THE MIXED BLESSINGS OF SEX HORMONES
In this epilogue it is time to reflect on what sex hormones have brought us. Clearly, hormones have changed our world. The quest for sex hormones exemplifies the dreams of modernity. The promises of the new science of sex endocrinology mirror the modernist claim that “a progressive growth of scientific knowledge will uncover the natural order of things, making possible the construction of techologies through which control might be exercised over the course of the development of events” (Smart 1992:56). In this Enlightenment tradition, science and technology are considered as intrinsically progressive and beneficial. The role of science and technology in our society is perceived as improving the “human” condition.
The quest for sex hormones was firmly rooted in this belief of science as progress. Since its early years, the science of sex hormones promised to provide a technological fix for many problems, particularly “women’s problems.” Robert Frank’s The Female Sex Hormone very vividly illustrates this modernist tradition when the author promises his readers that female sex hormones are “bound to relieve many of the ills from which women suffer” (Frank 1929: Introduction). The intriguing question is: has Frank’s dream come true? My book would have a happy end, providing the answer is a straightforward yes. Unfortunately, but not unexpectedly, the answer is not that easy. The introduction of the hormonally constructed body concept has led to a situation in which “control can be exercised across the life course from menstruation through menopause” (Clarke 1990a). So far, we may be inclined to conclude that Robert Frank was right and very much ahead of his time. We may question, however, whether and to what extent sex hormones are an adequate solution for “women’s problems.” Undoubtly, many women will emphasize the benefits of hormone therapy. Yet it is the very idea of control and the awareness of (potential) health hazards that turned the dream of hormones as problem solvers into a reality of growing ambivalence and severe criticism. Two examples of the use of sex hormones, the pill and hormone replacement therapy, clearly illustrate the two faces of the hormonal revolution.
The story of the pill is a story about liberation and control. On the one hand the pill is “except for the word ‘no’ the most effective and convenient contraceptive ever devised,” a technology that contributed to the increasing liberation of women (Seaman and Seaman 1977:95). On the other hand it is a
story about Western science ignoring the local needs of specific users, particularly the communities on the Caribbean islands and other Third World countries. The “one size fits all”11 approach to making contraceptives such as the pill does not acknowledge diversities among women. I have argued that these universal tendencies are highly problematic because they cause serious health risks. Moreover, in the domain of population policy, the pill is not unproblematic because it serves as a tool in the pursuit of a technological fix for problems which ultimately are political, economic, cultural and moral in kind.
A similar story can be told for the use of sex hormones for the treatment of menopausal symptoms. Since the 1960s hormone replacement therapy for menopausal women has become very popular, particularly in the United States, where the sales of estrogen preparations have quad-rupled. Today these drugs are even one of the top five prescription drugs (Greer 1991:185). Again, the use of hormones has two faces. It promises a relief of many negative bodily experiences during aging. Many women consider hormone replacement therapy as an efficient therapy and as an acknowledgement of their problems by the medical profession. The other face is more gloomy. It shows the many controversies that have accompanied the introduction of hormone replacement therapy. There are the recurring debates about risks of cancer and other serious side-effects. There is the criticism on the reductionist view on menopause: hormonal explanations of menopause reduce the complexity of aging to a disease entity. (Greer 1991; Seaman and Seaman 1977).
In summary, sex hormones may best be portrayed as a mixed blessing. The implication of my remarks is not a cultural or technological pessimism but rather that we need to understand science and technology with all its tensions and ambiguities. My argument throughout this book has been that bodies and technologies are not unequivocally determined by nature. Medical technologies do not necessarily have to be the way they actually are. Who knows what might have happened to the hormonally constructed body concept if there had existed an andrological clinic, rather than a gynecological clinic? Imagine what might have happened in a world with different cultural and moral attitudes towards gender and responsibilities for family planning and childcare. It is not beyond imagination that we would have ended up with a male contraceptive pill, a medical treatment of male menopause and a classification system of multiple sexes. Alas, we will never know whether this really would have happened. We know, however, one thing for sure: science and technology can take many shapes. A critical deconstruction of the processes that shape science, technology and bodies might help us to envisage technologies that have a chance of survival.