Testosterone and Its Discontents

That angry, raging warrior, Pete Hegseth is concerned about the testosterone levels of his armed forces.

The implication is that he does not want any low testosterone soldiers around, and, further, that we would be better served by high testosterone level soldiers, sailors and airmen.

The questions here are:

1/ Do higher testosterone levels result in better performance?

2/ What should the goal levels be?

3/ What would you do if you found a soldier who has testosterone levels lower than you think ideal?

4/ Females have testosterone levels which are typically only 1/3 to 1/2 that of males. Are they less lethal in today's battlefield? 

5/ And what is today's battlefield, anyway? If we put an incredible hulk on the field against a woman, will he defeat her or is he like the Abrams tank, huge and menacing looking, which is brought down by a small drone?

Part of the problem here goes beyond science, endocrinology and performance to an issue of language. "He's a low testosterone sort of guy," has become a trope of sorts for a man who lacks aggression, assertiveness, focus, sexual drive--a pale man, who is quiet, docile, who may respond but not initiate.

Those features may, in fact, accrue to men with low testosterone and, in fact, may ameliorate with testosterone therapy, but leaping to the conclusion that those characteristics are simply hallmarks of low levels is wrong.  There are men with lowish testosterone levels who are quite aggressive and bulky. There are men with testosterone levels at the upper range of normal who do not look intimidating. But, of course, those are not the men we focus on. The guys who stay fixed in our minds are the guys who got even bigger and more powerful by raising their testosterone levels sky high.

Ben John, Testosterone Works!

I would be the last to deny testosterone cannot improve athletic (and by extension, military) performance. The studies which exist, and there are precious few, suggest high levels of testosterone achieved with injections, which raise levels from a  normal of a total testosterone of 250-900 ng/dl (depending on the lab and the assay) to over 1200, will reliably increase muscle mass, strength and recovery. Free testosterone levels by mass spec/liquid chromatography are better assays, and they will increase from 50-200 to 200-800 with injections.

Looking at Sammy Sosa, Mark McGuire and Ben Johnson, I thought, "Uh-oh" seeing Sosa's facial acne, Johnson's huge biceps and McGuire's big trapezius muscles.

One of the most common referrals I got in practice was a man who looked like the Incredible Hulk sitting in my exam room who told me he was seeing me for his "low T."

What he had done, of course, was to stop his injections for  month and then he got his blood drawn, and his T levels were vanishingly low, because his testicles had shut down while he took injected testosterone. Then he gets his blood test and it's low. Why would he do this? Because he wanted me to prescribe a legal source of testosterone rather than his having to depend on a gym rat compounded version which was expensive and made in somebody's dusty basement.

What Hegseth Sees in the Mirror

The other side of the coin are elite female athletes. For the most part, in the few surveys which are available, elite female athletes have normal total and free testosterone levels for females--15-50 ng/dl. And they seem to perform remarkably well.

I don't know Caitlin Clark's levels, but whatever they are, she has enough to perform.

The fact is, there are at least 1,500 male track stars across the US who run faster 800 meter races than the world's record for any female runner who has ever run, and there are thousands more male runners across Europe, Africa and Asia who beat the world record for women.  Elite male athletes simply are stronger, quicker and faster than elite female athletes. 

Chris Evert, a sensational woman female tennis player, laughed when she was asked how she would fare playing against Jimmy Connors or any of the great men of her time. "I would not win a game, much less a set." When pressed, she said the power of the serves and volleys among the men was simply overwhelming.

So, I'll take it from her testimony, and from what little data we have, that testosterone makes a big difference in athletic performance. But there are other factors: male puberty, with it's effects on muscle, bone, brain, tendon is a potent factor. 

How Trump Sees Himself

But here we are talking about huge differences in testosterone levels when we talk about male v female. How much difference differences of 100 ng/dl among a male cohort would make is totally unknown. Putting more gas in an already full tank does not improve the performance of the engine.

Male wrestlers lose weight, train relentlessly and often sleep poorly all of which likely lower their testosterone levels, and yet they are beasts on the mat. Once you get above a certain threshold of testosterone, it's not clear smaller differences matter much, Once you reach a certain level of many things, additional increments result in only diminishing returns: Does a seven foot basketball player really have much advantage over a player who is two inches shorter?

The issue of whether female soldiers are in the same position as Chris Evert is lurking behind Mr. Hegseth's focus on testosterone levels. I would bet on a male warrior in a knife fight, all else being equal (training, size, nutrition), but as we have seen in Ukraine, most war is not fought with knives in the 21st century. Most women soldiers have guns and famously the best snipers of World War II were women.

Male Puberty

There has been an online gossip about "steroid rage" among men who have raised their testosterone levels into the stratosphere, and then beaten up their wives, friends, policemen, whoever. Maybe that's a real thing. Likely not, but maybe. If it is real, however, the question comes back to General Patton's famous remark to his soldiers: "I do not want you dying for your country. I want you to make that other poor bastard die for his country and we can kill him and win."

Testosterone level below 100. Still lethal.

Mr. Hegseth seems to have forgotten that rage and a rebel yell do not win wars.

Hegseth and Testosterone

 

Secretary of Defense/War/Superheroes, Pete Hegseth, is going to test his soldiers, sailors and airman for their testosterone levels.

He has not said if these tests were limited to males, or individuals with an XY chromosome complement or whether individuals with XX chromosomes, or women in common parlance will be tested.

The Secretary, answering questions about why he might want to know the testosterone levels of his warriors, said he did not intend to treat soldiers who fall below the median levels with testosterone injections. But he wouldn't be opposed to soldiers increasing their levels with testosterone injections.

Or something to that effect.

He did not make his own testosterone levels available to the press.

He has not released his SAT scores, either.

Nor has he released his biceps measurements in inches.

It is not clear if he has grown hair on his back or what his testicular size is. 

The thing about testosterone levels  of which Mr. Hegseth seems unaware, is that testosterone levels are not stable, like for example, cholesterol levels or red blood cell counts. Most men have a diurnal variation--highest around seven A.M. and lowest around 4 P.M. Levels vary across days of the week. When endocrinologists are trying to figure out which men have low testosterone levels, they ordinarily draw at least three levels over the course of two to three weeks. In fact, insurance companies require at least two levels before they will pay for testosterone replacement.

Other levels are germane: pituitary levels of the hormones which rise when the testicles fail to keep levels where the pituitary wants them to be, but Mr. Hegseth does not know about these, and he does not want to test them.

Mr. Hegseth has apparently heard about testosterone, but just as obvious, he has not read much about it. Nor has he actually bothered asking people in the field much about testosterone. He may have found some endocrinologist who thought it might be a good idea to screen for testosterone among military servicemen, but you can always find some doctor somewhere who will say crazy things--in Trump World they seem to have set out baited bottles and collected wacko doctors like mosquitoes in blood augar jars. That guy in Florida, Dr. Joseph Lapado, who does not believe in vaccines or COVID 19 and who thinks that vaccines boosters diminish immunity, that mRNA vaccines alter a person's own DNA among other bizarre beliefs. RFKJR, who is not a doctor but plays one on TV believes polio vaccines killed more people than they saved. 

So, expertise is, apparently, in the eye of the beholder and to Mr. Hegseth's eyes, jacking up testosterone levels will win the war in Iran, and make America safer and strike fear into our adversaries. 

Secretary Hegseth is no endocrinologist. But that does not mean he doesn't have an opinion.

Oh, How Speciale

 

Thomas Speciale is, by his own account an expert in terrorism and counter intelligence.

Mad Dog just ran across a Youtube of his testimony before Jared Moskowitz, Congressman from Florida, in which Mr. Speciale explained that most of the protestors who stormed the Capitol on January 6 were military veterans or policemen who invaded the Capitol not because President Trump had exhorted them to do just that just minutes before, but because, when they arrived at the Capitol, intending only to peaceably assemble, the Capitol police sprayed them with a gas and then their military and/or police training kicked in, and they reacted, as the government and the military had trained them to react, through no fault of their own,  by forcibly attacking the Capitol police, over turning the barriers, scaling the walls, breaking through windows, running through the halls of Congress, smearing fecal matter on the walls.

 All that because that's just the way they were trained to react by the military and/or the police.

Mad Dog thinks he's seen this movie before but he cannot recall exactly when.

They were simply doing what superheroes do when threatened, reacting as they were trained, because, you know, they are simply lean, green killing machines, macho men, who are really dangerous when aroused or triggered, or sprayed with certain sorts of gas.

So, it wasn't their fault, January 6th. It was the fault of the police who triggered them. 

Mr. Speciale rejected the question about their gallows and noose for hanging Mike Pence as an asinine and irrelevant question because, presumably, the hangman thing did imply a premeditation and planning and purpose which did not fit his, "they were triggered" story.

Looking at this shaved head beefy guy,  with his supporters sitting behind him looking like extras from the movie "Deliverance," we can see who Trump has got ensconced into positions of power, with their hands on the triggers. 

Right out of central casting. 

The self styled special ops intelligence guy projects the muscular aggressive stuff Pete Hegseth wants in all his military officers.

Below is his list of qualifications, as he presents himself:

Thomas A. Speciale II serves as the Senior Advisor for the Director of National Intelligence at the National Counterintelligence and Security Center (NCSC).  He is a career intelligence officer, having served across the U.S. Intelligence Community—

in and out of uniform for over 20 years.

Mr. Speciale cut his teeth working strategic military planning and counter terrorism 

at the Defense Intelligence Agency. He previously worked at the Office of the 

Director of National Intelligence (ODNI) in various capacities, including at the 

National Counterterrorism Center and National Intelligence Management Council.

Most recently, Mr. Speciale served at the Pentagon, where he supported our 

warfighters and the Intelligence Community at the Irregular Warfare Technical 

Support Directorate under the Assistant Secretary of Defense for Special Operations/Low-Intensity Conflict.

This is the type of looney tune champion who surfaces from under the rocks when guys like Trump and Hegseth get into office. He did not just serve; he "cut his teeth." And he supports not just ordinary soldiers but "warfighters," as a special ops guy, which, you know, from the movies, are like Navy Seals or real tough guys.

The Youtube is worth watching just to see how cunningly Mr. Moskovitz is able to taunt Mr. Speciale into launching his Jeremiad. But, it is ultimately no fun because Mr. Speciale is simply not smart enough to know how deeply he has dug his own grave.

It's a sort of "A Few Good Men" moment, when Colonel Jessup erupts, "You can't handle the truth!" But in the movie the colonel understands his eruption is in a courtroom and he will be judged guilty. Mr. Speciale isn't even that special.