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Parts of chapter 7 are reprinted, by permission, from J. Hoberman, , How Drug Testing Fails: Wilson and E. Derse Champaign, Ill.: Human Kinetics , John Milton , Testosterone dreams: Includes index.
Arnold Schwarzenegger. EUR 25, Frank Zane. EUR 9, Muscle fiber growth caused by mechanical tension English Edition. Chris Beardsley. EUR 2, Calisthenics Mass: Shoe Dog: Phil Knight. EUR 15, Produktbeschreibungen Kurzbeschreibung Five-time Mr. Shares the high points of the author's career up to his attainment of the coveted Mr.
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Kundenrezension verfassen. Spitzenrezensionen Neueste zuerst Spitzenrezensionen. Derzeit tritt ein Problem beim Filtern der Rezensionen auf. Actually, Arnold wrote this book long before his Hollywood career took off.
He tells an honest story about his life and career as a bodybuilder back in a time when bodybuilding was considered strange and obscure. Arnold helped shatter all the myths and stereotypes about the sport and realistically tells us how gruelling and demanding the sport really is. He is correct in accessing that certain body types have a better chance at succeeding while others have many obstacles to overcome.
Sheer muscle mass is only part of the sport. Just as important is definition and symmetry. Arnold was blessed with just about perfect body symmetry so he was a natural.
This doesn't mean he didn't work hard. In fact you'll gather inspiration as you read about him always pushing himself and striving to do better. Arnold is also not shy about some of the seedier elements that were around at the time he was in competition. Promises of contracts, endorsements, and money could disappear as fast as the unscrupulous businessman who took advantage of them. This is a great book about a great man and brought bodybuilding the dignity it deserves.
Tristan Heberlein vatolocouno juno. The book is an autobiography of Arnold, up through the mids. It is interesting to be inside the mind of a super-athlete such as Schwarzenegger. He conveys how and why he rose to become what many believe to be the greatest bodybuilder of all-time.
He writes about many of the distractions of the early days -- girls, school, parental disaproval, a year of army duty -- and how he dealt with these and managed to stay focused on his dream to be the best at the sport.
Within five years he became Mr. He perservered to become more than just a great bodybuilder. He became a superstar. After he had beat every other bodybuilder of his time, he decided to do away with competing and accomplish his next set of goals. He went into acting, and as we all know, became an international moviestar. In addition he went into the promotion side of bodybuilding, running competions such as Mr. Olympia, Mr. Universe, and of course, the Arnold Classic.
He also set up many gyms in several countries. The second half of the book is a rough guide on how to begin a progressive resistance program, additional motivational advice, nutrition and the like. Throughout the book he demonstrates the many benifits he obtained from bodybuilding -- optimal health, discipline, mind control, etc. Basically, I found it very inspirational to read. The employee may because of her emotional instability become irritable and thus lessen production, one concerned commentator warned.
After the war, as we shall see, many physicians promoted estrogen replacement therapy ERT with great success as an anti-aging therapy that could provide husbands with more satisfying sexual partners and thereby save endangered marriages. The biochemistry of sexual pleasure could thus enhance social stability. Todays version of hormone-enhanced well-being for older women is based on demands for productivity, disease prevention, and sexual fulllment.
It is important to recognize that these calls can come from institutions as well as from individuals. For example, the demand for emotionally stable female production-line workers in the s eventually became a demand for emotionally stable female executives.
In the s the estrogen-promoting physician Robert Wilson warned: With more and more women entrusted with decision-making posts in business, government, and in various institutions, the effects of menopause present a new type of management problem that has yet to be fully understood by the experts of corporate administration.
According to Sonia McKinlay, an expert on menopause, letting it be known that youre on HRT may become a requirement for women in upper levels of management and government to prove that theyre in control of possible symptoms and not declining. Margaret Thatcher made it known that she was a user to legitimize her power in the eyes of her male colleagues. Hormone replacement can also be presented as a cost-saving public health program: Hormonal replacement therapy.
If a consensus is. If the physician wants to act according to good medical practice, the prescription of hormonal replacement therapy is not only legitimated, but will be imperative. On the other hand, it is conceivable that the woman suffering from one of the aforementioned diseases, and who declines to take hormonal therapy, will be held responsible for her condition.
Presenting hormonal replacement therapy in economic terms is likely to turn it into a political issue.
In the worst of all scenarios, one can imagine that social security will penalize women for diseases or invalidity allegedly due to hormone deprivation. Hormone therapy to promote sexual desire in older women can include the administration of testosterone as well as estrogen. This procedure is increasingly popular, in part because of the greater sexual demands of older men who are now taking Viagra.
Patients come in and they look you straight in the eye and say, I have no libido, somethings wrong, x it, says Dr. Five years ago, nobody ever came in and said that. And I cant believe there has been a change in the way people relate to each other in that period of time.
This surge in demand for aphrodisia is symptomatic of a growing medicalization of modern life that appears to create opportunities for deepening human experience. Yet a medical technique that restores sexual activity can also be experienced as a mandate to be sexually active even in the absence of desire. Constant exposure to modern societys sexual propaganda means that many people will feel inadequate when faced with evidence about extremes of sexual performance. Drug-induced sexual tness and the concept of performance can turn sexual relations into an intimate competitive sport judged by quantitative norms.
Thus lifestyle medicine appears to offer a choice as to whether to grow old or not as a professionally or sexually active person.
In either case, whether the decision is to become more productive or to become more erotic, the availability of the hormone can create a social pressure to use it. Why testosterone did not become a mass-market drug in the s is a major theme of this book.
The most important factor was the sexual conservatism of most physicians and the society they served. The belief that testosterone was a sexually stimulating drug made it a potential threat to sexual morality as well as a promising therapy. Sensational coverage had given the male hormone a quasi-pornographic image that its female counterpart had never acquired.
Commenting on testos-. The pharmaceutical companies that sought to shape medical opinion by placing advertisements in professional journals were not yet allowed to go directly to the public and solicit customers for prescription drugs over the heads of their physicians.
What is more, the aging men of the s directed their requests for testosterone to male physicians who often had little interest in salvaging the sex lives of middle-aged or older people. The campaign to sexually rejuvenate senior citizens was not possible until a momentous social transformation of attitudes toward erotic experience had taken place. During the second half of the twentieth century the Kinsey Reports on human sexuality, together with the sexual freedom made possible by the birth control pill, dismantled the old cultural restraints that had prevented sexual expression from becoming an entitlement for the adult population.
This book tells the story of testosterones gradual liberation from the restraints that have limited its use over the past sixty-ve years. The transformation of testosterones roles inside and outside of medicine has taken place both in the larger social sphere, where ideas about health and sexual mores shape human desires and behaviors, and within the smaller world of clinical medicine that evaluates and promotes therapeutic drugs.
In the larger world the use of testosterone was once inhibited by a social conservatism that kept most doctors uninterested in the sexual problems of older people.
In addition, the idea that testosterone might serve as a tonic for the general population has for many years made little headway against the belief that people with normal hormone levels cannot benet from supraphysiologic doses of the drug.
The prevailing experience, the American Medical Association reported in , is that endocrine preparations almost invariably fail when they are given to otherwise normal individuals for the purpose of stimulating sexual desire. The same principle applied when testosterone was administered to stimulate premature babies or estrogen was given to women to increase the size of their breasts.
The marketing of testosterone and estrogen thus required the concept of a hormone deciency that could be normalized by means of synthetic hormone products.
Only such a deciency legitimized hormone therapy. Today it is the aging process that provides the deciency that justies hormone therapies that can include testosterone, human growth hormone, or both. The dramatic increase in the use of testosterone products is now a matter of record, even if medical authors are unable to determine how much of this trade outside doctors control occurs on the black market.
The medical publications that once decried hormone quackery now serve as a forum for a cautious but unmistakable legitimizing of hormone therapy to treat the process that has become known as the male menopause or andropause. Improvement of clinical symptoms of andropause via androgen substitution therapy has long been recognized, one team of medical researchers noted in The list of symptomsdiminished energy, virility, fertility and a decrease in bone and muscle massshows how easy it is to conate declining hormone levels and the aging process itself.
Clinical guidelines for the diagnosing of low male testosterone levels hypogonadism , published with pharmaceutical industry support in , point to symptoms that are often denied by the patient and ignored by the physician. In aging men, these symptoms and signs may be difficult to appreciate because they are often attributed to getting older.
This intriguing observation suggests that hormone therapy can make getting older a symptom-free experience, and it is this illusion that does much to sustain the antiaging hormone market. The frequent use of terms such as quality of life and psychological well-being to describe the effects of hormone therapies employing testosterone, the adrenal hormone DHEA dehydroepiandrosterone , or the prohormone androstenedione makes it clear that their purpose is life enhancement as well as therapy in the traditional sense.
Testosterone therapy is also being presented as less hazardous that it was once assumed to be. Even as designer androgens, which would have minimal effects on the prostate and on cholesterol levels, are being developed, the long-standing medical concern that exogenous testosterone stimulates the growth of existing prostate cancers has been called into question.
A study that administered supraphysiologic doses of testosterone to normal men for ten weeks detected no unhealthy side effects. The report concludes, however, with the standard warning about the possible consequences of extended use that has appeared in many such reports over the past decade.
This ongoing conict between cautionary statements and cautious optimism about hormone therapy has created an opening for medical prac-. The medical literature on the promises and hazards of testosterone and human growth hormone therapy has created a disorienting situation that is easily exploited by entrepreneurial physicians who have chosen not to wait for long-term clinical trials of these hormone therapies. The stunning discovery in that the overall risks of ERT outweighed its benets demonstrated that even decades of studies endorsing the value of a hormone treatment can be wrong.
As the principal investigator of the dissenting federal study notes: They linked up a very benecial product for treating menopausal symptoms to the answer for treating all of a womans aging problems, and it was the powerful appeal of a way to solve these problems that prevailed over scientic caution.
According to the same study, hormone therapy for menopause did not even improve quality of life measures such as sexual enjoyment. Here massive anecdotal evidence of lifestyle benets collided with the best available clinical data, leaving doctors wondering where the HRT boom had come from in the rst place. Testosterone, too, has beneted from a massive anecdotal endorsement of its effects and may well prove to be vulnerable to the same kind of scrutiny that has undone the reputation of HRT for women.
Finally, access to testosterone is facilitated by the various tricks and maneuvers that patients and doctors can use to circumvent the Anabolic Steroids Control Act of , which places limits on a physicians ability to prescribe anabolic steroids for patients who might need them.
Testosterone magazine offers advice on how to nd and manipulate open-minded doctors by inventing symptoms or producing them by means of dieting and sleep deprivation. A far more signicant workaround is the legal prescription of these drugs for off-label uses, dened as treatment indications with little or no proven efficacy that also lack package insert information approved by the FDA.
Even though this federal agencys approval of a drug is limited to the treatment of a specic disease, doctors are free to prescribe drugs for other usesincluding anti-aging therapies. This is how every blockbuster drug, from Prozac to Provigil, becomes a marketing phenomenon. This is why the vast majority of psychotropic medications prescribed for preschoolers are being used off-label. The use of human growth hormone HGH has spread in a similar fashion, since estimates suggest that one third of prescriptions for growth hormone in the United States are for indications for which it is not approved by the Food and Drug Administration.
The male hormone, too, has inspired many such experiments. Testosterone Dreams can thus be read as the story of how synthetic testosterone is becoming a major off-label drug. As the sun rises over the Palm Springs Life Extension Institute, situated amid the palm trees in the desert a hundred miles east of Los Angeles, a bare-chested patient named Bob Jones is already ascending into the foothills of the Little San Bernardino Mountains.
Clasping two hiking sticks, his bodybuilders torso dripping with sweat, the seventy-year-old prodigy wipes a lock of implanted hair out of his eyes and presses on toward the summit. His new and strenuous life under medical supervision has become a single-minded campaign against death and decay.
No one, he says, can age with dignity without a body that works. Not surprisingly, the dignity of the body comes at a price for the institutes affluent clientele: In the meantime, he will continue his individualized regimen of Total Hormone Replacement Therapyinjections of testosterone and human growth hormone, topically applied testosterone gel, tablets of melatonin, and as many as six other hormones that are supposed to slow the aging process and intensify the patients sense of well-being and sexual vigor.
Aging, the medical director of the Life Extension Institute declares, is a disease that His clear implication is that only fools or masochists would refuse to take them. Inspiring stories of hormonal rejuvenation appeared often during the s. The American Academy of Anti-Aging Medicine, founded in Chicago in , now has more than 11, members, most of them physicians, and many of them offer hormone replacement therapy.
These and other proponents of hormone therapy promote the idea of a male menopause or andropause to justify their medical evangelism, and the popular press has offered frequent encouragement.
Newsweeks Testosterone cover story in described the Life Extension Institute as the vanguard of a nascent movement to reshape American manhood and offered its own anecdotal accounts of the mental, physical, and sexual renewal of aging men. In the next few years, Gail Sheehy told the readers of Vanity Fair the same year, all kinds of people, particularly affluent boomers, will seek out anti-aging specialists for custom-designed hormone cocktails. Britains most prominent advocate of testosterone therapy, Dr.
Malcolm Carruthers, whose Harley Street clinic is said to have administered testosterone treatments to more than a thousand men, described a typical case: The menopausal man has lost his ability, and often his will, to succeed and in consequence he is depressed. The effect of testosterone implants, according to one satised patient, was like being turbo-boosted. How can we assess the social and medical signicance of such reports? First, we must keep in mind that the marketing of rejuvenation techniques has been ourishing since the latter part of the nineteenth century.
So our rst question is whether todays hormone therapies represent a medical advance over what came before them. Second, we cannot accept at face value journalistic reports about drug therapies in general and hormone therapies in particular. These stories tend to be too credulous and are frequently used to sell magazines rather than present the public with balanced coverage of medical advances. Finally, we want to know how many people are actually getting such hormone treatments, where these services are available, and who is providing them.
I strongly suspect that there is a signicant level of testosterone and hormone replacement going on, very much the same way estrogen is used in the general population, says Dr. Charles E. Yesalis, an epidemiologist and steroid expert. But we dont have, to my knowledge, any real hard data on the prevalence of hormone use. I argue here that demand for hormone therapies has now achieved a momentum that is both unprecedented and unstoppable.
Public interest. Here we nd, to take another example, the so-called Swiss Rejuvenation Clinic, headquartered in the Bahamas, with offices across the United States where prospective clients can have their blood tested for hormone deciencies that will qualify them for injections of testosterone and human growth hormone.
Here, too, is the Palm Springs Life Extension Institute, where a diverse clientele of sick, anxious, or narcissistic people pursue rejuvenation through Total Hormone Replacement Therapy. These operations thrive in a medical twilight zone, situated somewhere between quackery and mainstream medicine, that has existed since the marketing of glandular extracts began more than a hundred years ago. A fundamental thesis of this book is that powerful social forces are now pushing many mainstream physicians into this expanding hormone therapy market and its entrepreneurial ethos in the absence of countervailing values or interest groups of comparable inuence.
Nor is this migration of physicians into anti-aging therapy limited to the United States. In Germany, those competing for patients include urologists, endocrinologists, internists, dermatologists, and even gynecologists whose female patients bring along their husbands as prospective clients. This event, as well as recent professional congresses on The Aging Man Leipzig and Anti-Aging Medicine Berlin , points to the growing inuence of male hormone therapy.
According to the German endocrinologist Bruno Allolio, We are being steamrollered by the demands of the patients. A huge, uncontrolled eld experiment has begun. The search for rejuvenation through hormones and other drugs confronts us with profound questions about the role of biomedical ambition in the lives of modern people who place a premium on preserving their physical, sexual, and psychological functioning.
For the enhancing of human capacities is now a large and expanding commercial enterprise that has created a new class of medical entrepreneurs who offer what one researcher has called medically reinforced normality.
Plastic surgeries, once an exotic enhancement procedure, are experiencing dramatic growth and acquiring a new respectability among doctors and laymen alike. The booming trade in a vast array of supplements, an ambigu-. Whether these substances actually boost the human organism as the advertisements say they do is, for our purposes, less important than the widespread ambition to practice this socially acceptable form of doping ordinary people. The use of dietary supplements has outstripped the science to support their use, says the director of the Office of Dietary Supplements at the National Institutes of Health.
But this credibility gap has shadowed the hormone and supplements markets for most of a century without putting a dent in demand for what many people believe to be performance-enhancing substances. These new markets are also changing the economics of medicine, since they belong to the alternative medical practices that now compete effectively with traditional medicine.
As physicians have watched their share of the medical market diminish, many of them are responding to customer demands for enhancement procedures, such as hormone therapies and cosmetic surgeries, that they once disdained. The current proliferation of hormone clinics that accelerated sharply during the s is only one sign of the new age of medical enhancements that is now upon us.
Exploring the history of testosterone drugs allows us to understand modern attitudes toward a series of major medical issues bearing on the pharmacological enhancement of human beings. The sheer scope of these controversial topics can be expressed in the form of the following questions: How does a society dene the legitimate uses of drugs?
Who has the authority to manufacture and regulate drugs? How does the medical profession respond to public demand for drugs? Should people have the right to obtain all the drugs they want for therapeutic purposes? Will the current and dramatic expansion of cosmetic medicine promote the use of previously restricted drugs? How does a society confer official status on those syndromes and disorders such as menopause that justify a new pharmacological way of life? Can physicians use drugs to promote marital stability?
Should society make available drugs that enhance sexual gratication for the hormonally impaired or for anyone at all? Will demands for productivity in the workplace eventually legitimate the use of hormonal or other drugs for this purpose? Should we object to the pharmacological enhancement of normal people? Should elite athletes be denied drugs that are generally available to others who can afford them?
The unprecedented access to hormone drugs is in itself a signicant event in the social history of modern pharmacology. How the expanding de-. Regulating enhancements has proven to be very difficult because modern societies that run on the principles of productivity and efficiency cannot credibly oppose techniques that boost the human organism in order to enhance its mental, physical, and sexual performances.
As one Nobel Prizewinning brain researcher put it in January We are rapidly becoming a culture in which it will be normal to take drugs in order to function in an optimal way.
In ten years we will have a pill that improves memory in older people, and they will take it. Our view of what is normal is constantly changing as effective drugs come on the market.
The question of what constitutes normal functioning is crucial to the promotion of hormone treatments that are marketed under the rubric of anti-aging therapy. This deance of physical and mental decline among older people is based on what we may call a rhetoric of enhancement.
Its doctrine consists of a set of assertions and predictions about the powers of hormone therapy that have been widely promulgated in the popular media. Each of these claims raises important questions about what a human being is as well as whether the human organism should be altered for various purposes.
Its principal arguments are the following: The philosophical issues raised by enhancement procedures originate in the most basic questions about what it means to be a human being. More specically, enhancement procedures challenge our sense of human identity by moving or dissolving limits to functioning and performance that have been crucial to dening what a normal person is.
And at the very core of the enhancement problem is the question of whether we should be concerned about preserving the mental and physical limitations that inhere in being normal representatives of the human species. Erik Parens introduces his penetrating study of this problem by. Why worry about a new psychopharmaceutical agent that promised to enhance concentration and performance in school? What about a new psychopharmaceutical or genetic technology that promised to make us kinder and gentler?
It turns out there are two related reasons for such concern about enhancements. The potential for creating a caste of people who enjoy unfair competitive advantages is one. The other is the fear of creating an inauthentic self and thus leading an inauthentic life. Parens notes, For those committed to the idea of authenticity, using drugs to pursue the idea of self-fulllment is disturbing.
Inauthenticity is the consequence of a hubris that attempts the creation or radical alteration of a self that is and should remain a product of nature. This ideal of authenticity thus contains an obligation to practice selfrestraint. For modern people, however, a restraint that refuses the benets of medically sanctioned enhancements is a form of self-abnegation that stands in opposition to the declared ambitions of medical science and its evolving ideal of well-being.
The problem of enhancements can thus be dened as a fateful choice between two attitudes toward biomedicine and what it can and eventually will have to offer to people who may want to alter themselves in nontraditional ways. The normal function model of health care aims at preserving or restoring people to life based on the premise that there are natural differences and characteristics that medicine ought not to be used to erase. It assumes that there exists a normal kind of human functioning that is rooted in the design of the organism.
The enhancement model is based on the very different premise that medicine really has no proper boundaries, and practitioners and their patients should be free to decide together what problems to count as diseases and what interventions to count as treatments. We may call this latter approach client-centered libertarian medicine: One takes ones cues from the patients value system, and negotiates toward interventions that can help achieve the patients vision of human ourishing.
Here is the medical ethos of the results-oriented partnerships between high-performance athletes and the physicians who treat them with banned hormones and stimulants. But a signicant and increasingly conspicuous segment of todays medical clients is interested, as we have seen, in a broad range of enhancements that transcend mere athleticism.
Okun, the growing problem for regulators is not an appetite for illegal drugs, but rather client de-. Im talking about the performance-enhancing drugs or image-making drugsanorectics for slimming, steroids for building muscles, methylphenidates sold under the trade name Ritalin for hyperactivity disorder and, of course, Viagra for sexual performance.
This perspective is striking in that it turns the traditional model of drug abuse inside out. Once upon a time, respectable society feared contamination by illegal and disreputable drugs that were consumed by social deviants.
Now regulators are concerned about a growing demand for legal drugs that serve socially sanctioned goals such as productivity, physical attractiveness, and sexual viability. The threat posed by such drugs originates in the very system of values that sanctions their use, and it is a paradox that has put regulators in an untenable position.
For regulation becomes impossible once physicians allow patientsas some sports physicians have long allowed their athlete-clientsto specify their own pharmacological requirements so as to realize the patients vision of human ourishing.
Client-centered libertarian pharmacology of this kind means that the patient is in charge of how he or she is medicated.
More coercive scenarios arise when enhancement doctors collude with employers, educators, and military authorities who have an interest in getting enhanced performances from employees, schoolchildren, and soldiers or aviators. Newsweek has noted existing practices that point ahead to a scenario in which cognitive workers would eventually be forced to drug themselves into a state of higher productivity: Some colleagues and competitors of Ritalin-popping executives feel themselves at a disadvantage, like rulesrespecting sprinters facing a steroid user.
Will guidance counselors urge parents to give their kids memory pills before the SATs? Will supervisors suggest workers take a little something to sharpen their concentration? Such officially sanctioned doping of the workforce raises the prospect of reverse drug-testing that would enforce the consumption of performance-enhancing drugs by certain kinds of workers. As strange as such an arrangement may seem to people accustomed to the war on drugs, it is probably closer than we think. Imagine, Parens wrote in , a new drug or genetic technology that enabled us to sleep less and thus be more productive.
Less than a decade later we learn that such a drug already exists. Modanil Provigil appears to be a safe and effective treatment for the sleep disorder known as narcolepsy. But the implications of such a drug extend far beyond the private lives of drowsy individuals.
According to the Department of. Advanced Research Projects Agency DARPA , The capability to resist the mental and physiological effects of sleep deprivation will fundamentally change current military concepts of operational tempo and contemporary orders of battle for the military services.
In short, the capability to operate effectively, without sleep, is no less than a 21st Century revolution in military affairs. Another potential beneciary of this drug is the international competitor dubbed by Jerome Groopman the Olympian executive who can straddle time zones, bridging the Nasdaq and the Nikkei. Here, too, the world of high-performance sport offers itself as the prototype for larger-scale developments.
The analogy between economic productivity and athletic efficiency points to the sports mode of functioning that now serves as the idealized paradigm for so much competitive behavior in the modern world. Enhancement doctors serve several types of patients with various kinds of drugs.
The East German doctors who treated unsuspecting female athletes with anabolic steroids during the s and s were pioneers in the eld of coercive hormone therapies meant to boost the productivity of people whose performances supposedly served a greater good. Their predecessors in the eld of coercive pharmacology were the American, British, German, and Japanese military authorities who administered amphetamines to their troops during the Second World War.
In the Drug Enforcement Administration authorized Novartis formerly the Ciba-Geigy Company to produce 13, kilograms of the stimulant Ritalin to treat attention decit disorder ADD an overdiagnosed and almost undenable conditionin about 3.
In September lawyers led suit in federal courts in California and New Jersey against the Novartis Pharmaceuticals Corporation, the manufacturer of Ritalin, and the American Psychiatric Association, alleging they had conspired to create a market for Ritalin and expand its use. The alleged conspiracy presumably aimed at boosting the academic performance of distractible children along with the conspirators income. As for promoting better adult functioning, Peter Kramer wonders whether the Prozac equivalent Sarafem, officially prescribed for premenstrual syndrome PMS , will be used to pressure the moody woman to respond to demands that she be a more affable colleague.
For he, too, can see a future in which medication to alter normal but undesirable traits may become unremarkable. Modanil is the most interesting of these drugs because it seems to have no adverse side effects. As David Dinges, a sleep researcher at the University of Pennsylvania, puts it, modanil is the most tempting drug for our society to come along in decadespure performance enhancement without physiological risk to the human organism.
But it is also a drug that should compel us to ask some fundamental questions about our commitment to the ideal of productivity: Now is the time to have an open and frank discussion on how far we will go as a culture, what are our priorities, how regularly do we want to manipulate our brain chemistry.
What are the limits? Receptiveness to performance-enhancing or performance-enabling drugs of various kinds is a basic characteristic of modern civilization. Modern societys acceptance of these drugs has been effectively obscured by the notoriety of addictive drugs, such as heroin and cocaine, that have given the word drugs its ominous resonance.
Yet even these and other disreputable narcotics will be tacitly accepted as performance-enhancing substances if they appear to offer some kind of social benet. The drug habits of popular musicians such as Ray Charles or Keith Richards, to take two famous examples, are a familiar part of the pop cultural landscape. This kind of drug use is the unremarkable, and only faintly controversial, cost of providing musical entertainment for an enormous audience that could not care less about the drugs its icons consume.
Nor does the public worry about how artists might benet from composing or performing music while under the inuence of psychotropic drugs. It is more likely, in fact, that many people regard an artists drug use as a credential, as a source of creativity and inspiration. The legend of the Beat Generation novelist Jack Kerouac includes the story of how he wrote his cult novel On the Road during a twenty-day, amphetamine-fueled binge in The great French novelist Honor de Balzac consumed massive amounts of cold, concentrated coffee on an empty stomach with the following result: The ideas surge forth like army battalions on the eld of battle, and the battle begins.
Memories charge ahead, their ags unfurled; the light cavalry of comparisons develops at a magnicent gallop, while the artillery of logic arrives with its retinue, and so forth. It is a curious fact that neither mental doping of this kind nor the use of anxiety-reducing beta blockers by orchestral musicians provokes public disapproval.
Unlike doped Olympic champions, Balzac and Kerouac are in no danger of losing their literary laurels because they resorted to enhancements to boost their mental productivity.
As Parens notes, There is something indeed odd in worrying about aiming technologies at the enhancement of human capacities. Comparisons of socially acceptable and unacceptable doping practices point to the inconsistent, and sometimes illogical, rules that determine which drugs merit regulation and which do not. The commerce in alcohol and tobacco products, for example, is granted an exemption from effective regulation, despite the socially sanctioned harm inicted by these drugs on millions of people.
The key point here is that drug habits that do not appear to threaten the social and political equilibrium of a society will be only lightly regulated. Drugs that do not threaten the stability of a societys system of values fall under the same rule.
This theory of how drugs are regulated enables us to formulate two hypotheses. The rst is that the social status of a harmful or controversial drug can change over time, since commercial promotions, social fashions, or scientic discoveries can alter the images of drugs in ways that make them more or less vulnerable to regulation. The second proposition is that the new status of enhancements means that regulating performance-enhancing drugs is becoming increasingly difficult for the governmental agencies that are charged with this task.
For the absence of a general consensus on the goals of medicine makes it ultimately impossible to say whether certain drugs are treatments or enhancements.
The regulation of testosterone products is, as we shall soon see, a cardinal example of how demand for a charismatic hormone enhancement can circumvent a regulatory process that was originally intended to protect the public from substances and procedures it was expected to regard as harmful rather than helpful. Every society develops pharmacological practices that are the result of a complex process of negotiation that involves the public, the medical establishment, the pharmaceutical industry, and public and private institutions such as governments, schools, media, and religious organizations.
Every pharmacological regime is, therefore, an inherently unstable arrangement that is subject to unpredictable scientic developments, corporate marketing ambitions, public curiosity about drugs, the whims of politicians, and the economic circumstances of physicians, who are already modifying their medical practices in order to enhance their incomes.
A gradual shift from purely therapeutic medicine to practices that include lifestyle procedures such as cosmetic surgery and hormone therapies is already under way. Prescription drug laws and official antidrug campaigns may at rst make regulation seem like the order of the day, but one sign of the precarious state of this consensus is the seemingly unstoppable spread of drug sales on the Internet. While the United States government has announced its resolve to regulate this market, the legal and technological obstacles to regulation are formidable.
The unstable. These alternative drug markets traffic in large volumes of hormone drugs and prohormones, such as the dietary supplement androstenedione, which was made famous by the baseball star Mark McGwire in Much larger markets for alternative medicines such as herbal remedies and dietary supplements are worth billions of dollars. Indeed, the inuence of the supplements industry has already become a political force to be reckoned with. These markets are now out of control, driven by a combination of medical needs, consumer fantasies, sexual and athletic ambitions, and hyperbolic media coverage of fashionable drugs.
The enormous publicity surrounding superstar drugs such as Prozac and Viagra has further intensied the publics sense of entitlement to various kinds of therapeutic medications. Pharmaceutical companies are now allowed to advertise directly to consumers, bypassing physicians who are already besieged by drug company representatives and by the drug advertisements that subsidize major medical journals.
These are the shifting sands on which our official pharmacological culture is based, and it is hard to imagine that the traditional restraints on consumption will survive the emerging populist pharmacology intact. Congressional resistance to regulation of the dietary supplements industry by the Food and Drug Administration FDA is a harbinger of the libertarian pharmacology that is already evident in the popularity of supplements and the proliferating pharmacopoeia of herbal remedies.
A more libertarian approach to testosterone and other hormones is the logical next step.
How modern societies deal with hormones is signicant for two reasons. First, decisions to legitimize or forbid the expanded use of drugs that can produce both mental and physical transformations create precedents that shape attitudes toward even more powerful medical procedures.
Sex hormone therapies, including hormone replacement therapy HRT for women, are among the most widespread procedures that can or are imagined to alter the physiological foundations of moods and emotions and, consequently, human identity itself. In this sense, synthetic hormones are an antechamber to the Great Hall of genetic engineering and its more profound transformations of human identity.
Second, understanding our deepest feelings about hormone therapies can help us to predict how we and our descendants will react to the biomedical innovations of the future.
As this book demonstrates, modern. Today medical and popular attitudes toward these therapies still show signs of ambivalence, as interest in their potential benets confronts deeply rooted inhibitions about the pharmacological transformation of human nature.
The prospect of extending hormone therapies and other psychoactive drug regimens into the lives of millions of aging but otherwise normal people is now at hand. We are, in fact, in the midst of an epochal contest between biomedical innovations and cultural restraints; the latter are gradually eroding under the constant pressure of pharmacological products that promise to repair the aging human organism and boost its various performances.
The inhibitions of religious origin that have restrained intimate modications of the human organism now confront the appeal of rejuvenating therapies for an affluent and middle-aged generation that feels entitled to medical advances of all kinds. This sense of entitlement has developed along with the view that desirable modications of human beings are not violations of human identity but are actually forms of therapy that preserve or enhance the normal self.
An important example of this kind of reasoning is the process of rationalization that permits modern societies to overcome traditional doubts about new reproductive technologies such as in vitro fertilization, the freezing of human embryos, and surrogate motherhood.
As two fertility experts once described it, the initial response of horried negation eventually gives way to negation without horror, which is followed in turn by slow and gradual curiosity, study, evaluation, and nally a very slow but steady acceptance. Recent societal responses to such drugs as Prozac and Viagra show that inhibitions about embarking on psychological and physiological enhancements survive now as an instinctive but weakening cultural reex.
Moreover, the time that passes between horried negation and the acceptance of new transformational therapies is constantly growing shorter, owing to the erosion of the cultural restraints that are incarnated in the myth of Dr. Frankenstein and his workshop of lthy creation. Indeed, the Frankenstein story continues to maintain its hold on the modern imagination precisely because it serves our biotechnological age as the last symbol of a need for restraint, as the ultimate warning against the biomedical blasphemies that are now taking shape before our eyes.
But it is also a myth that will become increasingly peripheral to a modern civilization whose denition of human nature is constantly being modied by a panoply of therapies that are constantly changing our sense of what a normal person really is. Testosterone Dreams is a medical and social history of synthetic testosterone and the anabolic-androgenic steroids that are modied versions of the testosterone molecule.
Testosterone has long been referred to as the male hormone, since more of this sex hormone circulates in men than in women, while women have higher estrogen levels than men. That both male and female hormones occur naturally in both sexes, albeit in different proportions, is not widely understood, because it does not conform to the hormonal folklore of our culture, which remains rooted in archetypes of hormonally determined masculine and feminine essences.
The complex and interesting histories of the estrogenic female and androgenic male drugs that have been manufactured since the s and s, respectively, reach deep into the lives of modern men and women in more ways than are generally understood. The purpose of this book, therefore, is to illuminate the important and sometimes bizarre roles that testosterone drugs have assumed in clinical medicine and in the wider world of diverse personal needs and ambitions that range far beyond the therapeutic aims of the clinic.
Both the medical and social histories of testosterone belong to the larger history of synthetic hormone drugs that must be numbered among the revolutionary medical advances of the twentieth century. The quest for sex hormones exemplies the dreams of modernity, the medical historian Nelly Oudshoorn notes, in that modernity demands a biological wisdom and a technological mastery that make possible human control over human biology. For these are the technologies that determine whether we will be healthy or diseased, comfortable or distressed, destined to live or to die.
The history of synthetic testosterone and its roles in the management of various disorders appears to be unknown to most medical professionals. Recent medical commentaries on possible uses for these drugs show little awareness of their long and controversial career in clinical medicine. Scientists have only recently recognized how the decline in hormones affects sexual desire, according to one physician who specializes in sexually transmitted diseases.
But if that is the case, then why were doctors recommending hormone replacement therapies for sexually declining menopausal men and women as early as the s? Anabolic steroids, according to this cancer researcher, have been used by the medical community in rare situations.
In fact, they have been.
Unbeknownst to this author, papers asking the same question about the clinical value of androgenic drugs had been published over the preceding half century. This loss of contact with the past can have serious consequences: Testosterone occupies a unique status among the socially controversial drugs for several reasons. First, its public image is not comparable to those of intoxicants such as marijuana and cocaine that are widely believed to ruin the people who use them.
Although testosterone is a psychoactive drug, most people associate it with building muscle rather than with dysfunctional dependencies. Its notoriety derives from its association with socially marginal people like bodybuilders and with the ethical transgressions of doped athletes rather than with a possible threat to the general population. Finally, testosterone is now undergoing a social rehabilitation because it is imagined to be a source of dynamic and useful personality traits for people of all ages.
After more than half a century, testosterones career as the rogue hormone is gradually coming to an end. A decade after the discovery of testosterone, one American physician wrote in , the uninformed continue to believe that the sole use of this innocent chemical is to turn sexual weaklings into wolves, and octogenarians into sexual athletes.
Half a century later, sexual athleticism has become a socially sanctioned goal for everyone. It is, in fact, the unprecedented respectability of sexual therapies and performance norms for older people that is most inuential in normalizing the status of testosterone products in the minds of many physicians and ordinary people. Testosterone also appeals to a wide variety of younger people on both sides of the law. In Oslo, Norway, nightclub bouncers and criminal enforcers known as torpedoes take anabolic steroids to achieve the violent emotional state their jobs often require.
It is well known, says one Norwegian official, that combining anabolic steroids and central nervous system stimulants like amphetamines produces violent, almost uncontrollable aggression. Some members of this underworld see this as a useful side effect. On the other side of the law, policemen in England take steroids to help them survive encounters with violent criminals.
Many officers around the country, the Sunday Times reports, have turned to steroids as a way of minimizing their chances of being hurt or humiliated, thereby mimicking the behavior of steroid-consuming bodybuilders around the world.
Steroid use by police officers in the. United States is both widespread and a virtually tabooed subject.
The French customs police who initiated the Tour de France doping scandal found vials of testosterone that were to be injected into professional cyclists to fortify them for their grueling ordeal. The Italian police who raided the hotel rooms of professional cyclists during the Giro dItalia race found testosterone patches among other hormonal contraband. In the United States, increasing numbers of adolescent and even preadolescent boys and girls use steroids, but there is little public alarm.
Steroid use among female adolescents increased rapidly during the s, yet this epidemic of reverse anorexia has not attracted much interest. Of an estimated 83, teenage steroid users in Canada, 25, share needles to inject themselves, thereby creating a major threat to public health that receives much less attention than the injection of traditionally stigmatized drugs such as heroin and cocaine. While testosterone was promoted as an anti-aging therapy just after the Second World War, its long career as a sexual stimulant prescribed by licensed physicians has remained one of the better-kept secrets of modern medicine.
Nor is secrecy about this drug conned to its role as an aphrodisiac. Public discussion of users such as police officers, reghters, and professional football players has been kept off the public policy agenda for many years, just as rampant drug use among Tour de France riders was covered up for decades by the many journalists and sports officials who might have reported it. In all of these cases, the interested parties enter into private arrangements that allow patients and athletes access to useful drugs.
Today, the privacy of such arrangements is diminishing in the face of more frequent public claims from physicians and others that testosterone and other hormonal drugs can rejuvenate the muscles and the sex lives of an aging population.
The male sex hormone testosterone is well suited to be a charismatic drug. Pharmacological charisma means that public discussion of a drug takes for granted its power to signicantly enhance the functioning of most people.
The fact that only a small fraction of any population will ever use any charismatic drug is largely ignored. Far more conspicuous is the general belief that the drug can alter human nature in a new and exciting way. The image of the drug and its powers has mythic force that may bear little relation to its actual therapeutic value. Hormones and the glandular extracts that preceded them were associated with biological vitality throughout the twentieth century.
Both doctors and laypeople have seen hormones as the wellsprings of personality, while hormone deciencies appeared to cause physical and psy-. One persisting theme has been that hormones are the basis of personality itself.
Attempts have been made, one physician wrote in , to explain even psychic processes such as emotions and states of mind through the increase or diminution or alteration of secretions of this or that gland.
While this explanation seemed radical at the time, it was also the shape of things to come. Reports that testicle transplants could reform the sexual orientation of bisexuals and homosexuals, or bring about the transformation of a lethargic individual into an enthusiastic athlete, seemed to conrm the almost magical powers of glandular substances. Now for the rst time in human history, one hormone enthusiast declared in , we know the underlying causes of the quality called personality, and we possess the practical means of shaping and directing it.
Commenting in on the lack of charm of women who lack good ovarian function, the author of Glands, Sex, and Personality condently asserts that personality reconstruction may well begin with appropriate hormones.
More recent claims about the rejuvenating powers of various hormone replacement therapies continue this tradition, showing that popular belief in the power of hormones to shape identity remains the basis of their romantic aura. The idea that testosterone is a potentially rejuvenating force of nature is supported by research on the correlation of testosterone levels with specic character traits and social behaviors.
The American psychologist James M. Dabbs has dened a high-testosterone approach to life as a combination of amboyance, directness, self-condence, and what he calls simple thought and actiona set of traits that are a legacy of our primeval past.
The evolution of testosterone in human beings, he writes, resulted in the muscles, energy, sexual interest, and combativeness needed for survival in a primitive world. This research is the scientic basis for testosterones popular association with male unruliness, which has become a familiar part of our hormonal folklore.
Testosterone poisoning has found a place in colloquial speech as a sardonic diagnosis of masculine excess. Indeed, the word testosterone has entered the vernacular as a synonym for both male unpredictability and impressive displays of physical dynamism and virility. Of the many hormones that ow through the human body, only this one has been dressed up as a persona, an attitude, and has acquired a kind of cachet. The potential for hormone-induced bedlam is conveyed in the phrase roid rage, as illustrated by the steroid-abusing shot-putter who threw his girlfriend through a window.
At the same time, vernacular references to testosterone and its derivatives, the anabolic-androgenic. This semihumorous, and therefore inherently tolerant, attitude toward the male hormone and its effects has become ubiquitous in popular culture and journalistic parlance.
In this vein, the animation experts at Disney engineer the new anabolic Tarzan for an audience of children already acculturated to hypermuscular action gures. The behemoths of the Worlds Strongest Man competition, a bizarre collection of gargantuan mummies come to life, are featured in Sports Illustrated as the Titans of Testosterone, most of whom will conrm off the record that they take steroids.
Lifestyle magazines of the men-behavingbadly genre are testosterone-driven. A book reviewer imagines a testosterone-addled, myopic car nut. The stock market plunge that followed Mayor Rudolph W. Giulianis crackdown on New York strip clubs is whimsically attributed to a testosterone drought. The election of the former professional wrestler Jesse Ventura as governor of Minnesota is part of a testosterone backlash that has also fostered the rise of high-decibel male politicians such as Patrick Buchanan and Rudy Giuliani.
The testosterone owed freely when a ruggedly masculine actor shared military memories with a general at the U. Marine Corps Birthday Ball. The Hyundai Corporation once put its investment fund on steroids by harnessing the patriotic emotions of South Korean housewives.
An armored military vehicle looks like a Tonka toy on steroids. The humorless, unnecessarily sadistic lm Soldier is a blustering testosterama, a testosterone-fueled futuristic fantasy. Absent from all but the last of these images is anything resembling genuine alarm at the roles synthetic male sex hormones play in modern life. In fact, testosterone has become a positive and even fashionable concept in public discourse because it conveys the aura of power that is so useful to businesses and advertising agencies.
When a New York Times columnist calls multinational companies Corporations on Steroids, the point of the metaphor is sheer magnitude rather than unnatural growth. The same ambiance of power and charisma is invoked in a printed advertisement by the Saab automobile company that is inscribed on the muscled back of a bronzed male sculpture: Anabolic steroids build muscle mass. More muscle increases strength. In car terms, this means a bigger engine and more horsepower. The equating of male hormones and sheer energy could not be more straightforward.