- Excerpt
MALE MENOPAUSE
by Jed Diamond
INTRODUCTION
The frenzy over
the new "erection drug" Viagra
caught a lot of people by surprise. Apparently, a lot more men are having
problems with sexual performance than anyone realized. Well,
almost anyone.
A few months earlier, Sourcebooks,
Inc., of Naperville, IL, published "Male Menopause," a massive,
groundbreaking work by
Jed Diamond, a licensed psychotherapist specializing in
intimacy dysfunctions. Diamond -- who has counseled men and
women for the past 30 years -- compiled his research,
surveys, and interviews to build a complete picture of the
physical, psychological, and sexual changes associated with
male menopause.
Right now, more than 25 million
men in the United States are going through the "male menopause passage." That
number will more than double in the next 25 years as the baby boom
generation matures. Clearly, we need a better understanding
of male menopause and Jed Diamond's book is the definitive
guide on the subject.
The excerpt below deals with problems in sexual function that
occur during male menopause, and some of the treatments for
them. It's important to remember that sexual dysfunction is
only one of the symptoms of male menopause and that it is
necessary to deal with many other issues -- indeed, with the
whole man -- to successfully navigate the male menopause
passage.
"Male Menopause and Loss of Erections"
by Jed Diamond
One of the most
devastating problems men experience at midlife is an inability to attain
and maintain an erection adequate to permit satisfactory sexual performance.
This is what medical professionals term "impotence" and I
call erection dysfunction.
I believe the word impotence is
inaccurate and misleading. The definition of "impotence" is "powerless to act or
accomplish anything, physically weak." This view of a man
only adds to his fear and shame. Erection dysfunction says
what the problem is without adding all the extra baggage that
makes a man feel like he is good for nothing. An inability to
keep an erection adequate for sexual intercourse is baggage
enough for the millions of men who are affected. According to
Donovan Webster in his article, "Erections 'R' Us," in the
June, 1996, issue of "Men's Health" magazine: "Impotence
affects eighteen million American men, with as many as thirty
million suffering its occasional effects."
Despite the prevalence of the problem and the importance to
men and their partners, little attention has been paid to the
causes of erection dysfunctions. Until recently,the Kinsey
survey, which was conducted more than forty years ago in a
social and medical context vastly different from that of the
present day, provided the only reliable data we had on
erection dysfunction.
Yet that neglect is beginning to change as greater attention
is focused on male sexuality. Many clinicians and researchers
are now beginning to recognize the biological basis of
erection function, particularly in older males.
Some important findings on erection dysfunction are being
reported now from the federally financed Massachusetts Male
Aging Study, the largest study on male sexuality since the
Kinsey Report. Over seventeen hundred men between forty and
seventy years of age took part in the study. Blood samples,
physiological measures, sociodemographic variables,
psychological indexes, and information on health status,
medications, smoking, and lifestyle were collected by trained
interviewers in the subject's home. A self-administered
sexual activity questionnaire was used to characterize
erectile potency.
Startlingly, the study revealed that erection dysfunction had
occurred in more than half of all American men over the age
of forty. The study also found that the prevalence of
complete erection dysfunction tripled from five percent in
subjects in their forties to 15 percent in subjects in their
seventies. The good news, of course, is that the vast
majority of men, even in the older age groups, maintain their
potency and enjoyment of sex.
Although the study found that psychological factors play a
role as men age, physical factors are more significant. There
was a high correlation between erection dysfunction and heart
disease, hypertension, diabetes, as well as with the
medications that are often taken to deal with these problems.
Of the seventeen hormones measured in the study, only the
adrenal androgen DHEA showed a correlation with impotence.
The age-adjusted probability of complete impotence increased
from 3.4 to 16 percent as DHEA decreased from 10 to 0.5
mg/ml.
Interestingly, there was no significant correlation found
between impotence and lowered testosterone levels.
"DHEA drops precipitously as men
age," according to Dr.
Crenshaw. "By the time they are eighty, it is almost
undetectable. When sixty healthy men twenty to eighty-four
years old were compared with sixty healthy women in one
study, DHEA was significantly lower in the men."
"Male Menopause and the Wisdom
of the Penis"
Though erectile dysfunction is not a normal part of aging, we
need to accept the fact that our sexuality does change as we
age. We no longer experience the same kind of erections that
embarrassed us when we were young but often miss as we get
older.
A man often treats his penis like an unruly servant who must
be at his beck and call every moment and who must be whipped
into shape so he is always ready, willing, and able to
perform any duties asked of him. Like most masters, men fail
to understand the changing needs of those who serve them. Men
would save themselves a great deal of grief if they
understood the normal changes that occur in our sexuality
over time.
Seven Changes That Occur in Healthy, Normal Males as They
Age:
1. Erections take longer to occur.
2. Men more often require direct physical stimulation to get
an erection; a sexy sight or fantasy may not arouse him as it
did before.
3. The full erection doesn't get quite as firm as it used to.
4. His urge to ejaculate is not as insistent as before.
Sometimes he doesn't feel like having an orgasm at all.
5. The force of ejaculation isn't as strong as it was in the
past. The amount of his ejaculate is less, and he may have
fewer sperm.
6. The desire for and frequency of masturbation may drop, but
in some men may increase.
7. The testicles shrink some, and the scrotal sack droops.
The sack doesn't bunch up as much during arousal.
Although recent research shows there is more of a physical
basis to sexual problems than we once thought, the intimate
connection between mind and body is nowhere more obvious than
in the expression of our sexuality. We now know, for
instance, that changes in hormone levels affect our sexuality
and that changes in sexuality affect our hormone levels.
"The androgens do stimulate sexual behavior," says Dr.
Cutler, "but sexual behavior in turn seems to stimulate the
production of sex hormones. The testosterone levels before,
during, and after sexual intercourse are usually higher than
they are during times of celibacy."
How does the relationship between the
mind and body effect men's health, sexuality and the Male Menopause Passage?
We will deepen and expand our understanding in the next chapter.
"Better Sex Through Chemistry"
No one wants to have a problem for which there is no cure.
For a long time we assumed that loss of sexual function was
just a part of men getting older. If there was a male
menopause, you just had to accept your losses.
However, recent research offers hope that there is something
men can do to stay healthy and sexually vital into their
fifties, sixties, seventies, and beyond. We are starting to
recognize that male menopause, rather than signaling the
beginning of the end, actually signals the end of the
beginning. It tells us we are finished with First Adulthood
and ready to embark on a trek up a new mountain to Second
Adulthood.
Some believe that male menopause is the road to oblivion, the
end of our sexual power. But for those who have the courage
to take that road, male menopause is the passage to the most
passionate, productive, and purposeful time of a man's life.
The greatest concern most men have
as they enter the Menopause Passage is the loss of sexual functioning.
Many men cling to memories of the rock-hard-fire-hose penis of their
youth. They are unprepared for the normal changes associated
with Second Adulthood. Dr. John Medina, author of "The Clock
of Ages" says that maximum "ejaculatory distance" declines
from roughly one to two feet in young men to three to five
inches in the elderly. Many men become terrified, sure that
the next step may be no ejaculation at all.
For some time now, doctors have given men testosterone when
there were medical problems that caused blood levels of the
male hormone to be abnormally low. Yet, testosterone levels
decrease for all men as they get older, and hormone
replacement studies that focus on normal healthy men are just
beginning. Endocrinologist Peter Snyder, M.D., a professor of
medicine at the University of Pittsburgh School of Medicine,
is currently leading a study of one hundred men aged sixty-
five and older who were randomly treated with either a
testosterone patch or a placebo patch.
"If we prevent the decline in testosterone with age, will
that do more good or more harm?" questioned Dr. Snyder. "[By
1998] we'll have the beginning of an answer."
Research is also taking place on
other hormones associated with sexuality. DHEA -- short for dehydroepiandrosterone
-- which is produced by the adrenal glands (located on the
kidneys), as well as by the brain and the skin, is the most
abundant steroid in the human body. Like testosterone, it
also declines as we age. According to Dr. Samuel Yen, a
reproductive endocrinologist and principal investigator of a
major DHEA study at the University of California at San
Diego, DHEA is "a drug that may help people age more
gracefully."
"In particular, Dr. Yen's group
found that the men and women on DHEA experienced increased energy and
better sleep; they felt more relaxed and were better able to handle
stress. Those with a history of arthritic symptoms also reported less
joint pain. Moreover, none of the study participants
experienced any negative side effects."
Many doctors are so encouraged by
the results of DHEA research that they are not waiting until final
results are in before offering DHEA to their patients. William Regelson,
M.D., author of "The Super-Hormone Promise," has been
prescribing DHEA to patients for many years and has also been
taking it himself. His conclusion: "I think that just about
every adult age forty-five or older can benefit from taking
DHEA."
"One of the most constantly repeated comments I hear from
patients as well as colleagues and friends who are taking
DHEA," says Dr. Regelson, "is that it has renewed their
interest in sex. Men, particularly, report that it has
revived their sexual interest."
DHEA's effect on male sexual function
was documented in the groundbreaking "Massachusetts Male Aging Study," which
investigated, among other things, sexual function and
activity in men aged forty to seventy. The researchers sought
to determine whether there was any correlation between health
or personality changes and impotence, which the study showed
was a problem for over half of all males. Of the seventeen
hormones measured in each of the men, only one showed a
direct and consistent correlation with impotency: DHEA. As
DHEA levels declined, the incidence of impotency increased.
With so much media hype on the benefits
of taking the latest hormone that will return men to the sexual vigor
of their youth, it is easy to overlook those who counsel caution. In
the July, 1997, issue of "Harvard
University's Men's Health Watch," the authors concluded:
"It's clear that much more
information is needed before DHEA can be recommended to men of any
age. Testimonials notwithstanding, it is unlikely to be the fountain
of youth; unfortunately, it's already out of the bottle, being widely
available before scientific studies have evaluated its
efficacy and safety."
"Men's Health Watch" also
reviewed the findings on three other hormones that decrease with age:
growth hormone, testosterone, and melatonin. Although there were some
studies indicating the benefits of these substances, they concluded
that more scientific study was needed before it was clear
whether the benefits outweighed the risk.
Men have finally come out of the closet in acknowledging
problems with sexual arousal and functioning. There are now
an increasing number of options for help becoming available.
Upjohn, a leading pharmaceutical company, is selling the
world's first commercial erection injection. Instead of
activating a spring-loaded implant or applying a vacuum pump
(which are methods that have been used for some time), the
user injects a fifth of a teaspoon of prescription medication
into the side of the penis.
If getting a shot in the shaft gives men the shivers, other
solutions will soon be available. A Menlo Park, California,
company called VIVUS recently received FDA approval on a
system called MUSE (Medicated Urethral System for Erection),
which uses a disposable applicator to squirt a premeasured
dose of alprostadil -- the main drug used in injection
therapy -- into the opening at the tip of the penis. This
causes only minimal discomfort. Just as with injections, the
drug relaxes penile arteries and increases blood flow,
beginning an erection. Clinical trials show that it works for
approximately 60 percent of men.
Other companies, including the drug giant Pfizer, are
scrambling to license what could be the ultimate erection
aid: a pill taken an hour before sex. The Pfizer remedy uses
a drug called sildenafil, which has been studied in England
and seems to improve erections in men who have no physical
cause for difficulty with erections, or illnesses such as
diabetes. The drug, which is being tested under the name
Viagra, increases blood flow to the penis, enhancing a man's
normal response to stimulation.
According to one of the leading
researchers in the field, Stephen M. Auerbach, M.D., interviewed at
the recent National Conference on Men's Health, "thus far, the
research on Viagra is very promising. It has helped 90 percent of the
patients who have taken it, and there seem to be few side effects."
Steven Lamm, M.D., author of "Younger at Last," says,
"another drug, phentolamine mesylate, which has been used for
over forty years to treat hypertension, is currently
undergoing human trials as an impotence medication. It will
be submitted soon to the FDA for approval under the brand
name Vasomax. It, too, will be in pill form."
Pausinstalia yohimbine (also called yohimbe), an herb
obtained from the inner bark of the yohimbeh tree that grows
in Africa, has been used throughout the world to stimulate
and restore sexual functioning.
A study, conducted by Dr. Robert
Margolis and published in the journal "Current Therapeutic Research," of ten thousand
impotent patients who took yohimbine, said that 80 percent of
them reported good to excellent results. According to Robert
Ivker, M.D., who quoted the study in his book "Thriving," most
patients using yohimbine reported that overall sexual pleasure increased
with more intensive orgasms. It also decreases the latency period between
ejaculations and can stimulate blood flow to the penis."
After extensive testing of yohimbine,
A.J. Riley, M.D., a specialist in sexual medicine, has concluded that "it
is now possible to restore usable erections for up to 95 percent of
men with erectile inadequacy."
With new technologies becoming available nearly every year,
however, there is a tendency to focus on specific problems,
such as impotence, and ignore the health of the whole man.
One person who has pioneered a comprehensive program is
Kenneth A. Goldberg, M.D., founder and director of the Male
Health Center in Dallas, Texas. Goldberg's center,
established in 1989, was the first facility in the country to
focus on all men's health issues.
Though he acknowledges that the
new medical interventions becoming available seem miraculous, he recognizes
that complex sexual problems associated with male menopause are
not so easily handled. "We need to deal with the whole man --
his diet and exercise habits, his other physiological
problems, his relationship with his partner, his ability to
communicate, and indeed, sometimes his hormone levels."
It seems clear that continuing scientific
discoveries will allow men to live longer, healthier, and sexier lives
than ever before. The more important question, which science
cannot answer, is "what will men do with these added years?" Without
a strong purpose for the second half of life, men begin to feel unnecessary
and useless. To survive and prosper in the second half of life, men need
a different kind of motivation.
Copyright ©1998 by Jed Diamond
and Sourcebooks, Inc. All rights reserved. Please request permission
from the publisher before duplicating or distributing this file. Thank
you.
