The Midlife Crisis In Men
Some men reach a certain age in life when it sinks in that they are mortal and that their lives are ultimately limited. This can be a difficult adjustment for anyone. For a man who has been working hard to achieve goals which he may now never reach, or who has achieved those goals at the expense of family, self or health, it can be particularly difficult.
What you really need to do is to give yourself a chance to grieve anything that you feel you have lost. After that, you need to evaluate what your new mission in life is going to be. Given where you are now, and what you care about in the present, what path do you want to pursue? It may turn out to be nothing like the dreams you had as a child or as a teenager, or as a man in his prime, and that is perfectly natural.
A midlife crisis is often fundamentally an experience of realizing that your values have changed, and that you are no longer satisfied with what has occupied you for many years. The key to happiness in later life is to get past the expectations that you have placed on yourself in the past and create a new set of values, one that is much more in line with your current hopes, desires and expctations.
The male andropause and the mid-life crisis
As a man gets older, he produces less testosterone. This leads to a loss of erections, an under-used penis, perhaps even an inactive penis, and a loss of some vital male qualities. A man’s lowered testosterone level can develop slowly, his testosterone dropping by about 1 or 2% a year from the age of thirty-something, or it can happen suddenly.
The most obvious sign of this is that his penis starts to behave differently: over the space of a few months he may lose his erections, his penis may even appear smaller, he starts feeling depressed, lacking in energy and libido, he may experience rapid climax or lack of desire, and his emotions may become unpredictable and rather irritable.
In the latter case, he’s going through a change like a menopausal woman. And it can be just as unsettling. But this sudden drop only happens in about 3 – 5% of men. The more coomon picture is one of gradually declining testosterone.
Typically a guy starts to notice his testosterone dropping when he’s in his forties, though it can happen sooner. He loses his drive, his vitality, his sex drive and his motivation. His penis is less often erect. Fatigue sets in, sometimes depression too, and he begins to feel stressed and unhappy.
He realizes he’s no longer able to keep up with the young bucks, and may feel this to be a serious self-esteem challenge. That’s especially true if he hasn’t made what he considers to be a worthwhile contribution to the world or achieved something of personal significance. In a desperate attempt to keep his youth, he may find a younger woman or buy a motorbike – a gesture of some sort which represents an attempt to recapture or prolong a certain way of being in the world. A way of being that fits with an old self-image that my no longer be appropriate.
(Buying a motorbike or screwing a younger woman aren’t actually compulsory parts of a male midlife crisis. But thye do make the point that a man going through this turning point will often do something that seems out of character.)
However, midlife changes don’t have to be like this: there’s a natural sequence of life changes which require us to move into the role of “male elder” at some point. This is simply because a man can’t go on keeping up with young men and their frantic pace of life for ever.
Moreover, young men need the advice and guidance of elders – older mentors, if you like. Though this rarely happens nowadays, when a man becomes a true elder, he gains a new role that compensates for the loss of his testosterone and his youthful vigor.
But sadly it isn’t often like that in our society. More mature men, already going through their own internal struggles as their potency and sex drive diminishes, may feel even more rejected or unwanted as downsizing or redundancy stares them in the face. They may feel that the value of their life-long experience is worthless and unwanted. As men, we so often tie our self-esteem to our jobs and the results of the emotional and physical transition into our fifties can be painful.
The whole impact of this process – physical, emotional, and psychological – is the andropause. If you like, you can call the emotional and behavioral bit the midlife crisis. But it’s all part of the same process.
It’s even worse when testosterone decline happens suddenly, perhaps as a result of illness, fatigue, burn-out, or simply because your genes predispose you to an early andropause. This can happen from the late thirties onwards. Like the slower onset andropause, the psychological symptoms included a loss of vitality, of what seemed like the very basis of my life energy, of my sexual drive, and the physical symptoms included poor circulation, tiredness, lack of energy, aches and pains, and night sweats.
The andropause is the explanation of why the vitality and virility of millions of men has faded in middle age or later. It is the explanation of much misery, depression and unhappiness, loss of sexual performance, failing lives, failing health and failing relationships. Above all, it is a major cause of impotence and loss of sexual desire and normal ejaculatory function. But it would be a mistake to see this as merely a sexual issue.
Testosterone permeates every aspect of the male body, every nerve, every muscle fiber, every brain cell. It isn’t just about sexual desire and erectile capacity. There are testosterone receptors on every cell in the male body, and when there isn’t enough testosterone to fill them, things begin to go wrong. The first thing to go is often a man’s sex drive, followed by night-time erections, and then his energy. Next, positive mood and optimism may disappear, he may lose his sense of emotional well-being, and then his self-esteem. And lastly, along with the physical symptoms described above, he may question his masculinity.
Yet if all of this misery is caused by falling testosterone, isn’t the obvious answer to provide testosterone supplementation?
You might think so, but there’s been a big debate in the medical world about the merits of artificially increasing a man’s testosterone levels. What seems clear, though, is that a man whose testosterone level falls to the extent that his enjoyment of life and ability to function effectively is impaired, might benefit from testosterone replacement therapy.
(You’ll see suggestions that such therapy can increase a man’s risk of prostate cancer. However, if you read the research by people who know most about such cancer, you’ll find that testosterone supplementation can actually be protective against prostate cancer.)
By the way, there is an idea that testosterone causes aggression. But this is most likely untrue. Testosterone actually makes a man show more of his existing primary personality features: in other words, it does not cause men to behave aggressively unless they already are aggressive.
Measuring the effective testosterone level in a man’s body is a fairly complicated process. His total testosterone level is not a good guide to his internal state because much of it is not available to his body. It’s the amount of “free testosterone” that needs to be measured. This is just one reason why a specialist in male hormonal medicine is essential to get a true assessment of a man’s hormonal condition.
The causes of low testosterone
Put simply, either your testicles fail or your pituitary – which controls the testicles’ activity – fails. In either case, the hormonal mechanism that has ceased to function can be effectively replaced by hormonal supplementation. You can read more about this condition here.
Middle-aged men also produce more estradiol (a hormone similar to estrogen) and this can block his cellular testosterone receptors and prevent testosterone from doing its job. The effects of excessively high estradiol levels on a man’s maleness and health are very negative.
Dr Eugene Shippen discusses this issue at length in his book The Testosterone Syndrome. He also points that incorrectly administered testosterone supplementation can make this situation worse. Other books worth reading include Malcolm Carruthers’ books, the first of which was called Maximizing Manhood.
Testosterone Replacement Therapy
To cut a long story short, if you go to see someone who is not an expert in this field, you’re likely to be told “your testosterone is in the normal range” or “you’re just depressed” or “you’re impotent because you’re depressed – take Viagra” or “there’s nothing wrong with you” or something similar.
The simple truth is that while these statements may be true, they are quite likely to be wrong. Doctors who are not trained to understand the male hormonal system in midlife may simply not have the experience to help you.
There are several effective ways of taking testosterone supplementation including patches and gels which you can put on your skin. New research is coming up with better methods of getting the testosterone into the body all the time.
Some other benefits of hormone replacement therapy for men
Testosterone maintains the fitness of the ejaculatory muscles of the genital region and the muscles that close off the blood flow from the penis when you get erect.
When your testosterone level falls, these muscles gradually fade away and you can’t get a decent erection or have a powerful ejaculation. In many men, therefore, hormone supplementation has a powerful impact on erectile functioning.
One expert claims that even though restoration of sexual function may take a while as the muscles and nerves regenerate to a fully effective state, the majority of his patients are restored to full sexual function.
However, some men don’t get their erections back even with added testosterone, for many things can get in the way of an erection, including drinking, smoking, fatty deposits in the arteries, and the actions of certain drugs.
Testosterone declines with age – and that matters for you!
In all cases, the cause of the problems is the gradual decline of availability of the most important hormone in the male body – testosterone. Note that we do not say “decline of levels of testosterone” – it is the availability of testosterone which is the problem.
Happily, more and more doctors now advise testosterone therapy, knowing that it is not just the absolute values of testosterone which indicate the bio-availability of the hormone.
Factors Which Affect Your Testosterone Levels
Testosterone, produced in large quantities during puberty and early adulthood, causes development of the secondary sexual characteristics such as axillary and pubic hair and affects the testosterone receptors in all body tissues. This means testosterone affects all organs and glands: it’s effects are most obvious in the hair follicles, muscle cells, and maturation of the penis and testicles. Testosterone also has a role to play in such things as aggression, risk taking, and territoriality, and it also helps to mitigate depression.
Testosterone does not work alone, nor is it an entity in the body in isolation. The sequence begins with cholesterol, from which is produced pregnenolone, the “master hormone”; that is used by the body to manufacture dehydroepiandrosterone (DHEA), which is a precursor to testosterone. Both testosterone and estrogen are produced from pregnenolone and DHEA. DHEA is the steroid found in highest concentrations in the male and female body. Changes in DHEA levels, and changes in levels of the enzymes that convert DHEA to testosterone and estrogen, can have major effects on sex hormone–dependent systems.
Changes naturally occur during male ageing which reduce the amount of testosterone effectively available to the male body. These changes alter the ratio between testosterone and estrogen (actually estradiol) in a man’s body, and produce the symptoms known as partial androgen deficiency.
One of the most crucial factors in the metabolism of male hormones is an enzyme called aromatase, especially prevalent in fat tissue. This enzyme turns testosterone into estradiol, so changing the balance between estradiol and testosterone. Men who have too much body fat, especially around the abdomen, may well have higher estradiol levels as a result of this aromatase activity. This can produce a high ratio of estradiol to testosterone. Increased estradiol is linked to decreased insulin sensitivity, and possibly blood glucose problems.
Low testosterone and excessive obesity is the so-called hypogonadal /obesity relationship, where a low testosterone level produces excess abdominal fat. This in turn causes increased aromatase activity, which causes even more conversion of testosterone to estradiol. Ad this, in turn, naturally further reduces testosterone and then reinforces the tendency toward the laying down of abdominal fat.
Sex hormones are closely affected by the level of sex hormone–binding globulin (SHBG). Only a little testosterone is free in the blood stream circulation: most of it is bound to SHBG, a specialized carrier protein which actually inactivates the sex hormones. Clearly the more the SHBG, the lower the effective levels of testosterone.
Aging men with testosterone deficiency experience more aromatase activity and higher SHBG production. Overall this means the ratio of estradiol to testosterone goes up, and the bio-available testosterone level goes down. And since the liver is responsible for removing the surplus estradiol and SHBG, any deficiency in liver function – such as that resulting from alcohol consumption – can make the overall situation even worse.
Effects of Decline in Testosterone Levels With Age
Nervous system effects. Low testosterone is associated with depression and other psychological problems. Also, conventional antidepressants are of limited use because they suppress libido. Feelings of emotional health and well-being are associated with testosterone treatment. Just as importantly, cognition and alertness are affected by testosterone.
Low testosterone levels correlate with low scores on psychometric tests. Similar effects have been observed in those men who are persuaded to take androgen-reduction agents for prostate cancer. Testosterone can protect nerve cells against several toxins, including oxidative stress. There is also an association between neurodegenerative disease and low testosterone levels.
Sexual enjoyment and function. Low levels of free testosterone reduce sexual desire, capacity for penile erection, sexual pleasure and sexual performance. Men who have low free testosterone levels find that sexual function improves when they have testosterone replacement therapy.
Cardiovascular disease and metabolic syndrome. Low levels of testosterone are associated with cardiovascular disease. The levels of testosterone are correlated with metabolic syndrome, the combination of abdominal obesity, together with high blood pressure, featuring insulin resistance, and accompanying lipid disorders in the same person. This also carries a high risk of cardiovascular disease. Some studies show that testosterone therapy is helpful in alleviating metabolic syndrome.
The musculoskeletal system. Bone density is the result of a balance between bone resorption and bone formation. These are controlled by several factors including estradiol and testosterone levels. Various clinical trials have demonstrated that testosterone has the capacity to increase bone mineral density in men of middle age and older. Testosterone supplementation also has improves muscle metabolism and strength.