CRISIS-SHY MIDDLE-AGE MEN DON'T SPEAK UP.

Byline: Felicia R. Lee The New York Times

Middle age is a time when a man's body becomes vulnerable - to prostate cancer, heart disease, hypertension, weight gain, impotence and depression.

And while health-care experts do not agree on whether these changes constitute an inevitable midlife crisis, or male menopause, there is one thing on which they do agree: Men aren't talking about it much with anyone, even with their doctors or with their partners. They may not be as strong as they once were, but they're still just as silent.

``Men don't talk to each other about serious issues,'' said Michael Lafavore, a panelist at a colloquium titled ``Sex, Health and the Midlife Man'' held recently at Rockefeller University in New York. ``They talk about fishing and sports.''

Lafavore, the executive editor of Men's Health magazine, pointed out that among other issues, ``Impotence is a huge, huge under-reported problem.''

``You've really got to be in a crisis to go to another man and say, `I can't perform sexually,' '' he said.

And few physicians are comfortable talking with men about sexual function or other health issues, including depression, according to a Gallup survey released at the conference.

About 200 people, including medical professionals, anthropologists, sociologists and journalists, attended the conference, which was sponsored by the World Association for Social Psychiatry, Men's Health magazine and SmithKline Beecham, the pharmaceutical company.

In the opening session, physicians discussed how much is still unknown: What is the ``normal'' testosterone level for a man in midlife? Do men over 50 suffer an inevitable drop in sexual desire?

Recent studies suggest that testosterone levels slump gradually with age, perhaps by as much as 30 percent to 40 percent between ages 48 and 70. This has led to new debates about testosterone replacement therapy, and the role hormones play in the mental and physical health of men.

Testosterone is a naturally occurring hormone responsible for such male characteristics as a deep voice and facial hair. Low levels can produce sexual dysfunction, fatigue, depression, muscle atrophy and osteoporosis.

A man 65 or older might have a testosterone level that is 30 percent of what it used to be, said Dr. Adrian Dobs, an endocrinologist who teaches at Johns Hopkins University. Some men may experience no decline at all.

But researchers estimate that only about 5 percent of men suffering from the effects of low testosterone receive treatment, because their problem has not been identified. Government-sponsored studies are exploring the use of testosterone supplements that could be used in much the same way that estrogen therapy is prescribed for menopausal women.

``Are we going to get to a point where men know their testosterone levels like they know their cholesterol levels?'' wondered Robert Bazell, a correspondent for ``NBC Nightly News'' and the moderator for one of the panels.

Dr. Domeena Renshaw, a psychiatry professor at Loyola University of Chicago and director of the Sexual Dysfunction Clinic there, said, ``To me, sexual ignorance in the 1990s is one of the main reasons for sexual dysfunction.'' For instance, she said many men over 50 don't realize that it is common to have partial erections, and that they may need longer and more direct foreplay.

Dr. Renshaw said that about 10 million to 20 million men of all ages suffer from impotence. What most of those men don't know, she said, is that the causes can include high cholesterol, hypertension, diabetes and ``tons and tons of medications that include sleeping pills, tranquilizers, hypertension pills and heart pills.''

She added that men and women should be aware of the causes of impotence and the availability of help.

``The main thing I want men and women to know is they're not alone,'' Dr. Renshaw said. ``This is common, and few of us are in an arena where we are educated about sexuality.''

The range of physical problems that midlife men face often coincides with events such as career changes, a wife's menopause or changing roles in their children's life.

For that reason, midlife for men can lead to crisis and fear, some panelists said. But unlike women, some men rarely talk about their problems, a situation the experts want to change.

``Many men are kind of adolescent boys in that they think someone else will take care of them,'' said Dr. Eliot Sorel, a psychiatrist and professor at the George Washington University School of Medicine and Behavioral Sciences in Washington.

``Women are better at expressing how they feel and at taking care of themselves,'' said Sorel, who is also the president of the World Association for Social Psychiatry. ``They can help men by modeling better behavior.''

``I don't think we have sufficient evidence to call this a male menopause, but it's a fertile area for research,'' he continued. ``It is time to look at some of the discoveries made in psychiatry and endocrinology and sociology, and integrate them. It is very important for men to attend to their total well-being - social, emotional and spiritual.''

The Gallup survey released at the conference was a telephone poll that divided respondents into three categories: 252 physicians, 502 men age 40 to 65, and 502 women in relationships with men in a corresponding age group.

Although depression was cited by 66 percent of the physicians as the most common emotional health problem of middle-age men, only 23 percent from the men's group said they would be very likely to see a doctor if they were feeling depressed.

Fewer than 43 percent of the physicians reported asking patients about sexual problems, according to the survey. Seventy-three percent of them said that low testosterone often went untreated because it is under-diagnosed.