Like many other Americans her age, Dwyn Harben had trouble getting pregnant. While seeking medical treatments, she met Dr. Norbert Gleicher from the Center for Human Reproduction (CHR) in New York, who advised her to undergo in vitro fertilization (IVF). The process took years, with numerous attempts involving ovarian stimulation to release healthy eggs, but all in vain. Tired of the lengthy and costly treatment, Dwyn turned to online forums, where several women had successfully become pregnant by taking dehydroepiandrosterone (DHEA), a precursor to testosterone. She then decided to take the risk and make a combo: injecting herself with DHEA and continuing IVF treatments. The result? In addition to producing much healthier eggs than Dr. Gleicer expected, Dwyn was finally able to become pregnant.

That could be a story of how medicine discovered a new way of treating female infertility from experimental treatments carried out by patients. But not quite. As Rebecca M. Jordan-Young and Katrina Karkazis recount in their book Testosterone: An Unauthorized Biography (2019), there are several deviations needed for DHEA to become an accepted treatment in the medical world.

The first one is its classification within scientific knowledge. DHEA is known to be a testosterone precursor. What does that mean? When inside the human body, this molecule will turn into some hormone depending on the body's needs—it is a prohormone with minimal hormonal effects. More specifically, DHEA converts to the much more active testosterone and androstenedione, which can then be used directly via androgen receptors, or further converted to estradiol or estrone.

Therein lies the issue: how to even arrive at the idea that a molecule related to testosterone—the so-called male hormone—would have any role in eggs' ovulation and maturation process? How, within everything we know about the reproductive system, could we rationalize the idea that, contrary to what we had previously imagined, both male and female hormones are necessary for producing healthy eggs?

After she managed to get pregnant, Dwyn finally told Dr. Gleicher the reason for her success. Contrary to what she had read online, her doctor reacted with excitement and was interested in researching more on the subject. He was not interested in questioning Dwyn; instead, he became curious as to whether DHEA affected the ovulation process that had been utterly unnoticed until then by medicine, reinforcing the binary roles attributed to hormones since their discovery.

This is where the story hits its second hurdle: Dr. Gleicher, however interested he was in this subject, needed to convince other doctors and scientists that the idea that a male prohormone could indeed be essential in the ovulation process. And this is not an easy task.

As Fabiola Rohden tells us in her text, the association between hormones and the sexual dichotomy between men and women is a long-standing creation traced to the beginning of the discovery of testosterone and estrogen. The idea of ​​a male and a female hormone has endured for nearly a century, although several studies have tried to implode such thinking. And we don't need to go too far: the realization that male hormones are in female bodies and vice versa is as old as its discovery. As historian of science Nelly Oudshoorn recounted in her book Beyond the Natural Body: An Archeology of Sex Hormones (1994), researcher Enerst Laquer had already found estrogen in horse urine in 1927—in the early years of the discovery of hormones.

Here, it is not a matter of denying the hormonal effects of testosterone and estrogen but rather questioning why these effects must always fall into a binary sexual dichotomy. Is it possible to think that testosterone might have hormonal effects that aren't within that spectrum? Say, such as assisting the egg maturation process in its follicular phase?

The point is that this lack of imagination worked against Dr. Gleicher's plans to thoroughly research whether DHEA can help produce healthier eggs and aid in fertility treatment. That is because science ends up in a loop regarding the issue. The first step would be to prove that DHEA has a fundamental role in the egg maturation process, even though it is a male hormone precursor. For this, it is necessary to produce research with women who have difficulty getting pregnant and are willing to use DHEA as a treatment. However, there are two problems here: first, scientific knowledge so far reiterates the dualistic idea about hormones, and thus it is difficult to get funding for research. Funders insist that there is insufficient evidence in the scientific articles to justify the investment in this research. Second, most women within the expected target population are already being treated with DHEA, as the substance is sold in US pharmacies without needing a prescription.

Another vicious cycle: there is no incentive for this sort of research since the women being tested already seem to know about the effectiveness of DHEA from online forums and social networks. In the end, many women follow the same path as Dwyn, often a dangerous one: self-medication.

This story is added to several other reports produced within national and international research that seek to implode the notion of binary sex hormones. Daniela Manica, Fernanda Vecchi Alzuguir, Emilia Sanabria, Celia Roberts and Bruna Klöppel are some of the researchers who join Fabíola, Rebecca, Katrina and Nelly in this quest to think about the hormonal effects that we miss taking seriously when we dichotomize hormones into exclusive sex categories.

Being a 20th-century discovery, hormones are still a relatively recent object of study. There is much yet to be learned. When discovering these new molecules with near-magical powers, physiologist Ernest Starling took inspiration from an ancient Greek word to name them. The root hormao means to excite or provoke. I agree with the researcher Celia Roberts that this was a fortunate choice. To become excited means to change one's initial state, to leave a starting point, rather than to control or produce something. And this is how hormones should be perceived: less as normalizers of sexual characteristics and more as entities that provoke complex actions and pose profound questions to us.

In recounting Dwyn's case, my question is: why do we insist on a binary version of hormones when several stories point us to more complex and less dualistic relationships of these molecules? Why keep preaching that hormonal effects must fall into a sexual dichotomy? In this sense, when we describe hormones, we are always referencing the social sphere, as they have been historically used to reiterate a binary view of the world that does not seem to match their actual capacities. As far as hormones remain—until we can eventually implode them—it is essential to attach stories like Dwyn's to them to remind ourselves that even the most widely accepted explanations may not accommodate the complexity of this world.