Charles J. Ryan - The Virility Paradox: The Vast Influence of Testosterone on Our Bodies, Minds, and the World We Live In

Praise for The Virility Paradox

The Virility Paradox by Charles Ryan, MD, is a marvelous, timely, and fun book about testosterone and behavior in men and women. This is a must read for parents, teachers, doctors, psychologists, and everyone interested in gender.

Louann Brizendine MD, neuropsychiatrist, author of The Female Brain and The Male Brain

Charles Ryan has written a unique, easy-to-read medical commentary on the paradoxes of testosterone. Anyone wanting to learn about the scientific basis of puberty, crime, behavior, or prostate cancer will want to read this fascinating book written by one of our nations most outstanding academic physicians.

Stanley Prusiner, MD, director of the Institute for Neurodegenerative Diseases at University of California, San Francisco, Nobel Laureate in Medicine, and author of Madness and Memory

Fascinating! Ryan is a doctor and professor but also a natural scientist... The Virility Paradox is a book of remarkable scope, for this hormone plays a role in every human dramain sickness and health and in aging; in sex and power; morality and politics; in how we think and how we behave. With unforgettable stories to complement his extensive scientific research, Ryan has us not only rethinking all our ideas about masculinity but what it is to be human.

Jena Pincott, author of Do Chocolate Lovers Have Sweeter Babies: The Surprising Science of Pregnancy and Do Gentlemen Really Prefer Blondes?: The Science of Love, Sex, and Attraction

A terrific read. Dr. Ryan writes with grace, wit, and insight on a topic that touches on nearly every aspect of our society. Highly recommended.

Dr. Kelly Parsons, author of Doing Harm and Under the Knife and professor of urology at the University of California, San Diego

THE VIRILITY PARADOX

This book is for informational purposes only. It is not intended to serve as a substitute for professional medical advice. The author and publisher specifically disclaim any and all liability arising directly or indirectly from the use of any information contained in this book. Any product mentioned in this book does not imply endorsement of that product by the author or publisher.

In certain instances, names, persons, organizations, and places have been changed to protect an individuals privacy.

Copyright 2018 by Charles J. Ryan

All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in critical articles or reviews.

BenBella Books, Inc.

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Dallas, TX 75231

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Send feedback to feedback@benbellabooks.com

First E-Book Edition: February 2018

Library of Congress Cataloging-in-Publication Data Control Number: 2017053846

ISBN 9781944648565 (trade cloth)

ISBN 9781944648572 (electronic)

Editing by Alexa Stevenson and Lisa K. Marietta

Copyediting by Brian J. Buchanan

Proofreading by Lisa Story and Michael Fedison

Indexing by WordCo Indexing Services, Inc.

Text design by Aaron Edmiston

Text composition by PerfecType, Nashville, TN

Cover design by Pete Garceau

Jacket design by Sarah Avinger

Printed by Lake Book Manufacturing

Distributed to the trade by Two Rivers Distribution, an Ingram brand www.tworiversdistribution.com

To my dad, Tom Ryan, whom we lost suddenly in 2017. Thank you for sharing your love, wit, wisdom, and all of the best of you.

A special warm acknowledgment to Hudson Perigo for her patient mentorship, technical savvy, and persistent commitment to excellence that made completion of this book possible

L et us begin at the endthe end of a life.

Although his death certificate doesnt say so, my patient Jimmy died because of the irrepressibility of testosterone. I watched it happen slowly, over years, and did my best to stop it.

Jimmy was in his early seventies and, like me, was a big, tall guy with an Irish surname who wore his heritage proudly. During the four years he was under my care, wed bonded over that and other commonalities ranging from raising daughters to the San Francisco Giants. We became close, as is common in my line of work if you choose to let it happen (and not all of us do). After his death his wife, Barbara, gave me a couple of his cashmere sweaters. They were beautiful, and for a while I made a point of wearing them to work on days when I might run into her while she worked at the hospital gift shop. But truthfully, not only were they a bit too big, but I also felt constricted by the grief they carried, and I eventually donated them away. I guess there are limits to that closeness.

My last moments with Jimmy occurred less than an hour before he died. Barbara had called while I was flying home from a work meeting, and I listened to her voice mail while driving back from the airport. Her soft voice was full of pain; she was all alone with Jimmy and knew this was the end. Could we talk? she asked.

I called her back and arranged to come by. Their apartment was on my way home, and I appreciate that the occasional house call is good for the soul, mine included.

I parked on the steep, sloped street and made my way up the staircase to the door of a classic San Francisco Victorian, where Barbara greeted me with a tight hug. Shes one of those short, energetic women for whom the word feisty seems to have been invented, but her worry, fear, and exhaustion were palpable.

Most cancer deaths now occur at home, and while home care eliminates a costly and needlessly sterile hospital death, it also lessens the chances that a doctor will be at the bedside at the end to support and comfort patients and their families. This insulation between doctors and dying, though it may protect us doctors from burnout, also removes us from the raw corporeality of witnessing deathan experience that can inspire us to fight even harder for the living.

Jimmy was in the bedroom, in an adjustable hospital bed that had been placed next to the bed hed shared with Barbara for decades, close enough to allow the couple to touch. One look confirmed that although his heart was pumping and his lungs were taking in air, Jimmy had crossed into a place from which he would not return. He was breathing rapidly and barely responsive. His previously muscular body had been reduced to bony protuberances and wasting muscles, all of it tinged a sickly yellow, and the ammonia-like smell of his breath spoke of the necrosis raging inside him. He didnt appear to be in pain, but he didnt appear to be at peace, either.

I stayed for about an hour, examining Jimmy, speaking to him in a reassuring tone, and holding his hand while Barbara and I discussed the next steps. Medically, there wasnt much to doa dose of morphine to ease the labored breathing, little more. It wouldnt be long. She had questionsHow much time did they have? Was he in pain? What about medication?and I did what I could to answer her. But mostly we just sat.

Soon, their daughter arrived and Jimmy seemed more comfortable. Sensing that it was time for me to go, I quietly said goodbye, leaving the intimacy of Jimmys remaining moments to his immediate family. If they needed anything, the hospice team was just a few minutes away.