The history of hormone therapy that no one is talking about – The Dallas Morning News

In the late 1800s, seemingly out of nowhere, American doctors saw a massive, sudden increase in female patients suffering from “hysteria.” Dr. Robert Battey, one of the founders of the American Gynecological Society, proclaimed that hormones secreted by the ovaries were the culprit and stridently advocated surgical removal of both ovaries as the cure. Patients went from doctor to doctor begging for the surgery. Doctors who refused were criticized as “wanting in humanity” and “guilty of criminal neglect.” Doctors who complied were heroes, according to a history of the procedure recorded in the Bulletin of the History of Medicine.

Up to 150,000 women lost their ovaries in these operations, which, far from efficacious, resulted in surgically induced menopause. As Jessica M.E. Kirwan, an expert in 19th century medical history, summarized in the journal Synapsis in 2019, “The procedure was overly prescribed for various physical and psychological conditions despite the lack of evidence to its efficacy.” The entire episode is remembered as one of the biggest black eyes in the history of medicine.

Unfortunately, this is far from the only medical meltdown with sex hormones (estrogen and testosterone) at its center. In the 1920s, surgeons became rich and famous transplanting animal testicles into human scrotums to “rejuvenate” the recipients — an early form of hormone therapy before pharmaceutical estrogen or testosterone became available, the former in 1927 and the latter in 1937 . Beginning around that same time, doctors attempted to “cure” gay men with testosterone. And when that didn’t work, attempted to “cure” them with estrogen. When estrogen also failed as a cure, it was administered as a punishment. Alan Turing, widely considered to be the father of theoretical computer science and artificial intelligence, whose success in breaking the encryption code Nazi Germany used for military communication was central to allied success in World War II, was arrested for “homosexual acts” and given the choice of estrogen or prison. Turing is the best known, but far from the only, gay man to have been “chemically castrated” as the practice was known. He committed suicide when his breasts began to grow.

These medical scandals have a lot in common: a sudden increase in an old or vaguely defined disease; treatment considered cutting edge at the time but barbaric by later standards; crusading doctors who built careers pushing novel procedures based on little clinical data; activist patients begging for treatment; accepted science for which there turned out to be scant evidence; the close interplay of disease, belief, and what we now call identity; and, perhaps most importantly, the role of profit in medicine.

I spent five years researching the history of hormone treatment for my book Sex Science Self: A Social History of Estrogen, Testosterone, and Identity, and what I discovered is that the hormone therapy track record is troubling. But this history is not well-known. It is not taught in medical schools. It is almost certainly unknown to the medical staff of the many pediatric gender clinics that have sprung up around the country. It is unknown to patients, parents, and families, and to members of the LGBT community like me.

If you or your child are considering taking estrogen, testosterone, or hormone blockers, the history of hormone therapy will not tell you whether to do so. But knowing this history can make the choices you eventually make more informed.

Take, for example, the belief that testosterone and estrogen are the chemical essences of masculinity and femininity, and thus can be used to transition from one gender to another. This belief began as a marketing claim, which big pharmaceutical corporations spent millions of advertising dollars promoting over many decades.

Abbott Laboratories paid $6.6 billion to acquire the maker of AndroGel, then pumped $80 million into direct-to-consumer advertising for AndroGel in just one year, 2012, according to reporting published in The New York Times. Androgel is one of the biggest testosterone sellers, though not common in transgender care.

That is $80 million spent advertising one testosterone product in one year by one company. The many hundreds of millions of dollars spent advertising testosterone over many decades have sold not only the product but also the idea that masculinity has a chemical essence. As industry cheerleader Paul De Kruif trumpeted in 1945, “Manhood is chemical, manhood is testosterone.”

The problem with reducing gender to hormone levels is that it ignores the complex realities of body chemistry, psychology, and social factors. Consider just the first of those categories: All of us have both estrogen and testosterone in our bodies. The richest source of biological estrogen on earth is the urine of stallions, the very icon of male virility. When men take testosterone, it makes their testicles shrink and their breasts grow. If you believe the hype about testosterone being the chemical essence of masculinity, those are surprising “side effects.” But if you start from the idea that testosterone is just one of many hormones circulating in the body, which have complex and often poorly understood effects, there is no need to divide the results of testosterone into the expected “male” effects and the unexpected “side effects.”

History can also teach us the wisdom of humility in medical practice. There is simply no way to contemplate the story of the extraordinary rises and spectacular falls of medical practices based on testosterone and estrogen without at least considering the possibility that the beliefs and medical practices of today will prove just as transitory. The calamities of estrogen and testosterone are unique: there is no other field of medicine so replete with embarrassing and tragic mistakes.

Again, that is not an appeal for hormone therapy nor a polemic against it. My research is not a prediction of where hormone treatment will go in the future; it’s an examination of where it has been in the past.

At the end of my book, I took one, and only one, position regarding the medical use of these products: I opposed giving hormones to minors. I argued that while adults should be free to do with their bodies as they wish, the history of estrogen and testosterone did not provide confidence that experimenting on children was ethical.

Since I wrote that book, there have been five years of medical practice doing exactly that. One result is that there is now a lot more knowledge about what these substances actually do in adolescent bodies (and still many unknowns). And practitioners with years of clinical experience are engaged in a fierce debate over whether these practices should continue. But I believe my historical argument still stands, not in opposition to these clinical debates but alongside.

The debates that have erupted since my book was published are highly politicized. Those arguing in favor of treating minors with hormones are said to be on the political left, and those in opposition on the right. Yet I argued that we should be wary of extravagant claims made by giant corporations with millions of dollars of profit at stake, and that movements which see themselves as pushing for more personal freedom should be wary of tight alliances with institutions as powerful, hierarchical, and profit-motivated as the medical industry. By any definition I am aware of, that is not a “right wing” argument.

Sex Science Self does not give advice about hormone therapy. It gives information, history, context — all of which are still badly needed in the conversation around sexual development and identity.

Bob Ostertag is a journalist, author, historian and musician in San Francisco. His work has been published on six continents, featured in such publications as Pensamiento Propio (Nicaragua) Pensamiento Critico (Puerto Rico), The Guardian (London), the Weekly Mail (South Africa), and Mother Jones. His writing has won the “Most Censored Story of the Year” award from Project Censored and the “Most Important Book of the Year’’ designation from The Nation magazine. He wrote this for The Dallas Morning News.

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