Maleness, femaleness, heterosexuality – sold to us by capitalism

The right tells us that certain ways of life are natural. Yet capitalism makes big money selling the surgeries and pills that make these “natural” lives possible, as Colin Wilson explains.

Central to current reactionary gender politics is that people are defined by their biology – we are born female and male and remain that gender all our lives. One response to this is to point out that being a man or a woman is about living a life in society, not just about biology. When we encounter people in our daily lives we don’t know about biological features like their DNA, their genitals or their hormones. There are many examples through the centuries of people whose gendered lives vary from bodies, or an upbringing, associated with another gender.

The social reality of ‘being a man’ or ‘being a woman’ also changes over time, and has changed dramatically in the last 50 years. In 1970, the average woman in Britain married aged 21, had their first child at 23 and gave birth to 2.6 children. Now on average women marry aged 30, a first-time mother is 29 and the fertility rate is 1.4. A typical woman in the 1970s would have spent much of her twenties caring for her children, while most women today don’t give birth till their late twenties or later, and many don’t have kids at all. The social reality of a life gendered female, or ‘what it means to be a woman’, is not simply a question of biology – it is, as people now put it, a ‘social construct’.

The last few decades have increasingly seen not just the social construction of cisgender and heterosexual lives, but their biological construction. While being a man or woman and forming relationships with the ‘opposite’ sex is something that people are supposed to do ‘naturally’, in fact there exist large and growing industries dedicated to changing the structure and functioning of bodies so as to make these things possible.

What counts as acceptable when it comes to women’s bodies, of course, is much more closely defined than the bodies of men. The rise of transphobia in Britain in the last few years has seen regular reports of women – often, cisgender women – whose status as a woman is questioned because they are felt to be too tall, too hairy and so on. And the approved standard is also defined in racial terms – it’s African runners like Caster Semenya whose bodies are judged to be insufficiently womanly, just as it’s Michele Obama who gets described as a man by one of Trump’s birthday cage fighters. The first widespread use of cosmetic surgery in the 1950s US aimed to remove a supposed sign of ethnicity, the ‘Jewish nose’. Thousands of young Jewish women underwent surgery to give them what was referred to, remarkably, as an ‘Irish nose’. Seventy years on, in 2024, 93% of people undergoing cosmetic surgery in the US were women, as were 94% of people using procedures such as Botox, hair removal or chemical peels. With 61% of surgical procedures carried out on women aged 40 to 69, and popular procedures including liposuction, tummy tucks and eyelid surgery, the aim of many patients is a slender, 20-something femininity.

If most people seeking cosmetic procedures are women, an increasing number of men undergo cosmetic procedures. In the US, the most common surgical procedure is carried out to address gynecomastia, a condition described by the National Health Service website as one ‘where men have bigger breasts than usual’. Gynecomastia can be caused by hormone changes after the age of 50 or during puberty, when a man is overweight or for various other reasons. These categories include large numbers of men – the NHS webpage describes the condition as ‘common’ – and estimates suggest that between one-third and two-thirds of men experience gynecomastia at some point in their lives. Men who have surgery – which is not normally available on the NHS and costs from £3,500 to £5,500 – often have bodies which cause them real distress or lead people to make fun of them. Yet the flat-chested norm to which they conform after surgery is socially defined, rather than reflecting what men’s bodies are generally like.

Other forms and functions of people’s bodies, defined as ‘natural’, are also artificially created. Over 3 million Viagra prescriptions are issued each year in Britain on the NHS, and the US military spends over $80 million a year on this and similar medications, mostly on men retired from active service. The hugely profitable development of Viagra happened in a specific social context. First, the late twentieth century saw more discussion of women’s sexual pleasure, as a result of the women’s movement, and also as increased use of the pill meant that more women could enjoy sex without fearing pregnancy. The sexual performance of straight men was now up for discussion – could a man give his partner pleasure? Second, deregulation of pharmaceuticals in the Reagan era saw a huge increase in their use – by 2001 almost half of the US population was taking a prescription drug every day – encouraging the idea that many personal problems could be solved by medications. Third, until the development of Viagra, men with erection problems were often told that their problem had a psychological origin, which could be solved by talking cures such as sex therapy. In fact, erection problems are linked in maybe half of all cases to physical issues, for example the heart condition angina. But it’s also the case that many men want to believe their problems are physical and can be addressed by taking a pill, because they were reluctant to talk about their feelings around sex.

On top of this Pfizer, who make Viagra, redefined the problem which it solved. Men who could not get or maintain an erection were previously said to experience ‘impotence’ – a stigmatising term, but also a somewhat different medical condition from the one Pfizer claimed their drug treated. The company asked men over 40 if they felt that their erections were less hard and long-lasting than the ones they had aged 20, and if they would like their 20-year-old erections back. Many men said yes to both these questions, and were told they had ‘erectile dysfunction’, for which Viagra was the treatment. 

By this definition, as many as half of all men over 40 have erectile dysfunction, which again highlights the question of what counts as normal. As Meika Loe writes in her book The Rise of Viagra (lol): ‘Normal for males, as defined by Pfizer Pharmaceuticals and its experts, is having a consistently hard and penetrative penis, feeling eighteen again, and never having to worry about occasional problems with erections.’ A former Pfizer sales rep puts it like this: ‘Frankly I think Viagra – the real use of Viagra – is not in cases of absolute medical need… the real use of Viagra is, say, for the guy who is probably forty-plus to age sixty-five that just isn’t what he used to be… It will make it like he was when he was twenty…’ 

Advertising and packaging for Viagra, often featuring smiling older straight couples, sends as Loe puts it ‘powerful messages about what it means to have a good sex life, to be healthy and happy, or to be a real man or a real woman.’  And yet, ‘… since Viagra’s debut, ‘normal sex’ in America is more and more narrowly defined and difficult to achieve’ – the supposedly ‘normal’ and ‘natural’ is something many men can only achieve by taking a pill. Nor did Pfizer ask how far straight women enjoyed sexual encounters centring on the ‘consistently hard and penetrative penis’ which Viagra enables. Some surveys suggested that quite a few older women didn’t enjoy sex with their male partners much, quietly looked forward to it ending and did not think of Viagra as an entirely good thing.

A final example of the biological creation of supposedly natural cisgender and heterosexual bodies is the recent vogue for testosterone replacement therapy or TRT. Some effects of testosterone in the body are well documented – for example, that in adolescent males it causes growth of facial hair and a deeper voice. But since testosterone was isolated around a hundred years ago, a host of cultural associations have developed around it, including connotations of physical strength, athletic performance, sexual prowess and masculinity in general. Careful examination of the data (as in Rebecca M. Jordan-Young and Katrina Karkazis’, Testosterone: An Unauthorized Biography) highlights that most of these widely-believed claims are unproven. 

This has not stopped major private equity investment in clinics providing TRT, treating men who supposedly have ‘low testosterone’ – the supposed symptoms of which, including anxiety, lack of motivation and low libido, all have various potential causes. One company marketing TRT suggests that ‘one in four men suffer from low testosterone after age 30’, which isn’t supported by the science. A consultant endocrinologist and author of guidelines for the Society for Endocrinology comments that TRT providers have ‘invented a spurious pseudo-disease called ‘low testosterone’ from which vast numbers of men are said to suffer’. One man’s experience echoes that of men who take Viagra because they hope to be 20 again:

Matthew, 60, a travel agent from Manchester, started TRT in part because he found he was low on energy and it was affecting his sex life. “I was getting a bit saggy and a bit sad,” as he puts it. “I didn’t want to give up on life.” He buys his T from an “underground” pharmacy and is thrilled with the results. “I’m zipping around, I’m nightclubbing, I’m pubbing. I have a great time.”

Meanwhile, increasing numbers of women are receiving TRT. Guidelines first recommended the treatment for low sexual desire in women in 2015, specifying that it might be effective in post-menopausal women after other issues had been ruled out. Since then the number of women prescribed testosterone gel on the NHS has increased ten-fold, with more than a third of them aged under 49 and so many probably pre-menopausal. One consultant in sexual and reproductive health suggests that testosterone may be presented to female patients in the same way that Viagra is presented to men, as a pharmaceutical solution to emotional issues – ‘women are being led to believe that it’s the missing piece of the jigsaw, that it’s going to be the solution to their relationship problems…’ It’s especially striking that the potential over-prescription of cross-sex hormones for mostly cisgender women contrasts with the reluctance of British doctors to prescribe cross-sex hormones for trans people, and the attacks by the British government on trans healthcare more generally. More generally, the examples of cosmetic procedures, Viagra and TRT for cis people suggest that the supposedly natural is really not natural at all.