#374 - The evolutionary biology of testosterone: how it shapes male development and sex-based behavioral differences, | Carole Hooven, Ph.D.
The Peter Attia Drive
Implications for Testosterone Replacement Therapy
They discuss TRT benefits, risks, behavioral effects, and caution especially for younger men using exogenous testosterone.
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Carole Hooven is a human evolutionary biologist whose research centers on testosterone, sex differences, and behavior. In this episode, she explores how prenatal testosterone orchestrates male development in the body and brain, how early hormonal surges shape lifelong behavioral tendencies, and what rare natural experiments—such as 5-alpha-reductase deficiency—reveal about the biology of sex differentiation. She discusses distinct male and female aggression styles through an evolutionary lens, how modern environments interact with ancient competitive drives, and the implications of attempting to suppress them. The conversation also covers testosterone across the lifespan, the role of hormone therapy in both men and women, and Carole's own experience after surgical menopause, culminating in a broader discussion of masculinity, cultural narratives, and the consequences of denying biological sex differences.
We discuss:
- How Carole became interested in exploring the biological and evolutionary roots of sex differences and the role of testosterone [2:30];
- How testosterone and other hormones influence sex differences in aggression and behavior across species [9:45];
- How chromosomes, the SRY gene, and early hormones direct embryonic sexual differentiation [12:15];
- A stark contrast of male social bonding compared to females, and evolutionary parallels in chimpanzees [19:30];
- How hormones like DHT shape sexual differentiation, and how 5⍺-reductase deficiency reveals the distinct roles of these hormones [22:45];
- How sex chromosomes and prenatal testosterone shape early brain development and explain sex differences in childhood behavior [31:30];
- How gamete differences shape reproductive strategies, energetic costs, and sex-specific behavior [42:30];
- How evolutionary biology shapes sex differences in play, aggression, and conflict resolution (and how modern environments and cultural messaging can disrupt those patterns) [49:00];
- Why males commit disproportionately more violent crime, and how cultural and environmental forces shape aggression [1:01:00];
- Why females evolved different behavioral strategies: nurturing, risk aversion, and the cultural norms that override biology [1:04:00];
- Whether male aggression is still necessary in modern society, why the underlying biological drives persist, and how modern society redirects these drives [1:06:30];
- How testosterone levels naturally shift to support fatherhood and caregiving [1:13:30];
- How testosterone shapes male mating strategies, and why long-term pair-bonding persists even when reproduction is no longer at stake [1:18:30];
- The distinct roles of estrogen in male development, mood, libido, and muscle [1:25:00];
- How evolution, health, lifestyle, and androgen receptor biology shape modern testosterone replacement therapy (TRT) [1:34:15];
- Carole's experience with hormone replacement therapy (HRT), and the risks associated with TRT in younger men [1:45:15];
- How Carole rebuilt after controversy: leaving academia and recommitting to scientific honesty [1:51:30,];
- Carole's next book: examining masculinity, cultural narratives, and the cost of denying biological sex differences [1:57:30]; and
- More.
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