HOME / culturebox: Arts, entertainment, and more.

Rethinking Testosterone

Judith ShulevitzPosted Friday, April 7, 2000, at 11:44 AM ET

[To read Andrew Sullivan's response, scroll to bottom.]

If Andrew Sullivan's paean to testosterone ("The He Hormone") in last Sunday's New York Times Magazine were nothing more than a Philip Rothian screed on the underestimated glories of masculinity and a testimonial to a drug that restored potency to an H.I.V.-positive man, it would have been a perfectly acceptable (if overheated) personal essay. But instead it's the provocative packaging for a supposedly objective report on the current state of testosterone research. And that's a big problem right there. By letting Sullivan mix up his subjective reactions with laboratory work, by allowing him to blur the edges between his own powerful longings for a cure-all and several scientific studies whose authors--by the way--aren't necessarily in the mainstream of testosterone research (though Sullivan doesn't tell you that), the Times has put out under its imprimatur an account of testosterone, its therapeutic possibilities, and its larger social implications that is dangerously misleading.

RSS

First the news: Culturebox has interviewed several of the scholars and science writers mentioned by name in Sullivan's piece, and most of them think he goes way overboard in his confidence that varying levels of testosterone ("the big T") can explain appreciable differences in human competitiveness, social dominance, mental alertness, energy, self-confidence, etc.--though the critics don't all agree about how far is too far. (Three of them were sufficiently like-minded to sign their names to a letter to the Times that says: "In particular, there are scant results from well-controlled experiments showing that testosterone affects behavior of normal men in the ways asserted by Sullivan.") Robert Sapolsky, an eminent Stanford University professor of biology and neurology and an expert on testosterone who was not quoted in the article, told Culturebox: "[Sullivan] is entitled to his fairly nonscientific opinion, but I'm astonished at the New York Times." On the other hand, objections such as these must be taken with a grain of salt because scientists, who are steeped in caution, are notorious for objecting to representations of their work by journalists, who traffic in bold generalizations. So let us consider some of Sullivan's larger points--and the criticisms of them--one by one.

Are Sullivan's exhilarating experiences with injections of synthetic testosterone representative? Can we learn anything from them? This one's easy: Of course not. They're not even relevant. There's no way of knowing what's responsible for Sullivan's reactions. Did he feel his surges of energy and combativeness because he went from uncommonly low levels of testosterone to uncommonly high ones? (People with normal levels of testosterone do not report such dramatic results when injected with the hormone.) Could injections of any other chemical compound--estrogen, say, or nicotine, or Saint Johnswort--have produced the same outcome? Without controlled testing, no one can say. Sullivan alludes to the possibility that he was experiencing the placebo effect: "No doubt my previous awareness of the mythology of testosterone had subtly primed me for these feelings of irritation and impatience." But knowing that doesn't stop him from using his experiences as evidence anyway: "It seems plausible enough to ascribe some of this increased edginess and self-confidence to that biweekly encounter with a syringe full of manhood."

Do we really know if testosterone "leads to behavioral differences" in human beings, as, in Sullivan's words, "the evidence suggests that it does"? If it does, do we know how? No and no. Here we get to the fundamental flaw of Sullivan's piece--what a friend of Culturebox's calls "the old correlation-vs.-causation problem." A mistake often made by people writing about science is assuming that coincidences mean more than a strict reading of the data permits. Again and again, Sullivan presents research showing that testosterone happens to be high (by some statistically meaningful amount) in the presence of this or that psychological trait (aggression, social dominance, sexual drive). Sullivan understands that co-existence doesn't guarantee causality, because when reporting on the studies he carefully uses words such as "correlates" or "is associated with." But then, in a subsequent sentence or paragraph, Sullivan often lapses into implying that high testosterone levels do in fact lead to these behaviors.

But can't we at least say that it's likely that testosterone causes aggression, etc.? Some sociologists, psychologists, and evolutionary psychologists do believe that high testosterone levels cause "dominance behavior"--or at least that testosterone and dominance behavior have a reciprocal impact on one another. Alan Booth, a professor of sociology and human development at Pennsylvania State University and one of the signers of the letter to the Times, says that of the many traits Sullivan lists as being "associated with testosterone"--energy, tenacity, self-confidence, high self-esteem, psychological dominance, strength--only dominance and strength can be pegged to testosterone. Testosterone clearly boosts muscle mass, and Booth feels the research supports a link between testosterone and the effort to dominate "interpersonal relationships." Of the other traits, he says, "One can raise questions with each one of those." For instance, he says that high testosterone is also associated with depression, which would tend to diminish self-esteem, confidence, tenacity, energy, and conceivably sexual drive. Even in the absence of depression, he says, he knows of no research directly linking T and most of those qualities.

It's important to note that, their caution notwithstanding, Booth and his colleagues don't even occupy the center position in the field of testosterone research. They mark out one edge. On the other side are biologists and neurobiologists and endocrinologists who somewhat counterintuitively hold that the causality runs the other way. Quantitatively speaking, this side has more research to point to. Sapolsky, in a recent essay called "The Trouble With Testosterone: Will Boys Just Be Boys?" lays it out baldly:

OK, suppose you note a correlation between levels of aggression and levels of testosterone among these normal males. This could be because a) testosterone elevates aggression; b) aggression elevates testosterone secretion; c) neither causes the other. There's a huge bias to assume option A, while B is the answer. Study after study has shown that when you examine testosterone levels when males are first placed together in the social group, testosterone levels predict nothing about who is going to be aggressive. The subsequent behavioral differences drive the hormonal changes, rather than the other way around.

Now, Sullivan acknowledges that "the difference between cause and effect is often extremely hard to disentangle," but he doesn't appear to realize that if behavior causes testosterone rather than the other way around, then socialization is still as strong and valid an explanation for behavior as it has ever been, and none of the things he says about high-testosteroned men naturally being drawn to becoming trial lawyers or women not being designed for combat, etc., make any sense.

What do scientists know for certain? They know that testosterone is the cause of key developmental differences between male and female human fetuses. After that, what exactly it does in and to people is a mystery. Even Georgia State University psychology professor James M. Dabbs, probably the most supportive of Sullivan's story and one of its primary sources, admits that "we don't know too much about it. In those studies he cites, it's 100 people here and 100 people there. It seems like you have to go beyond the data a little bit to make the statements he does." Dabbs is alluding to the extreme thinness of testosterone research on human beings, compared with that done on animals. In a 1998 survey of the literature on testosterone and men written by Booth and Allan Mazur, a professor of public affairs at Syracuse University (another of the letter-writers), they explain in detail how hard it is to perform research on human subjects. The problem is that it's difficult to find large groups of men to test over long periods of time unless they happen to be in unusual situations, such as reform schools, prisons, or the military. The scholars write: "The question remains: Is high T a cause of dominant and antisocial behavior? The question could be answered with a double-blind experiment comparing the behavior of normal men whose T levels had been altered with a control group." But these studies haven't been done, since there aren't many normal men who'd mess with their testosterone levels for the sake of research.

But Sullivan has all those suggestive examples! On closer examination, Sullivan's examples seem unduly selective, or much less telling than they sound. For instance, Mazur points out that in the study Sullivan cites that notes consistently higher T levels in actors than in ministers, those could easily be accounted for by disparities in age and body fat--actors being on the whole younger and skinnier than ministers. And at least one of Sullivan's examples is a well-known scientific laughingstock. Sullivan alludes to a study of pregnant women injected in the 1950s with progesterone (which is similar to testosterone) whose daughters "later reported markedly tomboyish childhoods." According to Sapolsky, that study is "one of the most famous and most famously discredited literatures in psychoendocrinology." ("I just taught this one in my class last week!" he exclaimed to Culturebox.) First, contemporary scientists now dismiss the study's suspect definition of "tomboyish" behavior--it included such things as expressing an interest in a career. Second, by the time the study was done, its subjects had all undergone extensive corrective surgery on their genitals, which had been masculinized as a result of exposure to the drug in the womb--a circumstance that gives you, at the very least, a powerful alternative explanation for why the girls would exhibit or identify with so-called male behavior patterns.

What about the studies that show that blacks have 3 percent to 19 percent higher testosterone levels than whites? Now here's a touchy subject. None of the scholars Culturebox talked to had ever heard of the Journal of the National Cancer Institute study cited by Sullivan--which is not to say that it doesn't exist, just that it is not widely known. The letter-writers told Culturebox that their research showed no significant differences in T levels between whites and blacks that couldn't be accounted for by disparities in age and education and income levels. This gets complicated, of course, because other scientists would dispute whether education and income levels could play a part in this. The point is, Sullivan presents this inflammatory data as if it were matter of course, when it is at least controversial and possibly marginal.

What about the way he implicitly endorses testosterone gel for men and explicitly (though probably jokingly) endorses testosterone injections for women "to improve their sex drives, aggression and risk affinity"? It isn't made clear in the article, but what he's talking about here are steroids--the anabolic steroids that athletes take are essentially synthetic testosterone with the masculizining properties removed. In the case of men, everyone agrees that most men with minor variations in normal testosterone levels probably won't feel much of anything, unless they take enormous doses, which would also entail putting the body at risk for prostate cancer and other side effects. As for women: "Here he's speculating almost dangerously," says J. Richard Udry, a professor of sociology and health at the University of North Carolina at Chapel Hill (and the third signer of the letter). "Then you start getting side effects, getting hair all over your face and body and causing your voice to get deeper, and it won't go back up when you stop taking testosterone."

So, to sum up, does testosterone explain the differences between men and women? It certainly explains why boys develop penises and secondary sexual characteristics in the womb and during puberty. Some people--not all--believe that it helps explain why men are more predisposed to seek dominance than women, and they are working to pin down exactly how this presumed predisposition might interact with the environment. But their findings are far from conclusive, because no one really understands how testosterone acts in the brain. Sullivan writes,

What our increasing knowledge of testosterone suggests is a core understanding of what it is to be a man, for better and worse. It is about the ability to risk for good and bad; to act, to strut, to dare, to seize. It is about a kind of energy we often rue but would surely miss. It is about the foolishness that can lead to courage or destruction, the beauty that can be strength or vanity. To imagine a world without it is to see more clearly how our world is inseparable from it and how our current political pieties are too easily threatened by its reality.

Given the dearth of evidence about human testosterone and the uncertainty about the little there is, the act of imagination required here is figuring out what Sullivan is talking about.

Full disclosure: Culturebox could be construed as having a conflict of interest in writing about Sullivan, since he recently gave a negative review to a book written by her husband. She does not believe this has affected her research into Sullivan's essay, but it is obviously up to the reader to determine whether she has exhibited fairness and objectivity.

E-MAIL

RECOMMEND... Get Slate RSS Feeds

Judith Shulevitz is a former culture editor of Slate. She is writing a book about the Sabbath.

COMMENTS

Reader Response from The Fray:

I'm not sure how I could satisfy Culturebox. She spends the bulk of her article attacking me for things she then concedes I have already acknowledged. She says I make too much of my own experience with testosterone. I said in the article that I was aware I might be deluding myself, but that "it seems plausible enough to ascribe some of this increased edginess and self-confidence ..." to T. Does that sound like reckless exaggeration to you?

She says I confuse causation with correlation, but then concedes I myself wrote that the interaction of cause and effect is very complicated, that, given the ethics of human experimentation, there is no "proof" of T's effects, a word I put in quotation marks in the original piece. She even says I am "very careful" in my choice of words. So what more does she want? If a writer is clear about the limits of his material, but then draws provocative inferences from them, I fail to see the problem. I can't prove beyond a reasonable doubt that testosterone is as important in our society as I say it is, but my own experience and the mass of suggestive correlations leads me to believe it is. That's called opinion journalism. Of course, nervous scientists who are trained to say nothing beyond what the evidence at a minimum proves, will cavil at some of my conclusions. Do you think they want to be drummed out of a job by a bunch of p.c. feminists?

On the specifics, I do not say that James Dabbs is a fringe researcher, "outside the mainstream," or whatever sly smear Culturebox wants to attach to him--because he is not such a researcher. He has been published dozens of times in reputable peer-reviewed journals, cited in most articles on the subject, relied on by superb science writers like Deborah Blum, and generally unimpeachable. He's a psychologist, of course, and hard-core endocrinologists like to look down their noses at such people but his research on the behavioral aspects of T is the research most relevant to what I'm interested in and second to none. I am aware that environment affects testosterone levels--duh--and spend a great deal of time explaining this. The quote Culturebox dredges up to counter me argues that T differentials "among men" are hard to pin down as caused by nature or environment. But that's what I say! It does not address the more relevant question of whether T differentials between men and women are entirely environmental because no-one in his right mind believes they are. It's biology, stupid. The difference in T levels between the genders is bigger than any environmental effect could even begin to account for.

Culturebox says that only psychological dominance and strength are unimpeachably correlated with high levels of T. But these are subjective feelings we're talking about and language is often imprecise. Has it occurred to her that people who are psychologically dominant and strong might also describe themselves as having high self-esteem, self-confidence, and so on? These are just some of the hundreds of words high-T people use to describe their feelings.

I have no idea what she is getting at in her reference to the racial data. It's there in more than one large study. It's real. She doesn't challenge it. She merely says I present it as if it were simply a matter of fact. But I presaged my reference to the data by saying it was "explosive"! What would she be satisfied with? She quibbles with one study--on progesterone-treated girls. The study is indeed fraught with environmental noise, as I concede, but perhaps not as much as Culturebox implies. She ridicules the notion that seeking a career might be an indicator of "tomboyism." But, as we know, career women have higher T levels than housewives; and the study was also conducted in the 1960s and 1970s, when such careerism was not as commonplace as it is now, and is referred to in books as esteemed as Matt Ridley's The Red Queen. As for "dangerously misleading" medical advice, I list every possible side-effect from testosterone and recommend it only under a doctor's supervision. If Culturebox cannot believe T can be useful for post-menopausal women, I recommend Dr. Susan Rako's book, The Hormone of Desire: The Truth About Testosterone, Sexuality, and Menopause.

To sum up, we know an awful amount about testosterone, but we are still at the beginning of real research into its power. While not misrepresenting the data, I wrote an article affirming my own belief that it is probably far more powerful than we now concede. It's possible to draw a more modest conclusion than mine from the data, but that doesn't make my own illegitimate, drawing as it does on my own experience and that of others I know. For Culturebox, who is ideologically wedded to the notion of the complete interchangeability of the sexes, this is obviously troubling. But she better get used to it. As science advances and the power of nature becomes increasingly obvious, Culturebox's dogma is going to get harder and harder to sustain.

--Andrew Sullivan

(To reply, click here.)

(4/9)

Let's clear up a few confusions in Sullivan's letter: I am not "ideologically wedded to the notion of the complete interchangeability of the sexes," whatever that means. I've never written or said anything that could make that statement true, including in the item in question. In fact, in a relatively short piece, I say twice that there's evidence that men are predisposed by testosterone to seek dominance. I also say that 1) the evidence is thin and 2) there's some strong evidence that goes the other way, though it comes not from behaviorists but from biologists. All three statements are true, and Sullivan doesn't--couldn't--argue with them.

I am wedded to standards for reporting on intellectual debates. What Sullivan did is done all the time: He plucked a single thesis out of an entire field and presented it to the public as if it were the main flowering of all the research to date. Then he covered his bases by admitting occasionally to some vague and unspecified quibbling around the edges. This practice is no less troubling for being widespread. When you report on science (or humanities, or law, or administrative affairs, or what have you) you owe it to your reader to show how the interpretation you're advancing fits into the larger picture. A few offhanded caveats about uncertainty don't cut it when what's really going on is fierce dispute about the fundamental premises. I've gotten some mail from readers saying, hey, Sullivan was writing for the New York Times, it's not a scientific journal, who cares? But that's the point. The editors at the Times Magazine are normally quite devoted to fairness and accuracy. They're good at telling the difference between fact and personal opinion. So it was disappointing to see them let a writer present controversial and not particularly well-known material through a one-sided filter, then pretend it's an objective account of the facts ("studies show," etc.). Of the six people Sullivan names, three (Alan Booth, Allan Mazur, and J. Richard Udry) were upset enough to write to the Times, and two (James Dabbs and Deborah Blum) were willing to go on the record to say he went too far. (I didn't interview the sixth, Matt Ridley, because I ran out of time.)

What else? Oh yeah, I never said Dabbs was a fringe scholar, I said he wasn't in mainstream, which is not a "sly smear"--it's accurate. Dabbs goes further than most people in his claims about how differing levels of testosterone affect people--further, even, than his fellow behaviorists. That doesn't mean he's wrong, necessarily. Would Sullivan be happier if I said Dabbs was cutting edge? In the world of science, it amounts to the same thing. He's out there on the precipice, and Sullivan shouldn't put his word forth as doctrine--or rather, Sullivan may say anything he likes, but he can't have it both ways. He can't advance a controversial opinion then act as though his is an accurate map of the landscape of testosterone research.

As for the study of the girls whose mothers were injected with progesterone, Sullivan makes my case for me: If what constituted so-called "masculine" behavior in the 1960s and 1970s is standard behavior for females now, how can it be seen as an objective expression of the presence of the "he hormone"? Wanting a career seems pretty darned culturally determined to me.

--Judith Shulevitz

(To reply, click here.)

I'm sorry but the evidence is not "thin" that a) testosterone is correlated with aggressive, dominant, confident behavior and that b) men have up to twenty times as much of it as women. Dozens of studies show the former; no-one doubts the latter. The only reason there is no "proof" is the same reason there's no "proof" that smoking causes cancer. It would be unethical to prove such a thing in humans. In animal studies, as I wrote, the evidence for this is overwhelming. Culturebox says that some "strong" evidence points "the other way." What evidence? Where are the studies that show that T leads to decreased aggression, less dominant behavior, etc? I spent two months researching the piece and found none. If I'd found any, I would obviously have included it. The article reflected my own judgment as to where the balance of the evidence points. Disagree with me, but don't claim I'm skewing the facts. Despite her ceaseless attacks on evolutionary psychology, Culturebox says she doesn't believe in the interchangeability of the sexes. Ok, what differences between the sexes, apart from minor physical ones, does she consider biologically or evolutionarily based?

--Andrew Sullivan

(To reply, click here.)

I admired much about Andrew Sullivan's story. He did a brilliant job of showing why testosterone is one of our best models, thus far, of the interaction between biology and behavior. Do I think the science is more complicated than he indicates? Sure, I do. But more important, at this point, we need better understanding of the power of hormones like testosterone and I think Sullivan's article--and the discussion that results--helps get us there.

--Deborah Blum,
author, Sex on the Brain

(To reply, click here.)

(4/11)

Let me focus on two of Sullivan's statements:

(1)"the fact is that men have far more of it (testosterone) than women." With this sentence, as elsewhere in the article, Sullivan so vastly oversimplifies hormone metabolism as to provide a cartoon, where a complex and indeterminate wiring diagram is what's needed. More testosterone is meaningless without receptors to bind it to particular tissues (do men have more of these and in which tissues?) and without enzymes to convert it to estrogen, which is the most common active form of the molecule especially in men.

(2) "the sexual aspects of testosterone are related to the division of labor among hunter-gatherers in our ancient but formative evolutionary past." First, there is no credible evidence that the division of labor is as Sullivan imagines, as this information is not part of the fossil record. What we have is conjecture built in part from contemporary hunter-gatherer societies, some of which fit this picture, some of which don't, and virtually all of which are modern-era cultures, not ones with a continuous cultural thread reaching back to the Pleistocene. Furthermore, evolutionary psychologists have yet to do the kind of hard core number crunching using hypotheses about genes, rates of evolution, and the number of generations since the Pleistocene, to make their conjectures part of a creditable science of evolution. It would be within their means to do so, but they would rather tell stories about contemporary culture and make up evolutionary explanations which are scientifically untestable, at least by the standards of evolutionary biologists.

Finally, if the readers of Slate want to read some good history of how the powerful growth hormones we know of as testosterone and estrogen came to represent cultural and biological ideals of the masculine and feminine, I not immodestly recommend my new book Sexing the Body: Gender Politics and the Construction of Sexuality. I also address in this book the form of argument Sullivan uses--the linking of a series of poorly supported pieces of a puzzle in the hope that each weak link will strengthen the other.

Anybody, it seems, can write about science. Not everybody knows what they are talking about.

--Anne Fausto-Sterling

(To reply, click here.)

Culturebox failed to mention the emerging medical literature on testosterone. Double-blind experiments have been done. Modest doses of testosterone do affect behavior, among both men and women. A good brief summary appears in the February 2000 issue of the Archives of General Psychiatry. Interested readers can go to http://archpsyc.ama-assn.org/ and search for "Testosterone and Psychiatry."

--James M. Dabbs

(To reply, click here.)

(4/10)

I think Culturebox is forgetting a fellow Slate columnist's important rule which he stated thusly, "Kaus' First Rule of Journalism says that you should always generalize wildly from your own personal experience." That Mr. Sullivan would overestimate based on his personal experience, which he acknowledges immediately in his column, seems only right. And since readers know that his personal experience is so favorable, it makes it easier to judge the relative validity of his scientific observations.

--Richard Vagge

(To reply, click here.)

Sullivan's column wasn't published in a scientific journal. I'm a scientist and I read it and it did get ridiculous, but let it go. It's just the Sunday Magazine section. And it's a heckuva lot more interesting than Safire's columns.

--P.Smith

(To reply, click here.)

This is a terrific, smart piece that says what I thought reading the Sullivan rant. I was amazed that the NYT would publish a polemic like Sullivan's on such an important subject. Sapolsky is not only a distinguished researcher in this area, he is a terrific writer, and if the NYT was interested in the subject I am dismayed they did not select an expert to write it.

--Sandor

(To reply, click here.)

(4/7)

What did you think of this article?

Join The Fray: Our Reader Discussion Forum

POST A MESSAGE | READ MESSAGES