Is there really such a thing as male menopause? Conventional wisdom says that menopause is a "woman's condition," but as men advance into their 40s they also experience a progressive decline in hormone levels, namely testosterone. The result can be andropause, which is estimated to affect about 5 million American men.
The hormonal decline that men experience isn't nearly as abrupt as it is in women — it's more like walking down a hill than jumping off a cliff. However, waning testosterone is likely to make a guy moody, irritable and depressed.
(Upon hearing this list of symptoms, one woman joked of her husband, "Is it possible he's had menopause since he was 20?") A decrease in available testosterone also increases a man’s risk for heart disease, and makes him more prone to injury because of decreasing bone density.
Let's be clear: Andropause is not the same as a mid-life crisis, which is a psycho-social issue. And not all guys who experience aging — and the inevitable decline in testosterone that comes along with it — can be qualified as having andropause.
Andropause is a medical condition, diagnosed with a blood test by a physician that reveals testosterone levels below a certain level. If a diagnosis of andropause is warranted, treatment with testosterone replacement may be an option, depending on a man’s health history. Just as there are various hormone replacement therapies for women, there's also testosterone replacement therapy for men — and research is still ongoing into potential side effects.
However, the biggest, and most misunderstood, symptom of declining testosterone is a decrease in libido. Testosterone is truly the hormone that stokes the flames of desire. Many men confuse andropause with erectile dysfunction (ED), because they often occur around the same time. These men often turn to an ED medication, such as Viagra, to improve their erectile ability, which works for a time in most cases. However, as men get older, the gap between desire and arousal widens and many men become deeply disappointed when Viagra doesn't give them the desire to have sex. That's because Viagra doesn't boost testosterone levels.
The first issue for men, and their partners, is to accept the very concept of male menopause, talk about it as a couple, and, if they’re concerned, make an appointment with an endocrinologist to check hormone levels. But beyond medical therapies, it's also about knowing, understanding and accepting that sex evolves with the passage of life.
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. Unfortunately, many men have a limited idea of sex, and they feel that if they're not having sex the way they were at age 20 or 30, then something must be wrong. It's too bad more men aren't open to sharing their experiences with each other, since changes in sexual function are so common. Fortunately, if women know what's going on and realize that hormonal decline can affect their partners, too, then they can take a proactive lead in starting a dialogue.
For more on this subject, consider reading Jed Diamond's "Surviving Male Menopause: A Guide for Women and Men."
Saturday, January 17, 2009
Monday, January 12, 2009
Sex Education - Bedroom
I would like to take all the sexually active men in the world and cram them into a classroom. Then, my hair securely tied back in a bun and wearing a pair of black plastic-rimmed glasses, I would pull down charts, project slides, analyze charts and show films about the anatomy of female genitalia.
Somewhere along the winding road of male sex education, this subject appears to have been, well, ignored.
Like many of my girlfriends, I have long labored under the misapprehension that all men know about the clitoris. After all, I know about the penis, right? I was taught all about its shape, its physiology, its hidden ducts and channels in my seventh-grade sex education class in an all-girls school. But now that I think about it, I realize that the subject of the clitoris was blipped right over. We all suspected that the little hooded form was significant; at that point, we'd just made our own early inroads into the world of masturbation. Some of us had figured out that if you lay on your back in a bathtub and let the water splash over just the right spot of your prepubescent mound, a strange sensation rocketed through you, making you tremble and feel guilty.
Later, we looked at our parents' books: "The Joy of Sex," "How to Make Love to a Woman" and even the Japanese coffee-table tome, "Erotic Art." Seventies couples were pictured in the prototypical line drawings, men busily attending to that little rosy button between the legs of their women folk, who were seemingly paralyzed, backs arched, in the throes of what looked like pain. By the time our mid-teenage years had kicked in, we girls knew the clitoris was the gateway to our pleasure. We naively assumed the boys would make it their business to find out too.
My friend Isobel has been going out with Jack now for about a year. She is by all accounts in love. They mesh in all the right ways, she says, from their mutual love of "Law & Order" to their decision not to have children to their enjoyment of Alice Waters' cuisine. And yet, and yet. Isobel has never had an orgasm with Jack, which astounds me, but seems to only mildly bother her (which astounds me further). "Sometimes it feels like I might," she said to me. "When he's on top of me, and he's lasting longer than usual, and he's moving in the just the right way, when our rhythm is in sync. But then ... I don't."
"Have you tried ..." I cleared my throat, "well, talking about this?"
Isobel looked distracted. "I would," she said, "but at this point it's kind of too late. You know? I should have said something a long time ago. I don't think he knows anything about the clitoris, I don't think he knows that I can't get off unless he pays attention to it. I'm not sure he would know what I was talking about."
"What if you showed him?"
"It's not as if he hasn't ever touched me there. It's just that when he does, it's not the right way. He doesn't have any delicacy about it, he kind of fumbles around, and it ends up hurting more than feeling good. Then afterwards, when we're done and he gets up to go to the bathroom, I touch myself. I can come really fast on my own." Seeing my startled expression, Isobel said hurriedly, "It's not as if I don't enjoy having sex with Jack, because I do. We share other great things that make up for it."
Somewhere along the winding road of male sex education, this subject appears to have been, well, ignored.
Like many of my girlfriends, I have long labored under the misapprehension that all men know about the clitoris. After all, I know about the penis, right? I was taught all about its shape, its physiology, its hidden ducts and channels in my seventh-grade sex education class in an all-girls school. But now that I think about it, I realize that the subject of the clitoris was blipped right over. We all suspected that the little hooded form was significant; at that point, we'd just made our own early inroads into the world of masturbation. Some of us had figured out that if you lay on your back in a bathtub and let the water splash over just the right spot of your prepubescent mound, a strange sensation rocketed through you, making you tremble and feel guilty.
Later, we looked at our parents' books: "The Joy of Sex," "How to Make Love to a Woman" and even the Japanese coffee-table tome, "Erotic Art." Seventies couples were pictured in the prototypical line drawings, men busily attending to that little rosy button between the legs of their women folk, who were seemingly paralyzed, backs arched, in the throes of what looked like pain. By the time our mid-teenage years had kicked in, we girls knew the clitoris was the gateway to our pleasure. We naively assumed the boys would make it their business to find out too.
My friend Isobel has been going out with Jack now for about a year. She is by all accounts in love. They mesh in all the right ways, she says, from their mutual love of "Law & Order" to their decision not to have children to their enjoyment of Alice Waters' cuisine. And yet, and yet. Isobel has never had an orgasm with Jack, which astounds me, but seems to only mildly bother her (which astounds me further). "Sometimes it feels like I might," she said to me. "When he's on top of me, and he's lasting longer than usual, and he's moving in the just the right way, when our rhythm is in sync. But then ... I don't."
"Have you tried ..." I cleared my throat, "well, talking about this?"
Isobel looked distracted. "I would," she said, "but at this point it's kind of too late. You know? I should have said something a long time ago. I don't think he knows anything about the clitoris, I don't think he knows that I can't get off unless he pays attention to it. I'm not sure he would know what I was talking about."
"What if you showed him?"
"It's not as if he hasn't ever touched me there. It's just that when he does, it's not the right way. He doesn't have any delicacy about it, he kind of fumbles around, and it ends up hurting more than feeling good. Then afterwards, when we're done and he gets up to go to the bathroom, I touch myself. I can come really fast on my own." Seeing my startled expression, Isobel said hurriedly, "It's not as if I don't enjoy having sex with Jack, because I do. We share other great things that make up for it."
Sex Education
A little blue pill may have taken the heat off men with erectile dysfunction, but what if your wife is having trouble in the bedroom? According to a Yale study, one in two women experience some sort of sexual dysfunction (such as lack of desire, vaginal dryness, or an inability to orgasm), and experts say it is caused by everything from stress to insomnia to birth-control pills.
"Female sexual dysfunction is far more difficult to detect than a visibly flaccid organ," says Michael Krychman, MD, medical director of sexual medicine at Hoag Hospital, in California. "We are just beginning to understand the biology and neuro-chemistry involved." Two libido-boosting drugs for women, LibiGel (a testosterone patch) and Flibanserin (an antidepressant), are on their way to FDA approval and in phase III of clinical trials.
But not all experts agree that these drugs will be a cure-all. "If there are things wrong in the relationship, taking a pill or spraying something into your nose won't fix the problem," says Stephanie Buehler, a sex therapist in Orange County, California. Dr. Krychman believes there are several things a man can do to help. The first thing, he says, is to sit down and talk to your wife about what is happening. "Most men want to be supportive but are unaware of the facts," says Dr. Krychman. "Ask her what she is feeling, both emotionally and physically. Once she knows you want to help, she'll be more likely to open up about what she's going through." When she does, try these tips to get her back on track in the bedroom.
Get wet. Vaginal dryness is common in women over 40 and is also a side effect of certain medications, but there's an easy fix: water-based drugstore lubricants such as K-Y and Astroglide. "It seems like a no-brainer," says Dr. Krychman, "but I'm amazed by how many of my patients haven't tried them."
Feed her desire. A recent study in the International Journal of Impotence Research found that women who followed the Mediterranean diet (rich in whole grains, legumes, and olive oil) had increased libido and sexual function. Dr. Krychman agrees: "Any food that is good for your heart is going to increase blood flow to every area of your body."
"Female sexual dysfunction is far more difficult to detect than a visibly flaccid organ," says Michael Krychman, MD, medical director of sexual medicine at Hoag Hospital, in California. "We are just beginning to understand the biology and neuro-chemistry involved." Two libido-boosting drugs for women, LibiGel (a testosterone patch) and Flibanserin (an antidepressant), are on their way to FDA approval and in phase III of clinical trials.
But not all experts agree that these drugs will be a cure-all. "If there are things wrong in the relationship, taking a pill or spraying something into your nose won't fix the problem," says Stephanie Buehler, a sex therapist in Orange County, California. Dr. Krychman believes there are several things a man can do to help. The first thing, he says, is to sit down and talk to your wife about what is happening. "Most men want to be supportive but are unaware of the facts," says Dr. Krychman. "Ask her what she is feeling, both emotionally and physically. Once she knows you want to help, she'll be more likely to open up about what she's going through." When she does, try these tips to get her back on track in the bedroom.
Get wet. Vaginal dryness is common in women over 40 and is also a side effect of certain medications, but there's an easy fix: water-based drugstore lubricants such as K-Y and Astroglide. "It seems like a no-brainer," says Dr. Krychman, "but I'm amazed by how many of my patients haven't tried them."
Feed her desire. A recent study in the International Journal of Impotence Research found that women who followed the Mediterranean diet (rich in whole grains, legumes, and olive oil) had increased libido and sexual function. Dr. Krychman agrees: "Any food that is good for your heart is going to increase blood flow to every area of your body."
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