Inferior: How Science Got Women Wrong – and the New Research That’s Rewriting The Story

He took the testes from normal cockerels and transplanted them into capons to see what happened. Remarkably, he found the capons started to look and sound like cocks again. The testes were surviving inside them, and growing. It was a startling result, but nobody at the time understood the reasons for it. What was it in the testes that was helping the capons seemingly come back from castration?

Progress came slowly. In 1891 another unusual experiment, this time in France by university professor Charles-Édouard Brown-Séquard, finally began to get to the root of the mystery. He suspected that male testes might contain some kind of unknown substance that influenced masculinity. Attempting to prove his hypothesis the hard way, he repeatedly injected himself with a concoction made out of blood, semen and juices from the crushed testicles of guinea pigs and dogs. He claimed (although his findings were never replicated) that this cocktail increased his strength, stamina and mental clarity.

The British Medical Journal reported Brown-Séquard’s findings with excitement, describing the substance he had found as the ‘pentacle of rejuvenescence’. Later, researchers carrying out similar experiments using female juices from guinea pig ovaries claimed to see a parallel feminising effect. Over time, the secret juices inside all these male and female gonads were understood to be a specific set of chemicals, named ‘hormones’.

We now know that sex hormones, found in the gonads, are just a handful of the fifty or more hormones produced across the human body. We can’t live without them. They are the grease to our wheels. They’ve been described as chemical messengers, delivering memos throughout the body to make sure it does the things it’s supposed to do, including growing and keeping a stable temperature. From insulin to thyroxine, they helpfully regulate the functions of all sorts of organs. The sex hormones regulate sexual development and reproduction. The two main female ones are oestrogen and progesterone. Oestrogen is what causes a woman’s breasts to develop, among other things, while progesterone helps her body prepare for pregnancy. Male sex hormones are known as androgens, of which the most well-known is testosterone.

Even before birth, sex hormones play a crucial role in determining how male or female a person looks. In the womb, it’s interesting to note, all foetuses start out physically female. ‘The default blueprint is female,’ says Richard Quinton, consultant endocrinologist at hospitals in Newcastle upon Tyne. About seven weeks after the egg has been fertilised, testosterone produced by the testes begins physically turning the male foetuses into boys. ‘Testosterone says: “Make me externally male,”’ adds Quinton. Meanwhile another hormone stops this freshly male foetus from growing a uterus, fallopian tubes and other female parts. As we grow older, hormones again play a role in puberty and beyond.

It’s not surprising, then, that the discovery of sex hormones was one of the most important milestones in understanding what it means to be a woman or a man.

According to work done by social researcher Nelly Oudshoorn, now based at the University of Twente in the Netherlands, hormone research sent waves of excitement through the pharmaceutical industry in the 1920s. Suddenly, here was a way of scientifically understanding masculinity and femininity. With some effort, drug companies believed they could isolate and industrialise the production of sex hormones to make people more masculine or feminine.

Endocrinology – the new and controversial study of hormones – was turning into big business. Tonnes of animal ovaries and testes were harvested, and thousands of litres of horse urine collected, as scientists desperately searched for the chemicals that defined what it meant to be male or female. The director of Dutch pharmaceutical company Organon described the process of isolating hormones as ‘finding gold in the urine of pregnant mares’.

By the end of the decade, treatments based on sex hormones were becoming available, and there appeared to be no limit to what they promised. In the archives of London’s Wellcome Library, which keeps an enormous trove of historical medical documents, I find an advertising pamphlet from around 1929, produced by the Middlesex Laboratory of Glandular Research in London. It proudly announces that it’s finally possible to replenish the ‘fire of life’, to cure impotence, frigidity and sterility in men using ‘the therapeutic utilisation of the sex hormones of fresh glands removed from healthy animals, such as the bullock, ram, stallion, ape’. Treatments containing oestrogen made similar claims aimed at women, promising to cure irregular periods and symptoms of the menopause.

Of course, hormone treatments couldn’t possibly live up to all this hype. But they weren’t just a fad either. They really did seem to work for certain symptoms, even if the evidence was only anecdotal. An article in the Lancet in 1930 reports a male patient who had been given testosterone saying that he thought ‘his muscles were firmer and he felt more pugnacious; he nearly had a fight with his workmate’. Another man, aged sixty, was able ‘to play thirty-six holes of golf in a day without undue fatigue’. Testosterone became associated with what were believed to be manly qualities, such as aggression, physical power, high intellect and virility.

The same research was done on women using oestrogen. Another article in the Lancet in 1931, the researcher Jane Katherine Seymour has noted, connected the female hormones to femininity and childbearing. Under their influence, it also said, women ‘would tend to develop a more passive and emotional, and less rational, attitude towards life’.

In the very early days of endocrinology, assumptions about what it meant to be masculine or feminine came from the Victorians. With the discovery of hormones, scientists had a new way to explain the stereotypes. According to Anne Fausto-Sterling, professor of biology and gender studies at Brown University, Rhode Island, the prominent British gynaecologist William Blair-Bell, for instance, believed that a woman’s psychology depended on the ‘state of her internal secretions’ keeping her in ‘her normal sphere of action’. At that time, this meant being a wife and mother. If she stepped outside these social boundaries, scientists like him implied it must be because her hormone levels were out of whack.

In other words, according to researchers, sex hormones were doing more than just affecting reproductive behaviour. They were responsible for making men manlier, by the standards of the time, and women more womanly, again by the standards of the time. Reasoning in this way, scientists assumed that the sex hormones belonged uniquely to each sex. Male hormones – androgens – could only be produced by men, and female hormones – oestrogen and progesterone – could only be produced by women. After all, if they were the key to manliness and womanliness, why would it be any other way?

An interesting experiment in 1921 hinted at the possibility that all the assumptions scientists were making about sex hormones might be wrong.

A Viennese gynaecologist revealed that treating a female rabbit with an extract from an animal’s testes changed the size of her ovaries. Later, to their shock, scientists began to realise that there were significant levels of androgens in women and of oestrogen in men. In 1934, the German-born gynaecologist Bernhard Zondek, while studying stallion urine, reported on ‘the paradox that the male sex is recognised by a high oestrogenic hormone content’. In fact, a horse’s testes turned out to be one of the richest sources of oestrogen ever found.

Just when endocrinologists thought they were getting a grip on what sex hormones did, this threw everything into confusion. And it raised an interesting dilemma: if oestrogen and testosterone determined femaleness and maleness, why did both sexes naturally have both? What did it even mean to be born male or female?

For a while, some scientists thought that female sex hormones might be turning up in men because they had eaten them. This bizarre ‘food hypothesis’ was ditched when it gradually became clear that male and female gonads can in fact produce both hormones themselves. Others then thought that the only thing oestrogen could be doing in a man was pulling him away from masculinity and towards femininity, perhaps even towards homosexuality.

It took a while for scientists to accept the truth: that all these hormones really did work together in both sexes, in synergy. Nelly Oudshoorn has described how important a shift this was in the way that science understood the sexes. Suddenly a spectrum opened up on which men could be more feminine and women more masculine, instead of simply opposites. Writing in 1939, at the end of what he described as this ‘epoch of confusion’, Herbert Evans at the Institute of Experimental Biology at the University of California, Berkeley, admitted, ‘It would appear that maleness or femaleness can not be looked upon as implying the presence of one hormone and the absence of the other … though much has been learned it is only fair to state that these differences are still incompletely known.’

The implications of this change of thinking were spectacular. The entire notion of what it meant to be a woman or a man was up for grabs. Researchers in other fields began to explore the boundaries of sexual and gender identity. The American cultural anthropologist Margaret Mead started writing at around the same time about masculine and feminine personalities, and how culture rather than biology might be influencing which ones people had. Studying Samoan communities in 1949, she wrote, ‘The Samoan boy is not over pressured into displays of manhood, and the girl who is ambitious and managing has plenty of outlets in the bustling, organised life of the women’s groups.’ The Mundugumor tribe of Papua New Guinea, she also noticed, created women with more of a typically male temperament.

Not everyone today agrees with Mead’s observations, but her ideas did signal how society was changing, in part prompted by science. There was a radical move from the old Victorian orthodoxies of the kind to which Charles Darwin had subscribed. People could no longer clearly define the sexes. There was overlap. Femaleness and maleness, femininity and masculinity, were turning into fluid descriptions, which might be shaped as much by nurture as by nature.

This revolution in scientific notions of what it meant to be a woman came in time for the second wave of feminism in the 1960s and 1970s, following the pioneering movement decades earlier that had earned women the vote. By now, female biologists, anthropologists and psychologists were entering universities and graduating in growing numbers. They were becoming researchers and professors. This helped research on women to enter another era. Fresh ideas challenged long-standing narratives.

The path paved by Eliza Burt Gamble, the pioneering suffragist who had dared to challenge Charles Darwin in the previous century, was being trodden by a new generation of scientists.

We arrive at today.

Lingering stereotypes about sex hormones remain. But they are being constantly challenged by new evidence. According to Richard Quinton, common assumptions about testosterone have already been shown to be way off the mark. Women with slightly higher than usual levels of testosterone, he says, ‘don’t actually feel or appear any less feminine’.

In 2008, former Wall Street trader John Coates, a neuroscientist at Cambridge University who researches the biology of risk-taking and stress, decided to see whether the cliché of stock-market trading floors being testosterone-fuelled dens of masculinity was true. He took saliva samples from traders, and found that when their testosterone levels were above average, their gains were also above average. Another study in 2015 by a large team of scientists across Britain, the USA and Spain revealed that testosterone didn’t make the traders more aggressive, it just made them slightly more optimistic. And when it came to predicting future price changes, this may have encouraged them to take a few more risks.

Richard Quinton similarly claims to have seen no link between testosterone and aggression among his patients, despite the stereotype that testosterone makes people more violent. ‘I’m not sure where it comes from,’ he tells me. ‘Urban myth?’

The balance between nature and nurture is starting to be a little better understood. In academic circles at least, gender and sex are now recognised as two different things. Sex is something scientifically distinct for most people. It’s defined by a package of genes and hormones, as well as more obvious physical features, including a person’s genitals and gonads (although a small proportion of people are biologically intersex). Gender, meanwhile, is a social identity, influenced not only by biology, but also by external factors such as upbringing, culture and the effect of stereotypes. It’s defined by what the world tells us is masculine or feminine, and this makes it potentially fluid. There are many for whom their biological sex and their gender aren’t the same.

But we remain in the early days of this kind of research. The biggest questions are still unanswered. Does the balance of sex hormones have an effect beyond the sexual organs and deeper into our minds and behaviour, leading to pronounced differences between women and men? And what does this tell us about how we evolved? Is the traditional stereotype of the breadwinning father and the stay-at-home mother really part of our biological make-up, as Darwin assumed, or is it an elaborate social construction that’s unique to humans? Studies into sex differences are as powerful as they are controversial. In the same way that research on hormones challenged popular wisdom about masculinity and femininity in the twentieth century, science is now forcing us to question all aspects of ourselves.

The facts, as they emerge, are important. In a world in which so many women continue to suffer sexism, inequality and violence, they can transform the way we see each other. With good research and reliable data – with real facts – the strong can become weak, and the weak strong.

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Females Get Sicker But Males Die Quicker (#u0bc67060-a13d-5f77-853b-86359a55f230)

The evidence is clear: from the constitutional standpoint woman is the stronger sex.

Ashley Montagu, The Natural Superiority of Women (1953)

‘It’s wonderful,’ says Mitu Khurana, a hospital administrator living in New Delhi. ‘When you have your first pregnancy, everyone is very excited. It is a feeling beyond description.’

The time she’s so fondly remembering was a decade ago. She had become pregnant with twins just a few months after getting married, and she assumed that nothing could ruin her happiness. Raised in a family of sisters, Mitu didn’t care whether she was having boys or girls, or one of each. ‘I just wanted the children to be healthy,’ she tells me.

But her husband and his family didn’t feel the same way. They wanted sons.

So begins a common story. It’s one that has been repeated in millions of homes across India, China and other parts of South Asia, where cultures unashamedly prize sons above daughters. They are cultures, as Mitu learned all those years ago, that will sometimes go to terrible lengths to stop a girl from even being born. Some women keep having children until they finally have a boy. Others are pressured to abort female foetuses, even to the point of torture. If they do make it to the day of their birth, many female babies and young girls are routinely treated worse than boys. In the most appalling cases, they are killed. In 2007, police in Orissa in the east of India found skulls and body parts of what they believed to be three dozen female foetuses and infants down a disused well. A news report in 2013 described a baby buried alive in a forest in the central state of Madhya Pradesh. Another in 2014 told of a newborn in Bhopal dumped in a rubbish bin.

That year, a United Nations report described the problem as having reached emergency levels. India’s 2011 census had already revealed that there were more than seven million fewer girls than boys aged six and under. The overall sex ratio was more skewed in favour of boys than it had been a decade ago. Part of the reason was the growing availability of prenatal scans, which for the first time allowed parents to find out the sex of their babies easily, and early enough to have selective abortions.

In 1994 the Indian government outlawed sex selection tests, but unscrupulous independent clinics and doctors still offer them for a fee, in private and under the radar. Mitu never wanted to have one of these prenatal scans, she tells me. But in the end, she wasn’t given the choice. During her pregnancy, she claims she was tricked into eating some cake that contained egg, to which she is allergic. Her husband, a doctor, then took her to a hospital, where a gynaecologist advised her to have a kidney scan under sedation. It was then, she believes, that her husband found out the sex of her unborn babies without her consent or knowledge.

‘I knew it from his behaviour that I’m getting daughters,’ she explains. He and his family immediately began pressing her to have an abortion. ‘There was a lot of pressure.’ She says she was denied food and water, and was once pushed down the stairs. Desperate and frightened, Mitu went to stay with her parents, and eventually gave birth to her daughters there.

She managed to save her girls. But things didn’t change. ‘They were not at all warm,’ she recalls of her husband and his family’s attitude towards her daughters. A few years later she stumbled on an old hospital report revealing the sex of her foetuses. She read it as proof that her husband had indeed carried out an ultrasound scan on her while she was pregnant, without her consent. As a result of that discovery she launched a legal case against both him and the hospital, which is still making its way through the notoriously slow Indian courts at the time I interview her, ten years after the birth of her daughters. Her husband and the hospital have both strongly denied her allegations.

Now long-separated from her husband and awaiting a divorce, Mitu has become famous in India for being among the first women to take this kind of legal action. Taking her campaign across the country has confirmed to her just how widespread a problem this is, blind to class or religion. ‘I’m fighting because I don’t want my daughters to go through this. Women are wanted as wives and girlfriends, but not as daughters,’ she says. ‘Society has to change.’

However well-hidden the selective abortions, murders and abuse of mothers and their daughters, the countrywide statistics don’t lie. Reality is laid bare in the grotesquely uneven sex ratios. The 2015 United Nations report The World’s Women says, ‘For those countries in which the sex ratio falls close to or below the parity line, it can be assumed that discrimination against girls exists.’

It is a situation familiar to Joy Lawn, director of the Centre for Maternal, Adolescent, Reproductive and Child Health at the London School of Hygiene and Tropical Medicine. ‘You go to hospitals in South Asia and there can be whole wards of kids with illnesses, and you will find 80 per cent of them are boys, because the girls aren’t being brought to the hospital,’ she tells me. A similar gender imbalance was uncovered in a 2002 study in Nepal by public health researchers Miki Yamanaka and Ann Ashworth, also from the London School of Hygiene and Tropical Medicine. They looked at how much work children are expected to do to support their families, and found that girls worked twice as long as boys, and that their work was also heavier.

The effects that society can have on gender differences are profound, and include the taking of life itself. What makes the mortality figures even more shocking is that, contrary to assumptions about women being the weaker sex, a baby girl is statistically more robust than a baby boy. She’s naturally better built to live. As scientists explore the female body in fuller detail, they are learning just how powerful a girl’s survival edge is – even in a world that doesn’t always want her.

‘Pretty much at every age, women seem to survive better than men.’

We often think of males as being the tougher and more powerful sex. It’s true that men are on average six inches taller and have around double the upper-body strength of women. But then, strength can be defined in different ways. When it comes to the most basic instinct of all – survival – women’s bodies tend to be better equipped than men’s.

The difference is there from the very moment a child is born.

‘When we were there on the neonatal unit and a boy came out, you were taught that, statistically, the boy is more likely to die,’ explains Joy Lawn. Besides her academic research into child health, she has worked in neonatal medicine in the United Kingdom and as a paediatrician in Ghana. The first month following birth is the time at which humans are at their greatest risk of death. Worldwide, a million babies die on the day of their birth every year. But if they receive exactly the same level of care, females are statistically less likely to die than males. Lawn’s research encompasses data from across the globe, giving the broadest picture possible of infant mortality. And having researched the issue in such depth, she concludes that boys are at around a 10 per cent greater risk than girls in that first month – and this is at least partly, if not wholly, for biological reasons.

Thus, in South Asia, as elsewhere in the world, the mortality figures should be in favour of girls. The fact that they’re not even equal, but are skewed in favour of boys, means that girls’ natural power to survive is being forcibly degraded by the societies they are born into. ‘If you have parity in your survival rates, it means you aren’t looking after girls,’ says Lawn. ‘The biological risk is against the boy, but the social risk is against the girl.’