Since the late 1990s, a constellation of professional associations, journals and health promotion materials has emerged that has constructed the ‘aging male’ as a medical problem. Central to this construction has been a revival of a hormonal model of the male body in which anti-aging is linked to the restoration of masculinity. In this paper I revisit the association of aging and demasculinization that animated the rejuvenation movement of the early 20th century, and contrast this with the initial mainstream medical interest in testosterone therapy in the mid-20th century. Then I will demonstrate how the association between anti-aging and re-masculinization has been given new life in the remedicalized ‘andropause’, and as a contemporary focus on maintaining life-long virility has emerged as an important indicator of ‘health aging’.
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While not determinant, the pharmaceutical industry has been instrumental in producing and stabilizing the scientific ‘facts’ which ground particular models of sexed bodies. For illustrative case studies on the intersections of science and industry in the production of sex hormones, see Gaudillière (2004) and Oudshoorn (1994).
A search on Medline, a reference retrieval tool for medical journals, turned up 201 articles with ‘aging male’ or ‘ageing male’ in the article title, only five of which were published prior to 1998.
See Stolberg (2007) for an account of how Halford’s concept of the climacteric was disseminated and modified.
A companion volume, What a Woman of Forty-Five Ought to Know, was published the following year, which advised women that once their child-bearing years were over, they would “pass simply and easily from the reproductive period….into one of sexual inactivity” (Drake 1902, p. 23).
As Sengoopta notes, this is in direct contrast to the relative neglect of the testicle in the 19th century, when science was far more interested in ovaries as therapeutic objects.
Previous editions of Sexual Impotence paid homage to other influences: the preface to the 4th edition, published in 1912, reflected the ‘gains made by urology’, and the 5th edition, published in 1915, confronted the ‘beseeching demands of psychotherapy’.
While the focus of rejuvenation practice was on men, limited success was also reported with women. Most famously, US author Gertrude Atherten (1923) fictionalized an account of female rejuvenation in her novel Black Oxen. However, as reported in the press at the time, rejuvenating operations on women were ‘possible, but more difficult, owing to the greater inaccessibility of the female gonads’ (Anonymous 1923). In 1929, Harry Benjamin reported to the World Sex Reform Congress on the results of some 300 cases of ‘reactivation’ of women, using mostly non-surgical methods. These included injections of the ‘female hormone’ and X-ray stimulation of the ovaries and pituitary gland. Benjamin noted that while the main aim of reactivation was to ‘counteract the process of ageing and…to extend the platform of efficiency’, the restoration of sexual potency, which many men desired, ‘plays very rarely a part in the mind of the ageing women. Much more often a cosmetic effect is desired and a decided improvement in appearance has indeed been observed in a large number of cases’ (Benjamin 1929, p. 565).
Rechter (1997), among others, notes the eugenic subtext of some hormone enthusiasts.
Vecki railed against what he saw as mainstream medicine’s lack of concern with sexual vigor: “Maybe it is the aim of civilization and its evolution to evolve a well-dressed automaton that will be sexually indifferent, but it will be an insipid and sorry world to live in.” (Vecki 1920, p. vi).
This book, unlike most of Steinach’s work, was published in English and excerpted in the Journal of the American Medical Association, increasing its readership in the US.
For a more detailed account of the medicalization of the male menopause during this period, see Watkins (2007). A full comparative account of constructions of the male and female menopause and related therapies is beyond the scope of this paper, but is a project that I hope to pursue in later work. See Marshall and Katz (2006) for some initial thoughts.
See Watkins (2008) for a detailed account of the disappearance of the ‘male menopause’ in the 1950s.
Watkins reports that a Medline search performed in August of 2007 returned 267 articles with the keyword ‘andropause’, only 13 of which were published prior to 1990 (Watkins 2008, p. 329).
See, for example, the report on ‘Six Hundred Rejuvenation Operations’ given by Peter Schmidt at the World League for Sexual Reform in 1929, where he recounts that, in addition to the restoration of sexual powers, ‘bodily work and sports are again resumed’ ‘the daily obligations formerly intolerable are now easily carried out’, ‘the daily period of work increases, the quality improves’. As he summarizes the effects, ‘all these phenomena result in a new joy of life. Almost always rejuvenated persons tell us that they catch themselves singing or whistling’ (Schmidt 1929, pp. 576–577). Perhaps it’s no coincidence that Viagra advertising has featured men singing!
The European Menopause Society expanded its purview to become the European Menopause and Andropause Society in 1998.
That the same phenomenon can be both normal and pathological suggests that cultural standards of functionality now trump those of normality (cite Katz and Marshall 2004).
Because testosterone is only approved in the US and Canada for the treatment of hypgonadism, not ‘andropause’ per se, there is a major commercial motive for moving towards an age-independent definition of testosterone deficiency. Hypogonadism itself is a relatively rare condition, but there is a very large and growing number of men in the over-50 age group which represents a huge market for hormone replacement therapy.
See Katz (2001/2002) for a discussion of the relationship between positive aging, anti-ageism and anti-aging. As he notes, ‘…the ideals of positive aging and anti-ageism have come to be used to promote a widespread anti-aging culture…that translates their radical appeal into commercial capital’ (p. 27).
However, research shows that while testosterone levels and libido may be related at the population level, individual patient reports of reduced libido as indicating a testosterone deficiency produce less certainty, and ‘the effects of testosterone supplementation on sexual function and desire may diminish over time’ (Travison et al. 2006, p. 2512). This brings to mind Gregario Maranon’s observation on rejuvenation experiments in the 1920s: ‘The effects of achieved by these operations are limited to a passing reactivation of a sexual function which was languishing, and to an equally mild and transitory reanimation of the general state….Man may, by means of these operations, delay with his finger the hands of the clock, but it is futile to cherish illusions about such an act. The clock’s machinery continues marching on inexorably within its case’ (Maranon 1929, pp. 377–378).
I expand on the concept of ‘virility surveillance’ in Marshall (forthcoming).
In a Belgian study, the hormonal status of 81 men who self-referred to a clinic following a media campaign on the subject of andropause was assessed. Of those who took the initiative to consult the clinic because they had symptoms which matched those cited in the media campaign, only 7.1% were assessed as having low serum testosterone due to aging. The majority of men presented with erectile dysfunction for which no demonstrable organic cause could be found (T’Sjoen et al. 2004).
One anti-aging medical clinic promoting testosterone therapy refers to its practices as ‘age management’, and has trademarked the phrase ‘non-optimal aging’ to describe the commonly experienced symptoms of both men and women at midlife. (www.doctorsagemanagement.com accessed March 25, 2009.)
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Marshall, B.L. Rejuvenation’s Return: Anti-aging and Re-masculinization in Biomedical Discourse on the ‘Aging Male’. Medicine Studies 1, 249 (2009). https://doi.org/10.1007/s12376-009-0019-3