A topic that is not talked about much. However, andropause is a moment that many men go through when they reach middle or old age. It has specific symptoms and treatment, and it is important to have a diagnosis, especially to understand many of its effects, which range from a decrease in sexual desire, to anxiety, moodiness or depression.
In turn, this physical phenomenon is part of a moment in men’s lives in which they must assume grief linked to the passage of time, sexuality, and even the field of work, which have their own complexities on a psychological level. What, ultimately, does andropause represent?
This phenomenon, which is often compared to menopause, actually has little to do with it, the main difference being the fact that not all men present symptoms. As explained by urologist Mariano Cohen, head of the Andrology Section of the Hospital de Clínicas, it is said that a man reaches andropause when his testosterone production decreases, which affects his sexual desire. The diagnosis is confirmed by a blood study that evaluates hormonal parameters.
“It usually manifests itself around age 70 in the vast majority of men. However, we have younger men, who also have manifestations,” indicates the professional, who also works as head of Andrology at the Argentine Center of Urology (CAU).
How to know if a man is going through this period? Cohen indicates that the main symptom is the lack of sexual desire, due to the role played by testosterone, “the hormone that gives sexual characteristics, gives growth to the beard, and is linked to development.” However, he clarifies that not all men notice this alteration in libido. “Usually the patient consults due to lack of libido, lack of sexual desire, added to a delay in beard growth: he shaves less frequently.” Regarding the first point, he clarifies that it is not a problem of erectile dysfunction in itself, but rather this is specifically due to the lack of desire, linked to the decrease in the hormone.
Now, if it is a fundamental hormone, and it drops steadily, how do you deal with this loss? The urologist points out that the way to counteract the effects of andropause is with testosterone replacement, with methods that can be injectable, in creams, or in gel, always with the aim of maintaining and preserving libido. “In certain patients, it is given early to avoid osteoporosis due to hormonal deficiency,” he adds.
“It is not similar to menopause, which all women reach, but it does reduce the reproductive quality of men,” says Cohen, marking the point at which they can be similar. In addition, he points out other differences: “Andropause differs quite a bit from menopause, to begin with because menopause occurs in younger people, and andropause, furthermore, does not cause symptoms in all cases.”
For his part, Ricardo Iacub, doctor in Psychology, holder of the Psychology of the Third Age and Old Age chair at the Faculty of Psychology of the UBA, highlights a central difference: andropause is a topic that is talked about less. “Talking about ‘male menopause’ is inappropriate, because they are not homologous, no matter how much we tried to show their similarities. In reality, the process of andropause is much less pronounced than that of menopause,” the professional introduces.
And he finds the justification for the fundamental difference in the biological changes that this entails: “we can see a lower amount of testosterone and the impact it has on different areas, on erection problems, on loss of energy, on lower musculature, in obesity, even in thyroid changes that can occur.”
“I want to highlight something that has to do with the changes at the level of sexual capacity that occur in men and that have a peak between 48 and 50 years, one of the most pronounced peaks at the level of sexuality, then the “Falls at a biological level are supposed to be leveled,” Iacub introduces. As he explains, there are changes that occur in men’s sexuality, which it is good for them to be clear about, especially so that they do not feel that their sexual identity, generally identified with what is known as “potency,” is threatened. .
“What happens is that from a given moment an erection will require more time, more time will have to pass between one genital relationship and another, that is, there will be a series of circumstances that will change” , he maintains. “A series of circumstances are generated that have to do with changes that our society usually conceives as falls, which begin to be seen after 45, 48, up to 55 years of age. Particularly on men, the loss of something as valuable to the male gender as erectile capacity, the ability to respond genitally to any demand, to be able to conceive of themselves as sexual subjects, beyond the fact that they do not have the same, in quotes, sexual power that they had at other times,” he adds. “That’s why some call it pitopause, because of the hypervaluation of the penis that occurs in the male gender and which leads to this often being seen as a demasculinization, as a disability.”
For all these issues, the professional explains that andropause can generate, for biological reasons, certain levels of depression, anxiety, discomfort, and bad mood.
The psychiatrist Pedro Horvat also highlights the importance of this issue, as if it were a narcissistic wound. “Part of the narcissistic economy of self-esteem revolves around virility and sexual performance, and this undoubtedly generates pain in self-esteem and concerns in relation to their image and the implications that this may have on their relationship as a couple,” ponder.
Every stage of change involves leaving something behind to face what is coming. The psychiatrist Pedro Horvat frames andropause in a broader stage of man’s life where several losses must be assumed. “On the one hand, the appearance of the symptoms of andropause, that is, the modifications that time imposes on biology, precisely mark the passage of time and what we could call the end of youth,” he introduces.
And he continues: “This is undoubtedly painful and brings with it all the consequences for people, the pain of objectifying the passage of time and the proximity of old age. “Some people can accept it maturely, and in other cases overacting occurs.” The professional refers to “men who are very careful about their appearance and trying to appear much younger than they are or sometimes getting involved with much younger women with the same objective of maintaining a situation of idealized youth.”
Given this panorama, the professional assures that there may be different types of responses, from the “healthiest” ones, such as taking care of one’s health, doing physical activity, talking about the topic with one’s partner and, eventually, resorting to the possibilities that pharmacology today it provides (“that allow these symptoms to be largely hidden”); to other less healthy extremes such as cases in which depression and pain “end up winning the scene.” “Of course, in any situation, it is key to be able to have a good dialogue with your partner around these issues,” he summarizes.
Finally, Iacub relates it to other characteristics of this stage, in which man may feel that little by little he is being left on the sidelines. “This must be thought about many times in relation to changes that occur at the work level, another of the great figures of masculinity, especially at later ages, where the prospect of retirement begins to impose a limit,” he describes.
At this point, he points out an intrinsic relationship between the mental and physical plane: “Certain losses, such as widowhood or retirement, have a negative impact on testosterone and sexual capacity, so what we see is that there are ways of interaction from the biological to the psychological, but also from the psychological to the biological,” he analyzes.
“Between the ages of 40 and 55, situations arise where sexual interest at the couple’s level deteriorates, what some call sexual boredom,” Iacub ponders. And he maintains that this is not related to an erection problem, nor to a physical problem, “but basically and unfortunately, to something about sexuality, which generates a loss of interest due to repetition and where many times the search for a new partner or being interested in other people can be a way to have more fun or to arouse a desire that perhaps a lifelong partner does not generate.”
“Many believe that this happens with old age, but in reality what we know is that this precedes biological changes and has more to do with a deterioration in the patterns of the couple’s relationship,” he argues. And he continues: “desire seeks novelty and sometimes sexuality requires other images, other forms, or finding new resources within the couple in order to continue reinventing themselves.”
“One of the main challenges for men in view of these gender determinations – which are so much more rigid than in women, this demanding demand on a sexual level that it seems that we always want, we always can – is to understand that it can function as a pause that allows us to choose more, that allows us to find other options,” Iacub proposes.
By this he means leaving the imperative of ejaculation, and, in his words, “being able to think about other possibilities that a person has of being able to enjoy with his partner without always resorting to something that, especially at later ages, can begin to be less predictable than it was when we were younger,” he analyzes. And he closes: “I think it is a moment in which we still have resources, we have many ways to explore, but at the same time we have the possibility of reinventing ourselves as men, we do not always have to be able, but we can choose how, when, and add “new dimensions to sexuality”.
