Dr. Testosterone and Mr. Steroids

In the 2000s, the media painted two pictures of the same drug -- and overlooked a budding crisis among teen girls

In 2022, US Senators Ed Markey and Elizabeth Warren (both Democrats from Massachusetts) called for President Joe Biden to make testosterone easier to access:

“Congress’s response more than 30 years ago to testosterone’s non-medical use by athletes has inadvertently created health and criminal justice barriers to gender-affirming care today.”

Indeed, Congress banned synthetic testosterone use in 1990. But legislators called it something else: steroids.

In the 2000s they went on the warpath again, investigating the use of this dangerous drug in pro sports. At the same time, steroids were becoming popular on the street not only for building muscles, but also for melting thigh fat. Meanwhile, transition caught fire among lesbians, whose doctors prescribed them “T.”

The media reported on all three developments. But journalists didn’t acknowledge that “anabolic steroids” and “synthetic testosterone” were the same thing, and they didn’t follow up on evidence that teen girls were using the substance — under both its names.

So the coverage proceeded along two parallel tracks. Steroids were treated as a grave public health threat affecting competitive athletes and bodybuilders. Testosterone was treated like a wonder drug for cheeky lesbians out to cadge male privilege. (Unlike in later years, journalists did not suggest that these women needed T to ward off suicidal ideation.)

There seems to be an unstated assumption in these pieces that female bodies are the same as male bodies, except with less testosterone (roughly 5%). By that logic, women should be able to tolerate an increase. One journalist argued all women should consider using testosterone to make up for their natural deficit. His essay was printed in the New York Times Magazine.

Reporters missed omens and screaming red flags in their own articles. You can see at-risk teen girls in the margins of the steroid coverage, and intoxication and homophobia between the lines of the FTM stories. 

In this post I’ll place major events and stories about steroids/testosterone on a single timeline. This format reveals horrors that were hidden in plain sight by journalists who used two different words for the same thing.

(Note: anabolic steroids are not to be confused with corticosteroids.)

What We Know in 2024 About Steroids

According to the US Drug Enforcement Administration, steroids can cause: 

• “High cholesterol levels, which may increase the risk of coronary artery disease, strokes, and heart attacks,” 

• “Lengthening of the clitoris,”

• “Acne,”

• “Dramatic mood swings, increased feelings of hostility, impaired judgment, and increased levels of aggression,” and

• “Psychological dependence and addiction.”

The UK’s National Health Service explains:

“Anabolic steroids are addictive. This means you can crave the drug, require more to get the same effect, and have withdrawal symptoms if you suddenly stop taking it. A person who is addicted to anabolic steroids will want to keep using them despite experiencing unpleasant physical side effects.”

The American College of Obstetricians and Gynecologists (ACOG) warns that steroid use in women can:

• “Significantly increase the risk of cardiovascular disease and thrombotic events, including venous thromboembolism, stroke, and myocardial infarction,”

• Cause “irritability, hostility, mood changes, personality changes, and psychosis,” and

• Cause “tendon injuries” due to “changes in the biomechanics of limb movements.”

ACOG supports “gender transition care” but notes that:

“Testosterone commonly will cause vaginal tissues to atrophy ... These tissues may be more susceptible to small amounts of tearing and changes in microbial environment, resulting in increased risk of bacterial vaginosis, cystitis, cervicitis, or dyspareunia.”

Toronto’s Centre for Addiction and Mental Health (CAMH) warns:

“Steroids can produce a variety of psychological effects ranging from euphoria to hostility. Some people who take steroids say the drugs make them feel powerful and energetic. However, steroids are also known to increase irritability, anxiety and aggression and cause mood swings, manic symptoms and paranoia, particularly when taken in high doses.”

(CAMH is known for its child gender clinic, where psychologists like Ken Zucker have supported minors in transitioning since the 1970s.)

Reporters, whistleblowers, and lawyers have documented side effects in women and girls who used steroids to transition, such as:

• Vocal cord damage that causes pain and disables the woman from singing or screaming (irreversible);

• “Bottom growth” that makes sex painful and causes the clitoris to chafe against underwear (irreversible);

• Male-pattern baldness (irreversible);

• Inability to cry;

• Overwhelming sex drive leading to risky behavior and pornography addiction; and

• Vaginal dryness, pain, and bleeding.

94% of young women using testosterone to transition experience pelvic floor dysfunction, according to a recent study. This means they suffer symptoms like wetting the bed or losing control of their bowels.

Detransitioners report emotional problems that appear linked to testosterone. For example, when she was using T, Helena Kirchner felt “numb for months” and experienced frequent “rage”: 

“I felt like my body would explode if I couldn’t hit or throw something … I resorted to hitting myself.”

Still female, after all.

You might ask whether the “steroid” users discussed below are on higher doses than “testosterone” users. Journalists did not ask that question. But it’s evident from their reporting that the “testosterone” users are experiencing the drug’s psychoactive effects.

And now, the timeline of steroids and testosterone.

1986

The term “roid rage” is coined to describe outbursts of aggressive behavior by steroid users, as bodybuilders gain a reputation for using the drug and committing violence.

1990

After holding hearings on steroid use by elite athletes, Congress classifies this family of chemicals as “Schedule III” controlled substances. The bill’s primary sponsor is Senator Joe Biden.

1996

The British Medical Journal reports on a study in which “most of the steroid users studied showed abnormal personality traits, including being paranoid, schizophrenic, antisocial …”

1997

The San Francisco Chronicle runs a feature by David Tuller on FTM activist Jamison Green (I’ve written about her “self-confidence”). Tuller lets Green explain the medical aspects of testosterone:

"First was an increase in libido. In four weeks, my voice started to break, and in eight weeks, my menstruation had stopped. And I felt calm, centered, grounded. I thought, 'This must be what normal feels like.' This was something my body was ready for."

Tuller attends a meeting of FTM International, the org that Green leads, and quotes an FTM’s account of telling her father she is transitioning:

"’I told him, The good news is, I'm not a lesbian,' he says. From the raucous laughter that follows, it is clear that many of the guys previously lived as lesbians, and that their parents frequently had difficulty accepting the situation.”

Green’s girlfriend notes that her mother was thrilled to see Green’s clean-cut photo because she had previously dated “a parade of long-haired androgynous hippies, struggling musicians, and several women[.]” 

1998

Sports Illustrated reports on the unlikely number of bodybuilders accused of murder, naming steroid use as a possible catalyst. One of the intoxicated murderers is a “strength champion” and wrestler, Sally McNeil, who shot her husband. She later accused him of hoarding all the “best steroids” so she had to take “the leftovers.”

A Harvard Medical School expert on steroid abuse relates the symptoms of the “manic syndrome” they can cause:

"euphoria, expansiveness, grandiose feelings, decreased need for sleep, irritability, racing thoughts, pressured speech, reckless behavior and aggressiveness."

1999

Lesbian Norah Vincent profiles FTM Drew Seidman (formerly Susan) in the Village Voice. She lets Seidman explain how testosterone works:

“He says he thinks that it’s mostly a myth … that testosterone causes undue aggression to manifest itself. On the contrary, he says that testosterone has had a calming effect on him, which may be in part because the rage and confusion Susan felt as a woman has been mitigated by becoming a man.”

(When journalists defer to FTMs’ description of testosterone’s effects, recall the NHS’s warning: “A person who is addicted to anabolic steroids will want to keep using them despite experiencing unpleasant physical side effects.” She might not be a reliable narrator.)

Seidman says her “sex drive went through the roof” on testosterone and she “felt like I had to have sex once a day or I would die.” She says she is now “really into porn.”

Trans activists attack Vincent over pronoun hygiene. She responds, accurately, “that piece was a paean to transsexuality[.]” 

2000

In April, gay journalist Andrew Sullivan gushes in the New York Times about the wonders of testosterone, which he has been prescribed to treat complications of HIV:

“I can actually feel its power on almost a daily basis. Within hours, and at most a day, I feel a deep surge of energy. It is less edgy than a double espresso, but just as powerful. … My wit is quicker, my mind faster, but my judgment is more impulsive. … In a word, I feel braced. For what? It scarcely seems to matter.”

Sullivan recounts hitting his beagle in a park and then almost punching a man who chastised him for it. He admits “losing my temper in a petty argument; innumerable traffic confrontations; even the occasional slightly too prickly column or e-mail flame-out.”

Sullivan speculates about how women’s testosterone deficit makes them miserable. For example, regarding the antidepressant effect of T:

“[I]t probably helps alleviate gloominess primarily by propelling people into greater activity and restlessness, giving them less time to think and reflect. (This may be one reason women tend to suffer more from depression than men.)”

Considering the huge gap in male and female testosterone levels, if this were accurate then you’d expect to see all women mired in sluggish rumination, and all men dancing and kicking each other all day.

Sullivan identifies litigation as a high-testosterone profession, then later remarks, “it makes sense that women will be underrepresented in a high-testosterone environment[.]” This low-T litigator snorted. But Sullivan seriously believes what he’s saying:

“A modest solution [to sex inequality] might be to give more women access to testosterone to improve their sex drives, aggression and risk affinity and to help redress their disadvantages in those areas as compared with men. … Its use needs to be carefully monitored because it can also lead to side effects, like greater susceptibility to cancer, but that's what doctors are there for.”

Sullivan notes that an “easy-to-apply testosterone gel” has just been cleared for market, meaning “recreational demand may soar.” It’s a crime to possess the chemical without a prescription – Sullivan never mentions that.

He concludes:

“I am perfectly happy to be a man, to feel things no woman will ever feel to the degree that I feel them, to experience the world in a way no woman ever has. And to do so without apology or shame.”

In October, Rona Marech at the San Francisco Chronicle profiles FTM Pat Califia-Rice, another gay with concerns about the opposite sex:

“I don't really, in fact, like men all that much, and I think most men really misbehave … And so one of the big issues for me is: Can you be a guy and still be a good person?”

Califia-Rice responds to hypothetical lesbian critics:

"I'm not doing this because I think there is anything wrong with being a woman. Or that there's anything wrong about being a dyke. It's not about that. It's about my relationship with myself."

The piece mentions Califia-Rice’s testosterone use but does not describe the drug’s properties.

2001

Norah Vincent dares to write about transsexuality again, lashing out against the city of San Francisco for covering its workers' transition-related medical costs. She’s concerned about harm to the taxpayer, not to the patient.

2002

In July, the San Francisco Chronicle reports that steroid use is rampant among bodybuilders and athletes. The right chemicals are very easy to access:

“Today, experts are seeing more use of steroid precursors [which the body converts into steroids] such as andro and DHEA (dehydroepiandrosterone), both of which can be legally purchased at most health food stores. They say these supplements have the same long-term effects as steroids.”

(Congress will ban these precursors in 2004 — except for one, DHEA, which remains legal today.)

In December, the New York Times reports that “medical experts are concerned” about steroid use because there “have been no rigorous medical studies to provide answers to fundamental questions about long-term safety.”

The Times interviews a steroid user who “quit after jumping out of his car to argue with another driver in a fit of rage, leaving his car to drift away[.]”

The story points out:

“Women in the centerfolds of men's magazines are increasingly muscular.”

2003 

In June, Louise Rafkin at the San Francisco Chronicle reports on the trend of young lesbian transition. Once again, the Chronicle focuses on goofy gender war jibes:

“Though [one FTM] is now afforded certain male privileges, he finds himself in the quirky position of becoming a man-hating man.”

That young woman’s girlfriend frets:

"Men are such a part of the ruling class. I have so much resentment about their privilege and the way the world works for them."

Older lesbians are uneasy about the trend but afraid to go on the record:

“Even a supportive therapist who works with transitioning FTMs (and who insisted on anonymity) voiced concerns about what she sees as an idealization of the teenage boy body in the FTM community. ‘It's a Peter Pan syndrome,’ she says, ‘many of these young people are not that different from their anorexic sisters - the thought of growing into an adult woman's body seems terrifying.’”

We meet a Bay Area gender doctor, Deborah Brown:

“Brown sees some patients in their early teens, some who come from as far away as the deep South. (Underage FTMs must be accompanied by their parents for treatment.) ‘Transitioning is much easier here than it is where they come from,’ she says.”

(Gender clinics like CAMH have long offered hormones to kids at age 16, and at least one girl in the western US was prescribed testosterone at 14 in the 1980s. Endocrinologists at Boston Children’s Hospital began treating pubertal kids with “Gender Identity Disorder” diagnoses in 1998.)

Don’t worry about side effects:

“Despite concerns, long-term health implications of the hormone seem slight, though there have been few serious studies. Generally FTMs are at risk for the same potential problems faced by biological men, namely the risk of high cholesterol and heart disease.

“If T injections are stopped, physical changes do not reverse. Still, says Brown, most young FTMs start T on a very low dose and those who change their minds about transitioning, do so fairly quickly.”

A middle-aged lesbian going by “M” describes a toxic social scene. In the reporter’s words: 

“[A] hierarchical view of masculinity has developed in the lesbian community; she's heard young butches say that if they don't transition, they fear they won't get dates.” 

M imagines herself in the young women’s shoes:

“M admits that if she were suddenly 20 years old again, she might be lured by T, and perhaps even by top surgery.”

Another concerned elder lesbian, Harry Dodge, says she “recently met a 23-year old lesbian with a mustache who had been called a wuss for not taking hormones.”

A 24-year old FTM gives a talk at a local private high school, describing how her religious parents rejected her for being gay:

“The teens are clearly charmed by the flamboyant, articulate Cruz. … After his presentation, a gaggle of girls approach hesitantly to say how sorry they are about the situation with his family. He smiles; they giggle. The interaction falls squarely under the umbrella of flirting.”

The peer pressure and grooming aren’t sinister because T is great. The reporter describes an FTM she interviewed before and after taking the drug:

“The anxiety he exuded before his transition is almost gone; his self-deprecating Jewish humor is lighter, more ironic.”

One middle-aged FTM started “injecting T” “as part of a campaign to stop procrastinating about bettering her life - ‘fix teeth, lose weight, bring ideal of physical and sexual body in line with internal vision[.]’"

The “man-hating man” with the ambivalent girlfriend is thrilled with testosterone: “He says he simply feels ‘magical.’”

In October, the New York Times reports that steroids “damage kidneys, harden arteries and raise blood pressure.”

2005

In March, the New York Times reports on a teenager who killed himself after quitting steroids, apparently due to withdrawal-induced depression.

The teenager’s friend describes the appeal of one steroid product: “you rub it on and it makes your fat go away." 

In June, the Times reports that teenage girls are using steroids to become lean and pursue sports scholarships.

The Times has set up a dedicated tip line, steroids@nytimes.com.

2006

In March, NBC reports that roided up hamsters remain aggressive after quitting the drug. A researcher extrapolates that teenage humans may feel the behavioral effects for after stopping use:

“[S]teroid abuse may hinder the development of the serotonin system, which suppresses aggression. So at a time when the young brain is still taking shape, teenage steroid users may enhance the development of the brain's aggression center while suppressing the maturation of its calming center.

“In the latter case, the damage might be permanent[.]”

In August, the New York Times reports that FTMs are causing “bitter tension.” According to the reporter, Paul Vitello:

“Among lesbians — the group from which most transgendered men emerge — the increasing number of women who are choosing to pursue life as a man can provoke a deep resentment and almost existential anxiety, raising questions of gender loyalty and political identity, as well as debates about who is and who isn’t, and who never was, a real woman.”

A plotline from The L Word provides much of the article’s backbone.

Here’s the discussion of T:

“[T]o transition … means … heavy doses of hormones that change the shape of the face, deepen the voice, broaden the upper body, spur the growth of facial hair, and in some cases, trigger the onset of male pattern baldness.”

This is immediately followed by:

“Politically and personally, the change has equally profound effects. Some lesbians view it as a kind of disloyalty bordering on gender treason.”

Vitello does not quote any lesbians who accuse FTMs of “disloyalty” or evince “deep resentment.” The edgiest remark is “don’t you know you’re going over to the other side?”

Judith Halberstam quips: “It’s as if the category of lesbian is just emptying out.” She will later rename herself Jack.

The only nonfiction conflict Vitello finds is between two ex-partners, Natasha and Shane, the legal director of Transgender Law Center. Shane decided to transition when Natasha became pregnant. Natasha tried to make the relationship work but found the change “overwhelming.” Now a mother sharing custody with Shane, she “still cries” about the whole ordeal. She does not accuse Shane of gender treason.

Vitello quotes the psychologist Ken Zucker, whose 1995 book defended wacky theories about homosexuality and danced around the question of whether conversion therapy worked, as an expert on lesbian culture:

“There is the sense that a transman is ‘betraying the team,’ joining the oppressor class and that sort of thing.”

2007

Researchers report that over 5% of high school girls have tried steroids. Use is more prevalent among girls born later, and the steroid users are less likely than their peers to play a team sport:

“Compared with nonusers, odds are higher that they became sexually active at a younger age and have had more sexual partners; they are more likely to carry weapons and to have experience with violence. Along with greater controlled and illicit drug use, they are more likely to resort to harmful weight loss practices. These adolescent girls' mental health is more likely to be impaired, with more than two thirds having had feelings of depression and with almost half having planned or attempted suicide.”

The New York Times does not cover the study.

---

In the 2010s, hordes of teen girls started declaring trans identity and seeking testosterone prescriptions. Mainstream outlets quoted “experts” saying greater acceptance of trans people had drawn them out of the closet.

Looking at US media coverage of testosterone, there seems to be a blackout on acknowledging it’s the same as steroids. But I can’t find evidence that GLAAD or other trans activists demanded the blackout. It may be that generations of journalists censored themselves.

When we talk about the spike in teen girl transition, we tend to focus on the parts of the story that sound novel and modern: civil rights grifting and YouTube videos. But this craze also has an old-fashioned component that I think has been neglected. The kids are seeking a glamorous, euphoria-inducing drug.

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