Randi Hutter Epstein’s new book, Aroused: The History of Hormones and How They Control Just About Everything, traces the development of our scientific and medical understanding of hormones from the late nineteenth century to the present. Each chapter focuses on a different hormone, linking the science of endocrinology to fascinating details about the social context that shaped the science.
Randi is a historian, science journalist, and medical doctor, and she’s also the author of Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank. We recently sat down for a great conversation about Aroused.
Lara: When I read your book, I thought about historian Barbara Duden’s description of women’s experiences of humoral, “flowing” bodies in 1730s Germany, and anthropologist Emily Martin’s work on the ways we came to understand our “selves” in terms of our immune system. In a way, your book is a story of us-as-hormones or hormones-as-us.
Randi: Before 1905, we didn’t even have the word “hormone,” so we couldn’t think of ourselves that way. Before the 1900s, we also didn’t think of ourselves as this mind-body connection, where changes in your body chemistry affect your mind. Today, we tend to think of “hormonal” as “I’m feeling cranky, something’s wrong,” without realizing that we are hormonal every day. We are hormonal in terms of our hunger, and our libido, and our drive, our energy. (That isn’t to say that that’s the only thing controlling us)….
My goal is to dispel some of the simplistic idea that “this hormone controls hunger, that hormone controls sex drive, that hormone controls growth.” The image in your head shouldn’t be so much of the starting gate of a horse race, where each horse has its own chute to run in. It’s more like a cobweb. It’s really complicated.
Lara: I love all of your analogies in your book; they really illuminate the science for me.
Randi: I think doctors speak in metaphors frequently — it was a big part of my medical training that helped me understand the body. [As a journalist] I think metaphors help readers picture what you are trying to explain. Sometimes you have to fiddle with the metaphors.
So for instance, when I was learning about the immune system in medical school, we learned about antigens and antibodies fitting together like a lock and key. That’s the way I figured hormones latched to their receptors, like jigsaw puzzle pieces.
Researching the book, I came to realize that that’s not quite the right image. They sort of bond, but more loosely, not locking in. I just couldn’t help but think of slow dancing at a high school prom, with someone cutting in for a bit. So that became my dancing metaphor for describing hormones and receptors in the book.
Lara: What were some of your goals with this book?
Randi: There hasn’t been a history book that looks at hormones in this kind of long narrative arc. I wanted to tell that story to readers who do not have a professional historical or scientific background.
Also, a lot of the books on hormones for a non-specialist audience are self-help guides, telling people which hormones to be on, or to avoid hormone-based medical treatment altogether. Hearing lessons from the past, the missteps we’ve made, might make us a little more fearful of doing certain things, but if your doctor says you’re low in a certain hormone, you shouldn’t be too fearful, freak out, and insist that you only want all-natural remedies.
Lara: You point out that almost 100 years ago there were organotherapies that look awfully like some of the hormone therapies that are being peddled now, so that should make us skeptical, and yet at the same time, we’re in awe of what we now understand hormones can do.
Randi: So many people are looking for the quick fix — some drug to boost energy, mental clarity, sex drive. Something to shed those unwanted pounds. If a health provider says, “I’ve got some hormone cures to balance you,” it may be too tempting to resist. I want my readers to learn to separate the marketing from the medicine. Am I poo-pooing hormone therapy? No. But I am knocking quack cures.
One of the stories that didn’t make it into the book is the story of a young man whose pituitary doesn’t connect to the rest of his body. If this child had been born 100 years ago, he wouldn’t have died, but he would have been cognitively impaired and never gone through puberty. Now, this kid is a brainiac star student, because he was able to see a pediatric endocrinologist, and all of the hormones that he needs, from thyroid growth hormone to testosterone, can be monitored and given to him, and he can live a normal life.
At one point, he told his endocrinologist that he didn’t want to take growth hormone because he didn’t care about being the biggest kid in his class, and his doctor explained, “no no, you need growth hormone for your metabolism, for insulin, for when you go through puberty, they’re all connected.” So we’ve done some amazing things, even while there’s a lot of wacky stuff that still goes on. I want people to be cautious, and ask good questions, but then know how to weigh the risks and benefits of what they’re doing.
I also want people to understand, when they get annoyed that medical advice flips over the years — it’s easy to feel as if the doctors lied to us, or they did a stupid study one year and now we know the truth. But really, we live in a world with fluctuating scientific information.
Anyone who has ever been ill with something chronic knows that your doctor will say, “this is what we think is the best now,” but you hope your doctor is going to keep up with the science, and you’re going to keep up with the science, which might mean tweaking something, or realizing that something was higher risk that you expected. Knowing the longer arc of history helps us engage knowledgeably with the ways science and medicine evolve.