- About the Book
Exhaustively researched and written with heart, author Jed Diamond shows that male menopause is indeed a medical, psychological, and emotional reality for millions of men and the women who love them. Much more than a mere midlife crisis, male menopause involves dramatic chemical and psychological changes that affect everything from a man's view on life to his ability to attain and maintain an erection.
In this groundbreaking, authoritative book, Diamond surveys the most current medical data surrounding men's health and listens to men's stories as they struggle to understand what they are going through. From the doctor's office to the bedroom, "Male Menopause" addresses the important issues men and women face, including:
Today, after years of jokes about the male "midlife crisis" (red hot Corvettes and Barbie sidekicks), male menopause is recognized as a true event, occurring in millions of men between the ages of forty and fifty-five. "Male Menopause" is at the forefront of the movement toward better men's health, bringing understanding to the changes men go through at midlife. Diamond shows us all how to survive the dropping hormone production, diminishing sexual vigor, and frequent mood swings of menopause. And, most importantly, he reveals how to find purpose and meaning in our middle years and arrive healthy and happy in the second half of life.
by Jed Diamond
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.
About the Author
Jed Diamond, a licensed psychotherapist and certified addictions specialist, has been helping others prevent and treat problems associated with alcoholism, chemical dependency, eating disorders, and intimacy dysfunctions for the past 30 years. A respected leader in the men's movement, Diamond is the author of "Male Menopause" and two previous books.
Diamond received his master's degree in Social Work from the University of California at Berkeley and is now on the faculty there teaching addiction studies courses. He and his wife live in Northern California and conduct men's workshops together throughout the country.
Diamond has lent his expertise on the nation's top shows and the world's most prestigious publications, including Good Morning America, National Public Radio, The View with Barbara Walters, Bloomberg Radio, The Business Radio Network, USA Today, The Wall Street Journal, The New York Post and The Boston Globe. Diamond's "Male Menopause" is featured on a PBS special airing nationwide in August, November and December 1998.
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