This page intentionally left blank Sex Science Self This page intentionally left blank Sex Science Self A Social History of Estrogen, Testosterone, and Identity Bob Ostertag University of Massachusetts Press Amherst & Boston Copyright © 2016 by University of Massachusetts Press All rights reserved Printed in the United States of America ISBN 978-1-62534-213-3 (paper); 212-6 (hardcover) Designed by Jack Harrison Set in Adobe Garamond Pro with Huxley Vertical display Cover design by Kristina Kachele Cover photograph from Shutterstock © David Smart. Library of Congress Cataloging-in-Publication Data Names: Ostertag, Bob, 1957– , author. Title: Sex science self : a social history of estrogen, testosterone, and identity / Bob Ostertag. Description: Amherst : University of Massachusetts Press, [2016] | Includes bibliographical references and index. Identifiers: LCCN 2016004219 | ISBN 9781625342133 (pbk. : alk. paper) | ISBN 9781625342126 (hardcover : alk. paper) Subjects: | MESH: Gonadal Steroid Hormones | Drug Therapy—history | Drug Therapy—economics | Sexuality | Transgender Persons | Gender Identity Classification: LCC QP251 | NLM WK 900 | DDC 612.6—dc23 LC record available at http://lccn.loc.gov/2016004219 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. to my people, the freaks and the queers This page intentionally left blank Contents Acknowledgments ix Words xi Introduction 1 1. Before Pharmaceuticals 22 2. The “Male Sex Hormone” and the Testosterone Gold Rush 50 3. The “Female Sex Hormone,” the Goddess of Fortune 62 4. The Estrogen Mess 73 5. The Testosterone Comeback 85 6. “Sex Hormones” Redux—Not Yours, Your Mother’s 94 7. Brain Organization Theory 108 8. The Contemporary Landscape 134 Conclusion 145 Afterword 169 Notes 173 Index 187 vii This page intentionally left blank Acknowledgments The list of people who have generously helped me in one way or another with this book is long, and includes queers of all kinds, scholars, doctors, psychia- trists, psychologists, and friends. My deepest thanks to all of you. There are three people who simply must be thanked by name. The first is my editor, Brian Halley, who stuck with this project through thick and thin and was extremely generous with his comments and criticisms, all of which have made the book better than it would have been. The second is my copy editor, Mary Bellino, whose work went far beyond what is usually considered copyediting. The third is my longtime friend Christian Huygen, the founder and direc- tor of the Rainbow Heights Club in Brooklyn, New York, the nation’s only drop-in social center for LGBT people with severe mental illness diagnoses. Christian has spent I don’t know how many hours helping me think through the tangled knot of issues addressed in this book, educating me when needed, pointing me toward other people and resources, shooting down ideas without merit, and patiently answering the phone when I would call at odd hours with some new thought to run by him. That said, I should stress that his generosity does not imply that he agrees with everything in this book. If you ever find yourself in Brooklyn on a late Wednesday afternoon with a little free time and are up for a beautifully queer experience, Wednesday afternoon karaoke at the Rainbow Heights Club is sure to brighten your day. This page intentionally left blank Words The boundaries of sexual identities have become increasingly contentious. In this book, I use the words below as defined here: Transgender refers to people who have taken hormones as a means of “tran- sitioning” from one gender to another, possibly along with “top surgery” for female-to-males, and to all who claim that identity for themselves. Transexual refers to those who have had “genital sex reassignment” surgery in addition to hormone therapy, and to all who claim that identity for them- selves. Trans is used as an umbrella term for both transgender and transexual. Gay is used for all those who claim that identity for themselves. Lesbian is used for all those who claim that identity for themselves. Queer is used as an umbrella term for all of the above, as well as all others who claim that identity for themselves. Homosexual is used for men who have sex with men, and women who have sex with women. The term is used mostly when discussing scientific or medi- cal research that employs it. Bisexual is used for men and women who have sex with both men and women. The term is used mostly when discussing scientific or medical re- search that employs it. I make no claim that these usages are the right ones, only that if the subject matter of this book is to be discussed at all then these words must be used, and how they are used should be clearly explained and consistent throughout the text. xi This page intentionally left blank Sex Science Self This page intentionally left blank Introduction My hope is that this book will be useful for anyone who has taken es- trogen or testosterone, or considered doing so, for any reason. Given the sales figures for these products, and the advertising that has accompa- nied those sales, this includes many millions of Americans. When I began this project, my interest was more narrowly focused. I wanted to write a book, first and foremost, for young people wondering if they should begin hormone treatment in order to undergo what has become known as “transitioning” between genders. And their families. And their friends. This group has recently grown far larger than it was in even the recent past. This turn to pharmaceuticals is coloring queer culture more gener- ally. Beginning in the 1960s, one of the principle rights demanded by queer activists was the right to be left alone by doctors. Today, one of the principle rights demanded by queer activists is the right to receive medical treatment. This fact alone merits our attention. What were the causes and what will be the consequences of this about-face? The medi- cal industry is a powerful and complicated beast, with billions of dollars, entrenched hierarchies of power and authority, and a rapidly expanding arsenal of technologies. In seeking not to isolate ourselves from that beast but rather to embrace it more fully, queer culture is changing in ways both subtle and profound. But there’s more. Estrogen and testosterone, the so-called sex hor- mones, have become important to the queer community for reasons that go far beyond their use in transgender “transitioning.” The idea that 1 2 Introduction queers are “born that way” because of prenatal exposure to “sex hor- mones” has become the foundation on which many of the social and political claims of the community rest—enshrined in judicial rulings, legislation, health insurance policies, and medical practice, emblazoned on t-shirts, banners, and placards, and sung in pop songs. Few are aware that the science behind this claim, currently known as “brain organiza- tion theory,” is shaky to nonexistent. Even fewer are aware that this same research is routinely invoked for social and political ends many would find appalling. When Lawrence Summers, one of the most powerful men in the nation and at the time the president of Harvard University, provoked a furor by arguing that men outperform women in math and science because of genetic differences between men and women, he was invoking exactly the same research used by queers to claim that they too are “born that way.”1 As I continued my research, however, I realized that these issues were hardly limited to the queer community. “Sex hormones” have moved to the center of the stories we tell ourselves about not just what makes us transgender, or what makes us homosexual or heterosexual, but what makes us men or women, male or female. Corporate advertising cam- paigns claim that aging women and men whose bodies produce less “sex hormones” than when they were younger are no longer complete women or men, and sales figures suggest many people believe them. Just one es- trogen product generated $1.1 billion in sales in 2013, a year in which the maker jacked up the price 257 percent.2 Total testosterone sales in 2013 totaled $2.1 billion, and that figure is projected to jump to $3.8 billion a year by 2018, a 158 percent increase in five years.3 Taking hormones to amplify, attenuate, or alter your perceived mas- culinity or femininity has become as American as apple pie. Pro athletes who “dope,” gay gym bunnies, US Marines fighting wars in far-off des- erts, security guards, cops, bouncers, female politicians, male retirees, transmen, the captains of industry and finance, and high school jocks— all are loading up on T. And they are looking across the dance floor at beauty queens, drag queens, prom queens, transwomen, housewives, surrogate mothers, egg donors, women going through menopause, and more—all loaded up on E. A businessman in New York City reports that for many young MBAs he knows, “doing T” has become a routine part of getting started in business, as the pace of the work leaves little Introduction 3 time for the gym but having a muscular physique can give you that extra edge when you walk into a boardroom. A nationally known hus- band-and-wife team of yoga teachers take daily “sex hormones” to make them look even more dazzling to their students.4 E and T are among the most profitable pharmaceutical products ever sold. So the story told in these pages should be of interest to pretty much anyone engaged with American culture. And since mental health professionals from all over the world come to train in the United States more than to any other country—and carry home with them American notions of gender and sexuality—American beliefs about chemistry and gender are increas- ingly become the world’s beliefs.5 Given that pharmaceutical “sex hormones” have become such an impor- tant part of life for so many, there has been amazingly little discussion about them.