Patching up Testosterone

I IMAGINED IT AS A SWEET, TRANSPORTING OSMOSIS, A VITALIZING GEL THAT WOULD SEEP THROUGH MY SKIN AND INTO MY AND INTO MY BLOODSTREAM, AWAKENING THAT OLD BLACK MAGIC I NO LONGER KNEW VERY WELL BUT MISSED SO MUCH. A HORMONAL POTION TO MAKE EVERYTHING THE WAY IT USED TO BE--THE SPELLS OF ROMANTIC EUPHORIA, THE ZORBAESQUE DANCES ON THE BEACH AT SUNSET, A STUNNING ANKLE AT A PARTY ELICITING SHEER DESIRE, THE RETURN LOOK SUGGESTING "MAYBE", HER SOFT WORDS TURNING FROM CURIOSITY TO INVITATION.

But of course nothing like that happened until afterward.

Beforehand, I had been taking regular inventory, as most of us do, but adding plenty of denial, as I suspect most of us also do. What had I lost as I grew older? Among other things, running speed, endurance, strength, reflexes, muscle mass, and a little hair. Actually, I didn't lose that much hair, but its color, body, sheen, and curl withered. Most poignant of all, I lost the satisfaction brought about by a nicely functioning libido. I accepted these losses as natural and irreversible, going with the flow, looking square in the eye of nothing but spiritual and platonic relationships. Then Jerry, my sister's husband, blasted me out of my ignorance and inertia with all the exuberance of a moose in heat.

"The testosterone patch, I'm wearing one! You won't believe what it does." His voice on the phone sounded firm and huskier than usual. After years of lackluster sexual performance, he almost bellowed, he'd finally turned into a reliable, often sexually rambunctious animal. He emphasized the word, throwing in a few deep grunts for effect. His second wife, my sister--15 years his junior; he was my age, 60--didn't complain much about his renewed prowess, he boasted, although it exhausted her, made her late for work.

"Get it," he demanded. It was a direct order, not a suggestion, unusual coming from my typically retiring brother-in-law.

When I joked with my girlfriend Laura about Jerry's renaissance, she raised an eyebrow, reminding me, I suppose, that I was no Valentino, not lately anyway.

"He says he feels like he's 25 again," I marveled.

"Twenty-five?" she rolled her eyes. "I don't know if I can handle that, but I wouldn't mind if you felt 50 again."

Me either, but I didn't say anything, even though I was already planning to see a doctor as soon as possible--and secretly aiming for 25. If Jerry could wear the patch and reap the benefits of testosterone replacement, why couldn't I? Of course, I cleverly decided not to share this competitive impulse with my doctor, lest he conclude that enough free-ranging testosterone still sparked around my circuits to preclude any battery boost.

"I'd like to go on the patch," I told him on the phone, "if that's all right with you."

"Good," he replied. "It'll ease the withdrawal process."

Withdrawal? "Not the nicotine patch, doctor. The testosterone one."

"Oh. In that case, you need to come see me," he said.

BEFORE THE ADVENT OF THE PATCH, testosterone was delivered in other ways: as pills, lozenges, topical creams, and intramuscular (IM) and even penile injections. Except for the most fastidious, people tend to be a little lax in taking pills on schedule, and in the case of testosterone this carelessness leads to a jumpy and inconstant supply. Besides being painful, injections pose the same problem. IM injections are typically given at three-week intervals, meaning you start with a bang and end with a limper. Penile injections are self-administered, but since they provide little more than a half hour's effect, they don't enhance the spontaneity of sex very much. So patch technology is revolutionary, because it provides a constant, correct dosage and is easy to slap on.

A few days later, I had a physical and left some blood for testing. The next week, I arrived at the doctor's an hour early for the results. By then I'd boned up on the rudiments of testosterone, realizing for the first time that a shower of it in the womb had engineered me into a male. Then, during adolescence, the hormone helped bring about my wide shoulders, rampaging acne, exciting (and victorious) fistfights, success as a high school quarterback, unbelievable erections, and the virtually nonstop sexual pursuits that caused my grades to plummet through distraction.

But as the decades passed so, evidently, did my body's ability to produce enough testosterone. Some drying up happens to most men over time. We get a little flabbier, lose muscle mass, grow more irritable, and less lustful. Our bones weaken and our zest drops. One researcher in human sexuality, Theresa Crenshaw, M.D., equates this slump with female menopause, dubbing the male version "viropause." Happily, she claims the emotional and sexual side effects of both pauses can be avoided or reduced by a judicious mix of hormonal supplements.

My blood tests revealed a few unpleasantries, including a slightly elevated cholesterol level. But the good news was that my total testosterone level was low enough to justify some replacement, particularly as my libido was on permanent vacation.

The end result? I was cleared for a test-drive.

DAY ONE

"WANT THIS IN A BAG?" THE PHARMACIST ASKED IN A DISCREET VOICE.

A box of 60 Androderm testosterone patches make for a hefty package, all right, but I didn't feel the slightest need to disguise the purchase, carrying it instead in such a way that anyone could see what I was toting home. I caught one amused glance from a middle-aged woman, but that was it.

That night, alone in the bathroom, I carefully bathed and dried the two places I'd be applying the patches, treating the process as a sacred ritual. The outer envelopes ripped open easily, but getting the patches themselves open reminded me how far down life's road I'd already traveled when it came to vision and digital dexterity. Putting on my bifocals and fiddling as I might, I couldn't separate the plastic cover from the actual patches, each the size of a communion wafer. It was as frustrating as trying to open those plastic bags dispensed in supermarket produce sections. A pair of scissors finally did the trick, though they marred both the patch and the ritual. Still, I fell into bed confident that five milligrams of testosterone would seep through my skin over the next 24 hours and get the hell busy.

I awoke the next morning with the distinct impression I'd experienced a nocturnal erection, though I may have dreamed it. Something more odd, however, took place that afternoon. With scarcely any forethought, I found myself making long-avoided phone calls to male friends who'd fallen away through inattention, geography, or erosion of common interests. But why call now, with a reputedly aggression-enhancing substance now supplementing whatever piddling amounts of the hormone my own body was still producing?

I came up with a speculative answer thanks to a book on primate behavior, Demonic Males, by Harvard anthropologist Richard Wrangham, Ph.D. Put simply, life among most animals is fraught with the challenge of maintaining rank in the social hierarchy and attempting to move up in status. Male chimps are no exception. Sometimes just being the toughest chimp around earns you the top slot, the much-coveted role of alpha-male. But other times subordinate chimps engage in what might anthropomorphically be called power politics. That is, subordinates form strategic liaisons and depose numero uno by ganging up on him. Then each subordinate rises a notch and luxuriates in the promotion, at least until the next shake-up.

Perhaps I'm stretching it, but I believe I placed those calls to reestablish my male network--maybe form some strategic liaisons, get back into the swing of things. As many studies show, status and testosterone levels are not only correlative but reciprocal. Testosterone production plunges in soldiers when they are subjected to domination and humiliation during the first weeks of officer training school, Crenshaw notes in her book The Alchemy of Love and Lust. But upon graduating their hormone levels rise in concert with their new status as officers. The same pattern occurs when trainee parachutists achieve master jumping. And no doubt the same dynamic operates in corporate pecking orders. So if my phone calls were indeed an attempt to reestablish myself in my social hierarchy, they may well have been both a testosterone-driven and testosterone-enhancing activity.

DAY TWO

"I SEE YOU'RE USING THAT LARGE TOOL AGAIN." Halfway through saying it, Laura realized her double entendre. Well, it was a large tool, an industrial-size screwdriver that provides terrific torque and serves as a handy pry-bar as well. After several months of chronic disregard for our house, I found myself newly intent on repair and maintenance: fixing the broken banister, tightening a rickety chair, hanging a flowerpot holder.

"C'mon, Laura," I said. "It's only the second day! Give it a little more time." But even if my libido hadn't come galloping back yet, and my strategic liaisons were still at an early stage, I nevertheless felt a new sense of command.

DAY THREE

AS I PUTTERED, READ SOME MORE ABOUT TESTOSTERONE, AND WORK ON A NOVEL THAT WAS REACHING ITS CONCLUSION, I found small bubbles of endearment toward Laura rising in my system. Something was definitely stirring. I tried calling her office several times to convey these feelings, but she was caught up in some major-league business meeting. I let it be, not wishing to leave sweet nothings on her voice mail. Instead, I'd wait, whip up a romantic candlelight supper. Do it right.

Except that she didn't show, calling late and arriving home long after I'd gone to bed miffed, my bubbles not burst, but evaporated. Considering my testosterone level was rising, I'm surprised I didn't wait up and display my best aggressive, insulted roar. But all I could muster was miffed. Sound asleep, I didn't hear her come in.

DAY FOUR

I discovered two related facts. First, I read about a recent study in which UCLA's Christina Wang, M.D., looked at a group of men who for a variety of reasons--including such testosterone-draining conditions as arteriosclerosis and excessive smoking--showed low levels of the hormone. But these men, she found, resembled irritable lions rather than timid lambs. After testosterone replacement therapy, however, the men became much kinder and gentler. So testosterone's aggressive and antisocial rap may be a bum one after all.

Alas, it was a misconception Laura subscribed to, the morning's second fact. We sat at breakfast, each reluctant to bring up her late arrival the night before. "To tell you the truth," she said at last, "I stayed out late on purpose."

"But why?"

"I guess I'm afraid of the testosterone. Jerry was pretty graphic about all that wild-animal energy stuff. It scared me a little."

I sat there speechless, frozen in an irony: I was damned if I did, damned if I didn't.

Reading about Dr. Wang's study gentled her. So did 1, in a nonsexual way. But that night, after applying the patches, we made love. I was careful not to get too gymnastic, not wanting to perpetrate any misconceptions. But a wonderful fire burned, even so. I felt 50 again. Ten years down, 25 to go.

DAY FIVE

The directions recommend applying the patch at night, when testosterone production begins to rise in healthy men. I was actually starting to enjoy the nightly ritual, which became both simpler and more complex, like all meaningful rites.

It was simpler because I now opened the patches with no difficulty. Practice, I assumed. Then I read that Joseph Brandt, M.D., a psychiatrist at the Johns Hopkins School of Medicine, believes that extra testosterone increases men's ability to work with three-dimensional objects. No wonder my dexterity was improving. Next thing you know, I'd be able to thread a needle and sew on some of the buttons popped by my potbelly--which, incidentally, was beginning to flatten.

The application ritual's complexity is spatial as well, but in another sense. The patch's diameter is 21/2 inches, so the daily dose of two covers 5 inches. The idea is to stick the patches onto new hairless areas each night to avoid irritation and assure maximum absorption. But if, like me, you wear dark T-shirts, when the patches are removed, the residual adhesive creates neat rings of lint. The rings can be scrubbed off, but I don't do it since they mark used turf. Trouble is, I'm running out of virgin territory at the moment. I suppose there's always my forehead.

By the way, it doesn't bother me, or Laura, that all the lint circles on my upper torso make me look like a tattooed Maori tribesman. Kind of exciting for both of us, in fact. A lot like sexual ornamentation, come to think of it.

DAY SEVEN

Erections are now a regular phenomenon, sometimes not prompted by any cues whatsoever. Better watch it. My doctor warned me that in rare instances excessive testosterone can lead to priapism, a state of constant erection. Don't want to get into that awkward territory, do we now?

All other signs are positive, though. I feel better, look better, and I'm making lots of eye contact with attractive women around town. Indeed, sometimes I walk to the store or library just for such positive feedback. Meanwhile, Laura and I are a far happier couple. I figure I've taken 15 years off my age by now and can touch my toes again. In fact I can touch a lot of other things, including Laura, more often and tenderly. She even likes it when I swagger a bit.

DAY 14

Our sex life has returned to normal and occasionally approaches monumental. An element of passion, in fact, has returned not only in the sack but elsewhere in my life. For example, I managed to get a full refund on an unopened, outdated but unconscionably mold-infested container of sour cream at a local grocer. The manager resisted, fought tooth and nail. But I stood my ground, cleverly making our dispute more public, and in the end received a $2.99 credit, which I applied to a couple of stalks of celery.

But that was minor compared to something that's taken hold over the last two weeks. Here's what it boils down to. I don't think like God, behave like Him, or know what He knows. But these days I sure sound like Him. My voice is deeper, more resonant and authoritative. Even at my most humble--say, when I'm apologizing to Laura for not putting my underwear in the hamper--thunderous words boom down as though the heavens have opened. Maybe I should get work doing voice-overs.

DAY 30

No, I'm not God. But I'm certainly a new man. The month-long test drive I'd planned may have come to an end, but I intend to continue my affair with the patch for the foreseeable future. In fact, I'm already fantasizing about the far-off day when we'll be able to buy what I think of as the Dick Tracy patch--a high-tech version loaded with an array of hormones and medications, all under the control of a monitoring system that will read what you need and release it into your bloodstream accordingly.

As for now, I feel younger not only physically but mentally as well. I can attest to this because of the unexpected return of one of my old fantasies. Until about 10 years ago, each spring I'd have a yen to take a bus to Florida with my catcher's mitt and try out for a position with the Detroit Tigers. Thanks to the testosterone patch, I'm oiling my glove again, getting it properly supple. I know it's a wistful thought, a complete impossibility. Even so, I've started checking out the bus schedules. The sirens of spring are singing their alluring messages to me once again, and I hear them--or something in me does.

TALKING TESTOSTERONE

Testosterone is, perhaps, the key ingredient for manhood: the beef in the stew, the chicken in the soup. The dish requires additional seasonings and directions for it to turn out properly, to be sure. But without enough of the hormone, you don't get anything like the proper libidinous brew.

Testosterone is an undergone--literally, a "male maker." It's responsible for changing prototypical girls into boys early in fetal development: We all begin life as females, but the presence of a Y-chromosome tells testosterone to kick in around the seventh week and masculinize half of us., Later, at puberty, the hormone presides over a second transformation: the emergence of facial and body hair, muscle growth, libido, a deepening voice, and sperm production.

Although estrogen is the primary hormone for women, a dash of testosterone is essential for them as well. Although they secrete it in far skimpier amounts than men, women derive from K sexual desire, energy, assertiveness, elevated mood, and a sense of well-being.

Testosterone surges and ebbs daily in men, fluctuating every 15 to 20 minutes and normally reaching its peak around 7 or 8 A.M. It fluctuates seasonally as well: We all know the metaphor about sap rising in spring. Personal situations, culture, and environment also influence male testosterone levels, including social rank, competitive success, sexual cues, stress, and aging. Our body responds to our environment, but in predictable, programmed ways. Nature and nurture, utterly interactive.

During the male life span, testosterone peaks during fetal development, at birth, and at puberty. It remains high throughout early adulthood, dipping only slightly among men in their late thirties. At that point levels begin to drop by about 1 percent a year, declining by 30 to 40 percent by the time most men reach retirement age. After that it's downhill for the muscles, bones, and alas, the libido.

While the adrenal glands of both sexes, and women's ovaries, produce trickles of testosterone, the testicles of adult males make floods of the stuff--20 to 40 times what ovaries produce. Surprisingly, most testosterone doesn't do much of anything. About 95 percent of it is bound to protein molecules and is thought to be metabolically inactive. The remaining 5 percent is free to make the rounds, kicking up a good kiss here and there. This is the molecular juice that makes a man a man by triggering the actions associated with virility.

In men, the decline of testosterone with age is gradual. But in women, testosterone declines precipitously at menopause. While the simultaneous disappearance of estrogen is more urgent for women, the loss of testosterone matters, since it often results in fatigue and the decline of sexual appetite. As a result, many postmenopausal women find themselves in the middle of a medical quandary: Should they risk taking a dollop or two of testosterone to regain some of their sexuality, sensuality, and vitality? The question is especially difficult to answer since it I depends in part on the infinitely variable physical and emotional characteristics of individual women. Some doctors do treat postmenopausal women with small, carefully-dosed amounts of testosterone and see renewed libido. But other doctors are hesitant about carrying hormone therapy quite this far, citing, such possible side effects as the growth of unwanted facial and body hair.

Then, of course, there's the possibility that a woman's revived libido will so far out-pace her partner's that he'll find himself considering testosterone replacement just to keep up with her.

--ALFRED MEYER

PHOTO (COLOR): Can the new testosterons patch really rekindle a listless libido?

PHOTO (COLOR): ALFRED MEYER takes the patch out for a month-long test-drive.

PHOTO (COLOR): On the third day I felt bubbles of endearment toward Laura rising in my system. Something was definitely stirring.

PHOTO (COLOR): Lint circles appear where the patch adhesive used to be. It's kind of exciting--I look like a tattooed tribesman.

Science writer and former ferryboat captain Alfred Meyer wrote about Paxil in the July/August 1996 Psychology Today.