Who would have thought that my search for an expert to discuss the fact that men change hormonally as they age would elicit such profound silence? This had me worried for a time, since I truly wanted to have a man handle the very masculine topic of andropause. However, eventually one brave man, Dennis Marasco, came to my rescue. With humor and wisdom, Dennis tells us about andropause, explaining in the process why the answer to my general inquiry was so underwhelming.
Dennis Marasco, M.Div., NCC, LPCC, spent the years between 1981 and 2015 as a Licensed Professional Clinical Counselor. He is now a chaplain at Crossroads Hospice in Cincinnati. In the following essay, he sheds some light on the touchy topic of andropause.
What is Andropause?
As a mental health professional having provided counseling to individuals and couples over the last three decades, I have dealt with andropause often, although indirectly, on a regular basis.
We’ve all heard of “male menopause”. However, when this term is used, no (stereotypic) man “worth his salt” is going to take that term seriously! He would likely excuse it as an androgynous joke with no possible truth to it, particularly for him.
There are various medical terms for this age-related decrease in testosterone. You may have heard such conditions as late-onset male hypogonadism, androgen deficiency or testosterone deficiency, but each one refers to the same hormonal phenomenon.
Male menopause, while tangentially similar to female menopause in a few ways, is actually quite different. In males, the hormonal effects of aging occur comparatively slowly over the course of many years. According to the Mayo Clinic, testosterone levels decline approximately one percent each year after age 30.
The Stigma of “Male Menopause”
When considering all of the strange labels related to the male aging process, it can be a sensitive topic for many men. Consider the basic definition of andropause. “Andro” means male and “pause” means stopped. How exactly can a man stop being a man?
The definition according to Merriam-Webster:
“A gradual and highly variable decline in the production of androgenic hormones and especially testosterone in the human male together with its associated effects that is held to occur during and after middle age —called also climacteric, male menopause.”
This process is also called reverse puberty and even “middlescence.” What man wants to be going through this just as his son is enjoying the height of his youth and corresponding testosterone levels?
When we hear the word andropause, how in the world are we men even going to imagine what it means? Men don't talk about that unless they're in the locker room or barbershop busting each other’s chops. The only permission men of my generation have had to talk about something of this nature had been through taunting and teasing other men. Therefore, we could never acknowledge a “weakness” of this sort without compromising our (perceived) manhood.
But we are learning. During the past years, I have been involved in starting a number of men’s groups and have found that when a group of only men get together, we talk differently. And when men talk candidly and openly, we talk deeply and accept the challenge to face reality. We are somehow less defensive than we are when in the company of women. That is progress.
Missing a Chance to Educate
There is one place in society where we are indirectly talking about andropause. We are all seeing it on television in the form of erectile dysfunction medication advertisements for products like Viagra and Cialis. There is no mention of why there is a need for such medications. As usual, it is sold with sensuality while sidestepping the real problem of impotence. Once again, the media have successfully backed into an unspeakable topic.
While these ads may have assisted some couples in breaking the silence when alone in their own homes, this does not actually educate us. The media could at least play with the subject, spurring aging boomers into understanding the background of the problem and then selling a solution.
So, yes, regardless of stereotypes, we men intuitively understand that as we age, things will change. But we assumed it would change gradually to the point that we wouldn't even notice it, or be aware of the impact on us, our actions or our relationships (including sexual relationships). We never thought that it would end up changing our perceptions of ourselves, which we have spent a lifetime developing.
Research and Hormones
Research says that testosterone levels decrease around 10 percent per decade, and this can wreak havoc on men in the following ways: changes in sexual drive and function, emotional, psychological, and behavioral changes, sleep disturbances, decreased muscle mass and loss of muscle strength, gynecomastia (swollen or tender breasts), increased upper and central body fat, osteoporosis or weak bones, back pain, and increased cardiovascular risk.
So let’s concretize the impact of these changes. Imagine a couple that wants help with their marriage. They have been married for 20 years and are both in their 50s. Each is less than fulfilled in what has been, until this point, a relatively stable marriage with few financial issues and only the usual concerns that occur when teenagers appear. Neither person has been unfaithful. Both have satisfying social and spiritual connections in their community and church.
But the husband has few male friends and only sees them intermittently. Like any good husband, when he was first married, he “put away childish things” and stopped focusing on his long-time friends to give his all to his family. So he, over the years, has become somewhat isolated. His family has become everything to him.
In his 40s, he increasingly became aware of his relational connectedness to his wife and children. Yet, at the same time, he found a vague dissatisfaction and lack of excitement in life. Isn’t it ironic that as he becomes more aware of his desire and need for deep relational connection, he is also beginning to lose the chemistry of his youth that engaged him at the core of his being? When these two natural phases of life overlap, issues can easily compound and wreak havoc on relationships and emotional and physical wellbeing.
If this couple goes to a therapist, the therapist might work on strengthening their communication and try to engage them in their relationship more meaningfully. If they were to go to a medical doctor, he or she might recommend testosterone supplementation. If, instead, they went to see a psychiatrist, he or she might recommend an anti-depressant. And if, perchance, they had gone to a nutritionist, a focus on a healthy diet would have likely been suggested. Finally, a fitness expert would have advised the couple to engage in cardio, strengthening and stretching exercises. Prescribed treatments could vary widely.
Maybe all of these recommendations would be the combined treatment of choice to help get this couple back on track. The point is that we need balance in life. Too much of anything is not good, and neither is too little of anything.
My take on andropause is to say that we need to maintain ongoing physical, mental, social and spiritual balance throughout life. This is only a hypothesis, and it may also be indicative of my own denial as well. It is of note that this is taking place at the same time that our spouse may just begin to be “feeling charged up,” as one of my best friends has noted.
In any case, we need balance in life and we need to begin to face the fact that things are slowing down. As one of my close male friends said to me regarding this article, most men want to have the “will, and effort to get and stay involved with other people, including some close buds so as not to die painted into the lonely stereotypical role of monosyllabic TV dad. Men don't want to be pitied, stereotyped, or shamed into limited roles any more than women do.”
So we need to talk with those whom we find trustworthy: our spouses, close male friends, physicians, therapists, and so on. We must begin to look for new goals, ones that help us see the depth and meaning of a life well lived and that leaves something we have to give for others. This phase of our lives is critical. It will allow us fully to feel the joys and sorrows as we face things like andropause on the backside of the beautiful quilt we call life.
Thanks to E. Dennis Marasco, M.Div., NCC, LPCC, for his insight and his generosity in helping us understand what men may be going through, but not talking about, as they age.