While American novelist, Chuck Palahnuik’s Fight Club had a lot to say about the purposelessness of modern-day men, tempered male aggression and self-destructive anarchy, the very first reference to masculinity in the story is a lot simpler, subtler, and closer than you think.
This in-your-face (pun intended) reference comes across in the form of Bob — a ‘roided-up wrestler turned testicular cancer survivor. Bob’s botched hormone therapy programme resulted in him developing gynecomastia, a hormonal disorder caused by irregular levels of testosterone, or ‘T’, in males. Bob’s unfortunate condition is a depiction of warped masculinity in both the novel and its famous film adaptation — it betrays a startling reality that hasn’t changed much since the scene was first conceived in the nineties: that men have a dangerously low level of awareness of their own bodies.
The Mysterious Effect Of Androgens
This influence starts much earlier. While we’re all aware that puberty entails the first big ‘flush’ of androgens — male sex hormones — through a 30-fold increase in testosterone, it isn’t the first time that male bodies undergo the procedure. As early as six weeks into conception, male fetuses experience a similar boost in testosterone levels, priming the brain and body for a lifetime of changes.
Some of these are obvious, such as differing reproductive systems, body hair, upper-body musculature and the like. Others, however, are behavioural. While the scientific literature here is inconclusive, wavering levels of testosterone have led to changes in energy levels, confidence, competitiveness, strength, and sex drive — all markers of virility and success in our social hierarchies. Interestingly, high levels of testosterone can demonstrably be found in trial lawyers and winning tennis players, according to research published in the Journals of Applied Social Psychology and Sports Science & Medicine, respectively. And despite this hormone’s clearly profound effect on our health and lives, men seem woefully unprepared to understand, let alone discuss hormonal health in general. “Most men may not be aware of the changing hormonal milieu in their bodies, but some may definitely experience severe symptoms and they may not be aware of the hormonal changes,” warns Dr Amit Mutha, a sexual medicine and andrology consultant at SL Raheja Hospital, Mahim, who attributes this lack of knowledge to social conditioning.
The cultural impact of testosterone is undeniably vast, so it’s no wonder that most messages aimed at men revolve around their insecurities and gendered expectations. Just Google search ‘male hormone supplements’ online and you’ll be bombarded with ads featuring chiseled models touting promises of ‘increased muscle mass’, ‘hair loss prevention’, and the timeless favourite — ‘natural penis growth’. Dr Farah Ingale, a senior consultant physician at Hiranandani Hospital, Vashi, makes the same observation as Dr Mutha, although her analysis specifically touches upon the ‘influence of the male ego.’ “They should feel free to discuss this issue with family and friends,” she urges. “They shouldn’t shy away from meeting consultants to seek medical advice.”
The elephant in the room is how this entire narrative upends the way we regard women’s hormonal health in contrast. While men have historically been viewed as dependable and stoic, the derogatory label of ‘hormonal’ women is referenced everywhere from boys’ poker nights to the Old Testament. At a glance, it seems that the average urban woman is a lot less insecure of how her body responds to hormonal cycles and more aware of the nature of various related disorders or how to manage their symptoms. Female celebrities have championed educative, open discourses on hormonal regulation and healthy practices, while women around the world continue to track their cycles on apps, seek advice from gynecologists, and ultimately, take charge of their hormonal health.
While hormonal cycles are impossible to ignore for most women, men experience their fluctuations within a less-obvious 24-hour window and often in unpredictable, oscillating ways. “The morning highs, daily fluctuations, and seasonal cycles whip men around,” wrote the late sex-ed pioneer, Theresa Crenshaw. “Think about the moment-to-moment impact of testosterone levels firing and spiking all over the place during the day and what this must be doing to a man’s temperament. Men who so strongly need to feel in control are in fact in much less control than they realize.”
Indian Men and Hypogonadism
Given that one’s environment — physical and cultural — plays a massive role in testosterone levels, we can observe a range of variation in T-levels across different societies. “Almost 20 percent of men experience symptoms of low testosterone as they age,” explains Dr Mutha, while commenting on the scenario in India. “Symptoms of andropause, also known as ‘male menopause’, begin in the early to late 40s, with the highest incidence in the 60s and 70s, increasing with each subsequent decade.” While Mutha notes that clinical literature on the topic is lacking in India, a recent 2022-23 study by Indian researchers on hypogonadism (low testosterone levels) confirms his concerns.
This trend can be observed across the subcontinent, but with an interesting demographical twist. Pakistan, for instance, has some of the highest levels of hypogonadism in the world, largely connected to its plummeting healthcare budget, which in turn produces the world’s highest rates of type-2 diabetes — a key factor in testosterone production. In India, where healthcare is still relatively accessible, it is lifestyle-related issues that affect testosterone levels, especially in its bustling metropolises.
“Apart from cortisol and thyroid imbalances, low testosterone is one of the most common hormonal issues faced by men,” shares Dr Ingale. “The signs and symptoms are problems such as erectile dysfunction, low libido, weight gain, hair loss, fatigue, mood swings, insomnia, and ‘man-boobs’ or gynecomastia.” Both physicians observe a clear upswing in unhealthy living that contributes to rising rates of these issues. “A sedentary lifestyle, obesity, smoking, alcoholism, lack of sleep, a stressful job or business environment, and junk food all are reasons for hormonal issues,” adds Dr Mutha, noting how men have largely failed to adapt to the pressures of modern life, and have turned to harmful addictions to cope.
Common sense dictates that lifestyle changes, in turn, will help manage the effects of hypogonadism. This advice is rarely followed, however, as several men diagnosed with the issue seek TRT, or Testosterone Replacement Therapy as a solution. While this has great potential to help men with genetic issues or specific illnesses, it’s often misused. At least in the US, up to half of such men are self-medicating without specific diagnoses, some studies suggest. This foreshadows a looming problem in India’s relatively unregulated supplement market, where fake medicines and ayurvedic cures add an additional layer of obscurity to the issue. Pharma firms exploit low testosterone levels, labelling them as an illness affecting all men. Some end up convinced that common signs of aging — like reduced energy and sex drive — are now a disease that requires medication. This message is tempting for men who simply want to feel better and are willing to try a quick fix.
“Testosterone Replacement Therapy is not meant for every patient suffering from erectile dysfunction, baldness, or low libido,” cautions Dr Mutha. “In fact, it can lead to these symptoms as a side-effect. The Internet is not the right source of information, when it comes to hormone treatment options,” he adds, touching upon the growing rise of misinformation and toxic male discourses online. “TRT is to be advised in carefully selected patients. Before initiating the TRT, we must make sure that the testosterone levels are low as it is common for them to vary from morning to evening, and across a few days, depending on various factors. I advise prostate-specific antigen levels to rule out any prostatic pathology before initiating TRT.”
While there are no guidelines for hormonal check-ups, Dr Mutha notes how hormonal health should be a key factor for middle aged men, who are the highest risk group for related disorders. “I advise my patients, who are above 40 years of age, to undergo hormonal tests as a part of a first consultation; if everything is fine it’s suggested every five years. But if hormone levels are low, I advise hormone tests every year,” he concludes, urging men to carefully consider medical interventions and openly discuss these health issues with their peers and family members while doing so.
