Testosterone replacement therapy (TRT) is getting trendier—more and more men are using it, sometimes without even checking their testosterone levels. Others are getting their testosterone levels checked for vague, nonspecific symptoms like just feeling “off,” while some are giving themselves testosterone despite having normal blood levels.
What does this tell us about our bodies and our lives?
In his 2007 book The Medicalization of Society, Peter Conrad defines medicalization as “a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders.” The rise of medicine as a powerful institution over the past century has pushed people to think of more and more problems (such as menopause or ADHD) as diseases that need medical treatment.
For example, drug companies looking to sell drugs like Paxil ran ads asking people if their shyness or discomfort in groups could be symptoms of social anxiety disorder—transforming personality traits or a lack of courage into an illness and then requiring a doctor’s treatment through medication.
Testosterone deficiency is another fascinating example. Medicine has long recognized that a severe deficiency of testosterone (seen in patients with hormonal tumors or testicular disorders) can decrease muscle mass and cause sexual dysfunction. Once testosterone could be synthesized, it was used to treat these patients. But men have also sought all kinds of medical interventions simply because they felt their mojo was off. Sigmund Freud, W. B. Yeats, and others had partial vasectomies to improve their creative and sexual vigor!
The mid-20th century saw athletes and bodybuilders using various injectable forms of testosterone to enhance their performance. However, it was not until the pharmaceutical industry developed convenient methods of replacing testosterone that moderate forms of testosterone deficiency began to be treated and prescriptions for testosterone began to take off. TRT has grown in fits and spurts since then, as have concerns that testosterone supplementation could increase the risks of cardiovascular disease or prostate cancer. (More recent evidence suggests that these risks are negligible.)
Still, aggressive use of TRT has not been able to shake the accusation that it is another form of medicalization and overtreatment. No major medical society recommends screening testosterone levels in asymptomatic men, and no evidence suggests testosterone ought to be checked in men who have nonspecific symptoms like fatigue or low mood. It’s unlikely that testosterone helps men who don’t have a measurable testosterone deficiency. As one endocrinologist put it: “Testosterone is highly susceptible to wishful thinking, marketing, and promotion leading to its use as an anti-aging or sexual dysfunction tonic and for cyberchondria.”
Why are so many men concerned about their testosterone levels and susceptible to this wishful thinking? Brewer Eberly and Devan Stahl have observed (in an unpublished draft of their paper I was able to read) that while “gender affirming care” is usually used to describe hormones or surgeries for transgender people who want to alter their bodies, it can also describe the needless medicalization of people who feel they are insufficiently male or female. In an age obsessed with gender, fearful of aging, and contemptuous toward weakness, it’s not surprising that men look for a medicalized, technological solution to their self-doubt.
Similarly, the demands of work and family often seem more intense as the proliferation of screens makes us feel more anxious, stressed, and sleepless. Other problems that contribute to sexual dysfunction, like porn addiction and obesity, are running rampant. Influencers are getting rich feeding a sense of fear that your body is not okay and needs medicalized optimization to thrive, and it seems simpler and easier to look for a solution in bloodwork and hormonal treatment than to exercise control over the things that overwhelm us.
Christian theology has long recognized that our bodies are gifts to us from God. We are fragile vessels, though, and the kernel of truth within the medicalization impulse is that we are stewards of our bodies. To honor our Creator we need adequate sleep, regular exercise, and healthy food. Today, we also have preventive health measures like colonoscopies, vaccines, and blood pressure screening to help detect diseases that could suddenly curtail our lives—although it’s important to look at which kinds of tests and treatments are recommended and why.
Our desire for health and vigor should point us back to bigger questions about wellness. As men, do we want to be healthy and strong to use our strength to worship God and bless others? Or is our anxiety about testosterone levels part of a desire for power, control, and sexual potency? Is our vision of masculinity shaped primarily by advertisements and podcasts? Or are we seeking to be conformed to Jesus Christ’s tender compassion? (It should be noted that our Savior was no couch potato, though I’d decline to speculate on how much he could bench press.) Would you rather be like Samson—musclebound but morally weak—or like Paul—physically unimpressive (2 Cor. 10:10) yet spiritually strong?
We don’t have to choose between physical and spiritual strength, and the two will often sustain one another as physical exertion supports spiritual vigor. A desire to honor God in our bodies leads us to good habits.
But our bodies will eventually become weaker. Some people may never be able to perform an impressive deadlift because of injuries or disabilities. If our understanding of our bodies and the hormones within them can’t appreciate how in Christ the weak are made strong, we’re bound to fall for the quackery of testosterone replacement—and the lie of idolizing power.
Matthew Loftus lives with his family in Kenya, where he teaches and practices family medicine at a mission hospital. His book Resisting Therapy Culture: The Dangers of Pop Psychology and How the Church Can Respond is forthcoming from InterVarsity Press.
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