A case of hormones
Most people know about menopause, a natural stage in a woman's life where her body stops producing the female sex hormones estrogen and progesterone. Menopause is defined as not having had a menstrual period for the past 12 months. The average age at menopause is 51 years, but symptoms of declining hormones often begin years before. This is called perimenopause, and often starts when a woman is in her 40s. Symptoms of menopause include:
- irregular menstrual periods that eventually stop completely
- hot flashes (feelings of intense heat, flushing, and sweating)
- vaginal dryness
- bone loss
- weight gain
- sleep problems
- problems with concentration and memory
- lower sex drive
- night sweats
Many of us are unaware that men also experience declining sex hormone (testosterone) levels as they get older. The gradual decrease in testosterone production that occurs when a man ages is called andropause.
Andropause is different from menopause. After menopause, women are unable to become pregnant. But men can still father children after andropause. During menopause, a woman's hormone levels decline very suddenly and dramatically. With andropause, the decline of hormone levels is more gradual. But it can still lead to very real physical effects. Symptoms of andropause include:
- lack of energy and drive
- lower sex drive
- decreasing strength and endurance
- loss of height
- mood changes (a man may be sad or grumpy more often)
- erections that are less strong
- decreased work performance or athletic ability
- decreased enjoyment of life
At around the age of 30, available testosterone levels in men begin to decrease about 10% every 10 years. Andropause usually affects men over 40 years of age.
Both menopause and andropause can cause physical symptoms (such as loss of energy and sex drive) that can put a damper on a couple's sex life – especially if both people are going through menopause or andropause at the same time! The most important step is to recognize the problem and seek help. A declining sex drive in middle age may often be due to hormonal changes or other physical causes, which can often be treated.
Once you've figured out the cause of your dampened desire and gotten access to treatment, the next step is to rebuild your sexual relationship. The key is communication. Because sex is a way of reaffirming your attraction to and feelings for the other person, it's important to reassure your partner that it's not their fault. Explain how the changes in your sex life have been making you feel, and encourage your partner to share their thoughts and feelings as well. Try to use "I" statements rather than "you" statements, as these are less likely to make the other person think you are accusing or berating them. Discuss your expectations for your sex life going forward, and don't be discouraged if it takes time to build up the relationship again. Make sure you take time to be alone together, and don't be afraid to get creative!
Give low hormones the heave-ho!
Low hormone levels can lead to flagging sexual desire. But low hormones don't have to spell the end of your sex life! Here are the treatment options available for low hormone levels.
For men with andropause, the main treatment is testosterone replacement therapy. Testosterone is available in patch, injection, gel, topical solution, or capsule form. Testosterone patches, gel and topical solution are all applied once daily. Capsules are given at least twice daily with food. The injection is given once every 2 to 4 weeks in a doctor's office. The most appropriate form of testosterone depends on the man's lifestyle as well as his overall health.
Some of the possible side effects of testosterone replacement therapy include change in mood, hair loss, high blood pressure, weight gain, fluid retention, acne, stimulation of prostate growth, sleep apnea (brief episodes where breathing stops during sleep), increased blood cell production, and decreased sperm production. Testosterone replacement therapy is not suitable for all men - men with prostate or breast cancer should not use it. Keep in mind that for every individual, the balance of benefits and risks may be different. Your doctor or pharmacist can advise you on the risks and benefits of different options in relation to your own health history.
For women, the main treatment for menopause symptoms is hormone replacement therapy (HRT), which means receiving estrogen and/or progesterone. Because using estrogen alone can increase the risk of endometrial cancer (cancer of the lining of the uterus), women who have not had a hysterectomy (surgical removal of the uterus) need to use estrogen in combination with progesterone (which reduces the risk of endometrial cancer by causing the lining of the uterus to shed). Women who have had a hysterectomy are not at risk of endometrial cancer and can use estrogen alone.
Estrogen and progesterone are available in a variety of different dosage forms. Estrogen is available as creams, patches, tablets, vaginal tablets, and a vaginal ring. Progesterone is available as tablets and creams. The tablets and creams are usually used once daily. Patches are usually applied to the skin once or twice weekly. The vaginal tablets are inserted into the vagina twice a week. The vaginal ring is inserted in the vagina and changed once every 3 months.
The benefits of short-term hormone therapy usually outweigh the risks in most women with severe postmenopausal symptoms. However, some of the possible side effects of estrogen replacement include nausea, bloating, breast tenderness, headache, and changes in menstrual bleeding patterns. Possible side effects of progesterone include mood changes, bloating, fluid retention, difficulty sleeping, and headaches.
There are many different forms of HRT, and sometimes switching from one form to another can reduce the side effects and long-term risks a woman experiences. Estrogen plus progesterone may have long-term health risks including a higher risk of blood clots, heart disease, breast cancer, and stroke. Women taking estrogen alone may be at a higher risk of stroke, dementia (problems with memory and thinking), and blood clots. If you are considering HRT, it's important to see your doctor to discuss your own personal balance of risk and benefit.
Sexing up your relationship
Sex can be fun, but did you know that it's also good for you and your relationship? Good sex has many health benefits. First of all, it's great exercise! An energetic sex session works many of your major muscle groups, improves your cardiovascular fitness, and burns calories. Vigorous sex burns about 90 calories per hour for a 130-pound (59-kilogram) person, and even more for a heavier person. Similarly, regular sex can maintain your sexual energy and help keep a sexual relationship alive into those later years.
Sex has other body bonuses as well. It can also help you get better bladder control, because it works the muscles involved in stopping the flow of urine. For men, sex can improve bone and muscle health through the stimulation of hormones. Likewise, sex can also stimulate the release of chemicals that improve the immune system’s health.
In a recent study, men who ejaculated 5 times per week cut their risk of prostate cancer by one third. Sex can cause a surge in the levels of endorphins, the body's natural pain relievers. It may even reduce the risk of heart disease and death. In one study, men who had sex at least three times a week cut their risk of heart attacks and strokes in half. And another study found that men with frequent orgasms (more than twice weekly) had half of the risk of death compared to men with less frequent (less than monthly) orgasms, even when researchers filtered out the effects of other risk factors for death.
The lower hormone levels that may come with age can dampen sexual desire in both men and women. Couples often end up having sex less and less often, until eventually they're living like roommates. A long "dry spell" can wreak havoc on even the strongest relationship, causing frustration, resentment, and feelings of rejection.
It's important to nip the problem in the bud - if you or your partner are experiencing lower sexual desire, check with your doctor to see if this is due to low hormones or other health conditions like erectile dysfunction, diabetes, or high blood pressure. If so, take steps to find an effective treatment. This will help get your sex life back on track. Other strategies like maintaining a healthy weight and diet, smoking cessation, and moderating your intake of alcohol can help you enjoy a healthy sex life. Communication is essential to good sex, and it will also boost your relationship. Plus, enjoying good sex together will strengthen your relationship.
Of course, the health and relationship benefits of sex depend on practicing safe sex (using a condom every time you have sex unless neither of you has sex with anyone else and you are both free of sexually transmitted infections), and neither person feeling pressured or forced.
Has your man lost his drive?
Has your man lost his drive? Does he seem to have less energy and less interest in sex? Is he falling asleep after dinner? He may be experiencing andropause, a condition where testosterone levels slowly decrease with age.
Take this quiz to see if your man may have low testosterone. For each question, answer "yes" or "no":
- Does he have a decrease in sex drive (libido)?
- Does he have a lack of energy?
- Does he have less strength and endurance?
- Has he lost height?
- Does he seem to have less "enjoyment of life"?
- Is he sad and/or grumpy?
- Are his erections less strong?
- Has he noticed a recent deterioration in his ability to play sports?
- Is he falling asleep after dinner?
- Has there been a recent deterioration in his work performance?
This quiz is based on the ADAM (Androgen Deficiency in Aging Men) questionnaire, which is used by doctors to determine whether men may have low testosterone. If you answered "yes" to questions 1 or 7, or "yes" to more than three questions in total, your man may have low testosterone.
The only way to find out for sure is for him to visit his doctor for a blood test that measures his testosterone levels. Keep in mind that these symptoms may be caused by other health conditions as well, so it's important for your man to speak with his doctor to find out what's going on.
Help your man to talk to the doctor
Low testosterone can wreak havoc on your life, affecting even the strongest relationship. If you've completed the testosterone quiz in the previous section ("Has your man lost his drive?") and you think your partner may be suffering from low testosterone, the first step is to talk to your partner about arranging an appointment with your family doctor.
Raising the subject of sex with the doctor can often be embarrassing, so here are a few ways to make the discussion easier:
- Print out the testosterone quiz and fill it in. Have your partner bring the results to his visit, then just hand the piece of paper to the doctor to get the discussion started!
- Before the visit, sit down with your partner and jot down your questions or concerns about low testosterone. This will help you remember the issues to cover. Leave space to write in the answers during the visit so you have the information for your records.
- If your partner is embarrassed, telling his doctor can help. The doctor can then try to make him more comfortable. Just saying that he's embarrassed may also help him feel more at ease.
- Ask your doctor to recommend pamphlets, websites, or books that provide more information on low testosterone that you both can read in the privacy of your home.
Testosterone: Find a treatment that fits
There are a number of treatment options available for the symptoms of low testosterone. Making a decision about which is best depends on your partner - his lifestyle, his concerns, and his preferences.
Have your partner answer the following questions and bring this list to his doctor, so together you can decide which option is the most appropriate.
Questions for your partner:
- Do you have another condition that may rule out testosterone replacement therapy (including breast cancer, prostate cancer, suspected prostate cancer, heart disease, kidney disease, or liver disease)?
- Are you concerned about the side effects of testosterone replacement therapy?
- Is the convenience of a once-a-day product an important factor to you when choosing a medication?
- Is it important that the treatment you choose does not interfere with your daily routine?
- Do you prefer to be treated in your doctor's office or would you prefer a treatment that can be administered at home?
- Are you concerned about the safety of testosterone treatments on others you come into close contact with (e.g., wife/partner, female children, etc.)?
- Would you prefer a treatment that matches your body's natural circadian rhythm (i.e., your body's biological clock)?
- Of all the treatment options, which ones appeal the most to you?