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Section 18
Midlife Transitions

Question 18 | Test | Table of Contents

When does male menopause kick in?

"The old zest starts going in your fifties; there's no question about it," grumbled my friend Fitzgerald. "Men will often run after other women at that age, but the point is that the same cycle starts all over again."

Are we talking simply about getting older? Yes, but also about a larger challenge to a man's vitality and virility, an identifiable phenomenon that begins in many men's lives usually in their fifties or sixties. It is a normal process without a proper name. ("Menopause" refers to a pause and eventual cessation of fertility hormones in women and thus cannot accurately refer to men; nonetheless, "male menopause" is a shorthand label in popular use.) With men, the issue is not fertility. A healthy proportion of men continue to produce enough upwardly mobile sperm to sire children into their late age. But most men in middle life do experience some lapses in virility and vitality.

This might be called the "male middle-life pause"-or MANopause for short-a five-to twelve-year period during which men go through hormonal fluctuations coupled with accelerated physical and psychological changes. Dr. Tom Lue, an internationally renowned researcher and professor of the Department of Urology at the University of California at San Francisco, refers to the syndrome as "male middle-life slowdown." He notes that almost all parts of the male body and metabolism slow down during the midfifties to the late sixties-an accelerated slide-before they stabilize and a normal rate of attrition resumes. Dr. Lue's private practice has been overwhelmed in the last several years by more than three thousand men seeking help for male middle- and later-life impotence.

MANopause is more gradual and elusive than female menopause. Common symptoms are irritability, a feeling of sluggishness, and mild to moderate mood swings. The most familiar psychological effect is a slump in a man's overall sense of well-being. Physically, a man may notice a decrease in muscle mass and strength. Hormonally, he won't notice anything, unless he goes to a urologist and asks to have his testosterone levels measured. Surprisingly, a lot of otherwise educated men don't believe they have hormones-those are something women have-so how could they have anything equivalent to menopause?

But the greatest fear, the phobic event that may become a self-fulfilling prophecy, is intermittent problems in gaining and sustaining an erection. How many men in the general population are affected?

Moderate impotence was recently found to be much more widespread and less benign a problem than previously thought, according to the most comprehensive study of male sexuality since the Kinscy Report, the Massachusetts Male Health Study. This community-based survey of aging and sex conducted in 1987 to 1989 among a normal population of healthy, aging men, produced startling results. Projecting from that study:

52 percent of healthy American men between ages 40 and 70 can expect to experience some degree of impotence.

A rough estimate by the National Institutes of Health (NIH) is that 20 million American men suffer ftom some degree of impotence, although Dr. Leroy Nyberg, Jr., director of urology programs at NIH, believes that is just the tip of the iceberg. When ignored or denied, this sexual freeze extends more deeply into every aspect of a man's life than was previously thought. "Impotence is a highly prevalent health problem which has a profound impact on the quality of life of many men," conduded Dr. John McKinlay and the Massachusetts researchers. It can be an underlying cause of depression, divorce, even suicide.

The most predictive factor is age. Important hormones-not just testosterone but human growth hormone and DHEA (Dehydroepiandrosterone)-decline gradually in direct proportion with advancing age. Dr. Richard Spark, a Harvard Medical School endocrinologist, describes other changes with aging: "Blood flows less briskly to the genitals, and nerves that carry signals to allow erections have less velocity. Meanwhile, the hormonal system chugs along at an adequate if not ideal pace." The combined effect of simultaneous slowdowns is what produces a more halting sexual response. But aging alone does not foretell a droop in mood or manhood. Let me state an important fact up front:

Forty percent of normal, healthy males remain completely potent at age 70.

Underneath the whole "male menopause" syndrome may be a man who feels he is losing controL The more uncertain a man feels about having control over his life, the harder the middle-life male slowdown may hit him, Losing his job or being passed over for an expected promotion in midlife, for instance, is tantamount to falling off the top of the heap in the chimpanzee hierarchy. Empirical evidence from both humans and animals demonstrates that defeat decreases testosterone. Therefore, a sudden loss of self-respect and dominance reduces male sex hormones, which may further dampen a man's sex drive,

Bob Graham, the former outplacement counselor, told me that many of the men who consulted him after being downsized confided that their libido was flagging. "And when they did try to have sex, they were so uptight they'd be impotent," he added. "At least half of the men I counseled took a vacation from sex while they were out of a job."

Thus the midlife male potency crisis has a cluster of causes-age, hormone levels, psychological mind-set-but more and more it is recognized as being mediated-or exaggerated-by a man's physical condition. Basically, anything that dulls the nerves, weakens the muscles, or impedes the flow of blood and oxygen to the penis is a natural enemy of Homo erectus.

"Anywhere from fifty to eighty-five percent of patients have a real physical cause for their sexual difficulties," claims Dr. Myron Murdock, director of the Impotence Institute of America in Maryland and instructor of urology at George Washington University Medical School, His estimate is considered exaggerated by some other experts. But even he acknowledges, "Of course, any male with sexual difficulties will have a secondary psychological impact-they go hand in hand."

The idea of a male equivalent to menopause broke into the national consciousness in the spring of 1996 through an episode of Coach, then one of America's top ten TV sitcoms. A middle-aged coach by the name of Hayden Fox is shown feeling generally lousy and, worst of all, uninterested in sex with his wife. Not even the bouquet of beautiful budding cheerleaders around him can arouse his interest. His wife suggests that he might be going through something like male menopause. The coach recoils. The term horrifies him: menopause is woman stuff Finally his wife persuades him to see an endocrinologist-a specialist in hormones- who diagnoses the coach as having a low testosterone level and recommends a testosterone patch. When the coach returns home, chagrined, his wife tells him he is really terrific. He has made a breakthrough. He is a pioneer All the coach can think of is: "Ohmigod, they're going to start calling it Hayden Fox disease!"

In fact, "male menopause" is a contemporary label for a dread as old as the Bible. King David reached a point where neither the familiar charms of Bathsheba nor those of his many other wives and countless concubines could arouse him. His people, like people today, equated sexual potency with power. His advisers brought him a young virgin to relight his fires. She cherished the king, the Bible tells us, "but the king was not intimate with her." So King David (knowing nothing about testosterone patches) suffered an ignominious overthrow by subjects who saw him as a weak, impotent leader.

Like TV sitcoms, most physicians and researchers home in on sexual pathology and cast the whole issue for men in terms of impotence. It is such a repugnant word, it is not even allowed within the lexicon of curses men use on one another, (Nobody says, "Your old man's impotent.") The preferred term today is "erectile dysfunction," or ED for short. Yet the near-universal nature of the male midlife experience need not be fraught with secrecy, shame, and denial. Younger men seem eager to learn about it, and even some men in middle life were willing to talk with me about it.
- Sheehy, Gail, Understanding Men's Passages: Discovering the New Map of Men's Lives, Random House: New York, 1998.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. Thus, space has been provided for you to make personal notes as you apply Course Concepts to your practice. Affix extra Journaling paper to the end of this Course Content Manual. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socioeconomic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 150 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress”. You will not be required to provide us with these Journaling Activities. Only the Test is to be returned to the Institute.

Personal Reflection Exercise #10
The preceding section contained information about male menopause. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Etaugh, C. (2018). Midlife transitions. In C. B. Travis, J. W. White, A. Rutherford, W. S. Williams, S. L. Cook, & K. F. Wyche (Eds.), APA handbook of the psychology of women: History, theory, and battlegrounds (pp. 489–503). American Psychological Association.

Komlenac, N., Siller, H., Bliem, H. R., & Hochleitner, M. (2019). Associations between gender role conflict, sexual dysfunctions, and male patients’ wish for physician–patient conversations about sexual health. Psychology of Men & Masculinities, 20(3), 337–346.

Mellor, D., Connaughton, C., McCabe, M. P., & Tatangelo, G. (2017). Better with age: A health promotion program for men at midlife. Psychology of Men & Masculinity, 18(1), 40–49.

Sanderson-Cimino, M., Panizzon, M. S., Elman, J. A., Tu, X., Gustavson, D. E., Puckett, O., Cross, K., Notestine, R., Hatton, S. N, Eyler, L. T., McEvoy, L. K., Hagler, D. J., Jr., Neale, M. C., Gillespie, N. A., Lyons, M. J., Franz, C. E., Fennema-Notestine, C., & Kremen, W. S. (2021). Periventricular and deep abnormal white matter differ in associations with cognitive performance at midlife. Neuropsychology, 35(3), 252–264.

What two factors may further dampen a man's sex drive? Record the letter of the correct answer the Test.

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