Looking for Mr T: the politicisation of testosterone

https://www.theguardian.com/global/2019/jul/28/looking-for-mr-t-the-politicisation-of-testosterone-and-toxic-masuclinity

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Florida was on a knife-edge during the 2016 US presidential election. Almost every poll had it too close to call. In the final few weeks before the vote, a rash of ads appeared on radio and TV claiming that Hillary Clinton was too frail, too liberal and too ethically compromised to become president.

Dr Dareld Morris, the owner of a small medical clinic in Florida, recorded and paid for his own anti-Clinton ad. Unlike the others, he suggested a vote for the Democratic candidate wasn’t merely the wrong political choice, but the result of a chemical imbalance. “Hi guys, Doc Morris here,” it began in a chirpy, mattress-salesman tone. “Most are not aware of the negative effects low-T can have on your mental state, for instance, your ability to focus and think clearly… So, as a community service, I have this special offer: for any guys out there that are thinking of voting for Hillary, I want to offer you a free testosterone test. Just come in and register in my office in Fort Myers and let’s see if we can help.”

Not many people took Morris’s ad too seriously; most news outlets were pleased for a frothy story in an election that was short on light relief. Even Morris himself back-pedalled slightly, telling local news that the ad was just an “experiment”, although he added: “I’m actually voting for Donald Trump, so I think it’s even more funnier.”

Yet in the years since, it has become a strange kind of orthodoxy among American conservatives that being a liberally minded man who supports feminism is simply a result of having abnormally low levels of testosterone. Like much of conspiracy conservatism, it began on message boards where various alt-right activists gather. There, being “low-T” has become the ultimate insult, alongside other masculinity-challenging burns such as “cuck”, “soyboy” and “beta”. On Reddit’s biggest Trump community, The Donald, there are thousands of posts that say things like “POST-VEGAS CUCKOLDRY: Low-T Leftist Decides to Virtue Signal by Turning in His Guns.” There’s also a “low-T beta male starter pack” that includes pictures of Bernie Sanders and desert boots.

But it’s an idea that’s spread quickly to the political mainstream. When then-attorney general Jeff Sessions suddenly became more active in trying to prosecute White House leakers, Republican congressman Matt Gaetz suggested he’d started “taking those supplements for low-T”.

During the campaign, Trump’s own testosterone levels were revealed during a special episode of the talkshow Dr Oz, certainly a presidential first. The audience whooped and cheered as Oz confirmed that Trump’s T-score of 441 was “good”.

Politicians have long believed that demonstrating physical strength projects strength as a leader. But the obsession with testosterone is about more than being able to win in a fight. Testosterone is an often-misunderstood hormone, present in both men and women. It plays an important role in sexual function and having a lot of it can help you build muscle, but it also helps with cognition, energy and mood. People with low testosterone are more likely to have multiple chronic health conditions (although researchers argue that a causal link has not been proven). So saying someone has low testosterone taps into a murky mix of insecurities: about not being manly, lacking assertiveness and being unable to satisfy sexually.

In reality, levels of testosterone are far more complex to understand. Only a small percentage of total testosterone molecules are “free” to be used by the body, and levels change constantly depending on your mood, time of day and other environmental factors. Nor is it true that testosterone makes you more athletic – this issue has come to a head in the case of Caster Semenya. But the IAAF’s own analysis of 1,100 female runners found that in three of the 11 running events, women with lower testosterone performed better than those with higher levels.

One activist says: ‘The movement to empower women has gone too far’

The truth is that most men experience a decline in testosterone levels from around the age of 30 and, until recently, most people thought of having low testosterone as part of a kind of “male menopause”, an issue for older men with waning libidos. But this new, politicised, understanding of testosterone isn’t just about ageing. It’s succinctly explained in a video entitled The Truth About Soy Boys made by Paul Joseph Watson, a member of Ukip and one of the shining lights of Britain’s alt-right community.

Watson demonstrates that many of the politically correct left-wingers he despises are also committed vegans and argues that because foods like soya milk and tofu contain oestrogen, and oestrogen lowers testosterone, they are making vegans more feminine and therefore more liberal – or as he puts it: “Buzzfeed-watching, tofu-eating, male-feminist virtue-signalling, beta-orbiter soy boys.”

It seems like this is just a churlish new way to mock political opponents, but there is a scientific backdrop to the banter. A 2007 study shows that average levels of testosterone in the main population have been going down considerably, so that, for example, men who were 50 in 1988 had higher testosterone concentrations than did comparable 50-year-old men in 1996. The study hypothesises that levels could be dropping by as much as 1% a year.

In other words, men as a group are becoming softer and there’s science to prove it. To reverse the trend, we just need to boost our testosterone. What could be better grist for the mill for those trying to make America great again or take back control?

Big pharma has been quick to offer miracle cures to this apparent ill. I first came across this strange linking between Trumpish rhetoric and hormone treatments watching TV adverts in America. One, for a product called Ageless Male, asks: “When did it become OK for men to become softer, lazier, weaker?” The same brand offers a free month’s trial if you text the promo code “wimp” to its hotline.

Since those adverts began, there’s been an increase in the number of men seeking to boost their testosterone levels. In the US, more than 1 million men have been getting new tests for testosterone levels and more than 283,000 initiated testosterone treatment in a four-year period.

That impact is being felt in the UK, too. High-street pharmacies, as well as online start-ups, are now offering testosterone testing, letting men do at-home blood tests to help satiate or stoke their fears.

Superdrug says it has seen the number of requests per week for the kits more than double since February. More people are going to their doctor with their worries, too, and NHS prescriptions for testosterone increased by 20% in the four years after 2012.

Stricter controls on television advertising in the UK mean that pro-testosterone thinking is being stoked in books and online. The charge is led by Daniel Kelly, a fitness coach from Stoke-on-Trent who has written his own book advocating testosterone-replacement therapy (TRT) for young people. It’s called Optimized Under 35: How to Boost Your Testosterone, Increase Your Sex Drive and Achieve Incredible Health.

‘It gives you acne and shrinks your balls, but there are no risks’

Kelly’s book is typical of the way testosterone devotees like to blend their version of science with a conservative worldview. In the introduction he talks about how testosterone use helped him with his anxiety and libido, and promises that the book will advise any reader how to reap the same benefits. Much of the book includes highly technical hormone advice and references to scientific studies.

But the science is blended with sentiments more familiar to late-night listeners of LBC. “The movement to empower women has swung the pendulum too far,” he writes. “Young men are brainwashed with anti-male vitriol…” and so on.

Kelly sees this not just as a crisis of masculinity, but a crisis of testosterone; indeed he says the two are “inseparable”. In one passage he writes: “This low-T reality has infested many areas of society to the point that it’s unacceptable to bring up traditional or conservative views in polite conversation… make no mistake, it’s not ‘toxic masculinity’ that’s the problem, it’s the toxic progressive ideology that hates anything masculine that poses a real problem to society.”

It would be easy to dismiss this as meninist nonsense, yet a part of me also thinks I would feel quietly emasculated if I were to discover I had low-T. It makes me think of the way false versions of femininity have long been measured in expensive grooming regimes and unrealistic body types. Even politically aware feminists can still feel inadequate staring at a size-zero model. Those are pressures that men have found it easier to avoid. Yet now, here we are creating our own field in which to feel deficient and unmanly – one which is completely invisible.

To find out where I stand, I order a £50 T-testing kit from Superdrug. Soon there are Sweeney Todd-like scenes at my kitchen table as I try to produce enough blood from a series of pinpricks to fill a vial. “Babes, you’ve got to milk your finger!” shouts my girlfriend as she tries to scoop blood into the plastic tube. I’ve always been told my bald head, monstrous body hair and speedy facial hair growth are classic signs of high testosterone. I send off the sample relatively confident I don’t have any of the symptoms associated with low-T.

While I wait for the results, I try to find out if there’s any actual scientific proof behind the fears that we’re not getting enough testosterone. I speak to Rebecca M Jordan-Young, a sociomedical scientist at Barnard College, Columbia University, and co-author of the forthcoming book, Testosterone: an Unauthorised Biography. I am not surprised when she tells me that much of the received wisdom about testosterone is nonsense.

“The idea of low-T has been really pushed, but low-T in and of itself is not a problem – you can have pretty low-T and be getting an awful lot out of that,” she says. “The average man has so much more testosterone than is needed for sexual functioning. In placebo-controlled, randomised trials, when they start with healthy people who have no complaints… most trials find no difference in any aspect of mood or cognition or behaviour even at massively high levels of testosterone.”

Jordan-Young says that hormones are extremely complex. The idea that ingesting more oestrogen from soy means you have less testosterone is a complete misunderstanding of how hormones work. Indeed, testosterone is often converted into oestrogen, which means that people who routinely inject testosterone often end up growing breasts.

Other research has shown that some testosterone treatments, especially those self-administered without regular medical checks, may make men more prone to heart attacks and prostate cancer. Boosting testosterone can also make a man infertile. Jordan-Young says the reason for much of this confusion comes from the misconception that testosterone is “the male sex hormone”.

“Hormones were originally discovered within a research programme that was already set up to characterise them as about masculinity and femininity. It was originally thought that when they did find the ‘male essence’ it would only be found in male bodies, that it would be detrimental to female bodies and that it would be exclusively about sex-related functions. None of those things turned out to be true, but all of them lived on in our folklore.”

It’s true that for people who do have dangerously low testosterone, TRT can be very effective, but we’re probably talking about less than 1% of men. For everyone else, the biggest impact TRT can have is a massive placebo effect.

Jordan-Young says there is little solid evidence of a testosterone decline in men. Even the claim that men have less testosterone now than they did a generation ago is doubtful. Studies are conflicting: some say there’s no decline at all; a couple say there’s a small but statistically significant decline over time. But the best population-based data from the US doesn’t show any decline in men.

Yet in this strange world in which endocrinology has overlapped with gender politics, the myth has spread faster than any scientific approach. Many healthy men believe they need more testosterone, not least because there are some men for whom TRT can be life-changing.

Some of them are treated by Dr Richard Petty, who runs the Wellman Clinic. Petty is a fantastically posh doctor who calls his secretaries “the girls” and has an office on Harley Street as big as my flat. He began specialising in men’s health after running a private clinic in the 1970s in Chelsea. When the recession and the three-day week hit, his patients could no longer afford to live in the area – as he puts it: “They had to live in their country houses or move to Putney” – so the wives and children got new doctors in the suburbs and he kept “the chaps”.

He began dealing more with prostate cancer, learning about testosterone and publishing on its importance. He’s rather more bullish than Jordan-Young about the prospects of TRT for transforming lives.

I ask whether he can tell when someone comes through the door whether they have low testosterone. “Absolutely, I can see from the street. You get anaemic, you see. So they’re pale. Even if they’re brown they’re not pink. Arteries in the face are less dilated than they would be otherwise.”

Petty says for a number of the patients he sees, TRT can not only perk up their sex life but lead to major improvements in mental health, lifting a depression that they have previously been unable to treat effectively.

I ask about my own test and he says he’s very dubious about online laboratories, saying they can be as much as 15% off. Still, I’m only hoping for a very rough idea. He tells me that seriously low-T would be a score of less than 13: “That’s one-star petrol.”

Armed with a new understanding of how testosterone works, I give Daniel Kelly a ring, hoping to convince him that men under 35 don’t need to get involved with testosterone boosting. He’s jollier than I expected, although occasionally says things like: “Society is trying to pigeonhole men almost into behaving like women.”

He explains that he now injects testosterone directly twice a week and plans to do so for the rest of his life. He did have quite low testosterone levels to begin with, but says he’s not concerned simply about remedying low testosterone, but having an optimum level.

I explain what Jordan-Young has said, that optimum testosterone isn’t real and your body can do a lot with a little T, and Kelly groans. “Mainstream doctors think it’s fine, as long as the hormones are in an arbitrary range made up by someone in an ivory tower who doesn’t understand it. It’s an arbitrary reference range that they made up. There’s a big difference between normal health and optimal health. It’s going to take some balancing, but what’s the alternative: feel like crap because you’re in some arbitrary reference range?”

He quotes studies at me that refute the link between testosterone and prostate cancer. He says over-the-counter hormone boosters can be dangerous, but he only advocates prescription TRT that “shrinks your balls” and gives you acne, and otherwise he believes “there are no risks”.

He accepts that some people don’t need TRT and it should be a last resort after changes to diet, getting fit and giving up booze. Yet he still believes many men – not just men with severe symptoms, or men who doctors believe have dangerously low-T – would be happier if they increased their T-levels artificially, even though it means they’ll have to do so for the rest of their lives. “Low testosterone makes men more meek and lacking in confidence, and the honest truth is if you walk down the street most men won’t even give you a strong handshake.”

As so often happens when science and politics collide, there are some slivers of truth hidden beneath a lot of nonsense. Testosterone can be transformative for those lacking it. But the idea that any kind of crisis of masculinity has been caused by lower testosterone in the population is a fiction, wished into existence by those peddling right-wing pseudoscience.

Or so I had convinced myself, right up until my T results land in my inbox. I’m shocked. I’m in the one-star petrol category, with a score my “Superdrug doctor” describes as “within the normal range, but at the lower end”. Despite not experiencing any of the associated problems with low testosterone, I honestly feel ashamed of my T-score. My logical brain might know I shouldn’t be worried, but I find myself flicking back through Kelly’s book, looking for advice. Maybe I do struggle to concentrate. Who doesn’t feel a bit lethargic sometimes? If testosterone insecurity has been manufactured out of nowhere over the past decade, it’s certainly working on me. Superdrug says I should do a second test to make sure of the result. I immediately start Googling to find a company that will give me a second opinion – and hopefully a better result.