After the age of 35, many men begin to notice changes in their sexuality and health. Testosterone, known as the male hormone, is essential not only for libido and erections, but also for muscle strength, bone health and even mental sharpness. However, a decrease in its levels can lead to various problems, from lack of energy to loss of sexual desire. What exactly happens to a man's body after 35 and how can he regain self-confidence? In this article, we look at the most important reasons and solutions.
Consulted by
Juris Ērenpreiss,
andrologist, head of the iVF Riga Andrology Centre, leading researcher at Rīga Stradiņš University
The most important hormone for men
Testosterone is often called the main hormone for men, because it really determines a lot. Mostly everyone knows that it is necessary for sex drive, sperm production and good erections. But it is also one of the most important hormones, as it determines normal bone structure, muscle mass, volume and strength, as well as cognitive function. Testosterone also participates in erythropoiesis in the kidneys, and its deficiency can lead to anaemia. In short – if there is not enough testosterone, you don't feel like having sex, your head doesn't work, your bones gradually decay, your muscles decrease, you grow a fat belly, and there is little joy in life.
"Some time ago, it was fashionable to say that, just as women have menopause, men have andropause, primarily characterized by testosterone deficiency. To address this, men of a certain age were advised to inject a testosterone-containing medication every three months. This view was strongly promoted and maintained by American pharmaceutical companies that also produced these injections.
It is clear that there are not few such – unhealthy – men.
My colleague Anatolijs Požarskis from Daugavpils, who was then a family doctor, but is now an associate professor, sexologist-psychotherapist, and I found it interesting to study the situation in Latvia, because we suspected that everything was not so simple. As part of my colleague's dissertation, we conducted a study that included 1200 men aged 40 to 70 years. After general health examinations, we found that 400 of them were, as doctors say, relatively healthy, but 800 had some disease – metabolic syndrome, type 2 diabetes, hypertension, lung diseases, etc. It turns out that two large groups participated in the study – with and without health problems – and we determined the testosterone level in both.
We found that among healthy men, only five percent had a deficiency of this hormone and, accordingly, andropause. But in the second group – about 70 percent. Thus, we proved the same as a large European study: if a man is healthy, then at the age of 40, 50, 60 and even 70 years, he has a sufficient amount of testosterone to have both good erections and a functioning reproductive system. But if a man has other ailments, then testosterone deficiency will also be one of the health manifestations of an aging, unhealthy man. It is clear that there are not few such – unhealthy – men. So, they, then, perhaps, should also additionally inject testosterone," says Dr. Ērenpreiss.
A little more gently
"Sometimes a patient over fifty comes to me and says: "I'm not like I was at 18." I ask: "How is that?" – "Well, I can't make love three times a day anymore." But that's just normal!" the doctor comments.
It is not without reason that the biological gap between women and men is often discussed. A man's sexual peak is between the ages of 16 and 30. For women – from 30 to 50. That's how nature has arranged it. In youth, a man wants and can do it three and even five times a day. However, after thirty, his sexual activity gently calms down. We can assume that this is arranged so that he stops chasing girls and takes care of his family. After the age of 50, the curve goes down even further – the desire to make love does not disappear, but it is much lower than in youth, because this is the time when a man, philosophically speaking, should start taking care of society, for example, by becoming a mentor, lecturer or head of state. It is normal that at this age, sex interests him much less.
On the other hand, a woman between the ages of 30 and 50 enjoys sex, because her children are most likely already grown up, pregnancy no longer occurs so easily, she has become familiar with her body. It turns out – if her partner is of a similar age and his sexual interest begins to wane, now the woman motivates the man to make love so that he does not completely let himself go. "That's how beautifully and wisely it is arranged in nature. But if a man thinks that at sixty he should be able to perform a sexual act three and five times a day, then the problem is in his thinking, not in his physiology, which cannot do that," adds the doctor.
If it doesn't work at all
There are three main causes of erectile dysfunction.
Testosterone deficiency.
In this case, the man will have no interest in sex and erections will have disappeared completely. There will also be no morning erections, as this is a reaction to testosterone production, which occurs at night during sleep. This can be easily checked by performing tests. They are always performed in the morning between 8 and 10 am, because that is when testosterone levels are highest. In the evening, they are about 25 percent lower.
Atherosclerosis in the arteries of the penis.
This can be checked with dopplerography or vascular ultrasonography. The arteries of the penis are some of the finest in the body, so if a doctor finds that they are, simply put, clogged to a certain threshold, then it is quite clear that if this man does not get treatment, he faces a heart attack within the next five years, when larger arteries – the heart's coronary arteries – will also become clogged. In this situation, the three biggest culprits are a sedentary lifestyle, overweight and smoking. Here, it is urgently necessary to think about weight loss, quit cigarettes, and definitely go to a cardiologist.
Psychological reasons.
Longer breaks in sexual life, stress, failure contribute to the autonomic nervous system going out of order.
In 80-90 percent of cases where a man has erectile problems, psychological reasons are either the sole or a strong accompanying factor. "Erections are regulated by the autonomic nervous system, which is not subject to the mind and will. The autonomic nervous system has two parts: the sympathetic, which, simply put, provides tension and activity, and the parasympathetic, which is responsible for relaxation. For erections to work well, both must be in balance and able to switch from one to the other. Longer breaks in sexual life, stress, failure contribute to the autonomic system going out of order. For example, perhaps a man's blood vessels are working a little worse, everything doesn't succeed immediately, or a break is needed during the process, but if he starts to worry about it, the psychological background deteriorates, so it may happen that nothing works anymore. Or – a classic story: a man lived with his wife for a decade, for the last three years the relationship was bad, sex was rare or nonexistent, after the divorce he lived alone for a while, there was no sex, then he met a woman... Everything could be, but – nothing works anymore. And – the more he worries about it, the more nothing works. A vicious circle is entered, from which it is difficult to get out on his own. I prescribe him a low dose of a new generation long-acting preparation that acts directly on the blood vessels of the genitals. This provides a background – whether the man worries or not, everything works out for him. After a month, if everything goes well, I say – listen, maybe it's just a placebo effect, try taking this medicine every other day. And so, gradually, the medication can be discontinued, because everything has settled down," explains the doctor.
It was and it passed
If the start is promising, but during the act the man loses his erection, for example, while a condom is being put on, the reasons can be the same as in those cases when an erection does not occur at all. That is, testosterone deficiency, blood vessel problems, but most often in this case, too, psychology is to blame. Especially if it happened suddenly – everything was always fine, but now this – it is almost certain that the problem lies in emotions. If the fault is physiological, then it usually develops gradually.
If it ends before it begins
The question of premature ejaculation is always a bit philosophical – how fast is too fast? An international definition says – before the man or his partner wants it. But what if five minutes seems O.K. to him, but not to her? Therefore, doctors usually talk about premature ejaculation if it's seconds.
Premature ejaculation can be of two types. Approximately five percent of men have it congenitally, and then it will have always been that way. This system works a little incorrectly for him, and unfortunately, nothing has been invented yet to do with it.
However, if everything has been normal until now, but suddenly the act becomes shorter and shorter, then prostate inflammation is most often to blame. All seminal ducts pass through the prostate, and one of the sensations of orgasm for a man is prostate and perineal contractions. When there is inflammation, everything there is irritated, and then it can happen that everything happens too quickly. By curing the inflammation, the problem is resolved.
An hour, two...
You can satisfy any woman, because for a man everything is simple – he has one type of orgasm.
Much less often, but there are men who complain that their erection lasts too long and they cannot reach climax. Dr. Ērenpreiss replies: "Here, too, emotions and psychology are primarily at play. Frankly, I first try to convince these men that it's not really a problem. I say: you know, for every one of you, I have at least ten men whose semen flows out in 30 seconds, and they would be willing to switch places with you for any money. You can satisfy any woman, because for a man everything is simple – he has one type of orgasm. But a woman has clitoral, vaginal, uterine, and even whole-body orgasm. The founders of sexology, Masters and Johnson, in their book Human Sexual Response, describe both these types of orgasm and the amount of friction required for each of them to occur. I tell him – understand, in some ways you are a superman!
However, I don't manage to convince everyone. Usually, it's a psychological problem, so I recommend talking to a good psychotherapist. In my opinion, in this situation, it's better – with a man."