The Testosterone Myth

In 1889, at a meeting of the Société de Biologie of Paris, a physiologist named Charles-Édouard Brown-Séquard described the results of an experiment he had recently performed on himself. He had painstakingly mixed an elixir of blood, semen, water, and “juice extracted from a testicle, crushed immediately after it has been taken from a dog or a guinea-pig,” and then injected the fluid into his arms or legs 10 times over a three-week period. His goal, he told the audience, was to see if he could reverse some of “the most troublesome miseries of advanced life.”

Brown-Séquard, who was in his seventies, had a shiny pate, a halo of snow-white hair, a neat beard, and bags under his eyes—not unlike the Travelocity gnome. He had been a distinguished and prolific researcher but found himself hobbled by old age. His experiments, however, produced “a radical change.” Just one day after the first injection, he reported increased physical stamina, “facility of intellectual labour,” and a markedly longer “jet of urine.” The biggest change he observed was in his “power of defecation.”

The benefits of the therapy lasted, Brown-Séquard said, for a month—though he could not confirm whether it was the dog or guinea pig tissue that had given the elixir its potency. Though his experimentation took place before scientists had isolated the hormone testosterone, Brown-Séquard was laying the groundwork for an idea that is still in force today: that testicular tissue contains the substance responsible for a man’s strength and virility. Possibly for masculinity itself.

In the decades that followed, researchers tried other dramatic and crude techniques to similarly rejuvenate adult men—including implanting chimpanzee testicles in their groins or injecting testicular matter from goats, rams, or boars into their abdomens. The results were published in top medical journals and then reported in newspapers, yielding waves of enthusiastic adopters.

In 1935 the synthesis of testosterone streamlined the delivery system for what came to be seen as the active ingredient in male vitality. No further need for goats, in other words. Avenues for research and commercial opportunities multiplied briskly. Testosterone injections were widely touted as a remedy for male menopause, or “andropause”—a condition supposedly marked by loss of sexual vigor, fatigue, and trouble concentrating. In 1945 a book called The Male Hormone peddled testosterone as “magic far beyond the merely sexual. It boosts muscle power. It banishes mental fatigue. It eases heart pain. It even restores the sanity of men in middle life.” Hopeful men flooded doctors’ waiting rooms. Numerous scientists set out to debunk the supposed wonder powers of the hormone, but their voices did little to curtail the hype. Instead, the industry dwindled for a time in part due to manufacturing problems.

Then in 1995, the US Food and Drug Administration approved a testosterone patch, and the modern era of T—as the hormone is now colloquially known—kicked in.

Today, people can take testosterone orally, nasally, intramuscularly, or even transbuccally (through the gums), via drops, creams, sprays, injections, and pills. Officially, T is approved only for use in men with “low testosterone levels in conjunction with an associated medical condition,” such as genetic irregularities or side effects from chemotherapy. Few men have such conditions. Yet sales from testosterone prescriptions, most of them for middle-aged guys, rose 12-fold between 2000 and 2011, fueling a multibillion-dollar industry. The hormone’s powers—actual or ascribed—are in unprecedented demand.

Testosterone is important for well-being. Both men and women need it for heart, brain, and liver function, among other things. Used as an anabolic steroid, it stimulates muscle growth—hence T’s popularity with bodybuilders, who take massive doses. And it’s true that not having enough of it can be bad for you. But what T does for a person depends on their age, their body’s history with testosterone, the number of hormone receptors they have, the dosage, and other factors.

Still, the industry continues to push the nebulous concept of “low T” as the central problem haunting men. One Bayer ad asks: “Over 40? Have you lost your lust for life?” T, the ad assures, can help. Outside the realm of advertising, the writer Andrew Sullivan—who began testosterone replacement in the late ’90s for low T levels related to HIV—has written multiple paeans to the hormone. “The Big T,” he wrote in a New York Times Magazine cover story in 2000, “correlates with energy, self-­confidence, competitiveness, tenacity, strength, and sexual drive.”

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By 2002, the National Institute on Aging and the National Cancer Institute began to express worries about the skyrocketing number of men using testosterone. There was, after all, woefully insufficient evidence to conclude much of anything about whether it actually improved libido, vitality, or cognition—never mind what dangers it could pose.

So researchers set about designing the Testosterone Trials: double-blind, randomized, placebo-controlled clinical trials—the gold standard in medicine. They went looking for thousands of men over 65 with low T and at least one of its supposed symptoms. When the first findings came out in February 2016, one thing stood out from the start: Of the more than 51,000 men who had been screened, fewer than 15 percent had testosterone levels low enough to be enrolled, even after the researchers relaxed their testosterone threshold. The widely held idea that low T is rife among older men seemed to be a myth.

All told, the studies found that T did not improve men’s physical function or vitality. Nor did it help with age-related memory impairment. It did help with anemia and bone mineral density. It increased sexual desire and activity, but the effect was modest; men were better off using Cialis or Viagra. The most worrisome findings came from a study on cardiovascular risk: In men with certain risk factors, T accelerated coronary atherosclerosis, possibly increasing their chance of heart attack.

Assessing the studies in JAMA, endocrinologist David J. Handelsman underlined how little evidence there was to support popular claims of T’s powers. And yet, he observed, “rejuvenation fantasies thrive on hope without needing facts.” Shortly after Brown-Séquard’s self-experiment in 1889, an editorial in what would become The New England Journal of Medicine warned of a “silly season” that was liable to follow. There’s nothing inherently silly about wanting to preserve health and vitality into old age. But the history of T offers a cautionary tale: Where rejuvenation is concerned, many of the ideas that hold the most allure are simply folklore.

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