Male menopause: myth or monster?

Questions arise about a rite of passage: For men, does middle-age anxiety lead to a virility crisis and menopause?

An older man is walking down the street when he comes upon a frog who says, "If you pick me up and kiss me, I'll turn into a beautiful woman." The man immediately picks up the frog and puts it into his pocket. The frog complains to the man, saying, "Aren't you going to kiss me?" The man replies, "I'd rather have a talking frog in my pocket."

However misguided in comparative values, the frog joke illustrates a common sexual insecurity of older men, many of whom reach a virility crisis in their 50s and 60s, unable to perform for any number of reasons. Such reaction is often attributed to a male menopause. It has been estimated that problems of declining sexual potency affect 18 million men in the U.S. today.

Is It Real?

Although there are reputable medical specialists--including clinical psychologists, endocrinologists, and various sexologists--who question the existence of the phenomenon of a male menopause, there are 80 million members of the soon-to-be-graying Baby Boom generation wondering about the lessening of sexual activity and competence as they move from middle to old age.

The exact age of onset varies to such as degree that generalization are flawed. T he very concept of middle age is considered by some to be a cultural artifact beset with a variety of physiological, psychological, and social components, and for many others filled with myths, misconceptions, and rumors. To come up with an acceptable definition of male menopause is even more controversial.

According to John McKinlay, epidemiologist at the New England Research Institute (Watertown, Massachusetts), "There's no physiological, endocrinological, psychological, or clinical basis for a male menopause. Whether or not people believe in it has nothing to do with whether it exists, only with whether the pharmaceutical industry can persuade them that it does," he says. There seems to be a developing belief in this country that there may not be a genetically programmed menopause in the DNA, at least, there is the realization men don't experience a midlife biological change equivalent to the one most women undergo.

A Gradual Process

Because the reproductive glands of men do not shut down at about the same age the way so many women's ovaries do, "the term `menopause' is actually a misnomer when applied to men," says Gail Sheehy, author of The Silent Passage, a book about female menopause. What happens to men is more gradual (and not universally similar) .

On the other hand, many older men do experience a lapse in virility that does not appear to be attributable to the natural process of aging. This apparent dichotomy leads to some confusion and lack of agreement as to what constitutes the precise nature of male menopause, if indeed it does exist.

With uncertainty and disagreement among doctors, the consensus seems to hold the primary cause of sexual impotence in younger men to be psychological stress. (Stress constricts the blood vessels that allow the penis to become engorged.) in men 55 and older, the cause of impotence is usually physical, with hormonal and vascular changes being primary causes.

Testosterone--the hormone that stimulates sexual development in the male infant, as well as bone and muscle growth in the adult male--is largely responsible for male sexual desire. "About one third of men over 50 have a testosterone deficiency," says Dr. john Morely, a professor of geriatrics at St. Louis University School of Medicine. Many men have been "unwilling to recognize that (eventually) they lose their sexual hormones," he adds, although it is impossible to predict exactly when the decline will start.

"Most men be in to taper off in their mind 50s to 60s," according to Dr. Pentti Siiteri, a senior authority in hormonal mechanism at the National Cancer Institute.

Prematurely Aged

Even though a man's testosterone level may measure within the broad band of normalcy--300 to 1,200 nanograms per deciliter--there is usually a decrease in free testosterone with age. A protein called sex-hormone-binding globulin (SHBG) is linked to the free testosterone and as a man ages, less of it is free to go into the bloodstream.

SHBG seems to make the body testosterone-resistant. No one knows why, says Dr. Malcolm Carruthers, medical director of the Hormonal Healthcare Center in London. His study of 400 men with menopausal symptoms (what he calls "viropause") showed normal levels of testosterone but abnormal levels of SHBG. "It's as if these men aged prematurely in hormonal terms," he explains.

Contradictions exist. In his book Male Sexual Health, Dr. Richard Spark, an endocrinologist at the Harvard Medical School, refers to changes that accompany the aging process in males. "Of all the immediate causes of impotency, the most common is restriction of the blood supply to the penis, often due to the narrowing of the arteries, cardiac problems, smoking, and chronic drug and alcohol use. The combined effect of vascular, neurological, and hormonal systems all slowing down produces a slower sexual response," he says, and contributes to impotence in at least some men.

Yet, strangely enough, Dr. Irwin Goldstein (Massachusetts Aging Study) says, "We found no evidence of a relationship between testosterone and impotence in the study. A man doesn't need testosterone to have an erection. It's primarily a vascular problem."

However, because testosterone levels affect a man's sense of well-being and stir his sexual desire, testosterone replacement therapy has been advocated as an answer. Adherents cite improvement in attitude and energy, claiming testosterone implants or pills affect the flow of blood and change its viscosity.

Some doctors disagree, saying the testicles will eventually atrophy, altering the consistency of the blood. Moreover, Dr. John McKinlay insists there is little if any evidence that testosterone affects the sexuality of men over 50 to 55 years of age and taking it as a supplement may actually increase the risk of prostate cancer.

Not Older, but Smarter

Despite contradictory conclusions, changes in sexuality and sexual performance with age (whenever it may occur) constitute a psychological turning point for most, if not all, men. Recognizing one's change and limitations is crucial in adjusting to these changes.

Communication is still the answer to closeness between men and women and may have more to do with sexuality than the act of intercourse it may have to do with what Dr. William Masters refers to as "the privilege of exchanging vulnerabilities."

Tom Jenkins is a freelance writer living in Englewood, Colorado.