On Anti-Androgens and Covid-19

 

Perhaps you learned this past week that among the self-"treatments" Americans opposed to vaccination have been using for cases of Covid are anti-androgens.

Anti-androgens are medications that block the body's production of testosterone. They have lots of uses recognized by the medical profession: as part of a medical transition for trans women; to suppress testosterone production in cis women whose bodies are making a lot of it and who don't like how that manifests; to slow the process of balding; to treat hormonal acne.

Taking them to try to treat Covid is not among these medically-recognized uses.

Some observers--especially in the trans community--have been chuckling or groaning or tearing their hair to see that a subgroup of people who are often highly transphobic have been ganking spirnolactone dosage and scheduling information off of transition information websites. Some suspect that a person who takes anti-androgens according to information they got from a transfeminine education site, all the while claiming to despise trans women and to be the most "alpha male" person ever, might as well be holding up a sign saying "Hi! I am selfhating, trans, closeted, and in denial!" That is an excellent point.

But what I wanted to focus on here is the underlying belief that has led those pushing "alternative" medical treatments for Covid to put anti-androgens on that list. That belief is a truism you hear all the time in discussions of Covid lethality. And that truism is that "males are more likely to die of Covid than are females."

It isn't actually true.

Or, ok: it is true in some places at some times, but false in others. In Texas, it has been true during the entire pandemic. In Connecticut, it was true during some months of the pandemic and false in others. In Massachusetts, it is women who have died at higher rates from Covid. There are more states in the US in which Covid has proven more fatal to men than women than the reverse, but it's highly variable by region and point in the pandemic.

Do you know what doesn't vary by region and month? Biological sex characteristics. If testosterone was making people more vulnerable to Covid, that would be as true in Massachusetts as it is in Texas.

What does vary regionally are social factors. What does the gendered division of labor and occupations look like in a given area of the country? And which of those gendered jobs involve heightened risk? (We often think of "dangerous jobs" being those that involve heavy machinery or violence, but caregiving jobs that are framed as feminine, like working in an elder care facility, or daycare center, or as a nurse's aide, are both highly stressful and associated with high exposure to disease.) Also varying by region is gender expression. How do men perform masculinity? Does it involve considering actions like handwashing "sissified," or not seeing a doctor until symptoms have become dire? Or are washing your hands and seeing a doctor deemed nongendered, commonsensical activities?

Suppressing testosterone production does have real effects--ask any trans woman on HRT, or cis woman with PCOS, who is taking spiro. Over time, it thins body hair production, for example. But those effects do not include making you wash your hands and wear a mask more diligently! They do not magically change the gendered division of labor in your region of the nation.

The presumption that if a gendered difference is noticed in some kind of health outcome, it must be biological and universal is, to be blunt, stupid. The ideology of biological essentialism blinds people to the empirical reality that what it means to be a man or a woman or any other gender is largely social. This is not to deny that biological sex characteristics are real! Estrogen really makes breast tissue grow. Testosterone really makes facial hair grow. But hormones do not cause employers to pay people in jobs coded as masculine more than they pay people in jobs coded as feminine. They do not make girls like pink and boys like blue. And they don't make you wear face masks more or less often.

Taking anti-androgens will not magically cure Covid. I can't say I'm surprised it has been proposed to do that by conspiracists on social media--having watched people fervidly believe in and seek out such "alternative treatments" as bleach solutions and horse de-wormer over the course of the pandemic.

What does sadden and annoy me is how there have been a bunch of medical studies looking at the idea of taking anti-androgens to prevent or treat Covid. Early in the pandemic, when we knew little about the coronavirus, its understandable that medical researchers would be grasping at straws. But it is now clear that the higher mortality rate for men that was observed in some studies is not at all universal, and doesn't appear in 11 US states. Medical researchers should know that if some phenomenon is gendered one way in state X, and the opposite way in state Y next door, and this shifts over the course of a year, then it is strongly social in causation, not due to chromosomal variance. 

But the demand for "alternative treatments" of Covid has been high, and the public's beliefs about testosterone inflate its importance and paint it in magical terms, for reasons rooted in patriarchy and the framing of testosterone as the "essence of maleness." And so, while most medical researchers consider the proposal that anti-androgens can prevent or cure Covid to have been disproven, a subgroup persists in asserting this claim--and they get lots of attention from conspiracists and tabloid-style journalism.

And that is how, recently, advice from "alternative medicine" influencers--a few of them doctors--to treat Covid with androgen blockers went viral. 

Anti-androgens will not save you from Covid. They'll slow your balding, if that's your thing. (It's not mine. I'm very happy with the balding hairline testosterone HRT granted me!) But a person who avoids vaccination, masking, and social distancing, thinking they can just take that bottle of spironolactone they acquired to cure Covid if they catch it. . . well, that person can die. 

And among the factors we can blame for their death--along with MAGA intransigence and the rage for conspiracies and quack doctors profiteering--are magical beliefs people have, about testosterone in particular, and physical sex characteristics in general.