for all that mad, bad, aggressive male stuff, all that power and attitude." In their minds it is, she says, "synonymous with, say, tribal chanting at the soccer or the behind-closed-doors terror of domestic violence. It's also about those bullies in business suits, and the general bravado, boasting and territoriality we encounter every day." The Dantean nightmare is of armies of Clark Kents bursting free of their phone boxes in amplified muscular glory, of middle-aged Casanovas trading in bridge clubs for nightclubs, of resurrected wrinklies swapping zimmer frames for zoot suits ...

Testosterone is not just a feminist pejorative. Only last month Labour MP Carlo Carli complained about bullying behaviour in the Victorian Parliament. "It really is testosterone-driven," he grumbled. "They call it a bearpit and it has been living up to its name." Female MPs backed up his claims of shirt-fronting, threatening behaviour, verbal abuse and intimidation in the hallowed halls.

Beyond that, women aspiring to middle management roles talk not so much of glass ceilings or Mahogany Rows but of breaching Testosterone Alleys. And verbal and physical harassment is a cliche in Italy and other (usually Latin Catholic) "testosterone cultures" where women are seen as either Madonnas or whores and treated accordingly. Ask any returned female traveller.

Testosterone, then, serves as social shorthand for maleness, for why men behave badly, are socially inept, forget birthdays (but never Grand Final scores) and are gruntingly taciturn when it comes to verbalising emotion ... why they are men, in fact.

It's the one-word explanation for war and boardroom battles, for why ghetto gangs stake out territorial boundaries and brawl to the death over them. It's why men are pathologically polygamous (in mind if not fact), why they leer and wolf-whistle, and why they lose all logic, principle and dignity when thigh or cleavage are flashed. It's why they drive so belligerently, refuse to visit doctors until they are at death's door, dominate the remote control and channel-surf with strobe-light frequency.

It's why they can trek to the South Pole through the most extreme depredations of nature yet whinge like toddlers when they're asked to clean the toilet. And it's why they follow sport so fanatically - a recent study found that testosterone levels increased after the game by about 20 per cent for winning male fans, decreased by 20 per cent for losing supporters. That's the fans, not the players, of which more later.

Basically, testosterone is to blame for boxing and Grand Prix racing, pornography, lap dancing and fart-lighting competitions. And for why males can live so unmindfully amid the clutter of pizza boxes, crushed beer cans and dirty socks ... (There's another aspect to testosterone, of course, if the drool pool around The Australian's office during the recent Olympic swimming trials is any measure. Senior pressroom staff were riveted by the televised torsos and rippling pecs of the Klims, Thorpes and Hacketts, and it was brutal watching them have to elbow aside hordes of swooning women journalists to catch a glimpse.)

Whichever way you look at it, that's a lot to hang on a simple steroid hormone, one of several hormones secreted by endocrine glands throughout the body (and some by nerve cells in the brain). Basically chemical couriers, hormones are dispatched via the bloodstream to targeted tissues where they trigger some change in physiological activity if - and only if - that tissue has the right receptors.

That's where it gets complicated. The popular perception is it that men produce testosterone, women estrogen, and never the twains shall meet. Not so - both sexes produce the same hormones. The difference is quantity: on a daily basis, men manufacture some seven milligrams of testosterone, women about one-twentieth of that. Curiously, women's ovaries primarily fabricate testosterone from which estrogen is then made, while men's bodies produce their own estrogen, converted by tissues from testosterone.

The trouble is, as with most hormones, blood levels of testosterone vary according to stress levels, age and other physical demands. After adolescence, most men experience a gradual decline in testosterone levels until they hit their 40s; past 50, the decline speeds up dramatically. But if they are put (or put themselves) in positions of high competitiveness or of life-and-death, levels increase significantly. In combat, for instance, soldiers' levels rise quickly and remain high for the duration of the war. It's the same in sexual combat: married men's levels are generally lowered (nature's deterrent to philandering) but if they separate or divorce, their levels rise in preparation for braving the singles minefield.

All this illustrates a scientific dilemma. Does high testosterone elevate aggression, or vice versa? Endocrinologists tend to favour the former, although a growing number is swaying towards the latter. It's a question of terms and methodology. Still, dominance among women in prison has been associated with higher levels of testosterone, while a study of male convicts found testosterone levels highest among those imprisoned for crimes such as rape and murder.

And when American university students were compared with similarly-aged non-students in a "delinquent urban subculture", the so-called delinquents had significantly higher testosterone levels. Yet another study ascertained that actors and footy players had higher levels than ministers of religion, another that "white collar" workers recorded lower levels than "blue collar" workers.

So what does this prove, when there's so much more to the life than endocrine systems? If testosterone does affect behaviour, the results of behaviour also affect testosterone levels: any biological analysis needs the context of social factors and environment.

*****

The American product, AndroGel, will be available only on prescription (although a blackmarket for it will no doubt spring up): it has just been cleared for use in the US and is expected to receive British approval later this year. There are no plans yet for Australian distribution, but given the speed with which Viagra penetrated consciousness here, it can only be a matter of time. The ramifications are wider reaching than with Viagra - that is specifically orientated, is expensive at around $70 for four erections, and cannot be used by men with heart conditions, diabetes and high blood pressure.

Testosterone supplements are aimed at the whole man. Until now, they have been given through fortnightly intramuscular injections, slow-release implanted capsules, tablets and two types of daily "patches" applied to the scrotum. They have offered some physical (and subsequent psychological) relief to men who experience hypogonadism (under-secretion of testosterone) and to Aids victims whose immune systems have been depleted. But these systems of supply have had drawbacks - they are either cumbersome, painful to apply or deliver doses beyond the body's normal regulatory capacity. While the upside has been a refreshed libido, resurrected strength and increased alertness and agility, the downside has incorporated extreme mood and physical swings. As well, older men risk exacerbating existing prostate tumours or sustaining liver damage.

The theory behind the ointment is that because it is administered once or more a day in minimal doses, it will more closely mimic the body's own regime. It will be more measurable in delivery, more sustained in action, less unpredictable in outcome, even if long-term side effects are yet to be determined. It is being touted as the male HRT - an anti-ageing liberator for men "of a certain age" experiencing their own Manopause of waning physicality and mid-life depression. And it's tipped to have a multi-million-dollar appeal to Baby Boomers facing an inevitable decline into indignity. This generation, so defined by its sexual drive and "youthful" attitude, is particularly resentful of the ravages of age and natural progression. If all that's needed to restore virility, muscle and get-up-and-go energy is a basic balm, they'll go and get it with enthusiasm. How ironic that Ponce de Leon braved Amazonian jungles seeking the fabled fountain of youth - and here it is, in a sachet of gel.

Some worry, however, that such a panacea will disturb the social balance, not the least in delaying the ceding of power and control to following generations. Beyond that, the fear is that it may attract devotees who do not need such medical intervention, that it will intensify society's "masculine maleficence", that young men who don't need it will use it to become maler than their mates. Or that it will be an irresistible lure to gym junkies and body beautiful builders.

Doomsayers posit a race of Rambos where even the most weedy transform into Adonises in aspect. It's not the physical facet that bothers them - it's the potential cataract of supercharged hormones let loose in society. Who needs such an unpredictable wildcard, they ask. There are other dangers too, not the least that teenagers toying with testosterone tonics risk side effects such as virulent acne, breast enlargement and bone growth retardation.

The cure-all allure of testosterone is not new, although its manufactured use is (relatively). Medicine and folklore long venerated the testes - in many cultures, its tissue was considered a quick fix for impotence. In 1889, French physiologist Charles Brown-Séquard (later credited as the "father of endocrinology") created an elixir made from guinea pig and dog testicles which purported to increase physical strength and intellectual dexterity, relieve constipation and "lengthen the arc of the urine" - obviously a desirable attribute if the rush of male enthusiasts was any measure.

Testosterone itself was isolated only in 1935 from mouse testicles, and earned its successful synthesizer, Adolph Butenandt, a share in a Nobel Prize for chemistry. Respected clinicians and numerous quacks quickly incorporated its use in therapies, if not with the indecent rapidity of sport. By the 1940s, testosterone was being used experimentally as a performance enhancer. Within 20 years, its illegal use (as anabolic steroids) to increase muscle mass was driving a blackmarket trade worth multi-millions. Professional sport, particularly in the US, became largely a chemical contest, while in the 1970s and 80s communist states adopted systematic doping policies for their athletes, male and female. The rewards were obvious in gold medals, the repercussions in physical degeneration overlooked.

Inevitably in sport, the strongest in mind and body prevail: we applaud and expect sportsmen and women to be aggressive, to elevate their intensity to battleground alertness. In contact games especially, whoever has the most testosterone triumphs. But after encouraging and lionising such testosterone "freaks" on the field, society has difficulty when their elevated "maleness" is let loose beyond the arena. We recoil from tales of rugby league players assaulting bar patrons, of rugby union players vandalising taxis on tour, of gridiron players snorting coke and raping fans. The AFL is even talking about the need to educate its players on issues ranging from indecent assault to public drunkenness and the litigation stemming from such offences.

Which essentially is where anti-testosterone advocates rest their case.

But therapeutic abuse aside, why shouldn't men welcome such an efficacious fix for what ails them? A man's self-image, however subconsciously, tends to reflect his confidence in his potency. At the most basic level, and in all its psychological variations. No matter how "evolved" he is, a suddenly vacillating virility can be a crippling threat. And if the mirror confirms that hair is migrating from head to eyebrows, ears and other bodily surfaces, that the skin colour is choleric, the nose has knobbed and that toes haven't been glimpsed for some years beneath the jut of gut ... it's welcome to serious depression territory. Fallibility strikes and the cardigan and easy chair beckon. How tempting might testosterone gel then become as salve to sanity? And how useful to society and the family in prolonging the energetic focus of the experienced? As gene exploration accelerates, senescence is under attack. Surely it makes sense that where practicable, testosterone and estrogen should add life quality to quantity.

On a wider scale, the very nature of manhood has been under attack for several decades as our culture has struggled (and largely failed) to come to terms with gender equality. And while it's probably coincidence that male fertility levels have dropped significantly in the developed world over the past 20 years, social commentators of every persuasion have delighted in detecting a crisis of masculinity, both physical and psychological. Male cosmetic surgery is a growth industry; steroid abuse is only as far away as the local gym; male depression and suicide figures have more than doubled in the past 25 years.

According to Susan Faludi in her book Stiffed, "Ask feminists to diagnose men's problems and you will get a very clear explanation: men are in crisis because women are properly challenging male dominance. Ask anti-feminists and you will get a diagnosis that men ... are troubled because women have gone far beyond their demands for equal treatment and now are trying to take power away from men."

Part of the problem, of course, is that we have entered uncharted regions in gender relations. And apart from an attack on fragile egos, boys and men are receiving mixed messages: they need dolphin-hugging sensitivity while still remaining intrepid and courageous. Their virility should be on tap without being the dominant drive. They should be receptive and giving, yet still capable of single-mindedness. They should be supportive and protective without aggressive intent. Many are patently failing to cope, are confused and adrift, unable to come to terms with their roles.

While some have resorted to unreformed New Lad larrikinism, more and more are turning to body-beautiful hedonism, becoming larger-than-life representations of man to compensate for internal confusion. They aspire to the idealised image represented on billboards and movie. It's the male Barbie Doll syndrome of yearning for an impossible perfection.

As Faludi puts it: "The internal qualities once said to embody manhood - sure-footedness, inner strength, confidence of purpose - are now merchandised to men to enhance their manliness." And every media message is that "manhood has become a performance game to be won in the marketplace, not the workplace."

The authors of a just-released book, The Adonis Complex, have discovered that more American men covet bigger pectoral muscles than American women wish for bigger breasts. In 30 years, their research found, the number of men unhappy with their appearance had tripled. On average, they wanted to add 13kg of muscle: the vision was of becoming Bionic Man in a business suit, with six-pack racks, hourglass waists and Schwarzeneggar-on-steroids flex-ability. (Women on the other hand favoured men only slightly more muscular than average.) Most disturbingly, perhaps, the US Drug Enforcement Administration reports that steroid use among American high school students has risen 50 per cent in the past four years.

In Australia, similar aspirations apply. The impetus is image; the impulsion is testosterone.

Testosterone and men

The primary androgen in men, testosterone is no ordinary sex hormone - the body has receptors for it from the brain to the toes. It is integral in protein manufacture, and thus in forming muscle, and critical in bone construction. As well, it promotes oxygen absorption throughout the body and is essential in controlling blood sugar, in regulating cholesterol and in sustaining the immune system.

It affects mental concentration, energy levels and mood, and is thought to be crucial in protecting against Alzheimer's disease. It also helps men maintain lean body mass and is the "desire driver" to a healthy libido. Men normally receive two distinct flushings of testosterone. The first is in the womb, when it prompts a male fetus to differentiate from the female; stimulated by a hormone in the placenta, testosterone induces the fetal testes to migrate from an area near the kidneys into the scrotum.

The second influx is during puberty when testosterone secretion increases from under 100 nanograms per decilitre of blood plasma to between 400 and 1200 n/d. Some adolescents even top the 2000 n/d mark.

This hormonal surge encourages the testes and scrotum to grow and stimulates the appearance of pubic and facial hair. It activates sperm production, makes the penis broaden and lengthen, helps the prostate gland to develop, the larynx to enlarge, and promotes increased strength and muscle bulk. This flood-level of testosterone usually remains until around 22, although in some individuals it lingers longer.

Post-puberty testosterone levels fluctuate in daily and seasonal cycles; they rise overnight, peak in late autumn-early spring and can increase as much as 20 per cent after exercise. Levels are highest in the morning then drop during the day by up to 50 per cent (an effect also registered in women).

The normal adult range is 270 to 1070 n/d, but by their 40s most men have about half their adolescent levels. Between 50 and 70, the average man's testosterone levels decrease a further 50 per cent.

Low testosterone symptoms can include decreased sexual drive and/or impotence, a loss of energy, strength and stamina, a decrease in lean muscle mass, more aches and pains in the bones and joints, a loss of facial and body hair, and less initiative and mental aggressiveness. (These indicators can be ascribed to other conditions but are often attributable to hypogonadism, or under-secretion of testosterone.) But the individual testosterone balance is fine: many men function perfectly well on less than average testosterone levels. And too much testosterone can wreak havoc on behaviour and physique.

In the Journal of Behavioral Medicine last year, researchers at Pennsylvania State University reported on a study of 4400 military-service men aged between 32 and 44 whose testosterone levels averaged 679 n/d.They found that men with slightly above average testosterone levels were 45 per cent less likely to have high blood pressure, 72 per cent less likely to have had a heart attack and 75 per cent less like to be obese than men whose levels were slightly below average. They were also 24 per cent more likely to injure themselves, 32 per cent more likely to drink five glasses of alcohol in a day, 35 per cent more likely to have had a sexually transmitted infection, and 151 per cent more likely to smoke.

Those with high testosterone levels (around 1000 n/d) were found to be most at risk: they were more likely to display criminal and antisocial behaviour, to have had troubled school years, to remain single and to be unemployed. The healthiest men overall had testosterone levels between 400 and 600 n/d - they experienced the most benefits and least risks associated with the hormone.


This article was first published in The Weekend Australian, June 3, 2000.
Copyright (c) Murray Waldren.

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