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. 

On "Male, Female, Transgender" Checkboxes

I've actually been encountering more forms on which I'm asked to identify my sex or gender using checkboxes labeled "male," "female" or "transgender." This is my response in image form:

"Wait. There are more than two religions--what if someone has a different religion, or no religion at all? And 'convert' isn't a religion, it means a person who has gone through a process that welcomes them into one."

Exactly.

On Escaping Sexism

As a trans* guy, I've been asked one of the classic questions a number of times: "Did you perhaps transition because you wanted to gain status as a man rather than fight sexism as a woman?"

The answer, of course, is no: I transitioned to male status because I am a man.  That's my gender identity.  Yes, I'm genderflexible about it; no, this flexibility doesn't mean I should have just stayed legally female.  I moved toward a position that would allow me to live my life authentically as myself, and I'm much, much happier now.  It's great to come home, as it were.

So, I didn't transition in order to gain male privilege.  But I do have it, now.  It's true that my male privilege is discreditable, so that I can lose it in situations in which my trans* status is held to negate my manhood, but most of the time, I am accepted as male, and this comes with benefits.

They're nice benefits.

I didn't ask for male privilege, but that doesn't mean I can disclaim it.  White antiracist activists still enjoy white privilege; male advocates of gender egalitarianism still enjoy male privilege.  As a man, I'm taken more seriously in a variety of ways than I was when I was framed by others as being female.  As a professor, for example, I'm less likely to have lecture points challenged by students now.

What got me thinking about this topic today was that I found myself looking at students' ratings of me on ratemyprofessors.com.  The majority of my ratings on the site were written after my transition, but there are 7 or 8 from before it.  The ratings are consistently positive and say that my classes are interesting both before and after my transition, but one thing has changed, and that is that my students who have known me to be male don't say anything about my appearance, but that's not true for pretransition raters.  In fact, one of my students who perceived me to be a woman gushed that I was "adorable."

Ick.

OK, why do I find it distressing to have a student write something they clearly intended to be complimentary?  Well, first off, because this is one of the ways sexism works: by associating women with the body, and imposing on them a duty to be attractive.  I stand in front of a class to convey ideas to them, but before transition, students were examining and judging my body on some attractiveness scale, rather than just engaging intellectually.  Now, I have always taken care to present myself professionally, and part of that means being well-groomed, and I take that care as a man--my shoes are shined, I wear a tie.  But I know from reading endless reams of student evaluations that my good grooming used to be much more important to my students than it is now.  Before my transition, I regularly got comments on student evaluations that complimented my clothing.  Now, I get none of that--my evaluations all focus on my teaching.  As they should.

But there's something else about the term "adorable."  Though the student that described me as adorable clearly meant it positively, the term is subtly belittling.  Supposedly it just means someone or something that is admirable, worthy of being adored, but people who admire President Obama don't go around calling him "adorable."  It's an adjective we use to describe kittens, cute children, charming little cottages. . . and women.  It presents the person or thing described as small and weak, not powerful.  So when a student calls a professor adorable, it presents the professor as lacking authority.  It belittles the person while framing them as appropriately feminine.

I am so glad to have left behind a life where I had to deal with this constantly, just because I was understood to be a woman.  

I try to imagine what it would be like to be a trans* woman instead of a trans* man.  How would I feel if, for the first time, a student wrote that I was "adorable?"  I imagine the difficult ambivalence: "Oh, I've been validated as a woman!  But *sigh* I'm being evaluated superficially on my body."  It's so much harder to have as a destination a place where you lose status than a place where you gain it.  I have a great deal of respect for my trans* sisters, who must take on both transphobia and sexism, when I only have to deal with the former.

So: I didn't transition to gain male privilege.  But I have to own that I do enjoy it.

On Masculine Honor

It may seem like an odd thing for a trans guy to say, but I've realized that I'm more secure in my masculinity than many men.

It's peculiar because, like other trans folks, I have to live with a great mass of cis people perceiving my gender as “fake.” I know that lots of people think that guys like me can't be “real men.” Many flatten all issues of sex and gender down to genitals and judge trans men as deficient, whether we've medically transitioned by one route or another, or not. Others prejudicially deny the reality of gender transition. They claim they can spot us a mile away, and if they can't, that we've deceived them, and deserve to be threatened with violence or humiliation.

You'd think that living under such circumstances would make me much less secure in my masculinity than most cis men, but I've not found that to be the case. It's not that I'm some icon of rugged manhood. I'm 5'2”. I have the musculature of a middle-aged college professor, which is what I am. I bind my chest, and my knees creak.

But all of that is fine with me, because I have no fear that it negates my male status. I am a man because I identify as such. That's all there is to it. I've walked the awkward and bemusing path of gender transition, and while I'm not done with that journey, I am fortunate enough to now be acknowledged as legally male, which certainly doesn't hurt. But by the precepts of the trans ethos, a person's gender is determined by their identity—not by the size of their feet or their phalloclitoris; not by whether they excel or suck at sports; not by bureaucratic rules or the marker on their passport.

However, for so many cis men, manhood is governed by the Code of Masculine Honor, not gender identity. According to this Code, status as a “real man” is a privilege, and can be revoked at any time. And what negates it is any whiff of feminine gender expression. Masculinity is defined negatively as the rejection of all things feminine, and femininity is defined through a disturbing concatenation of weakness, sexual desirability, technical incompetence, emotional tenderness, powerlessness, nurturance, and beauty. The result is the fodder for so much humor, middle-school fag-baiting, and towering insecurity based on feminine challenges to “true manhood.” A dude can find his masculine honor called into question in innumerable ways.  It could be by being discovered by others to be walking a chihuahua, crying at a “chick flick,” earning less than a female coworker, having a gay son, shaving his legs, being unable to throw a football, holding his girlfriend's purse or his daughter's Hello Kitty backpack, being technically incompetent and relying on his wife to fix the car or the computer, enjoying ballet, losing an armwrestling match to a woman, being a “cuckold,” or wearing any one of a panoply of feminine-coded garments, accessories, or cosmetics.

It's a tediously familiar scene. The new kid at school is discovered to lisp. A man at the office is publicly dressed-down by his female boss. As a guy bends over to tie his shoes, lacy underwear peeps out of his pants. What follows is a ritual tormenting by a group of other males: the victim is called a sissy, a bitch, a fag, a wuss, a GIRL, often in high-pitched, mock-feminine voices. The challenge to masculine honor is iconically avenged through violence—honor restored if the victim becomes the dominant aggressor. There are other ways out. The victim can clown around and try to turn the hazing into a joke. He can verbally disdain the harassment and assert that he has other forms of masculine power that matter more (income, political power, sexual prowess, physical strength). He can defend sensitive modern manhood. But under the Code of Masculine Honor, only the response of physical reprisal is seen as fully restoring “real man” status. Deck your challenger, and you can stand over him and crow, “Who's the bitch now?”

The ritual enforcement of the Code of Masculine Honor leaves swaths of cis men eternally insecure about their masculinity. Nobody can embody all of the precepts of ideal manhood—being tall and muscular and hung like a horse, able to fix machines with ease, being a sports hero, a deadly fighter, having political authority over others and enviable wealth and harems of nubile sexual partners. That's the stuff of fantasy. Of comic book heroes and gangsta personae. Mere human males can never meet such a standard, and so all are left aware of their “failings.” And to deflect attention away from these failings, the insecure call attention to others' in the endless ritual of hazing. They avoid any association with “sissies” and “fags”--even if they themselves are gay. Just look at all the men-seeking-men ads that frame the seeker as hulking and “straight-acting” and not interested in feminine men.

The thing is, the Code of Real Manhood doesn't just hurt men. It's built around class privilege and homophobia, and most especially, around misogyny. It centers on the idea that femininity is humiliating—that the worst thing imaginable is to be a “girl.” For this reason, feminists have long critiqued it, and championed gentle, sensitive masculinity. This is turn has led to one of the most longstanding and powerful bits of antifeminist rhetoric: that feminists are seeking to “unman” men. We may live in an era in which masculine behavior is evolving. Today, a man may change his baby's diaper without being laughed at as henpecked, as he would have been in the 1950s. Guys may pluck their unibrows without causing much of a stir. Middle-school boys may chide their friends for calling everything they dislike “gay.” But the hazing maintenance of the Code of Real Manhood retains great potency.

Gender transition has brought me many good things. One of these is that in order to do the hard work of coming out to family and friends and coworkers and negotiating the many hurdles of gender transition, I had to reach a place of surety that my masculine gender identity defined my status as a man in a way others must respect. This gave me security in my manhood. But gender transition also came with some “gifts” I could do without. One of those was a welcome into the world of random challenges to fight. As an academic and a shrimp, I don't get a ton of them, but it periodically happens. A guy cuts me off pulling out of an alleyway nearly causing an accident, and then storms out of his car and tells me to be a man and get out of mine, spoiling for a fight. Three large young men brimming with insecure cockiness follow me down a street, commenting on how faggy my pink hair is and how I'm too much of a faggot to turn around when they're talking to me.

Though I find myself in these situations, I've yet to get into a fight. One teenaged boy slugged me once and ran off, but that was random and not interactive enough to count as a “fight”--which is exactly the point. I haven't found myself in a fistfight because I don't rise to the bait to defend my masculine honor. It's not that I don't feel that if I had to defend myself, I couldn't. (And I don't say that to prove I'm a man—I think that most people of any gender can learn to defend themselves if they have to.) I don't rise to the bait because I don't feel challenged. My masculinity is not based on my vehicular dominance or the color of my hair or my physical strength, but on my gender identity. Inside, when I'm called a “fag” for dying my hair pink for a while, I'm rolling my eyes. Outwardly, being sane, I simply don't respond. And when my cheek is metaphorically slapped for a ritual duel and I don't return the slap, generally the fight fizzles. The Code of Masculine Honor is not served by fighting with girls, or with people who don't care if you call them one.

That doesn't mean I don't think the Code poses a serious problem for trans people. Those who enforce “real manhood” guard its territory closely, and are often hugely transphobic. They refuse to let people in or out of the man club based on their gender identities. While as a trans person I don't feel undermined by claims that my behavior is incompatible with honorable masculinity, I'm deeply hurt when people assert that I am literally not a man. And I am fearful of the fact that some defenders of “real manhood” engage in a very ugly form of violence—not individual duels of masculine honor, but warlike boundary guarding, involving group attacks on people who reject the archaic Code: fagbashing, gang rape, brutal trans murders.

The sad ubiquitous fact is that trans women are at particular risk from enforcers of the Code of Masculine Honor. From the perspective of the Code, they enact the ultimate treason when they leave the man camp to embrace their female identities. In asserting that they experience being a woman as preferable to enjoying the privileges of masculinity, they speak heresy.

As a result, women who are visibly trans gender suffer appalling levels of violence. I ache for what my trans wife must cope with on a daily basis: the ongoing harassment; the regular challenges to fight posed through body-checking and name-calling; the random terrorism of boundary policing in the form of bottles thrown at her out of cars or attempts at sexual assault. Whereas I face few overt threats, and have been able to diffuse them, the level of violent enforcement of the Code of Masculine Honor she encounters makes it hard for her to live a life not constantly on the defensive.

And what I find particularly sad about the violence my spouse faces is that most of it comes from men who are marginalized, and face challenges under the Code due to that marginalization. Guys with low incomes and men of color. Self-hating, repressed homosexuals. Pubescent boys. It's amazing how often the men who get in my spouse's face and tell her she's a “disgrace” are very short.

The Code of Masculine Honor operates not only to perpetuate masculine privilege, but to perpetuate marginalization. It keeps men who face discrimination for various reasons from uniting to change systems of social power. It mobilizes insecurity to divide and conquer. And it generates a constant level of self-doubt that leads to a situation in which I, a trans guy, am more secure in my masculinity than so many of the cis-privileged men around me.

As a man, I say down with masculine honor.