#374 - The evolutionary biology of testosterone: how it shapes male development and sex-based behavioral differences, | Carole Hooven, Ph.D.

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 1 December 2025

⏱️ 125 minutes

🔗️ Recording | iTunes | RSS

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Summary

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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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Transcript

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0:00.0	Hey everyone. Welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone.
0:24.1	Our goal is to provide the best content in health and wellness, and we've established a great team of
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1:00.6	If you want to learn more about the benefits of our premium membership, head over to peteratiaMD.com forward slash subscribe.
1:04.0	My guest this week is Carol Hoeven.
1:07.0	Carol is a human evolutionary biologist, a former Harvard lecturer, and non-resident senior fellow at the American Enterprise Institute.
1:15.0	Her research focuses on testosterone, sex differences, and behavior. She holds a PhD in biological anthropology, now human evolutionary biology, from Harvard University, and is the author of T, the story of testosterone, the hormone
1:29.0	that dominates and divides us. In this episode, we discuss how pre-nail testosterone shapes the male
1:34.3	body and brain, turning genetic signals into thousands of developmental changes that underlie
1:39.9	later sex differences, critical hormone surges and why they matter for lifelong behavior,
1:46.1	dh-ht, androgen receptors, and rare natural experiments, for example, 5 alpha reductase deficiency,
1:52.9	that reveal how external genitalia and the prostate masculinize, distinct male and female
1:58.9	aggression styles, direct physical confrontation versus indirect or
2:03.6	relational tactics, and the evolutionary logic behind each, why modern life changes but doesn't erase
2:10.3	ancient drives like male competitiveness and the trade-offs of trying to suppress them.
2:15.5	Testosterone, aging, and hormone therapy for both sexes,
2:19.2	including Carol's personal experience after surgical menopause, and the cultural debate over
2:24.2	masculinity and the cost of denying biological sex differences, a theme of Carol's forthcoming book.
	...

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