Randi Hutter Epstein M.D. M.P.H.

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For Women’s History Month, Here’s a Woman to Remember

Told to be a Scientist, she Became a Nobel Laureate Instead

In 1941, Rosalyn Yalow, a graduate of Hunter College with honors, told her teachers she wanted to be a scientist. They suggested she become a secretary to one.

Yalow persisted and 36 years after that discouraging conversation, she was in Stockholm, Sweden receiving the Nobel Prize in Medicine or Physiology.

Quite a leap for the daughter of Eastern European immigrants who never finished high school.

The award was for a technique that revolutionized twentieth century medicine. Yalow, along with her partner, Solomon Berson, created radioimmunoassay, or RIA for short. Before RIA, in the late 1950s, endocrinology was guesswork; doctors evaluated and treated patients for hormone deficiencies without knowing how deficient they really were. After its creation, doctors could measure hormones down to a billionth of a gram.

The same tool was used to measure all sorts of things that had been considered too scarce to measure—germs (including the HIV virus leading to the AIDS test), other hormones (helping to spawn the fertility business) and drugs (monitoring drug dosages to avoid dangerous interactions).

I’ve written about Dr. Yalow before—and write a chapter about her in my forthcoming book, Aroused: The History of Hormones and How They Control Just Everything. But hers is a story that deserves to be told again during Women’s History Month.

Rosalyn Sussman Yalow was born July 19, 1921 in New York City. She got into University of Illinois’s College of Engineering graduate program only because so men were fighting in World War II. The school reluctantly admitted a few a women. “They had to have a war so I could get a PhD and a job in physics,” Yalow would say years later.

Her Nobel Prize winning work was accomplished in a lab at the Bronx Veterans Administration. She turned what had been a janitor’s closet into a laboratory. Hardly any female scientists got hired at the V.A., and the few who did had to quit if they got pregnant. “I was too important to be fired,” she told her biographer. She kept her job through two pregnancies.

The kernels of the idea that led to radioimmunoassay began with basic endocrinology studies. Yalow, along with her partner Solomon Berson, proved that hormones can elicit an immune response—something that went against scientific dogma. Despite a scrupulous study, their research was rejected by several prestigious scientific publications. Eventually—after battling with editors, it was published in 1956 in the The Journal of Clinical Investigation. Their findings were quickly confirmed by other labs, and led them to their revolutionary technique.

Yalow lectured all over the world. One of her last talks was to a third grade class in a New York City Public School. She told the students, “Initially new ideas are rejected. Later they become dogma, if you’re right. And if you’re really lucky, you can publish your rejections as part of your Nobel presentation.”

My favorite Yalow story is this one: In her laboratory, she had this sign:

“To be considered half as good as a man, a woman must work twice as hard and be twice as good.” That’s a common feminist maxim.

But Yalow added the punch line: “Fortunately, that is not difficult.”

In honor of Women’s History Month 2018, let’s hope that from now on, women who are excited about science and eager to pursue a career can be nurtured and mentored and encouraged so the journey to success can be just as exciting and stimulating as the goals achieved.

For further reading: Rosalyn Yalow: Nobel Laureate: Her Life and Work in Medicine, by Eugene Straus (Basic Books: 2000)

 

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Predicting Criminal Behavior

In 1924, two rich teenagers from the suburbs of Chicago murdered a kid in their neighborhood. They were caught right away and the trial became known as the crime of the century. The gruesome story of Richard Loeb and Nathan Leopold became fodder for national newspapers and would inspire four films, several books and one play.

During the trial, the killers’ parents hired doctors who tried to convince the judge that the boys weren’t responsible for their own actions. Their faulty hormones made them do it. One doctor, using state-of-the-art tools of the time said he spotted a defective pineal (a gland in the brain) that triggered a lack of inhibition. Today we know the pineal gland emits bursts of melatonin that control our circadian rhythm, our internal clock. In other words, it has nothing to do with compelling someone to kill. In Leopold and Loeb’s time, it was connected ever-so-tentatively to sex and intellect. The doctor explained that because of Leopold’s hard pineal, he had too much libido, even for a 19-year-old boy, and not enough inhibition.

The judge said he was intrigued by this new field of endocrinology (the study of hormones), but these insights were not going to keep two murderers out of jail. The boys were each sentenced to life in prison.

For nearly a century, we have tried to use all kinds of tests to predict human behavior. Around the same time as the trial, Dr. Louis Berman, a New York City doctor, claimed he could look at people and figure out which of their many hormone-spewing glands controlled them. He labeled people “thyroid types” or “adrenal types” based on some dubious assessment. He also said he could forecast their future—whether, based on their hormones, they’d become leaders or movie stars, or criminals. Berman’s ambitions were lofty: he wanted to use his “skills” to evaluate school children and predict their futures. If a kid were destined for a wayward life, he’d prescribe preventive hormone therapy. He wrote books that the public adored and his colleagues loathed. Still, like many ideas based on conjure rather than data, his theory faded away.

We’ve tried for nearly a century to figure out ways to predict who is likely to be a killer, and then take extra cautions with those people. Last week, during a news conference about the flu epidemic, Alex M. Azar, the U.S. Department of Health and Human Services Secretary began by addressing the recent Florida massacre saying the administration needs to be “laser-focused on getting Americans with mental illness the help they need.”

That’s a nice idea. Those with mental health issues should get the therapy they deserve. We don’t need to stigmatize mental illness even further by assuming that anyone suffering from mental illness is a potential murderer. In a scientific article in 2105 published in the American Journal of Public Health, the authors write that the mentally ill are “far more likely to be assaulted by others or shot by the police than to commit violent crimes themselves.”

I’ve spent the past seven years exploring the history of hormones and the science of hormones and behavior. We’ve made great strides. We have more insight into the ways that hormones can make us moody or hungry or tired. We have hormone medicines that can help people with dysfunctional glands. But our notions of predicting a “killer instinct” are, at best, wishy-washy.

We are kidding ourselves if we think we can predict the next killer with tests based on hormones or surveys or any kind of chemical assessments. Politicians and others may look to these studies because they provide a good sound bite, but we need to reread the history of medicine and the recent history of killing sprees to appreciate that it’s highly unlikely we are going to find the sure-fire predictive test and then provide all of the best preventive care necessary to prevent the next massacre.

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Transitioning: The Power of Fiction

For those of who read the New York Times “Modern Love,” column, we know that every now and then, there’s one that resonates but not because of a shared experience. In fact, it’s just the opposite. It rings so close to the heart because we may not have shared the journey but we shared the emotions.

That’s how I felt when I read Laurie Frankel’s essay last fall about her six- year-old son transitioning from identifying as male to female. She wrote so honestly about wanting to cater both to her son’s happiness but also wanting to protect him from the potentially harsh ramifications, potential bullying.

As a mother of four children, I know there are the abstract conversations (“this is what I would do, if…” ) as we role-play perfect parenting. And then there’s the reality of what we do when we are in the thick of it, when we say the wrong thing, when we are not sure what to do to help our kids immediately making sure it’s best for the long term.

I read Frankel’s essay and was so impressed with her as a writer and as a  parent, that when I read in her byline just released the novel This is How it Always is, I clicked on my Amazon app and got it the next day.

After writing and researching medical and emotional issues of those who identify as transgender for my forthcoming book (digging into historical archives, reading memoirs, scouring a trove of scientific articles, interviewing those who identify as transgender, interviewing parents of children who identify as transgender, along with doctors) I was intrigued to see what a novel would offer that I hadn’t gleaned from non-fiction.

A lot.

Frankel intentionally sets up a situation including a family with five kids. She is the mother of one child. She wanted to make the point that identifying as transgender is one thing that complicates growing up, but it’s certainly not the only thing. The other children have their own adolescent issues, too. She also wanted the family to have to cope with the responses not just by parents and the community but by siblings too.

Midway through the book, the mother expresses her willingness to go along with her child’s wishes to transition but expresses her fears of the hormone medication and concerns about the permanence of it all.

“You think Poppy will be the only kid to feel betrayed by her body when it goes through puberty? All teenagers feel betrayed by their bodies when they go through puberty. You think Poppy will be the only woman to hate the way she looks?…..The drugs, other drugs, yet more drugs, a lifetime of drugs, the surgeries, the stuff that can’t be made whole regardless of surgery, these things are huge. These things are scary. These things are mysteries, unpredictable, uncertain….There are hard decisions she’s not old enough to make. There are decisions that just shouldn’t be made for you by your parents. If she is a girl, if deep inside this is her truth, if she needs this, if she wants this, if she must, if she’s sure, then yes, of course yes, thank God yes, we will support her and help and do all all we can and much we can’t yet but will have to figure out, as we have already , as we do for all of our children…”

I spoke to Frankel recently, and I thought she answered two of my questions so well, I wanted to share her answers rather than paraphrase:

RHE: Why Fiction and not memoir?

LF: You know the nice thing about fiction is that parts of it can be true and taken from your own life, but it doesn’t have to be. My hopes and fears drove this whole book. This is probably true of all novels. Also, we are really lucky to live in a community where it was just an easy supported transition in really every way—school, friends, community. It was exactly the way you would want your kid’s life to go. That would have been a short and boring memoir. I also remain keen to protect my kid’s privacy. Everyone knows it was a very public transition. But ten years from now when, who knows who she will be and what she will want other people to know. That would have been impossible in memoir form.

RHE: How do you think your book relates to all children, not just those who are considering transitioning?

LF: I think my story serves as a metaphor. The child you thought you knew turns out one morning to be someone else. That’s what parenthood is like and that’s what childhood is like. And kids change in ways you very frequently don’t know what do to about. You kind of think, here’s the thing: I obviously still love you but I have to think about what to do about it and I have to do the best I can.

RHE: Your book incorporates stories within stories, including a fairytale, and mothers sharing stories. How does the power of storytelling influence transgender rights?

LF: Everything is about story telling. Everyone is reporting and putting their story out, Snapchatting, instagramming. How do you tell your story well and honestly? I teach a college course in literature and we always start with fairytales. They are so problematic for trans kids, for all kids, because what comes first is the whole story. The transformations are instantaneous and painless and permanent and always forward looking and not backward looking. This isn’t a great model for kids with whom the transformation is everything and protracted. They may want to wipe out everything but their parents have no desire to wipe out the past. I’ve been talking to parents and trans kids about how to honor the past, making it part of the story.

This is How it Always is speaks not only to the transgender community, but to any of us who have questioned who we are and who we want to become.

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Hormones & Sexual Harassement

In the 1950s, Dr. Frank Beach fiddled with the testosterone levels of rats, the more testosterone the more they wanted to mate with female rats. He did the same for dogs, with less success. Some dogs were finicky and, regardless of the testosterone, injections, didn’t try to mount a bitch.

This led Beach to predict that the more complex the brain, the less direct control of testosterone and mating behavior. Beach, now considered a founder of the field in behavior and hormones, was onto something.

For the past five years, I’ve been interviewing experts, digging into archives, talking to patients who have had hormone ailments or have been treated with hormone supplements for my forthcoming book, AROUSED: The History of Hormones and How They Control Just about Everything.

It used to be that when I talked hormones, I got one of three responses: Women of my age want to know if I’m including menopause and whether I’m a pro or anti hormones for menopause. Men, around my age, want to know the deal with testosterone gel, will a little rub help rewind the clock? And the last responses are just a bunch of unfunny wisecracks or puns on the word hormone.

Lately, I’m asked about the role of sexual harassment and hormones.

One thing that often gets confused is that the animal studies of testosterone investigate mating behavior, which is different from libido (we can’t study that in animals) and it’s certainly different from bullying and humiliating. Most of the stories we are hearing lately do not have anything to do with mating or libido but have everything to do with the abuse of power.

Some studies have suggested that watching your sports team win leads to a fleeting uptick in testosterone. Perhaps bullying someone does the same. But bad behavior that bumps up a hormone level is far from an excuse or rationalization. That’s the tail wagging the dog explanation.

Nor can anyone claim “my hormones made me do that.”
That was tried that nearly one hundred years ago, during the 1924

murder trial of Nathan Leopold and Richard Loeb, two rich kids from Chicago who tried to get away with murder. They killed another rich younger kid from their neighborhood. Their trial became known as the Crime of the Century, turned into two feature films, one novel and at least three non-fiction books.

These were the days before testosterone was isolated or named. These were the days before we could measure hormones. Still, their parents hired a hormone expert who used a hormone defense. He claimed the boys lacked inhibition because of a stiff pineal gland. (We now know the pineal controls circadian rhythms but it was considered a seat of the soul then). The judge said (and I paraphrase): This burgeoning field of endocrinology sounds fascinating and I’m glad we are making advances, but it won’t get these kids off the hook for murder.

The thing is that we know that we can manipulate the mating behavior of rats quite simply by manipulating their testosterone; dogs not so much. It seems that most humans have higher cognitive functioning than rodents so with increased brain complexity, it’s hard to make one-to-one ties to upticks in hormone levels.

To be sure, the word “hormone” is not typically mentioned in articles about the recent cases of sexually harassment. But it is implied. When articles talk about people dismissing some behavior as “that’s just Charlie being Charlie,” or that’s just how some of the men here are. They are saying that it’s their chemistry. And if that’s the case, it’s something that colleagues should learn to deal with.

We’re learning a lot more about hormones and behavior and more about the impact of testosterone. We can measure fluctuations down to the billionth of a gram. But testosterone levels do not and should not provide men (or women) an excuse for harassing, bullying, or sexually assaulting other humans.

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Making Sense of Hormone Therapy

My mother is my news aggregator, better than any computerized algorithm. She culls stories for me that range from breaking news and general essays, to the arts, obituaries and every so often a wedding announcement. At 84, she’s sharper and more engaged than a lot of folks half her age. Last night, she shared with me an article posted on Facebook by one of her friends, an obstetrician-gynecologist.

I was enraged.

Her friend, who also lived around the corner from us growing up, promoted a piece about “optimizing your hormones optimal health and wellness.” It linked to a company that sells pills touted to be better than the ones your standard doctor prescribes. The article also said that she is part of group of doctors who have earned fellowships in Anti-aging Regenerative Medicine.

This whole thing infuriates me for so many reasons. Let’s start from the bottom:

To earn credentials from the American Association of Anti-Aging Medicine is about as worthy as having the Wizard of Oz place an award around your neck and tell you that you’re not longer cowardly or that you really do have a heart. It may boost your ego, but that’s about it. The anti-aging organization is not recognized by the American Medical Association nor do their board certifications count among the the American Board of Medical Specialities. If you want to read more, there’s a full account) in Arlene Weintraub’s Selling the Fountain of Youth. I went to one of their meetings and asked a doctor who was paying thousands of dollars to get board certified why he was doing it. He told me the piece of paper (you get a certificate) would impress his patients.

Bio-identicals, which my former doctor-neighbor is touting, means that the hormones mimic the exact chemistry of your body’s hormones. That may be a good thing. Some hormones have similar but not the exact chemistry and some studies show the ones that are “bio-identical” may have fewer side effects. I’m okay with that. What I’m not okay with is the insinuation that you have to go outside of the medical establishment to get them.

Bio-identicals are often confused with so-called “compounded” hormones. You’ll see advertisements, such as the one my mom forwarded to me, touting “bio-identical compounded hormones.”

Compounding is different. It means the hormones are tailor-made to fit the customer. That sounds all well and good. The point of compounding hormones is for the rare patient who is allergic to an ingredient in the mass produced pills, such as peanut oil; or the patient who can’t swallow a pill and may need a drinkable version. But in the last few decades, the compounding industry has skyrocketed. It’s not marketed to anyone, with the insinuation that it’s the organic version of drugs. It’s not. It’s the opposite. Compounded drugs are not within the FDA’s purview—that means that you may not be getting what you think you’re getting. There’s no quality control.

If you are thinking you want a hormone that is closer to the hormones in your body, there are standard drug companies that make them. Prometrium, a kind of progesterone that mimic’s the bodies hormone, is sold by pharmaceutical companies that are monitored by the FDA. For many women—who are taking hormones for menopause—this version may not have the same bloating, nauseating, moodiness impact that other forms of progesterone have. You don’t need to pay extra to see one of these anti-aging doctors, who are part of a multi-billion dollar industry.

My mother’s friend’s article (really an advertisement) gets worse. It tells patients that another mix of hormones also cures adrenal fatigue. Adrenal fatigue doesn’t exist! It’s a disease invented by folks who want to sell you a product for a fake ailment. You might as well sell me shampoo that claims to turbocharge by brain cells.

Doctors peddling cockamamie hormone treatments is nothing new. In the 1920s, a Kansas doctor became a mult-millionaire by selling goat testicles. Clients could shop at his farm, choose their own goat, and have the surgery done in the doctor’s kitchen. He wasn’t a surgeon. In the 1950s, a journalist published a book called, “Physical Attraction and Your Hormones, a Modern Guide to Beauty, Vitality, and Health.” It instructs women how to use hormones to find fulfillment, which was defined this way. “Woman,” Nina Katherine Lunn wrote, “is equipped by nature to be, first, a lure to man then, mother to the race.”

The Facebook message my mother forwarded to me was pretty much the same hogwash as this book written more than half a century ago, and not too different from the goat-gland doctor.

I am not against hormones to treat diseases. I’m not against hormones for menopause. I’m taking them, including prometrium (the bio-identical hormone) that my doctor prescribes and I get the old-fashioned way. (meaning a prescription that is covered by insurance.) What I am against is the insinuation that to get the safer versions of hormones you need to go outside of medicine and see doctors that have a silly credential and pay extra.

So buyer beware. To be clear, my mother—my news aggregator—did not send me this article to promote the wackiness of it all. She was curious about what her friend was up to. I detected a tone of skepticism in my mother’s voice. We’ll be talking about this as soon as she’s done with her morning water aerobics.

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