Book Review: Robert Sapolsky's "The Trouble with Testosterone"

I have written a review and summarised some key points from Dr. Robert Sapolsky's book titled "The Trouble with Testosterone". It offers excellent, scientific insights into stress, hormones and environmental triggers which help shape behaviour. It very much falls in line with what TZM advocates:

Throughout the chapters of this book, Sapolsky finds himself coming back to the same question – “Is there a neurochemical imbalance to blame for behavioural problems in society?" Many areas of this book seek to answer this question from many different angles.

Sapolsky argues that the biology of our individuality is still heavily contested. He addresses that generally, when it comes to the topic of human nature, people still don’t know where to draw the line. A useful analogy used in this book goes as follows:
Society determines that if an epileptic suffers a seizure, they are not held responsible for their actions if they hurt someone – however this is never applied to neural ‘diseases’ such as stress, which has adverse affects on one’s biology just as epilepsy does – in other words, we just don’t know where to draw the line of judgement, and hopefully the progressive fields of psychological science and neuroscience can concentrate on researching this further.
Fundamentally, Sapolsky supports neuroscience and behavioural biology understandings. Both fields adopt an objective view point when it comes to researching human behaviour. There is always an underlying biology going on – and also a trigger from the environment around us that sets this biological process off in the first place. Consider the fight-or-flight response for a moment just as an example to this.

Later in the book, the author addresses the importance of empathy. He says that empathy is almost always grounded in a face, in individual stories. This is why we sometimes witness a lack of empathy towards a group of people who have been exploited. We often prefer news stories in the media that convey individual lives and problems that people experience on their own in society. There seems to be a pattern which shows that the deliverance of empathy is generally adopted and limited toward individuals. This can surely be a big problem when we know how many groups of people in the world, such as whole nations of people in developing countries, starving of hunger, require our empathy and assistance. The theory of mirror neurons is particularly of great interest to many neuroscientists and psychologists in modern research because it demonstrates that we could be equipped and hard-wired with the necessary neuronal tools to carry out empathic actions to help each other. The idea of mirror neurons means that we have a group of neuronal structures in the brain which observe and put ourselves in the same position as a person who might be crying or upset. It urges us to feel compassion and activates various memories and emotions that can connect us to the person who is upset.

Sapolsky describes various case studies and experimental research which reveal new findings when it comes to stress and its effects on the body overall. A case study he demonstrated consisted of a baboon troop, which was comprised of 2 leading alpha-males. When a new alpha-male entered the established troop, the 2 previous alpha-males were under a lot of stress, and were shown to have a decline in white blood cells of around 25% compared to a normal, healthy baboon. This new alpha-male that entered the group is usually identified as a “transfer male”. Sapolsky repeated his research to ensure consistency. Stress hormones can be found in the blood, and Sapolsky had to put the stressed baboons to sleep in order for a blood sample to be taken and delivered to the lab. This is a very important finding – if there is a direct correlation here between a stressor in the environment and the declinature of white blood cells, we really need to rethink our own human society if we want to live healthy lives. This would mean questioning the monetary economic system itself, which is responsible for many varying degrees of stress and aberrancies.

Sapolsky delivers some excellent insights into various historical references regarding the correlation between living in poverty and feeling stressed. One particular example is one which was discovered centuries ago when biologists were given dead bodies as form of donation from Governments to encourage educational medical knowledge being derived from carrying out dissections of the human body. This was particularly prevalent in Britain many years ago, when biological science was still very much in its infancy. The adrenal gland secretes adrenaline when in a fight-or-flight state of mind - and steroids called glucocorticoids help speed up the heart rate and metabolism when in a stressful situation. The corpses donated to doctors were in fact bodies of members of the public who had been living in extreme poverty. It’s no wonder that when doctors dissected and investigated the dead bodies, they found that the adrenal glands of the poor were in fact much larger than higher classes of people in society – this was due to higher stress levels which they experienced in their environments when living their lives in society. This goes to show that stress can in fact have damaging effects on certain organs in the body.

Sapolsky clearly defines what he means by a “stressor” in the environment:
- “A physical or psychological challenge that upsets the body’s equilibrium”

Here is an important, direct quote to consider from the author: “A lot of research in health psychology has explored the immensely important fact that certain personality types seem to be predisposed toward stress-related disease or toward secreting TOO MUCH of certain hormones that can cause stress-related disease”.

He goes on to say that the most frequently researched hormones are adrenaline and glucocorticoids
1. Both are secreted straight into the bloodstream
2. They help to adapt you to an acute stressful crisis by mobilising the fight-or-flight response
3. If these hormones are secreted CHRONICALLY because of psychological stress as seen in certain personality types, they can cause problems such as:
ELEVATED BLOOD PRESSURE
IRRITABLE BOWELS
REPRODUCTIVE SUPPRESSION
IRREGULAR SLEEP

I’d like to extract some analysis from the book on testosterone; what it is exactly and how it affects our behaviour and biology. Sapolsky addresses the fact that testosterone is part of a family of hormones collectively known as androgens or anabolic steroids. The hormone itself “binds to specialised receptors on muscles and causes those cells to enlarge”. The author states that the consequences of this lead to unhealthy blood vessels and the seeping of the hormone into the brain where it binds to androgen receptors and influences behaviour in a way highly relevant to understanding aggression from a biological perspective. To gain a better understanding into the effects of testosterone, behavioural biologists over the years have conducted what are known as “subtraction” experiments. This consists of the removal of the testes on an animal – and results have proven after this that aggression had in fact plummeted. However, an injection of the hormone (synthetically) causes for aggression to return. Sapolsky goes on to say that “Knowing the differences in levels of testosterone in the circulation of a bunch of males will not help you much in figuring out who is going to be aggressive” - He attempts to explain that “Testosterone isn’t CAUSING aggression, it’s merely EXAGERRATING the aggression that’s already present.”

If we delve a bit further into the biological mechanics of all this, you end up with the following:
There is an area of the brain called the amygdala. This area is associated with aggression and our fight-or-flight response to suspected danger or a stressor in the environment. The hypothalamus is also a region of the brain relating to similar highly emotional responses. Both of these areas of the brain communicate to one another via a cable of neuronal connections called the stria terminalis. This acts as a bridge between the two.
Sapolsky then breaks down the following steps if the environment triggers aggression:
- First, the amygdala has its influence on aggression via that pathway, with bursts of electrical excitations called action potentials that ripple down the stria terminalis
- This then puts the hypothalamus in a pissy mood
- Finally, testosterone eventually makes its way to this part of the brain - However, it needs to be emphasised that “Testosterone does not turn on this pathway” I’ve explained - it’s only “increasing the volume of signalling if it is already turned on.”

To conclude, testosterone does not CAUSE aggression = it is merely EXAGGERATING the pre-existing pattern of it = EXAGGERATING the response to environmental triggers of aggression [in other words]. In the words of Sapolsky, “Removing the testes does not stop aggression altogether, it just declines”. --- “Social Conditioning can more than make up the hormone” - [In other words] aggression can still be present without testosterone.

The author is quick to reiterate that:
“Our behavioural biology is usually meaningless outside of the social factors and environment in which it occurs”.

Knowing all of this demonstrates that the ‘Nature vs Nurture’ debate is completely irrelevant. Biological and genetic situations are triggered by the social factors around us. Let’s look forward to further understandings of this in the realms of neuroscience and psychology put together.