- Testosterone Dreams: Rejuvenation, Aphrodisia, Doping
I will begin my review of John Hoberman's excellent new book with a criticism, albeit a positive one: its title does not indicate the scope of its subject matter. While the history of the development, marketing, and application of testosterone is central to his analysis, Hoberman goes well beyond these topics to provide important insights into social and cultural issues related to the use of drugs for therapeutic and performance-enhancement purposes. He provides a well-researched overview of the history of drugs and doping in sports in later chapters, but some of his most compelling and thought-provoking analysis lies in his examination of the effects of drug therapy on the medical profession and the patient-doctor relationship. Nor are testosterone and related drug therapies examined as exclusively male-centered issues: Hoberman's discussion of female sexual and drug-related issues exposes a long-standing, if sometimes unconscious, bias within the medical profession toward both women and homosexuals. Male hormones have a long history of use not only on men but to "cure" frigidity, nymphomania, and homosexuality, a goal that Hoberman explains as an effort to maintain "social stability."
The book's central theme is the expanding role in American society of what Hoberman calls "medically reinforced normality" (p.16): testosterone and other performance-enhancing drugs intended to enhance and/or restore human capacities, especially sexuality, have become a massive commercial enterprise and have created a new class of medical entrepreneurs dedicated to "socially acceptable" forms of "doping" ordinary people (p. 16). Testosterone emerges as the quintessential example of how hormone therapy has shifted from being therapeutic—that is, intended for sick people—to becoming a "lifestyle" drug for the healthy: in 2000, testosterone emerged from the medical shadows with the marketing of AndroGel, an ointment intended for the treatment of a tiny male population (less than 5 percent) deficient in testosterone. It was quickly seized [End Page 398] upon by a much larger male population for its association with "enhancement of energy and sexual pleasure" (p. 120).
In this regard, recent exposés of "doping" among professional athletes have highlighted the prevalence of performance-enhancing drugs beyond body-building gym culture. But Hoberman shows that the use of hormones, supplements, and a vast array of productivity-boosting substances has surged among all elements of the population, legitimized by the validation of "lifestyle" medicine and pharmacology. This phenomenon reflects the importance of "alternative" medicine, which not only increasingly competes with the mainstream medical profession but has had the effect of placing patients' value systems in contention with those of physicians, as patients increasingly demand a role in negotiating their treatment and medicalization. Under pressure from patients, the medical profession has been complicit in a crucial transformation of what were once known as "drugs" into "supplements" (p. 46).
A number of factors play into the new medical ethos of patient-centered "libertarian pharmacology" (p. 18). An inescapable demographic factor is provided by a seventy-six-million-strong baby-boomer generation determined to avoid signs of aging such as deficient sexual appetites and menopause (including the rather recently identified "male menopause," treatable by synthetic testosterone!); these natural life passages are no longer seen as normal, but as diseases that can be treated—for example, with hormones. From an economic standpoint, the domination of the medical landscape by HMOs since the 1980s has pushed underreimbursed doctors into supplementing their incomes with cosmetic and other optional procedures—procedures often demanded by patients rather than recommended by physicians, and thereby contributing to the shifting patient-doctor power balance. The HMO factor is further bolstered, Hoberman suggests, by the relentless forces of capitalist consumerism that have elevated the medical marketplace above clinical medical practice, transforming patients into "empowered consumers" with unprecedented influence over doctors (p. 151).
None of these trends is likely to subside; on the contrary, the acceptance of pharmacological solutions for an "expanding catalogue of human problems...