Abstract
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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Notes
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.)
References
Anonymous. 1923. Medicine: Voronoff and Steinach. Time, Monday July 30. http://www.time.com/time/magazine/article/0,9171,727231,00.html. Last accessed 31 July 2009.
Atherton, G. 1923. Black oxen. New York: Boni and Liveright.
Bauer, J. 1944. The male climacteric: A misnomer. Journal of the American Medical Association 126: 914.
Benjamin, H. 1929. The reactivation of women. In Third congress of the world league for sexual reform, ed. N. Haire, 564–573. London: Kegan Paul, Trench, Trubner and Co. Ltd.
Benjamin, H. 1946. A contribution to the endocrine aspect of the impotence problem: A report of thirty-nine cases. The Urologic and Cutaneous Review 50: 139–143.
Boggs, T. 2002. Male mid-life changes can lower libido: More than one million Canadian men are andropausal Toronto Star, Toronto, p. R5.
Borrell, M. 1985. Organotherapy and the emergence of reproductive endocrinology. Journal of the History of Biology 18 (1): 1–30.
Calasanti, T., and N. King. 2005. Firming the floppy penis: Age, class and gender relations in the lives of old men. Men and Masculinities 8 (1): 3–23.
Canadian Society for the Study of the Aging Male. 2007. Failure to treat sexual dysfunction can pose a serious risk for aging males (press release, February 5, 2007).
Canadian Urological Society. n.d. Male hormone supplementation in the aging male. http://www.uroinfo.ca/brochures_sexual/maleHormoneSupplement.html. Last accessed 31 July 2009.
Caprio, F. 1952. The sexually adequate male. NY: Citadel.
Charlton, R. 2004. Ageing male syndrome: Andropause, androgen decline or mid-life crisis. Journal of Men’s Health and Gender 1 (1): 55–59.
Clarke, A.E. 1998. Disciplining reproduction: Modernity, American life sciences and “the problems of sex”. Berkeley: University of California Press.
Corona, G., G. Forti, and M. Maggi. 2008. Why can patients with erectile dysfunction be considered lucky? The association with testosterone deficiency and metabolic syndrome. The Aging Male 11 (4): 193–199.
Cussons, A., C.I. Bhagat, S.J. Fletcher, and J.P. Walsh. 2002. Brown-Sequard revisited: A lesson from history on the placebo effect of androgen treatment. Medical Journal of Australia 177 (2): 678–679.
de Kruif, P. 1945. The male hormone. New York: Harcourt, Brace and Company.
Douglas, R.J. 1941. The male climacteric: Its diagnosis and treatment. Journal of Urology 45: 404.
Drake, E.F.A. 1902. What a woman of forty-five ought to know. Philadelphia: Vir Publishing.
Dunn, C. 1945. Discussion of August Werner’s “The male climacteric: Report of fifty-four cases”. Journal of the American Medical Association 127: 710.
Dunsmuir, W.D. 1999. Male sexual dysfunction: The male menopause. In Men’s health, ed. R.S. Kirby, M.G. Kirby, and R.N. Farah. Oxford: Isis Medical Media.
Estes, C., and E. Binney. 1989. The biomedicalization of aging. The Gerontologist 29: 587–596.
Fausto-Sterling, A. 2000. Sexing the body: Gender politics and the construction of sexuality. Toronto: Harper Collins Canada.
Featherstone, M., and M. Hepworth. 1985. The male menopause: Lifestyle and sexuality. Maturitas 7: 235–246.
Fishbein, M. 1932. Fads and Quackery in healing. New York: Blue Ribbon Books.
Foucault, M. 1978. The history of sexuality, vol. 1. New York: Vintage Books.
Frith, M. 2003. Is the male menopause just a convenient myth? The Independent, London, p. 6.
Gaudillière, J.-P. 2004. Genesis and development of a biomedical object: Styles of thought, styles of work and the history of the sex steroids. Studies in History and Philosophy of Biology and Biomedical Sciences 35 (3): 525–543.
Goldman, S.F., and M.J. Markham. 1942. Clinical use of testosterone in the male climacteric. Journal of Clinical Endocrinology 2: 237.
Gordon, M.L. 2008. The clinical application of interventional endocrinology. Phoenix Books.
Gullette, M.M. 1998. Midlife discourses in the twentieth century United States: An essay on the sexuality, ideology, and politics of ‘middle-ageism’. In Welcome to middle age! (and other cultural fictions), ed. R. Shweder, 3–44. Chicago: University of Chicago Press.
Halford, S.H. 1831 [1813]. On the climacteric disease. In Essays and orations, ed. S.H. Halford, 2–14. London: John Murray.
Hall, D.L. 1976. Biology, sex hormones and sexism in the 1920s. In Women and philosophy: Toward a theory of liberation, ed. M. Wartofsky and C. Gould, 81–96. New York: G.P. Putnam.
Haller, J.S. 1989. Spermatic economy: A 19th century view of male impotence. Southern Medical Journal 82 (8): 1010–1016.
Hamilton, D. 1986. The monkey gland affair. London: Chatto and Windus.
HealthyOntario.com. 2009. Andropause: A turning point for men—Part 1. http://www.healthyontario.com/FeatureDetails.aspx?feature_id=4096. Last accessed 31 July 2009.
Heller, C.G., and G.B. Myers. 1944. The male climacteric, its symptomatology, diagnosis and treatment. Journal of the American Medical Association 126: 472–477.
Hepworth, M., and M. Featherstone. 1998. The male menopause: Lay accounts and the cultural reconstruction of midlife. In The body in everyday life, ed. S. Nettleton and J. Watson, 276–301. London: Routledge.
Hirshbein, L. 2000. The glandular solution: Sex, masculinity and aging in the 1920’s. Journal of the History of Sexuality 93 (3): 277–304.
Hoberman, J. 2005. Testosterone dreams: Rejuvenation, aphrodisia, doping. Berkeley: University of California Press.
International Society for the Study of the Aging Male. 1999. Mission statement. The Aging Male 2: 6–7.
International Society for the Study of the Aging Male. 2009. About ISSAM. http://www.issam.ch/. Last accessed 31 July 2009.
Isidori, A.M., E. Giannetta, D. Gianfrilli, E.A. Greco, V. Bonifacio, A. Aversa, A. Isidori, A. Fabbri, and A. Lenzi. 2005. Effects of testosterone on sexual function in men: Results of a meta-analysis. Clinical Endocrinology 63: 381–394.
Journal of the American Medical Association. 1942. Editorial: Climacteric in aging men. Journal of the American Medical Association 118: 458–460.
Kammerer, P. 1924. Rejuvenation and the prolongation of human efficiency. London: Methuen.
Katz, S. 2001/2002. Growing older without aging? Positive aging, anti-ageism, and anti-aging. Generations 25 (4): 27–32.
Katz, S., and B.L. Marshall. 2003. New sex for old: Lifestyle, consumerism and the ethics of aging well. Journal of Aging Studies 17 (1): 3–16.
Katz, S., and B.L. Marshall. 2004. Is the functional ‘normal’? Aging, sexuality and the biomarking of successful living. History of the Human Sciences 17 (1): 53–75.
Kirby, M. 2004. Erectile dysfunction: A model for men’s health. Journal of Men’s Health and Gender 1 (2–3): 255–258.
Landau, R.L. 1951. The concept of the male climacteric. Medical Clinics of North America 35: 279–288.
Lespinasse, V. 1946. Discussion of August Werner’s “The male climacteric: Report of two hundred and seventy-three cases”. Journal of the American Medical Association 132: 194.
Liverman, C.T., and D.G. Blazer. 2004. Testosterone and aging: Clinical research directions, institute of medicine. Washington, DC: National Academies Press.
Loe, M. 2004. The rise of viagra: How the little blue pill changed sex in America. New York: NYU Press.
Lunenfeld, B. 1999. Hormone replacement therapy in the aging male. The Aging Male 2: 1–5.
Lunenfeld, B., F. Saad, and C.E. Hoesl. 2005. ISA, ISSAM and EAU recommendations for the investigation, treatment and monitoring of late-onset hypogonadism in males: Scientific background and rationale. The Aging Male 8 (2): 59–74.
MacIndoe, J.H. 2003. The challenges of testosterone deficiency. Postgraduate Medicine 114 (4): 51–62.
Mamo, L., and J. Fishman. 2001. Potency in all the right places: Viagra as a technology of the gendered body. Body and Society 7 (4): 13–35.
Maranon, G. 1929. The climacteric (the critical age). London: Henry Kimpton.
Marshall, B.L. 2002. ‘Hard science’: Gendered constructions of sexual dysfunction in the ‘viagra age’. Sexualities 5 (2): 131–158.
Marshall, B.L. 2006. The new virility: Viagra, male aging and sexual function. Sexualities 9 (3): 345–362.
Marshall, B.L. 2007. Climacteric redux? (Re)Medicalizing the male menopause. Men and Masculinities 9 (4): 509–529.
Marshall, B.L. Forthcoming. Science, medicine and virility surveillance: “sexy seniors” in the pharmaceutical imagination. Sociology of Health and Illness.
Marshall, B.L., and S. Katz. 2002. ‘Forever functional’: Sexual fitness and the aging male body. Body and Society 8 (4): 43–70.
Marshall, B.L., and S. Katz. 2006. From androgyny to androgens: Re-sexing the aging body. In Age matters, ed. T. Calasanti, and K. Slevin, 75–98. New York: Routledge.
McLaren, A. 2007. Impotence: A cultural history. Chicago: University of Chicago Press.
Meryn, S. 2006. Why a theme issue on sexual health. Journal of Men’s Health and Gender 3 (4): 317–319.
Morales, A. 2008. The use of hormonal therapy in “andropause”: The pro side. Canadian Urological Association Journal 2 (1): 43–46.
Morales, A., and B. Lunenfeld. 2002. Investigation, treatment and monitoring of late-onset hypogonadism in males: Official recommendations of ISSAM. The Aging Male 5: 74–86.
Morgentaler, A. 2008. Testosterone for life: Recharge your vitality, sex drive, muscle mass and overall health. New York: McGraw Hill.
Morley, J.E. 2007. The politics of testosterone. Journal of Sexual Medicine 4: 554–557.
Nichols, T.L. 1873. Esoteric anthropology (the mysteries of man): A comprehensive and confidential treatise on the structure, functions, passional attractions and perversions, true and false physical and social conditions and the most intimate relations of men and women. Malvern.
Nieschlag, E., R.S. Swerdloff, H. Behre, L.J. Gooren, J.M. Kaufman, J.-J. Legros, B. Lunenfeld, J.E. Morley, C. Schulman, C. Wang, W. Wiedner, and F.C.W. Wu. 2005. Investigation, treatment and monitoring of late-onset hypogonadism in males. The Aging Male 8 (2): 56–58.
Nusbaum, M.R.H., and C.D. Hamilton. 2002. The proactive sexual health history. American Family Physician 66 (9): 1705–1712.
Oudshoorn, N. 1990. Endocrinologists and the conceptualization of sex, 1920–1940. Journal of the History of Biology 23 (2): 163–186.
Oudshoorn, N. 1994. Beyond the natural body: Towards an archaeology of sex hormones. London: Routledge.
Oudshoorn, N. 1997. Menopause, only for women? The social construction of menopause as an exclusively female condition. Journal of Psychosomatic Obstetrics and Gynecology 18: 137–144.
Potts, A. 2000. The essence of the hard-on: Hegemonic masculinity and the cultural construction of erectile dysfunction. Men and Masculinities 3 (1): 85–103.
Rechter, J.E. 1997. “The Glands of Destiny”: A history of popular, medical and scientific views of the sex hormones in 1920s America. Unpublished PhD Dissertation, University of California, Berkeley.
Rennie, T.A.C., S.A. Vest, and J.E. Howard. 1939. The use of testosterone propionate in impotence: Clinical studies with male sex hormones. Southern Medical Journal 32: 1004–1007.
Roberts, C. 2007. Messengers of sex: Hormones, biomedicine and feminism. Cambridge: Cambridge University Press.
Rose, N. 2003. Neurochemical selves. Society 41 (1): 46–59.
Rutherford, R.N., and J.J. Rutherford. 1965. The climacteric years in the woman, man and family. In Counselling in marital and sexual problems: A physician’s handbook, ed. R. Klemer, 220–230. Baltimore: Williams and Wilkins Co.
Schering Corporation Medical Research Division. 1941. Male sex hormone therapy: A clinical guide. Bloomfield, NJ: Schering Corporation Limited.
Schmidt, P. 1929. Six hundred rejuvenation operations: A nine-year survey. In Third congress of the world league of sexual reform, ed. N. Haire, 574–581. London: Kegan Paul, Trench, Trubner and Co. Ltd.
Sengoopta, C. 2001. Transforming the testicle: Science, medicine and masculinity, 1800–1951. Medicina nei Secoli 13 (3): 637–655.
Sengoopta, C. 2006. The most secret quintessence of life: Sex, glands and hormones, 1850–1950. Chicago: University of Chicago Press.
Shabsigh, R. 2006. Sexual health is the portal to men’s health 5th world congress on the aging male. Austria: Salzburg.
Shabsigh, R., S. Arver, K.S. Channer, I. Eardley, A. Fabbri, L.J. Gooren, A. Heufelder, H. Jones, S. Meryn, and M. Zitzmann. 2008. The triad of erectile dysfunction, hypogonadism and the metabolic syndrome. International Journal of Clinical Practice 2 (5): 791–798.
Spence, A.W. 1940. Testosterone propionate in functional impotence. British Medical Journal 2: 411–413.
Stall, S. 1901. What a man of forty-five ought to know. Philadelphia: VIR Publishing Co.
Steinach, E., and J. Loebel. 1940. Sex and life. New York: Viking Press.
Stolberg, M. 2007. From the ‘climacteric disease’ to the ‘male climacteric’: The historical origins of a modern concept. Maturitas 58: 111–116.
T’Sjoen, G., S. Goemaere, M. De Meyere, and J.M. Kaufman. 2004. Perceptions of males’ aging symptoms, health and well-being in elderly community-dwelling men is not related to circulating androgen levels. Psychoneuroendocrinology 29: 201–214.
Tiefer, L. 1996. The medicalization of sexuality: Conceptual, normative and professional issues. Annual Review of Sex Research 7: 252–282.
Tiefer, L. 2006. The viagra phenomenon. Sexualities 9 (3): 273–294.
Traish, A.M., I. Goldstein, and N.N. Kim. 2007. Testosterone and erectile function: From basic research to a new clinical paradigm for managing men with androgen insufficiency and erectile dysfunction. European Association of Urology 52: 54–70.
Travison, T.G., J.E. Morley, A.B. Araujo, A.B. O’Donnell, and J.B. McKinlay. 2006. The relationship between libido and testosterone levels in aging men. Journal of Clinical Endocrinology and Metabolism 91 (7): 2509–2513.
Tremblay, R.R., and A. Morales. 1998. Canadian practice recommendations for screening, monitoring and treating men affected by andropause or partial androgen deficiency. The Aging Male 1 (3): 213–218.
Van den Wijngaard, M. 1997. Reinventing the sexes: The biomedical construction of masculinity and femininity. Bloomington: University of Indiana Press.
Vecki, V.G. 1920. Sexual impotence. Philadelphia: W.B. Saunders Co.
Voronoff, S. 1925. Rejuvenation by grafting. New York: Adelphi.
Wang, C., E. Nieschlag, R.S. Swerdloff, H. Behre, W.J. Hellstrom, L.J. Gooren, J.M. Kaufman, J.-J. Legros, B. Lunenfeld, A. Morales, J.E. Morley, C. Schulman, I.M. Thompson, W. Weidner, and F.C.W. Wu. 2008. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. European Journal of Endocrinology 159: 507–514.
Warthin, A.S. 1929. Old age: The major involution. New York: Paul B. Hoeber.
Watkins, E.S. 2007. The medicalisation of male menopause in America. Social History of Medicine 20 (2): 369–388.
Watkins, E.S. 2008. Medicine, masculinity and the disappearance of the male menopause in the 1950s. Social History of Medicine 21 (2): 329–344.
Werner, A. 1939. The male climacteric. Journal of the American Medical Association 112: 1441–1443.
Werner, A. 1945. The male climacteric (including therapy with testosterone propionate): Fifty-four cases. Journal of the American Medical Association 127 (12): 705–710.
Werner, A. 1946. The male climacteric: Report of two hundred and seventy-three cases. Journal of the American Medical Association 132: 188–194.
Wilson, R.A. 1966. Feminine forever. New York: Evans.
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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, 249–265 (2009). https://doi.org/10.1007/s12376-009-0019-3
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DOI: https://doi.org/10.1007/s12376-009-0019-3