Steph's Place

Book Review: - Testosterone. The Story of the Hormone that Dominates and Divides Us, by Carole Hooven.

By Steph


All trans women like me know that "T" (testosterone) is the enemy. 

We all should know our enemies, and trans women have more than most. Some wish to completely eradicate us from this earth, such as one Republican politician, Robert Foster, who tweeted that a firing squad should execute all transgender people. Others, over thirty thousand worldwide, wish to eradicate trans women, supporting a document known as the "Women's Declaration". In short, these people don't want a trans woman like me visible because I give the name 'woman' a bad reputation - allegedly taking away "sex-based rights". 


For all its hate, Twitter has one tremendous benefit: we can bump into some pretty amazing people that we would never get to meet otherwise. This was the case when I met Carole Hooven (PhD), a Biologist who lectures at Harvard University and the author of 'Testosterone - The Story of the Hormone that Dominates and Divides Us'.

"I will review it", I said to her in a tweet - not knowing exactly where that would lead me. More bad news for the trans community? 

I prayed that was not the case. 

Fortunately, as I read the first pages, I was 'hooked' - Carole certainly knows how to write a great book. Her tale about collecting urine from chimps (our closest relative) in the jungle and how male chimps abuse female chimps were fascinating. 

"Really, I longed to understand men", writes Carole on page nine. - yes, don't we all, I thought - knowing what men have done to women for the last two thousand years and counting. 

The first chapter explains much of the basics, that men commit 95% of all murders (the exact figure for the UK is 4.89%) and that, in essence, we are all different. One small note here - there is significant evidence that the 4.89% stat would be substantially lower if it were not for male domestic violence and coercive male behaviour! 

 I enjoyed the references in this chapter to how men have shaped history - yet (as an observation), when we look back at our British monarchy on balance, the women (the two Elizabeths and Victoria) stand out. 

Strange that. 

 Carole does a great job of politely critiquing Charles Darwin and ends by saying, "Darwin, for all his greatness, got some important things wrong". The chapter also touches on eugenics, an essential issue in my view; fascism is starting to creep back worldwide - and human rights are being rolled back!    

 The book continues to explain that testes, the main driver of T in "males" (I do hate that word "male"), is not always housed externally - explains about eunuchs and castration and the origins of endocrinology. I found this chapter of Carole's book riveting.

 She then sensitively explains about people born with DSD (formerly known as intersex), rightly saying: "Masculinity and femininity don't always come in the packages we expect" - before then explaining about the "Baking of boys and girls". I loved her analogy of making cookies, pointing out that a tiny tweak to a recipe can make a massive difference to the final result. Some sections of Chapters Three and Four I found challenging to understand - perhaps forgivable given that biology and trans people are a toxic relationship. We live our lives by gender, not by binary biological sex, which many of us reject.  

Biology (in the purest form, I would argue) is not destiny - if it were, the LGBT+ community would not exist. Not every female is attracted to males. Not every female believes she should be female. 

Chapter Four centres on "T on the Brain" - and quickly mentions "males" protruding Adam's apple - a secondary characteristic that occurs at puberty. Carole mentions the Adam's apple a few times in her book. So much so that I started to search for mine. In fact, I don't have one - I am not even sure I went through puberty, the only clue being I did grow hair on my face and body, and my voice dropped a bit. Other bits of me appear to be more female than male. We are indeed all different.

 Carole's comprehensive explanation of a condition known as 5-ARD is sensitive and kind. She quotes a medical research report, cited nearly five hundred times, saying:

"Her data demonstrated that androgen (i.e., testosterone) exposure of the brain in utero during the early postnatal period and at puberty has more effect in determining male gender identity than does sex of rearing. I felt the sentence opened up a wide range of other possibilities. 

I learned from Carole's book that the scientific community sometimes doesn't always agree, so while I readily accept what Carole wrote is, in her view, accurate - there may well be some bright spark who disagrees. Indeed, a little further in this review, I will counter just a couple of points she raises. Carole also devotes several pages to a condition known as CAH, saying "that it affects the health of both males and females, but significantly affects the behaviour of girls only".

Chapter Five is covered later in this book review, and so on to Chapter Six, where Carole explains her time studying deer in Scotland. It is one heck of a story and proves (not that it needs proving) that Carole is very dedicated to her work. The castration of three deer to see how they changed behaviour was fascinating. This chapter also covers other animals' behaviour. Chapter Seven continues the theme of behaviour but this time centring on men - or to be exact violent men. Having written, for over one year, about the murders of 125 women, this is a subject I have some knowledge. In the end, it affected my mental health as researching the murders of so many innocent women became very upsetting. Carole incorporates many stats and points out that T affects aggression but not in all men; much depends on "receptors". She points out that the behaviour of men in Singapore is different to other countries - meaning we have cultural lessons to learn. How can that be achieved? 

I am not so sure. 

 Chapter Eight talks about sex, but one sentence (again, because I am trans) rebounded on me, saying:

  "As the figure above shows (and as we saw in Chapter Three), way back in the womb is where sex differences in T starts - boys are exposed to much higher levels than girls, at as early as eight weeks of gestation. This higher T masculinises the brain."

I know this to be true - but sometimes, things go wrong. In part, this is what makes us all different. Sexuality is also covered in this chapter - why are you possibly lesbian, gay or bi? Read the book. 

But back to those couple of chapters, I've missed out in this book review. Here things get a bit juicy!

Chapter Five is titled "Getting an Edge" with Carole discussing folk with abnormalities (DSD and trans folk) competing in a sport. She explains in full the issues around 5-ARD, that athletes have internal testes producing T and also clearly explains women in sport with a disorder called PCOS. She clearly shows the potential advantages that extra T gives to athletes. 

As someone who is passionate about everyone being able to compete in the elite level of sport, much of this chapter was a challenging read. In the UK, we are saturated with national newspapers (virtually all that are transphobic) telling us how unfair it is for an American university trans women swimmer to participate in women's sport. They are happy for her to race men, where of course, because of her transition and near zero T, she would be left dozens of metres behind. I find it reprehensible that since 2004 when trans athletes were allowed to participate in the Olympics, just three trans people out of some 71,000 Olympians have taken part - and the one trans woman who has competed, well, she came last!

Trans rights are human rights! 

 Sadly, there is no end to this nightmare for trans women, and Carole's book doesn't help pointing out that even if T is lowered, a potential advantage may be maintained because of that DAMN puberty. An alternative to Carole's opinions can be viewed by clicking HERE

In truth, the "sports debate" in the UK is somewhat academic. Statistics from UK Sport (November 2021) reveal that just 63 athletes across the country have applied for inclusion in relating trans policies - covering just 31 different sports.

Still, we don't hear the story that 80% of the UK trans community (around 390,000 people) who experience a hate crime every year. Would you play sport if you were likely to be abused? 

I think not.

Two years ago, I wrote an article saying a trans woman would never win a Gold Medal at the Olympics in my lifetime - I stand by that two-years on. This makes me very sad. 

In 'Testosterone - The Story of the Hormone that Dominates and Divides Us', Carole states that she doesn't know the answer for people with high T levels competing in sports. She takes no specific position on trans women in sport – she is more concerned about science and unbiased reporting.

She also states that testing methods are not always accurate or indeed fair. Like society, sport is very split. 

I think we should aim for the inclusion of all people - (including those with impairments), not exclusion. Other participants' safety is, of course, paramount, but advantages can be compensated against in some (but not all) sports.   

Chapter Nine is all about trans people. A subject I know all about. You tend to be an expert on something when you are that something!

Carole approaches our existence with sensitivity and care, saying:

"Many trans people suffer, or have suffered, from "gender dysphoria" - distress and anxiety about features of one's sexed body and the gendered ways in which one is perceived by others. It might be hard to imagine how that feels. As an imperfect analogy, consider how discomfort with various physical traits could affect your own mental health". 

In this chapter, she relates the life stories of a few trans people. She also touches on de-transition. In truth, I think she goes overboard on this issue, suggesting there is no significant data. I'm afraid I have to disagree with Carole, as per this report from Holland - click HERE

The issue is, of course, are people who de-transition reporting this fact to their clinics? Are the stats from Holland 100% correct? Or do some who de-transition then transition again? Certainly, I have a Twitter follower that has done exactly that! As a community, we have a responsibility to support people who de-transition because, like us who adored transition, they are human beings who deserve love and respect.

I have no scientific data to back up my opinion – but from what I have witnessed, virtually all the de-transitioners have been natal females, invariably aged between 17 and 26. The one thing no one wants is for people to make a mistake, though we must equally accept some mistakes are certain to occur - simply because human beings do make mistakes. 

Carole explains the effects of T in puberty brilliantly, and I was particularly impressed by her analysis of the voice and vocal folds. Nothing for me to learn here (I sing Alto and have taken singing lessons for years, so know about how the voice works) - but a fabulous clear explanation for her readers.  

Another contentious subject that Carole tackles head-on is that of puberty blockers.

In my view, she makes a good case for them, and while she may wish to come across 'as neutral', I am not so sure she succeeds by saying:

"Puberty leaves indelible marks on both males and females, which make physically transition after that more challenging, and perhaps more important there's the agony of puberty itself." She also says, "Puberty blockers are then (largely) temporary and reversible interventions."  

To be clear; in conversation with Carole after I wrote the draft of this book review, she now tells me this:

[I now wish I hadn’t written that sentence, because when taken out of context, it implies that there are no issues with blockers. But I spent significant time discussing the evidence that there are some potentially serious issues to consider. But I did write it, so I can’t deny that. I do think that blockers make sense for some people! Like some of the people I interviewed and other trans people I know. But nobody should take them thinking that they are reversible because they are not. There are some serious effects, and I hope that you would want young people, in particular, to know what the science says].

 She ends her considerable input about puberty blockers in her book with these words:

 "I should emphasise that this book is not meant to provide any medical advice. Particularly where blockers are concerned, parents and caregivers should consult with qualified professionals, preferably getting a second or third opinion. But one thing is clear: to provide the best support possible to young people who are making these life-changing decisions, much more research is required". 

 I was left with the feeling that this paragraph was an attempt at a "get out of jail card".

The simple fact is that with sporting federations starting to come out with guidance that trans kids must not experience puberty from Tanner Stage 2 onwards - puberty blockers have become an absolute necessity for some trans kids.

Further, they have been prescribed for decades without any significant issues, at least concerning precocious puberty. Our (not very scientific) research at Steph's Place UK suggests that 61% of the trans community know well before puberty that their gender doesn't match their sex. Further, I talk to the parents of trans kids regularly and know full well that puberty blockers are prescribed far too late in the UK and invariably have no meaningful effect. 

I want to emphasise that for most trans people who medicalise, the vast majority are happy with transition. The blocking of T and replacing it with E (Oestrogen) has been a lifesaver for me and many others like me, and I can't imagine de-transition. My brain has undoubtedly changed, but only for the better - these days, I can multitask, concentrate better and am significantly more relaxed and happier. For sure - my sex life is non-existent, but I don't care. 

To wrap up: 

My admiration for this amazing book comes with a health warning for trans folks. If you are dysmorphic or stressed out, I am not sure you will cope with some chapters in Carole's book. Although written in a sensitive and caring way, Carole is ultimately a biologist, and I have felt your pain. I don't think you should read it unless you accept the realities of sex. As a comforting thought, though - society recognises sex by gender expression - clothes cover genitals.  

Trans folks are, however, a tiny minority, and I hope this book becomes a best seller. 

It is beautifully written and goes into excellent but largely understandable detail regarding scientific information. It is a book I couldn't put down. I usually read in bed, and normally after a few pages, I go to sleep - damn it - Carole's book kept me awake until the early hours!

I also liked how Carole kept referring back to key points she raised in previous chapters - it helped to piece everything together. 

Men can learn so much about their shitty sex from this book - and women will learn about what drives them. Let's not forget that the root cause of virtually every crime and pretty much every single war in history is men!

So, while I agree there are some decent men on this earth, one benefit of free speech is I can say that as a sex class, I do not like men. I think I have every right to say this - as a child, I was sexually assaulted by a man. I never discussed this with anyone for over fifty years, feeling dirty and ashamed. Looking back, I was lucky to escape with my life. Some two decades later, I was attacked in the street – needless to say, my attacker was a man. Fortunately, all my working life, I have worked closely with women, often involving maternity and kids issues.

I genuinely feel the world would be a much better place if women dominated parliaments and the workplace.

To conclude. This book review was written up on the 22nd of July 2022. I had read every word in Carole Hooven’s book Testosterone - The Story of the Hormone that Dominates and Divides Us, and some chapters I have read twice. On the evening of the 26th of July, I started reading this book again – yes, it is that good!

I’m soaking every word - taking time to research the scientific bits that I don’t understand. Information is power – and as I stated at the start of this book review – trans women like me have enemies.

I protect myself (and hopefully others like me) - not with swords... but with words.


 A little about me: I am a post-op trans woman in my early seventies. I am a co-founder of Steph's Place UK, a trans-led human rights organisation nominated as a finalist in the 2022 UK National Diversity Awards.

In June 2022, BBC Radio Four platformed me defending trans human rights, with a live audience of 600,000 people. You can hear me speak by clicking HERE. I am the 2021/22 women's officer a Portsmouth Labour Party, and I campaign for trans and women's rights and women (especially pregnant women) in prison.

Steph Richards July 2022


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