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Testosterone Dreams TESTOSTERONE DREAMS TESTOSTERONE DREAMS REJUVENATION, APHRODISIA, DOPING John Hoberman UNIVERSITY OF CALIFORNIA PRESS BERKELEY LOS ANGELES LONDON Parts of chapter 7 are reprinted, by permission, from J. Hoberman, 2001, “How Drug Testing Fails: The Politics of Doping Control,” in Doping in Elite Sport: The Politics of Drugs in the Olympic Movement, edited by W. Wilson and E. Derse (Champaign, Ill.: Human Kinetics), 241–74. University of California Press Berkeley and Los Angeles, California University of California Press, Ltd. London, England © 2005 by the Regents of the University of California Library of Congress Cataloging-in-Publication Data Hoberman, John M. (John Milton), 1944– Testosterone dreams : rejuvenation, aphrodisia, doping / John Hoberman. p. ; cm. Includes index. isbn 0-520-22151-6 (cloth : alk. paper) 1. Testosterone. 2. Hormone therapy. 3. Meno- pause—Hormone therapy. 4. Testosterone—Therapeutic use. 5. Testosterone—Physiological effect. 6. Longevity. 7. Aphrodisiacs. [DNLM: 1. Hormone Replacement Therapy—trends. 2. Testosterone—therapeutic use. 3. Aphrodisiacs. 4. Doping in Sports. 5. Rejuvenation. WJ 875 H682t 2005] I. Title. QP572.T4H635 2005 615'.36—dc22 2003022824 Manufactured in the United States of America 14 13 12 11 10 09 08 07 06 05 10 987654321 The paper used in this publication is both acid-free and totally chlorine-free (tcf). It meets the minimum requirements of ansi/niso z39.48–1992 (r 1997) (Permanence of Paper).1 This book is dedicated to my father, Henry D. Hoberman, M.D., Ph.D., who taught me the dignity of medicine and the love of science. CONTENTS INTRODUCTION Testosterone Dreams: Pharmacology and Our Human Future 1 1 Hormone Therapy and the New Medical Paradigm 13 Enhancements: Where Are the Limits? 13 Testosterone as Therapy and Myth 25 “Psychic Steroids”: Prozac as a Performance-Enhancing Drug 30 Back to the Future: The Sex Hormone Market from Organotherapy to “Andro” 32 2 The Aphrodisiac That Failed: Why Testosterone Did Not Become a Mass Sex Therapy 55 What They Did to Women: The Origins of Sex Therapy 57 Sex before Kinsey: What Doctors and Patients Did Not Know 71 Hormones and the State: Sex and Marital Stability 79 Patriarchal Sex Therapy: Curing “Frigidity” with Hormones 84 Reorienting Male Desire: Curing Homosexuals with Sex Hormones 92 Aphrodisia for the Masses? The Secret Life of Testosterone Therapy 104 3 The Mainstreaming of Testosterone 119 Celebrating Testosterone 119 Hormone Therapy and the Discovery of Sexual Deficiency 124 Preserving the Feminine Essence: Estrogen and Menopause 130 Does the Male Menopause Exist? 141 4 “Outlaw” Biomedical Innovations: Hormone Therapy and Beyond 149 Hormone Therapy and Cosmetic Procedures: The New Medical Ethos 149 Offshore Entrepreneurial Medicine: From Embryos to Cloning 151 Medical Populism and Outlaw Medicine: Fertility Techniques and Medical Marijuana 161 Hormone Therapists and Hormone Evangelists 170 5 Hormone Therapy for Athletes: Doping as Social Transgression 179 Doping before Steroids: Clean Amateurs and Doped Professionals 182 The Entrepreneurial Physician 190 Medical Ethics 191 The Doctor-Athlete Relationship 194 The Patient as Athlete, the Athlete as Patient 210 6 “Let Them Take Drugs”: Public Responses to Doping 214 7 A War against Drugs? The Politics of Hormone Doping in Sport 239 International Doping Control before Reform 239 Sportive Nationalism and Doping 249 International Doping Control after Reform 260 A War on Drugs? Athletes and the Doping of Everyday Life 262 Athletic Doping and the Human Future 274 EPILOGUE Testosterone as a Way of Life 277 Notes 287 Index 359 INTRODUCTION Testosterone Dreams Pharmacology and Our Human Future Testosterone Dreams is an investigation of modern attitudes toward en- hancing the mental, physical, and sexual powers of human beings. The chapters that follow explore the theory and practice of human enhance- ment 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 seventy 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 re- garded 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 de- rivatives, the anabolic-androgenic steroids. Why has testosterone ac- quired a special, even fashionable, cachet as a particularly dynamic hor- mone? When have testosterone drugs been viewed as harmful 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. Chapters 3 and 4 show how the commercial 1 2/INTRODUCTION promotion of testosterone drugs has overcome these obstacles and is now mainstreaming testosterone therapy as a socially acceptable en- hancement. Chapters 5 through 7 examine the role of testosterone drugs in the world of Olympic sport and the doping epidemic they have un- leashed over the past forty years. We shall examine the world of high- performance athletics as a kind of parallel universe in which pharmaco- logical 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, sex- ual excitement, and supernormal human performance that have been in- spired by testosterone since it was first synthesized in 1935. This scien- tific 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 as- sociation 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 deriva- tives, 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.” Com- mending his “courageous honesty,” one reviewer declared that de Kruif had brought out into the open “the questions raised by the laboratory TESTOSTERONE DREAMS / 3 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 De- cember 1945, “testosterone is said to have the greatest market poten- tialities.” 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 adminis- ter 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 ap- peared 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 testos- terone 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.
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