Manhood
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an impotence
remedy.
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required kilograms of bulls’ testicles. At that point the miracle happened that so many scientists had been hoping for: it was found that cholesterol could be converted synthetically into testosterone. In no time there were several manufacturers. The discovery was the achievement of the chemist Leopold Ružicˇka, who worked for the Swiss firm of Ciba. Cod liver oil and sheep’s fat, both rich in cholesterol, became the main raw materials. Butenlandt and Ružicˇka were awarded the Nobel Prize in 1939, but Laqueur’s work went unrecognized.
How is testosterone viewed today, and what do scientists know about it? Testosterone is a compound of testis and steroid. Its systematic name is 17beta-hydroxy-4-androsten-3-on. The blood contains a large store of testosterone, a hundred times more than is found in those places where it should be active. This reserve in the blood is attached to transport proteins, which release it only when there is a demand.
A very large number of animal species produce testosterone, but in all females the amount of testosterone is considerably lower than in males. In the womb testosterone ensures that the embryo develops into a boy and during puberty it is responsible for the appearance of secondary male sexual characteristics (including the breaking of the voice, and the growth of the penis, scrotum, pubic hair and skeletal muscles).
After puberty testosterone also maintains the male reproductive apparatus, the male body shape and the production of sperm cells. Because it strengthens the muscular system, it is banned from sport. The principal male hormone also plays a part in men’s balding. In both men and women it ensures a healthy libido and also promotes the growth of female pubic hair. In men testosterone is produced in the adrenal glands and by the Leydig cells in the testicles, between 5 and 7 mg per day in all. In women the production is a tenth of that in men. In women testosterone is produced in the ovaries, in the adrenal glands and fatty tissue. The regulation of testosterone is very complex. It begins in the hypothalamus. From puberty onwards, besides its other functions, the hypothalamus transmits increasing numbers of special signals to the hypophysis. These signals (Gnrh, gonadotrophine-stimulating hormone) prompt the hypophysis in turn to pass on special signals to the testes by means of fsh – follicle-stimulating hormone – and lh –
luteinizing hormone. When the concentrations of fsh and lh are high enough, the testes produce more testosterone. The hypothalamus measures the concentrations of testosterone in the blood; when these exceed a certain level, the hypothalamus transmits a different signal to the hypo physis, so that the production of testosterone is inhibited.
Testosterone is broken down in the liver. In both the Leydig and Sertoli cells small quantities of female hormone (oestrogens) are produced from testosterone.
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The feedback
GnRH
mechanisms.
Hypophysis
Hypothalamus
LH
FSH
Testis
Testosterone
A serious depletion of testosterone is caused, for example, by certain diseases of the hypothalamus and abnormalities in the testicles, for instance in men with Klinefelter’s syndrome, and certain kidney diseases. Obese men with diabetes also often have too low a testosterone level (see the following section). If the hormone level is completely normal, there is no point in administering additional testosterone, which only creates additional risks of side-effects such as liver abnormalities and the activation of latent prostate cancer.
Testicular pension?
Men of sixty are often determined to prove their masculinity, basically because they have very little left. The pious King David in the Bible was no exception, when from his roof terrace he saw Bathsheba, the wife of Uriah, one of his bravest and most loyal commanders, taking a bath (ii Samuel 11:2). In a wave of passion he had her summoned and seduced her. However, when Bathsheba, who was quite flattered by the king’s attentions, became pregnant, David lost no time in recalling her husband from the battlefield, where he had been for months, in order to pass off the child as his. Uriah, as a dutiful soldier, refused to return.
The king devised a ruse. He had a message delivered to the general with the request that Captain Uriah be sent to the palace in Jerusalem. Uriah came and was most warmly received. The king inquired with interest about the course of events at the front, and also inquired about the general’s state of health. Uriah must have found this very odd, since it was most unusual to recall a junior officer from the front in order to report to the king. A monarch discussed important military matters with his most senior commanders.
David thanked Uriah fulsomely, gave him a splendid gift and sent him back home, close to the palace. The intention was clear: David 89
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wanted the sexually deprived Uriah to take his Bathsheba in a passionate embrace, and later discover that he had fathered an eight-month or seven-month child with her. Imagine David’s dismay when he learned that Uriah had not gone home, but had lain down to sleep among the palace staff at the entrance to the palace. David immediately summoned Uriah again and asked him why he hadn’t simply gone home to bed. His reply was typical of an upright professional soldier:
‘Your Majesty,’ said Uriah, ‘my troops and even my general are camped in the field, and are sleeping on the ground, or at best in a tent.
It would have been unbecoming if I were to sleep with my wife.’
It was not only the decency of the simple captain that thwarted the king’s evil plan. We know that at this period sexual abstinence during military campaigns was regarded as a religious duty. The king dreamt up a new ruse. He persuaded Uriah to stay a day longer in Jerusalem and invited him to dinner. He managed to get Uriah drunk, but it was no good. Even in his cups, the captain stuck to his principles and refused to go home. Again he lay down to sleep among the palace servants. Because of his decency he had unwittingly signed his own death warrant.
The king had no choice but to manoeuvre the dutiful captain into such a position on the battlefield that his death in combat was inevitable. A dastardly trick! But God punished him for it, immediately.
After his crime the king could find no rest. At the age of seventy he was a broken man, and rumour circulated throughout Israel that the king was completely finished. There was even talk of deposing him. Naturally his courtiers were alarmed: proof of his virility was needed, so that the monarchy could be saved! For this purpose they fetched a very beautiful virgin, called Abisag, from Sunem, about 13 km south of Nazareth. She became his personal nurse, companion and carer. At night she slept with him and with her warm young body drove the cold out of David’s stiff old frame.
Humiliatingly, however, the king could not manage to have intercourse with her. The rumour about his impotence spread throughout Israel; Bathsheba profited from his weakness and forced David to appoint her second son Solomon as his successor. And Solomon grew in power and strength and according to tradition had a thousand wives . . .
Why this wonderful biblical story? Well, in the view of modern scientists the king, with his declining sexual powers, was suffering from what today is called the male climacteric, or andropause. Strictly speaking there is no such thing as a climacteric in the ageing man. With men there is no sudden shutdown of the sex glands as is the case with women. The same applies to fertility, which is of course less great than when they were young, but even so . . . Anthony Quinn, Pablo Picasso, 90
t e s to s t e ro n e a n d s p e r m Charlie Chaplin, Yves Montand and Marlon Brando are well-known examples of men who became fathers late in life.
In men there is no abrupt cessation of testosterone production, more a gradual reduction. At the age of 75 it is only half of what it was at the age of 30. That reduction may be accompanied by loss of libido, forgetfulness, sleep disturbance, depression, loss of muscle mass and strength, loss of elasticity in the skin, osteoporosis and increased
risk of cardiovascular disease. Experts estimate that there is a testosterone deficiency in between 20 and 30 per cent of men between thirty and eighty. As regards the other hormones: the concentration of dhea (dehydropiandrosterone), which is produced in the adrenal gland, is only one-third of that in 25-year-olds. Oestrogen serum levels remain constant because of an increase in body fat; one result of that often seen in ageing men is the formation of breasts. The secretion of melatonin from the pineal gland is also reduced in older men.
Testosterone supplements?
For decades the reduction of sex hormones in post-menopausal women has been the subject of study and for decades women presenting with associated problems have been treated with female hormones. Nowadays a deficiency of active androgens like testosterone in men is known not as andropause but as padam, or Partial Androgen Deficiency in the Ageing Male. Every ten years those in the field dream up a new acronym. The term ‘penopause’ is, however, no longer current.
In contrast to the position with women, treatment of the ageing man with a deficiency of androgens is still in its infancy. Administering testosterone to ageing men may have a favourable effect on the previously mentioned symptoms. But what men should be treated? Up to now there has been no research on which to base an adequate answer to this question. The administering of testosterone to ageing men with
‘normal’ testosterone levels in their blood serum but with a typical pattern of symptoms is currently the subject of debate, but unfortunately the research that has been carried out has been with ‘healthy’ older men and there have been no double-blind placebo-controlled studies.
In the latter the effects of a possible drug are compared with those of a placebo, where neither the researcher nor the test subject knows which drug is being administered or taken.
As indicated by the term padam, older men suffer only from a partial deficiency, which fact needs supplementing only to the normal level. Until recently that could be done only with capsules or injections.
The use of skin patches is also possible, but the best way appears to be the daily application of a gel to the chest and shoulders. Two makes are 91
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available commercially, one smelling of perfume, the other of pure alcohol – take your pick. Finally, testosterone can also be administered via a bio-adhesive tablet on the gum above the upper incisor teeth.
Testosterone and drug-taking in sport
Testosterone was one of the first performance-enhancing drugs to be used in sport. In combination with strength training it is a powerful muscle strengthener, an anabolic. When scientists succeeded in manufacturing the hormone synthetically it fairly soon became all the rage among sportsmen. But not only sportsmen: Adolf Hitler and other top Nazi leaders became users. Servicemen were given doses to increase their belligerence and aggression. The mafioso Al Capone’s devotion to the drug accounted for his hoarse voice.
American research blew the whistle: testosterone and the derived anabolic steroids turned out to have too many side-effects. But athletes had realized that these ‘sweets’ helped enhance their performance, and the ban on use was flouted. During the world weightlifting champi-onships of 1954 the coach of the losing team discovered this in an odd way. Several Russian weightlifters could no longer urinate normally, but had to insert a catheter to empty their bladders. After the victory, a tipsy Russian explained: as a result of daily injections of testosterone the prostate had swollen so much that the urethra was squeezed shut.
There were no drug checks in those days, and meanwhile certain pharmaceutical companies steadily improved synthetic testosterone: injections became unnecessary and were replaced by pills, which proved to have less effect on the prostate. Bodybuilders, weightlifters, swimmers and racing cyclists flocked to take the wonder pills. The potential benefits of testosterone and its derivatives have probably been nowhere as thoroughly researched as in the former German Democratic Republic before the fall of the Iron Curtain. Whole series of theses appeared on the subject at Marxist universities.
On average the testicles produce between 5 and 7 mg of testosterone per day. If over and above that one administers testosterone in high doses, for example an extra 25 mg, the blood testosterone level scarcely changes, since the hormone is rapidly broken down in the liver.
In order to achieve a really positive effect substances were developed that acted in the same way as testosterone, but were not broken down so quickly in the liver. These molecules, which were chemically closely related to testosterone, were called anabolic steroids. Examples include methandrostenolon, oxandrolon, danazol and tanazol.
Abuse has been and remains widespread. Many users are young, insecure men, who use anabolic steroids, in combination with physical 92
t e s to s t e ro n e a n d s p e r m workouts, to train not only their body but their mind. Unfortunately that is not the end of the story. Anabolic steroids turn the body’s hormone economy upside down: cartilage growth increases, causing, for example, the Adam’s apple to widen and the vocal cords to lengthen, so that the voice becomes first hoarser and subsequently lower. Body hair increases and women develop beards and moustaches, while in both men and women the hair on the scalp thins. The skin becomes thicker and greasier as a result of the increased number of sebaceous glands, so that anabolic steroid users suffer more from acne. In women the breasts tend to sag and the clitoris increases in size – the latter effect is irreversible and the organ, which is normally mostly hidden, will become more prominent. Pregnancy while using anabolic steroids is a risky business: a female foetus has a good chance of being born with masculine features. Fortunately, in the great majority of cases women using anabolic steroids will not succeed in becoming pregnant.
Men disrupt their hormone economy to such an extent that their own testosterone production decreases or completely stops. This is because the hypothalamus, the centre in the brain that regulates and adjusts testosterone production, receives the signal that more than enough testosterone is circulating in the body. The problem is that anabolic steroids differ from testosterone in that they cannot regulate sperm production, with the result that men become infertile. All men produce a small amount of female hormone, though in a healthy body that is only a tiny fraction compared with testosterone, but if an indi vi -
dual’s own testosterone production stops, the female hormones increase in importance, resulting in shrinking testicles and breast formation.
Male hormonal contraception
The concentration of testosterone is many times greater in the testes than in serum. Unlike in other androgen-dependent organs, such as the prostate and seminal glands, a multiple of the serum concentration in the testes is also necessary for normal functioning (spermatogenesis).
Grateful use is made of this phenomenon in research into a male contra -
ceptive. If testosterone is administered to a man the secretion of, for example, luteinizing hormone (lh) by the hypophysis will be greatly inhibited. Testosterone secretion by the Leydig cells is brought virtually to a halt. A dose of 200 mg of testosterone per week, injected into the lumbar muscle, results in a doubling of testosterone levels. Partly through the inhibition in the Leydig cells and the accompanying fall of the testosterone level in the testes, sperm cell production virtually ceases.
As a young man the Groningen-based researcher Pek van Andel devised a method of measuring sperm production in rats: he severed 93
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the seminal ducts as far downstream as possible and implanted them directly into the bladder. In this way it was possible to monitor exactly how many sperm cells a rat produced daily, a process that Pek des -
cribed in his first publication. He was later to win the alternative Nobel Prize for his idea of using an mri scanner in which couples could have intercourse as a research tool.
In the spring of 2006 The Lancet, one of the world’s most authoritative medical journals, surveyed the state of research. It had been shown that the male version of hormon
al contraception was safe and reversible. The study concerned had involved over 1,500 men. The researchers found that the average time required for sperm to recover to a level of 20 million spermatozoa per millilitre (the level at which one speaks of a ‘normal’ sperm count), was between three and four months.
Older men, men of Asian origin, men with a high sperm level at the start of the study and men who had used hormonal contraception for only a short time, recovered quickest. The figures: 67 per cent recovered within six months, 90 per cent within twelve months, 96 per cent within sixteen months and 100 per cent were back to their original level after two years. According to the authors of the article in this leading publication their study had proved that the previously demonstrated efficacy of hormonal contraception was accompanied by a high degree of sperm recovery. New research is underway in which an androgen like testosterone is combined with a progestagen.
Testosterone and women
Testosterone production in women, as in men, is variable in several respects. Just after birth girls produce relatively large amounts of testosterone. Production declines throughout childhood and increases again with the onset of puberty. Testosterone levels peak around the age of 30, after which there is a steady decline. Women of around forty produce only half the amount of testosterone produced by those in their twenties. Testosterone production also fluctuates with the menstrual cycle: around ovulation the concentration is obviously highest, which is also when women feel most like having sex. It has also been shown that women have small day-to-day fluctuations: testosterone concentration in the blood is highest at about ten in the morning, and falls again through the day.
In his book De Mietjesmaatschappij (The Sissy Society, 2000), science journalist Marcel Roele writes that housewives produce on average less male hormone than career women. If one compares different kinds of working woman, women who are employed as pas, nurses or primary schoolteachers have less testosterone than women 94