| |
 |
| 
|
QUESTION: "I'm 47 & my husband is 54; we've always been very well matched sexually, & married for 20 yrs, but lately he seems to be having difficulty keeping his erection or even getting one for that matter. I know age may play a role in this, but is there something he, we or I should be doing to help with this? Will Viagra help? Is there really such a thing as male menopause?"
ANSWER: Whenever I talk to guys about male menopause, also known as andropause, many of them get twitchy and uncomfortable - some of them even get up and walk out of my office, refusing to listen.
The conventional wisdom is that menopause is a "woman's condition," but as men approach their 50s they also experience progressive declines in hormone levels, namely testosterone. The decline isn't nearly as abrupt as it is in women - it's more like walking down a hill than going off a cliff -- but waning testosterone is going to make a guy moody, irritable and depressed. (Upon hearing this list of symptoms, one woman in her fifties joked of her husband, "is it possible he's has had menopause since he was twenty?")
Additionally, a decrease in available-testosterone is also going to place men at greater risk for heart disease, as well as make them more prone to injury due to decreasing bone density. But without doubt the biggest, and most misunderstood, symptom is a decrease in libido, as testosterone is truly the hormone that stokes the flames of desire.
Let's be clear: andropause is NOT the same as a mid-life crisis, which is a psycho-social issue. Andropause is a medical condition, but lots of people confuse it with "erectile disorder" because they often occur around the same time.
Many men turn to Viagra to deal with the symptoms of male menopause, but here's a dirty little secret that you won't find Pfizer promoting in its commercials for Viagara - the little blue pill is not always effective for men with erectile disorder, especially those struggling with an overall lack of desire.
Viagra helps with the hydraulics of an erection, the physiology of arousal, but we need to distinguish between desire and arousal. Now it's true that in many men, especially younger ones, desire and arousal are virtually one and the same. That's why Viagra was so successful in the first place: give a guy an erection, he's going to want to use it.
But as men get older, the gap between desire and arousal widens and many men become deeply disappointed when Viagra doesn't give them a desire to have sex. That's because Viagra doesn't boost testosterone levels.
Just as there are various hormone replacement therapies for women, there's also testosterone replacement therapy for men - but the research is still cursory and there's a lack of clarity around potential side effects. (At one point there was a concern that Testosterone replacement might be linked to incidents of prostate cancer, but there turns out to be little merit to this claim: liver toxicity is a much greater concern, especially when the testosterone is administered orally.)
But for many men, medically supervised testosterone therapy may be a viable path to regaining desire, and a compelling argument can be made for the benefits of a Testosterone-Viagra combination.
But the first issue for men, and their partners, is accepting the very concept of male menopause, talking about it as a couple, and then going to an endocrinologist to check hormone-levels. But beyond medical therapies, it's also knowing, understanding and accepting that sex changes with the passage of life. I work with many couples in their 50s for whom sex is better and hotter than ever: they have more free time and more resources to spend on doing fun things together, and the sex is deeply gratifying. For many couples in their 50s, sex becomes a matter of "quality" rather than "quantity" and there's often less of a focus on orgasm and more of a focus on overall intimacy. Sex becomes about the journey rather than the destination.
For guys who can embrace a deeper intimacy and open themselves up to a different experience of sex, the passage of time brings many rewards. But unfortunately, so many guys have a limited idea of sex, one that's reinforced by porn, and they feel that if they're not having sex the way they were at 30, then something must be wrong ! It's too bad more men aren't open and sharing of their experiences with each other, since it's so common, but I doubt you'll find a find a guy asking his buddy in the locker-room, "Hey Charlie, I don't know about you, but my joie de vivre ain't what it used to be - you think I got menopause?"
But women need to know what's going on as well with their partners, and then they can take a proactive lead in initiating a dialogue. For more on this subject, consider reading Jed Diamond's Surviving Male Menopause, A Guide for Women and Men. |
|
|
|
