Testosterone


I recently found out that the medication I use to help me manage my blood sugar has a tendency to lower testosterone levels. For a while, I’d been experiencing low energy, a decrease in my sexual desire, and feeling less focused, but those are all so nebulous that I hadn’t connected them until I participated in a panel discussion on the topic of sex & aging and heard a presentation by a medical doctor who specializes in men’s sexual health issues.

I have to admit that I felt some trepidation about writing or talking about this. The cultural links between testosterone and masculinity are complex, and while many of my female friends who have health issues with their hormone levels have spoken and blogged about that, it felt different for me. Upon reflection, I realized that my hesitation was based on how I thought other people would perceive me if I admitted that my testosterone levels were low, even if it was the result of a medication. Testosterone is linked to our notions of masculinity differently from how estrogen and progesterone are connected to how we think of femininity.  Once that became clear, I decided it was important to come out about it. I refuse to let outdated ideas about masculinity whether mine or someone else’s, keep me from speaking my truth. If there’s no shame in having low estrogen or progesterone, whether because of a medication, a health issue, or anything else, then there’s no shame in having low testosterone.

It’s been really interesting to notice how things have changed over the last few weeks, since I started using a gel that delivers testosterone through the skin. I had a bit of a heads up regarding what to expect from some of the transgender men who have shared their stories with me, but there’s a big difference between their experiences and mine. After all, testosterone has been the primary sex hormone in my life and I don’t share their experience of switching from a primarily estrogen/progesterone-based system to a primarily testosterone-based system. For me, it’s been more like coming back to myself, rather than coming into myself (a phrase I’ve heard some trans* guys use when describing testosterone).

The biggest effect that I noticed almost right away was that I started feeling more energetic. I’m waking up more alert, I have more focus, I don’t get tired as easily, and I’m sleeping better. It’s as if the dial had been slowly getting turned down and now it’s back where it belongs. Life seems brighter and I feel a lot happier. I’m a lot more optimistic in the face of challenges and my “can do” attitude has returned. (Good timing, too. September has been an especially busy month.)

At the same time, I’m also a bit more irritable. Little things trigger anger more easily and it’s taking more work to contain and manage it. Most of the people in my life haven’t really noticed it, but my partner certainly has seen me get irritated or cranky more easily. That’s often the case- she saw the effects of my dysregulated blood sugar much sooner than anyone else, too. I’m also more easily distracted when I’m doing something that I’d prefer to skip. I have less patience for the tasks I need to do that I wish I didn’t have to do. And being interrupted when I’m working on something feels much more annoying than it did before.

Both my renewed energy and my increased irritability have been fascinating to observe, in as much as I can from the inside. I remember being a teenager not being able to sit still because I wanted to jump up and do stuff. I also recall how easily I’d freak out about things that seemed hugely important at the time and really were nothing to worry about. Part of what I’ve been sitting with around this is a deeper understanding of how much biology shapes how we interpret the world and how we choose to act in response.

Along those lines, I’ve also noticed that my urge to look at people I find attractive has has increased. Walking down the street or sitting on the train, I have more of an impulse to check folks out. I’m glad that I have more practice at managing my sexual energy than when I was younger. I’m also grateful that I’ve learned some better tools at initiating sex, at flirting, and at recognizing the differences between flirting and harassment. Though I wish it hadn’t been so, when I was younger and less practiced, there were times when my sexual energy came out more strongly than the person I was directing it at wanted. At 42, I have a much easier time keeping things in check than I did at 15, 25, or even 35.

I can say pretty much the same thing about my increased sexual desire. While it has definitely shifted in response to the increased testosterone, I don’t feel like it’s beyond my ability to manage it. But that was certainly not the case 25 years ago, when I sometimes felt like I was being pulled along at the whim of urges beyond my ability to manage.

All of this has given me a lot to think about. Without making excuses for anyone’s behavior in any way, it does seem to me that the ways that some people talk about how men manage ourselves rarely takes the physiological effects of testosterone into account. I suspect that part of the root of that is that most of the people talking about how men behave are women who don’t actually understand what it’s like from the inside. For example, I’ve been told by several women that it’s not hard to not check out somebody’s ass, or that it’s not difficult to keep from staring at someone’s breasts. But frankly, sometimes, it is. When I was younger and I lacked the skills to keep my impulses in check, it really was challenging and I wasn’t always successful at it. Now, I can notice the impulse and not act upon it, but that’s something that only came with age and practice.

Just to be clear- I’m not denying how annoying and oppressive such behavior can be. It’s just that we can’t teach young men (and, for that matter, older men) how to deal with this if we can’t be honest about what’s going on. I don’t want to coddle anyone, and the best way to support positive change is to understand where things start. In my view, gender is the result of a recursive interplay between biology and culture. There’s a lot of discussion about the cultural side, for a number of reasons. I think it’s time we started paying more attention to the biology side so that we can take it into account and develop strategies for working with it.

As an example, if I see someone I find attractive, it can feel like my impulse to look at them is beyond my control. It’s no wonder that so many cultures try to manage men’s sexualities by controlling women’s behavior. After all, if I can’t control myself, then external circumstances need to be controlled so I don’t get set off. The difference, of course, is that it can feel like things are beyond my control without that actually being true. We need to hold onto both of those pieces at the same time if we’re going to make any positive changes. We need to acknowledge how things feel AND the deeper truth that our feelings don’t always reflect what’s happening outside of our heads. When we can do that, we can support learning better tools with which to respond to our feelings.

In some ways, that’s a lot trickier when it comes to cisgender men’s experiences of testosterone. Without the ups and downs of a menstrual cycle, the shifts of testosterone are generally harder to observe. Men also tend to talk about our experiences in these realms less often. Most of the discussion about how these influences play out in the world comes from women, so they rarely reflect (and sometimes demonize) men’s patterns. And our society makes a lot of excuses for how men choose to act, rather than holding us responsible. But even so and without wanting to reinforce pointless gender essentialism, I do think that we need to stop pretending that the differences that roughly correlate with physical sex don’t lead to different perspectives, while also holding onto the goal of supporting behaviors that help people thrive.

Men’s anger is another place where we need to look at this. My increased irritability seems to be leveling out as my body gets used to things and as I become more accustomed to regulating my reactions. It’s become much easier for me to grasp why so many men, especially younger men, lash out or break things in a fit of anger. If they don’t have practical skills for keeping their reactions in check, knowing better or being attacked and shamed doesn’t do much good. Having the tools to notice and manage my reactions, as well as doing the physical and emotional self-care I need to support myself, does. Wouldn’t be lovely if we taught those to young boys instead of either excusing their actions or shaming them for their behavior?

I don’t have any specific answers for any of this. But having the opportunity to rediscover the influence of testosterone after developing some of the skills to manage it has been a really interesting ride. Some of it has been pretty much like I expected, but there have also been some surprises along the way. I’m curious to see where it goes and to discover what else comes up as  I move through this. It’s given me more compassion for my younger self, as well as the boys and young men I see around me. And it’s given me a different perspective on why addressing some of men’s actions has been so difficult.

If you’ve ever taken testosterone, whatever your gender or the reason, I’d love to know what that was like for you. What did you notice? How did it change your thoughts and feelings? What effects did it have on your sexual desires or actions? Add a comment below!

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9 Responses so far.

  1. Mindet says:

    This is the first time I’ve come across someone talking about having low testosterone, and I think it’s great that someone is.  It’s especially interesting to hear frank description of the challenges involved in talking about it.
     
    When it comes to impulse management, I think the development of a sex drive, sometimes the very very sudden development of a very high/strong sex drive, is an issue for both men and women.  Although it’s not talked about so much I think some teenage girls frequently behave in ways that can feel threatening to others or even be threatening to others for a while once their interest in sex appears.  This may involve different hormones, but I think the practical implications are the same; these are confused young people trying to deal with startling new physiological and psychological states with, frequently, very little information and even less guidance.  My suggestion is the same as it is usually; ethics-centred sex education starting at age 12 at the latest.
     
    If I had to pick one thing that I wish someone had pointed out to me when I was a 12 year old sex-obsessed girl it would be that not everyone’s interest in sex would have developed yet.  I went on about this amazing new thing that had come into my life in ways that I now believe to have been pressurising to people around me, saying things that I would never say now and, I think, just being not a nice person about it.  If someone had told all of us that everyone is different and we should be considerate I would have slapped my forehead and stopped being such an idiot.  I’m not laying all the blame on others here, but I do think that children should have access to that kind of guidance and I for one would have responded positively to it.

  2. Irene says:

    Since you knew you were taking testosterone, you’ve got to allow for considerable bias, especially given that, as you said, testosterone has been assigned a huge cultural role that doesn’t match up terribly well with its actual effects on male and female bodies. (An awful lot of people have no idea that women have testosterone at all, let alone that their bodies are more sensitive to its effects than men’s are.) Things like irritability are notoriously difficult to scale and compare.
     

  3. Irene, I’m not sure what your point is. Things that generally don’t bother me have been more irritating, and as I said in my post, my partner has also noticed a shift in my reactions to various things. So what’s your concern?

  4. Irene says:

    My concern is that you may be assuming that you’ll have a particular reaction because you’re on testosterone, and getting confirmation bias — whether it’s in fact being more irritable because you expect to be so, or having the sense that you’re more irritable than you really are because you expect to be so, or being more irritable for some quite unrelated cause (like people nitpicking your posts on the Internet 🙂 ) and assuming it’s down to the testosterone. 
     

  5. Irene says:

    Another thing is that hormone levels and actions aren’t a one-way street: in fact aggression raises testosterone, too, and one theory for why higher levels of T are associated with irritability and aggression is that they’re also associated with greater fluctuations in T, and the reaction is actually to  the times when T is on the low side. Aggressive actions can be a way of trying to get back to the higher level of T that’s associated with a feeling of well-being. (Incidentally, I don’t think aggressive actions are necessarily unpleasant ones — I suspect a lot of the joking and horseplay teens engage in ends up raising testosterone.) Add in that of course all hormones influence each other, and that often the ratio of one hormone to another is more important than the absolute blood plasma level, and — well, it’s FAR more complicated than just “lotsa testosterone makes boys do X and the absence of lotsa testosterone makes girls do Y.” And given that women react so very differently to various hormonal birth control and the like, it’s clear that personal biochemistry makes a lot of difference. I have a very hard time believing that’s not also true for men.

    In the matter of whether it’s difficult to keep from looking at attractive people, there are HUGE socialization things going on there. There’s a standard that says boys who drop their eyes and look modest are being girly; naturally most of them eventually learn to do otherwise (in my experience it’s the older boys, not the 13- or 14-year-olds, who have so much trouble with this, even though they’re more used to their sexual reactions).

    The same standard rewards girls who drop their eyes and look modest (which isn’t too tough when one’s an embarrassed teen who doesn’t want to betray arousal anyway). It’s easy for a woman like me who was brought up that way to think that of course averting one’s eyes is one possible natural reaction to arousal, and therefore easy to choose — it hasn’t been socialized out of me.

  6. Irene, I get that there’s both placebo effect and confirmation bias. I have to admit that I’m wondering what it is that you only mention that with respect to my extra irritability and not the other things I’ve noticed.

    And FWIW, I know myself well enough to know how I generally respond to various situations. I can tell that I’m both more sensitive and more reactive than usual. Could it be something else? Possibly. Though nothing else seems readily apparent. And I do know that the fluctuations are part of it, which is why I said “My increased irritability seems to be leveling out as my body gets used to things”. So we’ll see what happens as things level out.

  7. Irene says:

    “I’m wondering what it is that you only mention that with respect to my extra irritability and not the other things I’ve noticed.”
    Well, partly because I thought I was already being entirely too long-winded and not phrasing things as well as I would have liked. There’s an interesting discussion of the “it’s all more complicated” variety at http://www.realadultsex.com/archives/2008/02/men_women_and_stories_we_tell_about_hormones_and_p.

  8. figleaf says:

    Hi Charlie,
    While mileage varies in all things, more research than not suggests that increasing testosterone <em>from one’s current baseline</em> lowers aggression and irritability.  On the other hand formal research and most anecdotes suggest that testosterone really does increase libido.  And, um, attentiveness to potential partner’s physiques.
    If you Google the keyphrase “grumpy old men and testosterone” you’ll get the usual sample of responsible and irresponsible science reporting on the relationship between low levels and irritability.
    figleaf

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