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[Applause]
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When I was a college sophomore, 19 years
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old at Harvard College, uh I was on the
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street and one of my professors came by,
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saw me, and he asked me how I was doing.
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And I told him honestly, I wasn't doing
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well. I was feeling lost and I was
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thinking of dropping out.
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He said, "Why don't you come uh try
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working in my lab? You might like it." I
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did like it. And I spent the next three
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years working with the American
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chameleon anolus carolinensis.
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These are the little lizards you see
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everywhere in Florida. They're on the
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street. They're on the trees. Sometimes
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they're in your hotel room. And um when
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you put the male in a cage with the
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female, they've got this bright colored
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flap of skin under their neck called a
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duelap. The dlap comes out and the head
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bobs up and down really quickly as if
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the male saying, "Yeah, yeah, yeah,
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yeah, yeah."
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The female will do a little elegant push
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up to show some degree of interest. And
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then they each repeat this little dance
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and then they finally mate.
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Now, when I removed the testicles of the
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male and put them in a cage with the
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female, they didn't do their dance. The
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female would sometimes do her push-up as
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if to say, "Yoohoo, I'm over here." But
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the male didn't care. Once his testicles
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were gone, he had no testosterone.
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Now, the key part of the experiment was
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to put tiny amounts of testosterone into
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the sexual centers in their teeny little
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lizard brain. And when I was
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successfully able to do that, the male
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without testicles would see the female,
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the doolap would come out, the head
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bobbed up and down, and they made it. It
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was amazing.
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And what it meant was that testosterone
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in the brain was enough to regulate the
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entire range of sexual behavior for the
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male lizard. That was my first paper
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when I published that 1978.
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When I went to medical school and did my
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training in urology though, I learned
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something completely different about
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testosterone. It turned out it was a
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foundational concept that testosterone
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caused prostate cancer and made it grow
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rapidly.
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Every week on teaching grounds, I heard
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giving a man testosterone is like
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pouring gasoline on a fire. Pretty
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scary. No wonder there was a global
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prohibition against the use of
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testosterone back then.
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When I finished my training and I
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started seeing patients on my own, some
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of the men I saw had sexual issues and
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they were desperate. Doctor, they said,
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"My wife is going to leave me. There's
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got to be something that you can give
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me." It was years before Viagra,
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and truthfully, we didn't have that much
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to offer men. Um, some of these guys had
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low testosterone and I thought to
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myself,
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maybe these men are like my lizards.
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Going against all my training, I treated
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a few of these men with testosterone.
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And what they had to say when they came
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back was remarkable.
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Not only were their sexual symptoms
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better, but I heard things like, "I wake
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up in the morning with optimism."
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Doctor, my wife likes me again.
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This was pretty astonishing. I never
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heard anything like this with any other
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form of medication or treatment that I
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was giving. And I continued to give
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testosterone.
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About a year later, I ran into one of my
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urology professors at a conference and
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he looked at me sternly and he said,
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"Abe,
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I understand you're giving men
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testosterone."
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And I started telling him what I'd
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noticed with what the men were saying.
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And he said, "Stop.
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You have to stop what you're doing.
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You're giving these men prostate
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cancer."
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Well, I wasn't going to stop. The
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benefits to the men, what they were
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telling me, it made a huge difference in
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their lives. But I decided then that I
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needed to up my game in terms of
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protecting them from the prostate cancer
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issue. And so I started insisting on
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doing biopsies of the prostate
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before giving testosterone just to make
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sure there wasn't a rare individual with
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a hidden cancer that might grow quickly
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if I gave him testosterone.
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When I Now the training was not only
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that high testosterone was dangerous but
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also that if a man had low levels he
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would never get prostate cancer. He was
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protected.
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Surprisingly, as soon as I started doing
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biopsies, I found some cancers.
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And when I had six cancers out of my
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first 36 men, that was a high rate. I
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realized there was something wrong with
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the testosterone story.
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I was terrifically excited to be able to
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present my research at the national
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meeting of the American Urological
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Association. This would be my first time
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on the national stage and I had
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fantasies of these grand figures rising
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at the end of my talk congratulating me
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and telling me this was groundbreaking
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research. I gave my presentation and
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sure enough at the end one of the most
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famous urologists in the world stood up,
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went to the microphone and I couldn't
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wait to hear what he would have to say.
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This is what he said.
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This is garbage.
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Everybody knows high testosterone causes
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prostate cancer. Low testosterone is
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protective. You stuck your needles
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places you never should have stuck them.
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I'll bet you dollars to donuts. You do
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another hundred biopsies, you won't find
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another cancer.
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I had two immediate reactions as I
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listened to him and I saw heads nod in
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the audience agreeing with him. First
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was, okay, that didn't go like I'd
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hoped.
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The second was,
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"Oh my god, he doesn't know.
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He doesn't know what he's talking
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about."
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You see, by the time of that
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presentation,
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I had already done more biopsies and
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found more cancers.
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And the men that I was already treating
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with testosterone weren't coming back
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with prostate cancer like they were
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supposed to.
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You see, because testosterone was taboo,
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there wasn't a single person in that
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audience who had ever treated anybody
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with testosterone.
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Their knowledge was just this received
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wisdom that they'd been taught by their
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professors and their professors before
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them.
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It was only because of my experience
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studying lizards
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that had gotten me to step into this
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forbidden territory. And I was for the
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first time reporting back to the world
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what was true.
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I published that research in a top
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medical journal and have published more
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than 200 scientific articles since that
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time.
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A few years later, I gave a lecture and
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this senior figure in the prostate
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cancer world came up to me afterwards
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and he said to me, "Uh, Abe, uh, your
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work's very interesting, nice lecture.
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Um, but you know, I think that for men
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with advanced prostate cancer,
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testosterone has got to still be very
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dangerous." I thanked him and I said,
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"Why do you think so?" and he said,
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'Well, Huggin said so. You've read his
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article, of course.
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Now, Charles Huggin is the most revered
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name in urology and the world of
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prostate cancer. He won the Nobel Prize
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and uh he was the one that basically put
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out the idea that testosterone is
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dangerous for prostate cancer.
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Like every other trainee, I had learned
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about his work on my very first day of
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training. But his article was from 1941,
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and I was embarrassed to say to my
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colleague that I hadn't read the
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article,
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but I knew that I had to.
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Now, today, you can probably find that
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article on your smartphone in a few
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moments. But back then, it wasn't so
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easy. I had to go to a building that's
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unfamiliar to students today. It's
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called a library.
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And in the basement of the Harvard
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medical school medical school library is
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where they kept the old journals.
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So down the down the stairs I went into
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the basement and there was stack after
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stack after stack of these big
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leatherbound volumes. I searched until I
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found the one I needed. I pulled it off
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the shelf, blew the dust off of it, took
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it to a nearby desk, and started
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reading.
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Within a few moments, my palms were
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sweaty.
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My heart was pounding. Why? Because
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Huggin, the great Huggin, wrote that in
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every instance in which he gave men
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testosterone,
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prostate cancer grew rapidly.
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I thought all my patients on
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testosterone were going to get prostate
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cancer.
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I had a vision of the police coming to
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arrest me in the basement of that la
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that library right then and there.
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And then the next morning on the front
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page of the Boston Globe would be my
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picture in handcuffs with a banner
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headline that says Harvard doctor
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arrested for giving men prostate cancer.
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What a moment.
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I forced myself to reread the article
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and I was stunned
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to discover that Huggin had treated only
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three men with testosterone.
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Of those three men, he gave results for
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only two of them.
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One of those men had already undergone a
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procedure which would distort his
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results.
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And what that meant was that that the
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entire story of testosterone being
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dangerous for prostate cancer was based
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on one man treated for only 18 days and
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with test results that were wildly
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erratic and uninterpretable.
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This was the flimsy evidence that led to
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a prohibition against testosterone
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treatment for 60 years
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and for the unshakable certainty of my
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former professors that giving a man
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testosterone was like pouring gasoline
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on a fire.
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Unbelievable.
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As more research got published, mine and
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others, the fear of testosterone therapy
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diminished and physicians started
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offering testosterone.
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Today, millions of men and women in the
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United States and around the world are
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benefiting from testosterone therapy.
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One day, George came to see me. George
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was 94 years old, a scientist.
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His mind was still sharp as attack.
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Unfortunately,
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George had far advanced prostate cancer.
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It had spread everywhere. He had at best
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a few months to live.
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George asked me to treat him with
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testosterone.
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I said, "Why do you want it?" He said,
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'Well, I used to exercise every day and
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I've got colleagues around the world. I
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used to write to them and correspond and
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that's what gave me pleasure in life and
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I'm too weak and tired to do it now.
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I told him I'd never treated anybody
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like him with advanced prostate cancer
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and that the training was the teaching
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was that he would die rapidly if I did
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it. Maybe tomorrow, maybe in a week. He
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said, 'd I've read your articles. I
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don't think that's going to happen to
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me, but in any case, I'm 94 years old.
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I've got metastatic cancer.
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I'm going to die soon, whether you treat
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me or not.
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And here's the part that really got to
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me. He said, "While I'm alive on this
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planet,
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I want to live."
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I treated George
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and within a few weeks, he was
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exercising,
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corresponding with his colleagues,
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and he'd started work on his next
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patent.
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George lived almost a year
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Everything that I'd been taught about
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testosterone
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was wrong.
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And here's the point.
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A treatment
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that was valuable for people for decades
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was withheld for them because a belief
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no more true than the tooth fairy
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went unquestioned.
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and unchallenged.
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How can generations of physicians and
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researchers be so wrong
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for so long?
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Max Plank, another Nobel laurate in
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physics, struggled with the same
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question. And he wrote, "A new
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scientific truth does not triumph by
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convincing its opponents and making them
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see the light,
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but rather because its opponents
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eventually die."
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In other words,
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science advances one funeral at a time.
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A few lessons.
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Number one, even foundational concepts
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can be wrong.
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Number two,
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just because everybody believes
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something
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doesn't make it correct.
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And number three, if you really care
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about a topic,
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you have to read the primary sources,
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even if it means descending into a dusty
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basement to see for yourself.
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If I can reflect for a moment,
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what strikes me is that each of us
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brings to every moment
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our own unique perspective.
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If I hadn't had the experience of
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studying testosterone in lizards,
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it never would have occurred to me to
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offer testosterone to men.
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And looking back,
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I'm just blown away
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by how a single act of kindness
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asking a 19-year-old boy how he's doing
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could have a ripple effect far into the
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future, transforming the practice of
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medicine.
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There's an old rabbitical saying,
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"Seek truth
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like a mother seeks a lost child."
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In my case,
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I worked for years
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against ridicule,
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withering criticism,
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and powerful opposition
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to find that lost child,
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and to speak its name.
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Was it worth it?
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You bet.
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What was it like?
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It was thrilling.
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At the end of a long career, at the
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leading edge of controversy, this is
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what I want to leave you with.
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Armed with truth,
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driven by compassion,
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inspired by courage,
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one person can change the world.
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Thank you very much.
00:19:05
[Applause]
