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Testosterone Dreams tells the story of testosterone's growing and sometimes concealed influence in our culture over the past 70 years. It explores such controversial topics as the invention and marketing of the male menopause, the disturbing history of hormonal and other medical treatments aimed at boosting or suppressing women's sexuality, and hormone doping in sporting events such as the Tour de France and the Olympics, and in Major League Baseball. It brings to light the hidden use of hormone doping by policemen, soldiers, and other workers in a variety of jobs. It also discusses the burgeoning steroid use in the gay community and its relation to AIDS, and takes a hard look at the pharmaceutical industry's promotional campaigns to create new markets for testosterone products.
Testosterone Dreams is the first book to bring together the whole story of testosterone and to consider its social and ethical implications: Where does therapy end and performance enhancement begin? How are changing medical technologies affecting how we think about our identities as men and women and the elusive goal of "well-being"? This book will be essential reading as we move inexorably toward the wide-open, libertarian pharmacology that is now making these drug regimes available to a wider and wider clientele.
1. Hormone Therapy and the New Medical Paradigm
Enhancements: Where Are the Limits?
Testosterone as Therapy and Myth
"Psychic Steroids": Prozac as a Performance-Enhancing Drug
Back to the Future: The Sex Hormone Market from Organotherapy to "Andro"
2. The Aphrodisiac That Failed: Why Testosterone Did Not Become a Mass Sex Therapy
What They Did to Women: The Origins of Sex Therapy
Sex before Kinsey: What Doctors and Patients Did Not Know
Hormones and the State: Sex and Marital Stability
Patriarchal Sex Therapy: Curing "Frigidity" with Hormones
Reorienting Male Desire: Curing Homosexuals with Sex Hormones
Aphrodisia for the Masses?
The Secret Life of Testosterone Therapy
3. The Mainstreaming of Testosterone
Hormone Therapy and the Discovery of Sexual Deficiency
Preserving the Feminine Essence: Estrogen and Menopause
Does the Male Menopause Exist?
4. "Outlaw" Biomedical Innovations:
Hormone Therapy and Beyond
Hormone Therapy and Cosmetic Procedures: The New Medical Ethos
Offshore Entrepreneurial Medicine: From Embryos to Cloning
Medical Populism and Outlaw Medicine: Fertility Techniques and Medical Marijuana
Hormone Therapists and Hormone Evangelists
5. Hormone Therapy for Athletes:
Doping as Social Transgression
Doping before Steroids: Clean Amateurs and Doped Professionals
The Entrepreneurial Physician
The Doctor-Athlete Relationship
The Patient as Athlete, the Athlete as Patient
6. "Let Them Take Drugs": Public Responses to Doping
7. A War against Drugs?
The Politics of Hormone Doping in Sport
International Doping Control before Reform
Sportive Nationalism and Doping
International Doping Control after Reform
A War on Drugs?
Athletes and the Doping of Everyday Life
Athletic Doping and the Human Future
Epilogue. Testosterone as a Way of Life
Pharmacology and Our Human Future
Testosterone Dreams is an investigation of modern attitudes toward enhancing the mental, physical, and sexual powers of human beings. The chapters that follow explore the theory and practice of human enhancement by focusing on the complex, and sometimes bizarre, history of the synthetic hormone testosterone and the careers it has made, both inside and outside the medical world, over the past sixty years. Testosterone is the hormone of choice for this purpose because it has played all the major roles in which a charismatic hormone can function: it has been regarded as a rejuvenating drug, as a sexually stimulating drug, and as a doping drug that builds muscle and boosts athletic performance. The first chapter of this book presents a history of testosterone therapy and the primitive "organotherapy" that preceded it. Of particular interest here is the medical and social status of synthetic testosterone and its derivatives, the anabolic-androgenic steroids. Why has testosterone acquired a special, even fashionable, cachet as a particularly dynamic hormone? When have testosterone drugs been viewed asharmful or benign? Why is testosterone finally prevailing despite the law that regulates its use? What has the pharmaceutical industry done to create a market for testosterone products? The second chapter describes early testosterone therapies for "frigid" women and homosexuals and explains why the drug companies failed to create a mass market for testosterone products after the Second World War. Chapter 3 and 4 show how the commercial promotion of testosterone drugs has overcome these obstacles and is now mainstreaming testosterone therapy as a socially acceptable enhancement. Chapters 5 through 7 examine the role of testosterone drugs in the world of Olympic sport and the doping epidemic they have unleashed over the past forty years. We shall examine the world of high-performance athletics as a kind of parallel universe in which pharmacological performance enhancement has become a way of life for entire groups of athletes. In this subculture of drug-taking athletes we find the doctor-patient relationships that have long served as models for the hormone entrepreneurs who now offer to enhance the mental, physical, and sexual athleticism of their patients.
Testosterone dreams are the fantasies of hormonal rejuvenation, sexual excitement, and supernormal human performance that have been inspired by testosterone since it was first synthesized in 1935. This scientific achievement was driven by a competition among three teams of researchers sponsored by rival pharmaceutical companies, all dreaming of a male hormone market that would produce profits like those of the already-established market for female hormones. During the years that followed, a steady stream of medical observations pointed to exciting prospects for the "androgenic" drugs derived from testosterone. An association between testosterone treatment and muscular enlargement in male mammals was proposed in 1938. "Androgens exert a tonic and stimulating action, associated perhaps with their metabolic effects," the Journal of the American Medical Association stated in 1942. Scientists were already distinguishing between testosterone's effects on "sexual function" and "mental and physical vigor," between its capacities to produce "sexual stimulation" and "constitutional rehabilitation." Over the next several decades, the growing use of testosterone and its derivatives, the anabolic-androgenic steroids, would demonstrate that many people were interested in using testosterone products for a variety of purposes.
The first public advocate of testosterone therapy for aging men was the popular science journalist Paul de Kruif, whose manifesto The Male Hormone was published with some fanfare in 1945. Excerpted in Reader's Digest and promoted by a full-page review in Newsweek ("Hormones for He Men"), The Male Hormone was in some respects a prophetic book. "The male hormone," de Kruif declared, "is now ready for the trial of its possible power to extend the prime life of men." Commending his "courageous honesty," one reviewer declared that de Kruif had brought out into the open "the questions raised by the laboratory synthesis and the now unlimited production of testosterone, the male hormone."
The excitement about testosterone's medical and commercial prospects was shared by some of the major pharmaceutical companies of this era. "Of all the sex hormones," Business Week reported in December 1945, "testosterone is said to have the greatest market potentialities." Two companies, Schering and Glidden, had been fighting it out in court for the right to manufacture synthetic sex hormones. By 1937 testosterone propionate was being produced in sufficient quantities for use in clinical trials. By 1938 the production of testosterone had already resulted in antitrust proceedings and controversy in the pharmaceutical industry. The manufacture of testosterone, de Kruif predicted in 1945, "will make its producers wealthy."
De Kruif declared that a growing demand for testosterone would "soon bring it within reach of everybody." The availability of methyl testosterone in pill form convinced him that a practical way to administer the drug had finally been found. The potential clientele seemed to be enormous: "How many millions of American males, not the men they used to be, would flock to the physicians and the druggist, a bit shame-faced and surreptitious, maybe, but hopeful, murmuring: 'Doc, how about some of this new male hormone?" Physicians, too, seemed to be ready for a breakthrough in treatments. Despite the warnings issued by the American Medical Association, "many physicians, and more of them all the time, were trying out testosterone on this, that, and almost every disease of the middle and later years of the lives of men." So it appeared that an inexpensive supply, a healthy demand, and favorable medical opinion would soon add up to a viable market for androgen drugs.
Testosterone became a charismatic drug because it promised sexual stimulation and renewed energy for individuals and greater productivity for modern society. Physicians described the optimal effect of testosterone as a feeling of "well-being," a term that has been used many times over the past half century to characterize its positive effect on mood. In the early 1940s testosterone was hailed as a mood-altering drug whose primary purpose was the sexual restoration and reenergizing of aging males. The sheer numbers of these potential patients suggested that they would eventually constitute a lucrative market. This idea was still in the air a decade after The Male Hormone was published. "The present results with steroid therapy in geriatrics are astonishing," one gerontologist wrote in 1954. "Their future possibilities stagger the imagination." Interest in testosterone was strong enough to prompt the American Medical Association to advise that "these substances ought to be kept out of vitamin pills."
The idea that testosterone was a performance-enhancing drug that could boost the productivity of socially significant people appeared in 1939, along with the idea of the male menopause. Testosterone replacement therapy would help older men in important positions fulfill their "social and economic responsibilities." Paul de Kruif offered his readers a similar vision of drug-induced productivity that made a prophetic connection between elite athletes and their civilian counterparts. "We know how both the St. Louis Cardinals and St. Louis Browns have won championships, super-charged by vitamins," he observes. "It would be interesting to watch the productive power of an industry or a professional group that would try a systematic supercharge with testosterone[.]" Within a generation, sports audiences around the world were enjoying record-breaking performances achieved by athletes whose "productive power" was boosted by testosterone-based anabolic steroids. The "doping" of athletes with androgens and other hormones can thus be understood as one of the human enhancements that will precipitate an unprecedented crisis of human identity during the twenty-first century.
As more drugs are finding new and often unexpected uses, the distinction between illegitimate doping and socially acceptable forms of drug-assisted productivity is gradually disappearing. One consequence of this vanishing boundary is that the de facto legitimizing of a drug can also create an implicit or even explicit obligation to use it for purposes society or certain subcultures define as desirable. Compulsory doping of this kind has been observed in certain athletic subcultures for many years. Shot-putters, weightlifters, and professional cyclists are among the most obvious examples of athletes whose communities have legitimated (and effectively mandated) the consumption of illicit drugs for the purpose of staging more "productive" competitions. The former East German elite sports program practiced compulsory doping-and Olympic medal production-on a unique scale. My point is that modern societies have embarked on various kinds of pharmacological practices that exemplify what we may call compulsory or obligatory doping.
People can feel obligated to dope themselves for military, professional, or sexual purposes. The amphetamine drugs once known as "pep pills," for example, found widespread military use during the Second World War. In March 1944, the air surgeon of the United States Air Force explained to the American public that despite the "disgrace" into which Benzedrine had fallen on account of its widespread abuse by civilians, it played an essential wartime role in keeping military pilots alert while they were in action. Amphetamines were subsequently provided to pilots in the Vietnam and Gulf wars. After two U.S. Air Force pilots killed four Canadian soldiers in a "friendly-fire" incident in Afghanistan in April 2002, their lawyers argued that these men had felt compelled to take Dexedrine pills that could have affected their behavior on that fateful night. Although air force officials deny that they require pilots to take these drugs, the consent form presented to their aviators suggests otherwise.
It is not surprising that military officials are unwilling to endorse the doping of their personnel openly and unambiguously. "The aviation community and the air force community certainly don't like to talk about so-called 'performance enhancing' drugs," one defense policy expert pointed out during the Afghanistan inquiry. The blanket stigmatizing of drugs by governmental authorities forces those responsible for producing even legitimate drug-dependent performances to cover up or apologize for their pharmacological policies. In this sense, the U.S. Air Force policy that issues amphetamines to pilots and authorizes them to "self-regulate" their drug use bears a striking resemblance to the tacit drug policy followed for many years by the professional cyclists who ride in the Tour de France.
The same predicament has confronted Australian authorities, who in 1998 discovered that large numbers of soldiers in one of their elite units were using doping drugs. They responded by legitimizing these drugs and issuing guidelines for their use, on the grounds that any technique that promoted the survival of their fighting men was acceptable. In 2002 the Australian Defence Force's director of personnel operations expressed concern about an "apparent increase in illegal drug use, particularly steroid abuse" among soldiers. The Sydney Morning Herald reported that these military personnel were "using steroids to bulk up, boost stamina and self-esteem and to recover more quickly from injuries they have sustained." This ostensibly rational use of steroids could lead to a compulsory doping subculture if left unchecked. The director of personnel operations thus felt obliged to declare that steroid doping would subvert rather than enhance a soldier's fitness: "Drug involvement leads to reduced performance, health impairment, presents a security risk and has the potential to endanger the safety of our soldiers." As in the case of amphetamine-consuming pilots, a military establishment found itself caught between the potential utility of performance-enhancing drugs and a social stigma that threatened to become a public relations problem. The solution was to declare that any performance enhancement from these drugs came at too high a price in undesirable side effects. The problem with this argument, as we shall see, is that it offers no justification against performance-enhancing drugs that do not have side effects.
Compulsory doping in the workplace is a real possibility in a culture that promotes productivity and accepts pharmacological solutions to human problems. "How might a substance like Prozac enter into the competitive world of American business?" Peter D. Kramer asked in Listening to Prozac. As in the world of high-performance sport, it can be a short step from posing such questions to implementing performance-enhancing solutions that exert pressure on every performer. Some years later another psychiatrist answered Kramer's question by pointing out that SSRI (selective serotonin reuptake inhibitor) antidepressants like Prozac had become "all-purpose psychoanalgesics" for competitive situations. "People think they've got to keep up with the Joneses, pharmacologically-if everyone at your office is taking Zoloft to stay alert and work long hours, you've got to have it, too." This is the predicament Kramer had already anticipated in his best-selling book. The same dynamic has promoted the use of antidepressants and other psychiatric medications among American students-a trend that some find troubling. "We work against having medication used in the Olympics," says the director of psychological services at one American college, so why should drug-taking be allowed to "increase performance in school?" This flagrant discrepancy between the treatment of athletic and academic performances amounts to an unresolved cultural crisis to which we shall return later in this book.
Such scenarios show how hard it can be to determine where therapy ends and performance enhancement begins. This uncertainty about the boundary between healing and enhancement changes our sense of what is "normal" and what is not. If I become fatigued while my drug-taking coworkers stay alert, their "supernormal" stamina may well recalibrate the very idea of normal functioning. Their greater productivity might eventually legitimize their doping habit and make it compulsory for everyone. In this work environment, it is the drug-free worker who is in a state of deficiency. The ultimate drug of this kind, currently being marketed as Provigil, can apparently keep people awake and alert for days.
Excerpted from Testosterone Dreams by John Hoberman Copyright © 2004 by Regents of the University of California. Excerpted by permission.
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