The physician talks hormones, health literacy, and the trouble with "endopreneurs."
In her book Aroused: The History of Hormones and How They Control Just about Everything, physician/author Randi Hutter Epstein, writer in residence with the Program for Humanities in Medicine at the Yale University School of Medicine, tells the stories of people affected adversely by hormones. As she points out, what we know about hormones has been learned in the last hundred years, and our harnessing of that information has allowed us to control — or at least impact — everything from what we look like to what turns us on.
Aroused tells the story of the people who study the secretions of internal organs, and people with problems because of those secretions. What led you to share these stories?
I share the patient and scientist stories because I think we all learn better from stories rather than a list of facts. I know I do. I also like readers to get a variety of perspectives — from the scientist point of view, the clinician, and, of course, the patient who has endured the ailment or the treatment. I usually ask myself, “What’s the topic?” Then I ask, “What’s the story?” And, lastly, “Why am I telling this story? Why now?” Sometimes, I write that in a large font on the top of my page as I begin to write.
Often, it is desperate people or daring scientists who move our thinking and practice. What moves people to rebel in healthcare?
Passion plus fear. When it comes to desperate patients, they are worried about themselves, or perhaps were not happy with the experience they had with their own clinicians. That pushed them to take matters into their own hands — sometimes forging a path for the good of themselves and for others. Sometimes it led to dangerous decisions.
As for scientists, they are also, at times, compelled by a personal story. Or sometimes because they are frustrated with the pace of things. Again, sometimes they took leaps of faith which resulted in huge advances in our understanding. Other times, they — as flawed humans, as we all are — made mistakes and sent scientific understanding and treatments in the wrong direction.
But I think that’s what interests me: not just the story of one advance after another, but the decisions that both patients and doctors grappled with; what they did when they hit a fork in the road; and how sometimes we went along on a smooth path and sometimes we hit bumps along the way.
The incredible discoveries and outrageous claims from “endopreneurs” concerning hormones are both fascinating and concerning. How should public statements and scientific claims be vetted or reviewed?
I think we need more scientists and writers to communicate science accurately to drown out all the hoaxes. We also need more regulation over supplements. When something is a drug, there are strict guidelines about what you can say it does or doesn’t do. We need to teach science literacy in schools so [that] children aren’t duped.
How much science should the general public understand?
All of it. That should be my short answer. But I do think that communication between scientists and the population at large is crucial to appreciate the ever-present uncertainties in decision making, and to value what good scientists do to help us appreciate our complex bodies and the decisions we make to prevent disasters both within ourselves and the world at large.
Should our view change of people whose deviant behavior has an endocrine aspect to it?
For years, we’ve been trying to understand the brain chemistry of criminals and deviant behavior. I applaud these efforts — the research is fascinating. But understanding chemistry gone awry does not make a guilty person innocent. Ideally, we would be able to pinpoint faulty brain connections early on and fix them. Then we would have an ideal world. Researchers have tried. I write about them in Aroused. But, so far, we haven’t been able to understand humans well enough to create a perfect society. While we do agree about certain inhuman behavior (murder, for instance), I’m not sure — even if we had the ability to do it — whether we would agree or should agree on the perfect human traits and design ourselves accordingly.
There is a strong relationship between hormones and issues related to sex, from the development of males/females to sexual desire and, ultimately, aging. How close is the relationship between sexual issues and hormones?
I think we are understanding more and more the relationship between hormones and the development of genitalia and glands. We are beginning to unravel how these early hormonal surges in the fetus impact the developing brain. We know there is a big difference between gender identity (how you consider yourself) versus sexual desire (to whom you are attracted). I think we are learning, for sexual desire, that we are our chemistry. So, yes, attraction has to do with our inner chemistry and that of the person we lust/lure. But I’m not sure we will ever boil that down to a mathematical formula of hormones.
Have hormones made the world a better place?
We are our hormones, so they have made us who we are. We are, after all, our chemistry.
[Photo by Nina Subin.]
Tyler Cymet, DO, is the chief of Clinical Education at the American Association of Colleges of Osteopathic Medicine and is a clinical associate professor at the New York Institute of Technology, College of Osteopathic Medicine and sees patients in the emergency department at the University of Maryland Capital Region. He is also the author of Health Info to Go: General Medicine and Addictionary: Guide to Drug User Terminology.