by ANDREW
SULLIVAN
It has a slightly
golden hue, suspended in an oily substance and injected
in a needle about half as thick as a telephone wire. I
have never been able to jab it suddenly in my hip
muscle, as the doctor told me to. Instead, after
swabbing a small patch of my rump down with rubbing
alcohol, I push the needle in slowly until all three
inches of it are submerged. Then I squeeze the liquid in
carefully, as the muscle often spasms to absorb it. My
skin sticks a little to the syringe as I pull it out,
and then an odd mix of oil and blackish blood usually
trickles down my hip.
I am so used to it now that the novelty has worn off.
But every now and again the weirdness returns. The
chemical I am putting in myself is synthetic
testosterone: a substance that has become such a
metaphor for manhood that it is almost possible to
forget that it has a physical reality. Twenty years ago,
as it surged through my pubescent body, it deepened my
voice, grew hair on my face and chest, strengthened my
limbs, made me a man. So what, I wonder, is it doing to
me now?
There are few things more challenging to the question
of what the difference between men and women really is
than to see the difference injected into your hip. Men
and women differ biologically mainly because men produce
10 to 20 times as much testosterone as most women do,
and this chemical, no one seriously disputes, profoundly
affects physique, behavior, mood and self-understanding.
To be sure, because human beings are also deeply
socialized, the impact of this difference is refracted
through the prism of our own history and culture. But
biology, it is all too easy to forget, is at the root of
this process. As more people use testosterone medically,
as more use testosterone-based steroids in sports and
recreation and as more research explores the behavioral
effects of this chemical, the clearer the power of that
biology is. It affects every aspect of our society, from
high divorce rates and adolescent male violence to the
exploding cults of bodybuilding and professional
wrestling. It helps explain, perhaps better than any
other single factor, why inequalities between men and
women remain so frustratingly resilient in public and
private life. This summer, when an easy-to-apply
testosterone gel hits the market, and when more people
experience the power of this chemical in their own
bodies, its social importance, once merely implicit, may
get even harder to ignore.
My own encounter with testosterone came about for a
simple medical reason. I am H.I.V.-positive, and two
years ago, after a period of extreme fatigue and weight
loss, I had my testosterone levels checked. It turned
out that my body was producing far less testosterone
than it should have been at my age. No one quite knows
why, but this is common among men with long-term H.I.V.
The usual treatment is regular injection of artificial
testosterone, which is when I experienced my first
manhood supplement.
At that point I weighed around 165 pounds. I now
weigh 185 pounds. My collar size went from a 15 to a 17
1/2 in a few months; my chest went from 40 to 44. My
appetite in every sense of that word expanded beyond
measure. Going from napping two hours a day, I now
rarely sleep in the daytime and have enough energy for
daily workouts and a hefty work schedule. I can squat
more than 400 pounds. Depression, once a regular feature
of my life, is now a distant memory. I feel better able
to recover from life's curveballs, more persistent, more
alive. These are the long-term effects. They are almost
as striking as the short-term ones.
Because the testosterone is injected every two weeks,
and it quickly leaves the bloodstream, I can actually
feel its power on almost a daily basis. Within hours,
and at most a day, I feel a deep surge of energy. It is
less edgy than a double espresso, but just as powerful.
My attention span shortens. In the two or three days
after my shot, I find it harder to concentrate on
writing and feel the need to exercise more. My wit is
quicker, my mind faster, but my judgment is more
impulsive. It is not unlike the kind of rush I get
before talking in front of a large audience, or going on
a first date, or getting on an airplane, but it suffuses
me in a less abrupt and more consistent way. In a word,
I feel braced. For what? It scarcely seems to matter.
And then after a few days, as the testosterone peaks
and starts to decline, the feeling alters a little. I
find myself less reserved than usual, and more
garrulous. The same energy is there, but it seems less
directed toward action than toward interaction, less
toward pride than toward lust. The odd thing is that,
however much experience I have with it, this lust peak
still takes me unawares. It is not like feeling hungry,
a feeling you recognize and satiate. It creeps up on
you. It is only a few days later that I look back and
realize that I spent hours of the recent past
socializing in a bar or checking out every potential
date who came vaguely over my horizon. You realize more
acutely than before that lust is a chemical. It comes;
it goes. It waxes; it wanes. You are not helpless in
front of it, but you are certainly not fully in control.
Then there's anger. I have always tended to bury or
redirect my rage. I once thought this an inescapable
part of my personality. It turns out I was wrong. Late
last year, mere hours after a T shot, my dog ran off the
leash to forage for a chicken bone left in my local
park. The more I chased her, the more she ran. By the
time I retrieved her, the bone had been consumed, and I
gave her a sharp tap on her rear end. "Don't smack your
dog!" yelled a burly guy a few yards away. What I found
myself yelling back at him is not printable in this
magazine, but I have never used that language in public
before, let alone bellow it at the top of my voice. He
shouted back, and within seconds I was actually close to
hitting him. He backed down and slunk off. I strutted
home, chest puffed up, contrite beagle dragged
sheepishly behind me. It wasn't until half an hour later
that I realized I had been a complete jerk and had
nearly gotten into the first public brawl of my life. I
vowed to inject my testosterone at night in the future.
That was an extreme example, but other, milder ones
come to mind: losing my temper in a petty argument;
innumerable traffic confrontations; even the occasional
slightly too prickly column or e-mail flame-out. No
doubt my previous awareness of the mythology of
testosterone had subtly primed me for these feelings of
irritation and impatience. But when I place them in the
larger context of my new testosterone-associated energy,
and of what we know about what testosterone tends to do
to people, then it seems plausible enough to ascribe
some of this increased edginess and self-confidence to
that biweekly encounter with a syringe full of manhood.
estosterone, oddly enough, is a chemical closely
related to cholesterol. It was first isolated by a Dutch
scientist in 1935 from mice testicles and successfully
synthesized by the German biologist Adolf Butenandt.
Although testosterone is often thought of as the
definition of maleness, both men and women produce it.
Men produce it in their testicles; women produce it in
their ovaries and adrenal glands. The male body converts
some testosterone to estradiol, a female hormone, and
the female body has receptors for testosterone, just as
the male body does. That's why women who want to change
their sex are injected with testosterone and develop
male characteristics, like deeper voices, facial hair
and even baldness. The central biological difference
between adult men and women, then, is not that men have
testosterone and women don't. It's that men produce
much, much more of it than women do. An average woman
has 40 to 60 nanograms of testosterone in a deciliter of
blood plasma. An average man has 300 to 1,000 nanograms
per deciliter.
Testosterone's effects start early -- really early.
At conception, every embryo is female and unless
hormonally altered will remain so. You need testosterone
to turn a fetus with a Y chromosome into a real boy, to
masculinize his brain and body. Men experience a flood
of testosterone twice in their lives: in the womb about
six weeks after conception and at puberty. The first
fetal burst primes the brain and the body, endowing male
fetuses with the instinctual knowledge of how to respond
to later testosterone surges. The second, more familiar
adolescent rush -- squeaky voices, facial hair and all
-- completes the process. Without testosterone, humans
would always revert to the default sex, which is female.
The Book of Genesis is therefore exactly wrong. It isn't
women who are made out of men. It is men who are made
out of women. Testosterone, to stretch the metaphor, is
Eve's rib.
Soon after I inject myself with
testosterone I feel a deep surge of energy. My attention
span shortens. My wit is quicker, my mind faster, but my
judgment is more impulsive
The effect of testosterone is systemic. It engenders
both the brain and the body. Apart from the obvious
genital distinction, other differences between men's and
women's bodies reflect this: body hair, the ratio of
muscle to fat, upper-body strength and so on. But
testosterone leads to behavioral differences as well.
Since it is unethical to experiment with human embryos
by altering hormonal balances, much of the evidence for
this idea is based on research conducted on animals. A
Stanford research group, for example, as reported in
Deborah Blum's book "Sex on the Brain," injected newborn
female rats with testosterone. Not only did the female
rats develop penises from their clitorises, but they
also appeared fully aware of how to use them, trying to
have sex with other females with merry abandon. Male
rats who had their testosterone blocked after birth, on
the other hand, saw their penises wither or disappear
entirely and presented themselves to the female rats in
a passive, receptive way. Other scientists, theorizing
that it was testosterone that enabled male zebra finches
to sing, injected mute female finches with testosterone.
Sure enough, the females sang. Species in which the
female is typically more aggressive, like hyenas in
female-run clans, show higher levels of testosterone
among the females than among the males. Female sea
snipes, which impregnate the males, and leave them to
stay home and rear the young, have higher testosterone
levels than their mates. Typical "male" behavior, in
other words, corresponds to testosterone levels, whether
exhibited by chromosomal males or females.
Does this apply to humans? The evidence certainly
suggests that it does, though much of the "proof" is
inferred from accidents. Pregnant women who were
injected with progesterone (chemically similar to
testosterone) in the 1950's to avoid miscarriage had
daughters who later reported markedly tomboyish
childhoods. Ditto girls born with a disorder that causes
their adrenal glands to produce a hormone like
testosterone rather than the more common cortisol. The
moving story, chronicled in John Colapinto's book "As
Nature Made Him," of David Reimer, who as an infant was
surgically altered after a botched circumcision to
become a girl, suggests how long-lasting the effect of
fetal testosterone can be. Despite a ruthless attempt to
socialize David as a girl, and to give him the correct
hormonal treatment to develop as one, his behavioral and
psychological makeup was still ineradicably male.
Eventually, with the help of more testosterone, he
became a full man again. Female-to-male transsexuals
report a similar transformation when injected with
testosterone. One, Susan/Drew Seidman, described her
experience in The Village Voice last November. "My
sex-drive went through the roof," Seidman recalled. "I
felt like I had to have sex once a day or I would die.
... I was into porn as a girl, but now I'm really
into porn." For Seidman, becoming a man was not
merely physical. Thanks to testosterone, it was also
psychological. "I'm not sure I can tell you what makes a
man a man," Seidman averred. "But I know it's not a
penis."
The behavioral traits
associated with testosterone are largely the
cliché-ridden ones you might expect. The Big T
correlates with energy, self-confidence,
competitiveness, tenacity, strength and sexual drive.
When you talk to men in testosterone therapy, several
themes recur. "People talk about extremes," one man in
his late 30's told me. "But that's not what testosterone
does for me. It makes me think more clearly. It makes me
think more positively. It's my Saint Johnswort." A man
in his 20's said: "Usually, I cycle up the hill to my
apartment in 12th gear. In the days after my shot, I
ride it easily in 16th." A 40-year-old executive who
took testosterone for bodybuilding purposes told me: "I
walk into a business meeting now and I just exude
self-confidence. I know there are lots of other reasons
for this, but my company has just exploded since my
treatment. I'm on a roll. I feel capable of almost
anything."
When you hear comments like these, it's no big
surprise that strutting peacocks with their extravagant
tails and bright colors are supercharged with
testosterone and that mousy little male sparrows aren't.
"It turned my life around," another man said. "I felt
stronger -- and not just in a physical sense. It was a
deep sense of being strong, almost spiritually strong."
Testosterone's antidepressive power is only marginally
understood. It doesn't act in the precise way other
antidepressants do, and it probably helps alleviate
gloominess primarily by propelling people into greater
activity and restlessness, giving them less time to
think and reflect. (This may be one reason women tend to
suffer more from depression than men.) Like other drugs,
T can also lose potency if overused. Men who inject
excessive amounts may see their own production collapse
and experience shrinkage of their testicles and liver
damage.
Individual effects obviously vary, and a person's
internal makeup is affected by countless other factors
-- physical, psychological and external. But in this
complex human engine, testosterone is gasoline. It revs
you up. A 1997 study took testosterone samples from 125
men and 128 women and selected the 12 with the lowest
levels of testosterone and the 15 with the highest. They
gave them beepers, asked them to keep diaries and paged
them 20 times over a four-day period to check on their
actions, feelings, thoughts and whereabouts. The
differences were striking. High-testosterone people
"experienced more arousal and tension than those low in
testosterone," according to the study. "They spent more
time thinking, especially about concrete problems in the
immediate present. They wanted to get things done and
felt frustrated when they could not. They mentioned
friends more than family or lovers."
Unlike Popeye's spinach, however, testosterone is
also, in humans at least, a relatively subtle agent. It
is not some kind of on-off switch by which men are
constantly turned on and women off. For one thing, we
all start out with different base-line levels. Some
women may have remarkably high genetic T levels, some
men remarkably low, although the male-female
differential is so great that no single woman's T level
can exceed any single man's, unless she, or he, has some
kind of significant hormonal imbalance. For another, and
this is where the social and political ramifications get
complicated, testosterone is highly susceptible to
environment. T levels can rise and fall depending on
external circumstances -- short term and long term.
Testosterone is usually elevated in response to
confrontational situations -- a street fight, a marital
spat, a presidential debate -- or in highly charged
sexual environments, like a strip bar or a pornographic
Web site. It can also be raised permanently in
continuously combative environments, like war, although
it can also be suddenly lowered by stress.
Because testosterone levels can be measured in saliva
as well as in blood, researchers like Alan Booth, Allan
Mazur, Richard Udry and particularly James M. Dabbs,
whose book "Heroes, Rogues and Lovers" will be out this
fall, have compiled quite a database on these
variations. A certain amount of caution is advisable in
interpreting the results of these studies. There is some
doubt about the validity of onetime samples to gauge
underlying testosterone levels. And most of the studies
of the psychological effects of testosterone take place
in culturally saturated environments, so that the
difference between cause and effect is often extremely
hard to disentangle. Nevertheless, the sheer number and
scale of the studies, especially in the last decade or
so, and the strong behavioral correlations with high
testosterone, suggest some conclusions about the social
importance of testosterone that are increasingly hard to
gainsay.
estosterone is clearly correlated in both men and
women with psychological dominance, confident
physicality and high self-esteem. In most combative,
competitive environments, especially physical ones, the
person with the most T wins. Put any two men in a room
together and the one with more testosterone will tend to
dominate the interaction. Working women have higher
levels of testosterone than women who stay at home, and
the daughters of working women have higher levels of
testosterone than the daughters of housewives. A 1996
study found that in lesbian couples in which one partner
assumes the male, or "butch," role and another assumes
the female, or "femme," role, the "butch" woman has
higher levels of testosterone than the "femme" woman. In
naval medical tests, midshipmen have been shown to have
higher average levels of testosterone than plebes.
Actors tend to have more testosterone than ministers,
according to a 1990 study. Among 700 male prison inmates
in a 1995 study, those with the highest T levels tended
to be those most likely to be in trouble with the prison
authorities and to engage in unprovoked violence. This
is true among women as well as among men, according to a
1997 study of 87 female inmates in a maximum security
prison. Although high testosterone levels often
correlate with dominance in interpersonal relationships,
it does not guarantee more social power. Testosterone
levels are higher among blue-collar workers, for
example, than among white-collar workers, according to a
study of more than 4,000 former military personnel
conducted in 1992. A 1998 study found that trial lawyers
-- with their habituation to combat, conflict and
swagger -- have higher levels of T than other lawyers.
The salient question, of
course, is, How much of this difference in aggression
and dominance is related to environment? Are trial
lawyers naturally more testosteroned, and does that lead
them into their profession? Or does the experience of
the courtroom raise their levels? Do working women have
naturally higher T levels, or does the prestige of work
and power elevate their testosterone? Because of the
limits of researching such a question, it is hard to
tell beyond a reasonable doubt. But the social context
clearly matters. It is even possible to tell who has won
a tennis match not by watching the game, but by
monitoring testosterone-filled saliva samples
throughout. Testosterone levels rise for both players
before the match. The winner of any single game sees his
T production rise; the loser sees it fall. The ultimate
winner experiences a postgame testosterone surge, while
the loser sees a collapse. This is true even for people
watching sports matches. A 1998 study found that fans
backing the winning side in a college basketball game
and a World Cup soccer match saw their testosterone
levels rise; fans rooting for the losing teams in both
games saw their own T levels fall. There is, it seems,
such a thing as vicarious testosterone.
One theory to explain this sensitivity to environment
is that testosterone was originally favored in human
evolution to enable successful hunting and combat. It
kicks in, like adrenaline, in anticipation of combat,
mental or physical, and helps you prevail. But a
testosterone crash can be a killer too. Toward the end
of my two-week cycle, I can almost feel my spirits
dragging. In the event of a just-lost battle, as Matt
Ridley points out in his book "The Red Queen," there's a
good reason for this to occur. If you lose a contest
with prey or a rival, it makes sense not to pick another
fight immediately. So your body wisely prompts you to
withdraw, filling your brain with depression and
self-doubt. But if you have made a successful kill or
defeated a treacherous enemy, your hormones goad you
into further conquest. And people wonder why
professional football players get into postgame sexual
escapades and violence. Or why successful businessmen
and politicians often push their sexual luck.
Similarly, testosterone levels may respond to more
long-term stimuli. Studies have shown that inner-city
youths, often exposed to danger in high-crime
neighborhoods, may generate higher testosterone levels
than unthreatened, secluded suburbanites. And so high T
levels may not merely be responses to a violent
environment; they may subsequently add to it in what
becomes an increasingly violent, sexualized cycle. (It
may be no accident that testosterone-soaked ghettos
foster both high levels of crime and high levels of
illegitimacy.) In the same way, declines in violence and
crime may allow T levels to drop among young inner-city
males, generating a virtuous trend of further reductions
in crime and birth rates. This may help to explain why
crime can decline precipitously, rather than drift down
slowly, over time. Studies have also shown that men in
long-term marriages see their testosterone levels
progressively fall and their sex drives subsequently
decline. It is as if their wives successfully tame them,
reducing their sexual energy to a level where it is more
unlikely to seek extramarital outlets. A 1993 study
showed that single men tended to have higher levels of
testosterone than married men and that men with high
levels of testosterone turned out to be more likely to
have had a failed marriage. Of course, if you start out
with higher T levels, you may be more likely to fail at
marriage, stay in the sexual marketplace, see your
testosterone increase in response to this and so on.
None of this means, as the scientists always caution,
that testosterone is directly linked to romantic failure
or violence. No study has found a simple correlation,
for example, between testosterone levels and crime. But
there may be a complex correlation. The male-prisoner
study, for example, found no general above-normal
testosterone levels among inmates. But murderers and
armed robbers had higher testosterone levels than mere
car thieves and burglars. Why is this not surprising?
One of the most remarkable, but least commented on,
social statistics available is the sex differential in
crime. For decades, arrest rates have shown that an
overwhelmingly disproportionate number of arrestees are
male. Although the sex differential has narrowed since
the chivalrous 1930's, when the male-female arrest ratio
was 12 to 1, it remains almost 4 to 1, a close echo of
the testosterone differential between men and women. In
violent crime, men make up an even bigger proportion. In
1998, 89 percent of murders in the United States, for
example, were committed by men. Of course, there's a
nature-nurture issue here as well, and the fact that the
sex differential in crime has decreased over this
century suggests that environment has played a part. Yet
despite the enormous social changes of the last century,
the differential is still 4 to 1, which suggests that
underlying attributes may also have a great deal to do
with it.
This, then, is what it comes down to: testosterone is
a facilitator of risk -- physical, criminal, personal.
Without the influence of testosterone, the cost of these
risks might seem to far outweigh the benefits. But with
testosterone charging through the brain, caution is
thrown to the wind. The influence of testosterone may
not always lead to raw physical confrontation. In men
with many options it may influence the decision to
invest money in a dubious enterprise, jump into an
ill-advised sexual affair or tell an egregiously big
whopper.
