TREND WATCH: What’s Happening? The soaring popularity of testosterone therapy—not just among older men, but among young men as well—attests to growing worries over a gradual but significant decline in androgenic hormones among generations of men. Many experts link testosterone decline to other evidence of a widening masculinity deficit, such as falling male fertility and less musculoskeletal strength.
Our Take: This de-masculinization of men has been attributed to everything from environmental “xenoestrogens” and less exercise to higher stress levels and rising obesity rates. Regardless of its cause, it coincides with social and economic trends that are causing younger generations to rethink traditional notions of masculinity—for better or worse. Ultimately, and perhaps paradoxically, this rethink is very likely to trigger a “masculinity” revival.
According to a new report from JAMA, testosterone therapy among American men is on the rise. From 2010 to 2013 alone, prescriptions more than doubled. Much of this surge can be chalked up to now-ubiquitous drug marketing campaigns urging older men to boost “low T” levels—campaigns that are aggressively pushed by Big Pharma companies like AbbVie (ABBV) and Eli Lilly (LLY).
The huge demand for this therapy is not a response to marketing hype. In fact, men’s age-adjusted testosterone levels really are on the decline. And much evidence suggests that they have been declining for decades, going all the way back to the Silent Generation born in the late 1920s and 1930s.
The most prominent study, a 2007 report in the Journal of Clinical Endocrinology and Metabolism, revealed a “substantial” drop in U.S. men’s testosterone levels since the 1980s—with average levels declining by about 1% per year. This means, for example, that a 60-year-old man in 2004 had testosterone levels 17% lower than those of a 60-year-old in 1987. Another study of Danish men produced similar findings, with double-digit declines among men born in the 1960s compared to those born in the 1920s.
The challenges to men’s health don’t end there. Rates of certain reproductive disorders (like testicular cancer) have risen over time, while multiple European studies have found that sperm counts are sinking—which some experts link to today’s low fertility rates.
These trends coincide with a drop in musculoskeletal strength among young men. Research indicates that Millennial males have significantly weaker hands and arms than their fathers did. In a 2016 study, the average 20- to 34-year-old man could apply 98 pounds of force with a right-handed grip, down from 117 pounds by a man of the same age in 1985. Though grip strength isn’t necessarily a proxy for overall fitness, it’s a strong predictor of future mortality.
What’s behind all the downward trends? The answer is complicated.
Worsening overall health. The overall decline in testosterone levels is almost certainly linked in part to higher rates of obesity (which suppresses testosterone). It may also be linked to lower rates of smoking in men (since nicotine is a potent aromatase inhibitor).
More fat and fewer cigarettes can’t be the whole story, though. In the 2007 study, the age-matched testosterone declines persisted even after controlling for these variables.
Increased exposure to toxins. Many observers suggest that increased exposure to environmental toxins is the culprit. Pesticides, parabens, and chemicals common in household products (like phthalates and bisphenol A) contain potent xenoestrogens, antiandrogens, and endocrine disruptors—which could be driving down testosterone levels.
Research shows that this explanation is at least plausible. In a 2011 study published in Environmental Health Perspectives, researchers tested 37 widely used pesticides to see if any of them had antiandrogenic effects. Fully 31 of them did.
Shifting lifestyle patterns. Also playing a role may be long-term shifts in the way Americans work and live. By almost any measure, boys are spending less time outdoors and exercising less (walking, running, biking, etc.) and fewer young men hold jobs in manual labor. The Army and USMC have recently modified their basic training programs in response to a rising incidence of injuries (such as stress fractures) among recruits unaccustomed to dawn-to-dusk physical activity. For Millennials as a group, life today is vastly more sedentary and technology-dependent than ever before.
It’s not just stationary lives that could be contributing to low testosterone. Certain forms of close relationships—such as marriage, fatherhood, and increased time spent with children—are causally linked to lower testosterone levels, according to a definitive study by Harvard anthropologists.
Yet here again the evidence is muddled. On the one hand, Gen-X and Millennial men are marrying later and having fewer kids. On the other hand, young men today are more likely to live with other people—which may promote prosocial hormones like oxytocin that are natural antagonists to testosterone. And those who are fathers are spending more time with their children.
WHY IT’S HARD TO PINPOINT THE CAUSE
The sheer number of factors that may be in play make it tough to isolate any one as the primary cause of declining testosterone levels. Researchers have suspected other lifestyle trends as wide-ranging as increased temperatures in homes and offices to tight underwear.
It’s also difficult to establish the direction of causality. Is it testosterone that has declined in response to a changed world, or the world that has changed to accommodate less virile men? Or is it both? Take declines in strength, for example: While we know that supplementing with extra testosterone by itself increases muscle mass, we also know that strenuous exercise by itself promotes natural testosterone production. Bidirectional causality leads to both positive and negative feedback effects.
THE BIGGER STORY: CHANGING GENDER NORMS
What’s happening to men physically dovetails with a broader story of social transformation that has left many men adrift—particularly those in the working class.
Over the past several decades, the economy has shifted away from jobs that favor men, like manufacturing, and toward sectors dominated by women, like education. Young men have fallen behind women in attending college and obtaining degrees. They’re increasingly dropping out of the workforce and regard work as less central to their lives.
Widespread anxiety over the state of men has inspired a slew of essays from the likes of The New York Times, The Economist, The Atlantic, and National Review—and it may have even helped deliver the old-fashioned, overtly macho President Trump to victory.
The confusion over what masculinity means today is reflected in the conflicted feelings of males now coming of age. According to a new study from the Brazil-based nonprofit Promundo, most American Millennial men feel pressured to project a traditional image of manhood characterized by traits like toughness, self-reliance, and hypersexuality. But when asked if they wish to emulate these characteristics themselves, the majority don’t.
Promundo’s results echo those from a 2016 YouGov survey that asked men to rate themselves on a scale of “completely masculine” to “completely feminine.” Only 30% of 18- to 29-year-olds chose “completely masculine.” That’s compared to 65% of men over 65.
All these social and cultural changes have also left Millennial women in uncharted waters. More face a dating pool where partners of equal education and status are harder to come by, leaving them waiting for men catch up or deciding to go it alone. “They aren’t men,” one young woman told Philadelphia Magazine flatly. “They’re boys.” It’s a sign of a long-term generational reversal: When Boomer women were coming of age, they wanted kinder, gentler men in touch with their feelings. Now Millennial women yearn for guys who can “man up” and take care of business.
WHY THIS MATTERS
Let’s zoom out even further. In a way, this anxiety over men mirrors a larger debate over America’s national identity.
Americans have traditionally seen themselves as a “pro-testosterone” nation: restless, striving, and rowdy. Our heroes are risk-takers who break the rules and aren’t afraid to fail. Many consider these traits—and by extension, the “real men” who embody them—essential to our survival and destiny.
In his new book The Complacent Class, Tyler Cowen argues that America is losing the dynamism, mobility, and enterprise that made it special. Then again, others might argue that unrestrained masculine exuberance—as embodied by business leaders like Uber’s Travis Kalanick or political leaders like Donald Trump—could render America dysfunctional and even ungovernable.
Ultimately, it’s impossible to pigeonhole what’s happening to masculinity as wholly positive or negative. It’s a matter of perspective. The strongest objections come from critics who believe men and women are naturally built for traditional roles—or from those who argue that toxic chemicals are wreaking havoc on men’s health. Those who believe traditional gender roles are dysfunctional, however, welcome moving past them: A less testosterone-laden world, they say, might be more cooperative and less violent.
Falling testosterone rates, along with the broader discussion of men’s place in society, will have major implications going forward.
The debate over the safety of testosterone supplements will ramp up. With millions of men now boosting their testosterone with gels, patches, androgen precursors (like DHEA), and aromatase inhibitors (like DIM), the efficacy and safety of supplementation is now hotly debated. The official FDA concensus is that, for all men above very low testosterone levels, the positives (improvement in mood, strength, libido, bone density, and red-cell count) are outweighed by the risks (mainly, a higher rate of cardiovascular death).
Although higher testosterone is clearly correlated with better health and longevity, supplementation may not be the answer—especially when correctible lifestyle habits (diet and exercise) are to blame. In fact, in the years ahead, “regain your manhood” may become a mantra for more and more men who will embrace working out and living well as a way to boost testosterone levels naturally.
Millennial men will continue to flock to how-to-be-a-man guides. In recent years, we’ve seen a rise in the array of services, seminars, and media devoted to teaching Millennial men and women how to be an adult. The generation that brought “adulting” into the modern lexicon is being won over by companies like MassMutual, whose “Society of Grownups” class teaches Life101 skills (like balancing a budget) to young adults.
This wave of grown-up advice is mirrored by a spike in gender-specific how-to guides teaching young men how to act like a man. Look no further than the Art of Manliness, a popular blog started back in 2009 that offers tips on everything from essential life skills to effective workout routines to—you guessed it—increasing testosterone.
By the time its last wave comes of age, Millennials will trigger a resurgence in the “manly” ideal. At a time when Millennials are called soft, cossetted, and (most nefariously) “snowflakes,” this is admittedly a contrarian call. But I will stand behind it. We have seen such historical shifts before under similar circumstances. History teaches a simple lesson: With a lag, young men as a group always become what young women want them to be.
We are already beginning to see signs that Millennial men are taking the hint. Think for instance of the recent resurgence in beards among Millennial men. Overt masculinity is also making its way into advertising. In a hugely viral Under Armour ad that aired during the 2016 Summer Olympics, a bearded Michael Phelps swims laps in the darkness to train his body to peak condition. And then there’s the original Dos Equis “Most Interesting Man in the World”—who was ousted in favor of a younger-but-still-venerable bearded actor enlisted to appeal to Millennials.
These trends may ultimately culminate in the “revalorization” of traditional male roles that have lost their luster. Fatherhood is one example: Already, the “dumb dad” trope in commercials is being replaced by a string of father-friendly “dadvertising” depicting capable men doing valuable work. We may continue to see other male-dominated societal roles and professions glorified as Millennials age.
To be sure, this new Millennial masculinity will not mark a return to the masculinity of their fathers. Millennials will adopt a more socialized, restrained ideal that better fits their personality—rather than the over-the-top, rebellious brand that Boomers popularized.
The culture of female-dominated professions could change as more men enter them. The future of job growth—for men and women—lies in predominantly female fields like health care and education. These fields are largely service-oriented and prioritize traits like empathy and caring.
In order to attract men, some companies in these fields are playing up traits like risk and toughness. Some hospitals, for example, feature recruitment posters comparing the rush of being an operating-room nurse to mountain climbing. (The poster asks readers: “Are You Man Enough…to be a Nurse?”)
Ultimately, the masculinization of these industries may change their culture. There are historical precedents: A century ago, as working women became secretaries and teachers, they feminized professions that used to be dominated by men.
If there’s one thing on which observers agree, it’s the need for solutions to support the men the 21st-century economy has left behind. Somewhere between these two poles lies the ideal revised take on masculinity: one that is aligned with changing cultural norms and allows most men to feel useful and find meaning within it.