From
metabolism to sex drive, hormones come in tiny packets that pack a powerful
punch, and yet there is a lot of misinformation about these chemicals. So Randi
Hutter Epstein, a doctor and medical writer, decided to set the record
straight. The result is her book Aroused: The History of Hormones and How They
Control Just About Everything.
Though
we throw around the world “hormonal” today, the concept didn’t exist before the
1900s. In the past century, we’ve gone from not knowing what these glands
secreted to selling hormonal sprays that promise to make it easier to seduce.
How did we get here?
The
Verge spoke to Epstein about the short history of hormones, how they were
involved in the “crime of the century,” and how we sometimes give them far too
much credit today.
AC : The
word and concept of “hormone” only date back to 1905. Before that, what did we
believe was regulating our bodies?
RHE : We’ve
always wondered what makes our bodies function correctly. There was this
horrible, weird time of history in America in the late 1800s when doctors started
looking at these so-called “circus freaks.” These were people with disabilities
or something wrong with them, like the bearded lady or fat lady. They were
being put in the circus, and at the same time, doctors were saying maybe they
have some sort of glandular disorder.
It’s not
like the “nice doctors” versus “mean circus people.” The circus was paying and
doctors were researching them and not really helping them. So these doctors who
studied anatomy for years saw glands in the body — like the thyroid and adrenal
gland — but we didn’t understand what we did. Until the early 1900s, we thought
that everything marched along nerves like marching along train tracks, or went
through the blood like a raft going down a river, and then it’d just bang into
wherever it’s needed.
Hormones
are these internal secretions that come out of a gland, and they go through the
blood, but they go to a specific target. This was controversial, and there were
people saying it can’t be because how do they know where they’re going? I like
to talk about hormones like your internal Wi-Fi because they have these signals
that allow them to go to places.
AC : Why
didn’t we know about them before? What technology really changed the study of
hormones?
RHE : The
huge technological advance happened in the late 1950s and really took hold in
the mid-‘60s and early ‘70s. It was the ability to, for the very first time,
measure hormones down to the billionth of a gram. That’s like if you took a
gram of salt and threw it into the ocean, and it had a powerful impact.
It
wasn’t that we could sort of measure hormones before this, and then we
precisely measured them. Before this, we couldn’t measure hormones at all, and
it was all guesswork. This technology, which is called RIA (radioimmunoassay)
has made it possible to measure things we thought too scarce to measure. We
wouldn’t have been able to find HIV in blood if not for RIA. We wouldn’t be
able to track cancer markers.
The
other part of the story that I love about this technology is that the
co-creator, Rosalyn Yalow, graduated top in her class in physics but was told
to be a secretary. So she became a secretary for a scientist at Columbia, and
only eventually got into the PhD program at the University of Illinois because
there were some open spots because the men were gone for World War II. As she
told a biographer, “They had to have a world war for me to have a graduate
degree.” The rest is history. She revolutionized modern medicine, won a Nobel,
and was very supportive of other women becoming scientists.
AC : So
RIA lets us measure a billionth of a gram of hormone. Do we need that level of
precision? Can that really make the difference?
RHE : Yes,
hormones come in tiny packets. When we say you have too much of this hormone or
a lack of another hormone, we are talking in terms of nanograms. They’re
potent. We’re not talking about extra pounds of hormones.
AC : Are
some more powerful than others, if that question makes sense?
RHE : The
way to think about it is that most hormones don’t work on their own. There’s a
chain of hormones, helper hormones, “factors.” There are different types that
are super powerful and interact with each other, which is how things get super
complicated, and you can have a glandular issue that has nothing to do with
estrogen, but it’ll screw up your fertility because it’s all connected.
AC: Are
we still discovering new hormones?
RHE : Absolutely.
In the 1990s we discovered leptin, which is the appetite hormone. We discovered
it comes from fat cells, which was shocking because most people think fat cells
are just blobs of butter you can remove. We’re still learning about hunger and
appetite hormones, and there’s a new insulin growth factor, too. I think, in
the future, we’re going to be learning more about hormones and behavior, like
hormones that impact basic drives to eat, to lust, and so on.
AC : Speaking
of behavior, one fascinating part of the book was about the trial of Leopold
and Loeb, and how people tried to defend them saying, “The hormones made them
do it.” What precedent does this kind of approach mean for hormones and crime
and law?
RHE : The
trial was in the 1920s and called the “crime of the century” because it was two
rich kids who murdered another rich kid. You couldn’t measure hormones then. It
was speculative, and it didn’t work as far as the judge was concerned.
From a
scientific perspective, we’re still looking into this. Do I think this will get
people off murder? Probably not. I don’t think we’ll ever be able to say, “His
hormones made him do it.” But from a scientific perspective, it’s fascinating
to look at how hormones shape our behavior. And, of course, what they were
doing in the 1920s, unsuccessfully, and what we’re still trying to do now, is
look at what hormonal imbalances we can detect early on. And perhaps then we
can treat it and make sure that we, for instance, prevent killers.
But as
I’m saying these words, you can see right away this is a slippery slope. It’s
like the designer baby thing. We know hormones control us, and we’d like to
control them to the extent they give us quality, healthy lives, like the way we
use insulin to help diabetes. But then again, how much control do we need? We
don’t want to go the route of eugenics.
AC : What
do you think about the way we talk about hormones today? Like all the hype
surrounding the “love hormone” oxytocin, for instance.
RHE : We
simplify things too much. Too often there’s a seed of fascinating scientific
discovery. And before that seed has time to blossom, there are people who glom
on and extrapolate way too far. With oxytocin, yeah, it probably does have to
do with human mother-baby bonding, but we’re taking a major leap to say, “You
can buy an oxytocin love spray.”
There
are some clues that oxytocin impacts behavior. It might augment that feeling
that you have, but it could turn hate into more hate instead of necessarily
hate into love. People are hoping that giving oxytocin to children on the
autistic spectrum would help them, but so far, it hasn’t been very successful.
So I’m not saying we shouldn’t do this research, but it’s very different from
purchasing something over the counter that might not even have oxytocin in it.
It could just be water.
How
hormones went from theoretical to overhyped in one century. By Angela Chen. The Verge , August 7, 2019.
Lulu
Garcia-Navarro (NPR) talks with Dr.
Randi Hutter Epstein about her new book Aroused, which tells the story of the
scientific quest to understand human hormones.
The
Scientists Who Explore Human Hormones In 'Aroused'. NPR, July
1 , 2018.
This is
a well-written and informative book about the history of hormone research. The
interested reader will learn how scientists have come to understand what
hormones are and how they function. But it is also deeply disturbing: for what
this history entails, for how the author tells it and for what she leaves out.
“Aroused”
is organized around scientific and medical episodes from the 19th century to
the present, many of which involved dubious and unethical practices. Among the
central characters are doctors who promoted vasectomy to enhance male
youthfulness, who operated on patients without their knowledge and who
experimented on their own children. Randi Hutter Epstein, the author of “Get Me
Out: A History of Childbirth From the Garden of Eden to the Sperm Bank,” tells
us of a journalist paid by a doctor to ghostwrite glowing articles about
testosterone therapy and of a physician who kept a 17-month-old baby boy in the
hospital for a month while he performed experimental genital surgery without
parental support; the doctor then sent the child home instructing the parents
to expunge all evidence that “she” was ever a “he.”
Even
more disturbing than reading about these practices is that for the most part
Epstein shrugs them off, saying that the physicians involved were well
intentioned, that what they did was appropriate for their day or that they did
what they could with the information they had. These were the “best practices
of the time.” It was “just the way things were.” But that’s not quite true:
Some of these practices were questioned even at the time. And it doesn’t take
hindsight to recognize hubris.
In a
chapter titled “Pickled Brains,” Epstein seems to delight in the macabre
spectacle of abandoned organs in a university basement. The brains were
collected for research in the early 20th century; she notes that to handle them
now requires compliance with biohazard regulations yet she fails to explain
why. Neither does she tarry much over the ethical medical treatment of human
remains. Consider Charles Byrne, the so-called Irish giant who in the late 19th
century became the object of public attention. Byrne anticipated that after his
death, physicians would want to study and perhaps display his body, so he
instructed friends to seal his coffin and dispose of it in the ocean. They agreed,
but Byrne’s directive was circumvented when the prominent physician John Hunter
arranged for the cadaver to be stolen and the skeleton displayed in the
Hunterian Museum, London, where it remains today. Numerous historians,
ethicists and laypeople have objected to the continued thwarting of Byrne’s
wishes; Epstein reduces this complex and important matter to a footnote.
Epstein
contrasts “quackery” with “legitimate research,” and “craziness” with “serious
science,” but the crucial question of how to distinguish between them is
unaddressed. Many of the dodgy practices she describes were undertaken by
credentialed medical doctors and scientists. Today, testosterone therapy for
virility is endorsed by people with medical degrees, but there is little
evidence of its efficacy. Epstein offers no guidance on how we might evaluate
the untested or otherwise problematic therapies on offer today. If we were to
adopt her stance that this is “just the way things are,” we would have no way
to judge, and therefore no basis on which to object to current dubious
practices.
Epstein
also elides the problem of hormone-disrupting chemicals. Among the reasons
hormones long eluded scientific understanding is that they can be effective at
minuscule doses, and the body is acutely sensitive to when those doses are
released. One of the great advances of late-20th-century science was to
understand this; another was to recognize that some synthetic chemicals — most
notoriously the pesticide DDT but also many others — can mimic hormones with
great adverse effect. (DDT was banned in part because it was killing bald
eagles by disrupting their reproduction.)
These
chemicals are toxic, but not in the way that lead or mercury or arsenic is.
Rather, they alter endocrine function: hence the moniker endocrine-disrupting
chemicals or EDCs. The human health effects of EDCs are not entirely
understood, but the list of potential problems is long: prostate and breast
cancer, infertility, fibroids, endometriosis, male and female reproductive
dysfunction, birth defects, disrupted immune function, obesity, diabetes,
cardiopulmonary disease, neurobehavioral and learning dysfunctions like autism,
hermaphroditism and alternation of sexual identity in animals. One estimate
places the cost of the disease burden at $340 billion. Surely a book on the
history of hormone research should have something to say about that.
Science
or Quackery? The Study of Hormones Has Been Both, a New Book Suggests. By Naomi Oreskes. The New York Times ,
August 6, 2018.
“I think
I’ll go into wrestling. Blood, sweat, and fighting, that’s me.” I looked at my
seven-year-old daughter as we left the playground, that hotbed of jungle
activity after school. “Did something prompt this?” I pressed. My child has
never expressed an inclination toward blood and sweat, and fighting is
something she has historically interpreted as a verbal activity. We entered our
destination, the grocery store, and she jumped on the rolling basket so she
could ride it from the outside. Then: “It’s just — why are boys so … boyish?
What makes them that way?”
As it
happened, I had just finished Randi Hutter Epstein’s chatty and absorbing book,
Aroused: A History of Hormones and How They Control Just About Everything, out
in paperback from Norton. And that was how the old ladies examining the plums
at Zabar’s ended up hearing a mother say, “Well, it starts with androgens. When
an embryo is XY, it usually responds to hormones in the mother’s blood supply
that tell it to grow testes and a penis. Do you want sweet potatoes for dinner?
Later on, other hormones come into play.”
Hormones
have been on my mind quite a bit of late. Earlier today I sat before a sea of
papers, cross-hatched piles of notes and charts. Laundry remained unfolded on
the couch. I wanted to eat a pound of cheese for lunch, and no sooner did
something occur to me than I had forgotten it, lost in a fog of distraction.
Put simply, I have PMS. I begin counting the days at this time, waiting for the
near bacchanalian delight of my monthly blood flow. Oh, the release! Oh, the
energy! The depression lifts, and I coast into clear-thinking waters! I will no
longer study two pages of a newspaper article only to look up and say, “What
the hell have I been reading?” I will follow things again — schedules, TV show
story lines, a logical order of operations for housework. All this will be from
a change in hormones. Two weeks later, my husband and child will marvel at how
I’ve vacuumed the living room rug in a perfect pattern, scrubbed the bathtub to
a gleaming shine, alphabetized the books by author and arranged them by
subject. That’s ovulation. Then I will begin the downward slide once more to
PMS. Hormones. They do seem to control everything.
Aroused
begins at the turn of the century, when scientists tinkering in the lab began
to discover hormones, and how they differ from neurotransmitters: if our
nervous system is a highway of linked connections, our endocrine system is what
Epstein calls “your wireless network.” Where the book really takes off is in
its pointed examination of how social norms and sexual politics have interacted
with new discoveries in science. Dr. Louis Berman declared a new field in the
1920s, which he called “Psycho-Endocrinology.” He went on to write a book
called The Glands Regulating Personality, in which he suggested that women with
irregular periods “will also be aggressive, dominating, even enterprising and
pioneering — in short, [they have] masculinized ovaries.” To think: A woman has
no chance of being enterprising if she bleeds like clockwork every month! There
are plenty of other historical citations here that may make you laugh or cry.
In 1924, two doctors, Harold Hulbert and Karl Bowman, from Boston Psychopathic
Hospital — yes, that was a real place — were called in to examine Nathan
Leopold and Richard Loeb, two teenagers being tried for what had been dubbed,
“The Crime of the Century.” They had kidnapped, tortured, and murdered a
14-year-old boy. Other than depravity, there was no motive, but because the
case converged with the burgeoning era of endocrinology, a shocked public and
an eager defense attorney named Clarence Darrow sought answers in the new
field. During the examination, which took eight days, reporters crouched
outside the prison. Then Hulbert took the stand to declare Loeb suffered from
“multigland syndrome” and Leopold had, among other pathologies, a calcified
pineal gland, which accounted for his excessively high libido. Their chief
instruments were a metabolimeter and an X-ray machine (the theory being that
bones are pushed aside by oversized glands and would therefore show up on
X-ray). The judge ultimately decided that it made no difference whether the
endocrine experts were right or not. Murder was murder, and criminals could not
seek absolution in their biochemistry.
It’s a
problem that continues to fascinate us as a society: Does psychopathy excuse
certain behaviors? Does it make a crime more or less understandable? Many
experts debated the nature of notorious serial killer Ted Bundy’s character —
was he a classic psychopath? — and felt they had zeroed in on a crucial
question. But had they? Was it just about semantics, or were there important
questions of science, treatment, and punishment on the line? Certainly it is
interesting to see how the discovery of hormones kicked off a round of this
debate, and it is gratifying to see a judge apply a moral code equally.
The most
moving chapter of Epstein’s book follows the story of a baby named Brian
Sullivan at birth in 1956. The baby was labeled a “hermaphrodite” in his
earliest hospital records: he appeared to have both penile and vaginal tissue.
At 18 months, the doctor — rather drastically, by today’s standards — performed
an exploratory surgery and discovered the child had a vagina, uterus, and
ovaries in his abdominal cavity. Without consulting Brian’s parents, he
amputated the clitoris and then instructed them to begin raising the child as a
girl. Brian became Bonnie. Wardrobe, activities, even room color were switched
to the conventional “pink for girls.” And Bonnie promptly stopped talking. As
Epstein reminds us, it was a dark time for people born with atypical genitalia.
There was very little understanding of the complex processes underlying the
hard-wiring of gender identity. Discovering a uterus inside a child did not, in
fact, entail the discovery of the child’s gender identity. Later, after further
research, it would become clear that an initial spurting of estrogen or
testosterone into the bloodstream during pregnancy likely shaped at least some
of this hard-wiring. So whatever disrupted Brian’s genital development may also
have shaped whom he or she felt herself to be gender-wise. Bonnie’s life was
again disrupted medically at eight when she was operated on to remove genital
tissue from her abdomen. She was told that it was for her “stomach pains,”
though she reports not having any pain at the time. She was admitted to
Columbia Presbyterian Hospital in 1964, where photographers took photos of her
naked, and where she endured pre-operative pelvic exams. “The fingers in her
vagina and anus were mortifying. She felt like a freak,” reports Epstein, who
met Bonnie, now called “Bo,” years later. It was many years before Bo unearthed
her medical records, finding the crude designation “hermaphrodite” among the
other abuses she endured. Eventually, she founded the “Intersex Society of
North America,” in the hope of connecting with other people who had suffered
similar sorts of mistreatment and aggressive interventions, and consequentially
endured lives of loneliness and confusion. She also wanted to inform doctors on
how better to manage intersex children. Soon, letters from lonely and
discouraged intersex people flooded her post office box. A support network
sprang up.
Aroused
shows how hormone and surgical therapies hardened a binary gender system. “The
data,” however, “were showing a much more complex picture of humanity,” writes
Epstein. Christine Jorgensen, born George Jorgensen in 1926, transitioned at 26
from male to female with the help of surgery and hormones. The Daily News broke
the story in 1956 and, before long, the Danish doctor who performed the surgery
was inundated with requests for help. Americans turned to Dr. Harry Benjamin,
an endocrinologist specializing in gender and sexuality. It was Benjamin who
would clarify the notion of hard-wiring of the fetal brain toward gender
identity as being dependent on hormonal influences in the womb, and would go on
to write The Transsexual Phenomenon. (Transsexual is an outdated word, and has
since been replaced with the more accurate “transgender.”) He, in turn,
referred patients seeking surgery to the Johns Hopkins Gender Identity Clinic.
Epstein navigates this topic well, focusing on the complexity of the issue. “[W]hat
causes transgender identity in one person may not be the same as in another,”
she writes.
Ultimately,
the message of Aroused is that we know a lot about hormones, but definitely not
everything, which might well have been its subtitle. Enter the quacks, frauds,
careless researchers, and others looking for quick payoffs from new
discoveries. In nearly every chapter, Epstein stresses the vulnerability of new
scientific information about the maintenance of the human body to industry
objectives. Hormones were especially vulnerable since they seem to regulate
just about every major process, from growth to metabolism, sleep cycles to sex,
parenting to the immune system, stress to lactation. From the “revitalizing
vasectomies” and “epinephrine suppositories” of the 1920s, to the oxytocin
supplements currently being sold as enhancers of both arousal and intimacy
(despite no strong evidence that the hormone can be metabolized with a
sublingual dose and despite the precise function of the hormone not being
known), companies are eager to make a buck by turning new science into
ill-gotten profit. Just as we are vulnerable to well-meaning doctors, we are
vulnerable to our desires for treatments and cures.
Hormones
are tiny drops in a very big ocean, interacting in complex ways with nerve
cells and other chemicals in the human body, Aroused warns. Not only do we need
to strive for more knowledge but also for accurate testing of that knowledge.
We may have come far from the dark days when Blanche Grey, “The Fat Bride,” was
put on display in the New York City Dime Museum — for suffering some type of
thyroid or pituitary malfunction — or indeed from the days of nonconsensual
clitoral amputation of the sort Bo Laurent endured, yet our society still
struggles with accepting just how varied our gender spectrum is. My father, who
is 80, says he has no trouble with understanding different sexual orientations,
or transgender identity, but “nonbinary” is a bridge too far. Meanwhile, my
daughter is growing up in a world where people are claiming the pronouns they
feel best suit them, and she may be surprised to learn that there was ever a
need for adjustment to the notion of a spectrum. We are currently reading A
Wind in the Door, the sequel to A Wrinkle in Time, in which Madeleine L’Engle
introduces the concept of more evolved creatures who communicate with one
another by “kything,” which allows for a more complete understanding of
another’s interior world. This strikes me as an apt metaphor for humanity’s
expanding definitions of gender identity as science catches up to human
experience. At their best, the biological sciences can bring us closer to
understanding and helping one another, introducing our differences not as
obstacles but bridges.
And then
there’s menopause. “Mid-Life Psychosis,” screamed a New York Magazine cover one
week in December last year. “45, female, and hearing voices.” The article
examined a link between fluctuating hormones — specifically a drop in estrogen
— during menopause, and late-onset schizophrenia. The author admits she was at
first reluctant to take the topic on (she did not want to be responsible for
furthering the trope of the crazy menopausal lady). But, she continues, it
became clear that women were once again an underserved community: how hormones
affect women’s minds and bodies is little understood because it is little
studied. I am 44 myself and, while not yet in menopause, have begun to notice
small changes. I still menstruate every month, but I find my moods a little
less like clockwork, a bit more unpredictable. I notice increased restlessness,
as well as a driving need for solid exercise every day to calm and center me. I
notice a decrease in the symptoms of PMS, but find that those blue moods and
sudden cramps might take hold of me at other times in the month. Naturally, I
was both horrified and fascinated by the possible link between menopause and
schizophrenia. Something is definitely happening, I thought. Please let them
figure it out. A recent article linking cognitive decline and menopause made
the rounds on Facebook, and I eagerly jotted down what I learned, hoping to
glean tips on how to reduce my evidently gender-determined chances of
developing dementia. I’ve already added Darcey Steinke’s new book on her own
experience with menopause, Flash Count Diary, to my to-read-immediately pile.
Epstein’s
dry wit is put to best use in her chapter on menopause: “Some women skip
through the whole experience: their periods stop and that’s that. No erratic
temperature changes, no mood swings, no brain fog, libido as good as ever. To
those women, the rest of us must seem like cranky bitches.” I know how deeply
affected my brain is by hormones, not only because of my dramatic monthly
shifts and symptoms, but also because I experienced such a wrenchingly awful
pregnancy that the memory never leaves my mind. At only six weeks, I began
crying when the sun went down. At eight or nine weeks, my uterus began
contracting, leaving me breathless, and I developed a painful rash. I spent
much of my pregnancy deeply depressed, and I knew, even after I had seen my
beautiful child, that I could never do it again. So, I expect to be one of the
cranky bitches. I also want to be armed with knowledge. The trouble is, there’s
conflicting data. Is it the decline in estrogen that makes women more likely to
have heart attacks, strokes, dementia, osteoporosis, or is the reality more
complex? Epstein reveals that studies don’t show any benefit to long-term
hormone replacement therapy — that is, no reduction in these types of
illnesses. However, she does offer some encouraging news: a few years of
hormone therapy to ease the symptoms of menopause is unlikely to hurt you. The
establishment has been back and forth on that point a few times, and, she
acknowledges, who knows? It may swing the other way again. We have to muddle
through with the research we’ve got at the moment. If that isn’t exactly
comforting, Epstein’s writing so colorfully about the subject certainly is. I
felt I had a friend guiding me through the terrifying waters of my own biology.
In the meantime, I’ve got to go teach my daughter about estrogen. I sure hope
she appreciates her generous stockpile of the mysterious but clearly crucial
hormone.