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By Sex therapist and relationship counselor
TODAY contributor
updated 4/25/2008 9:12:27 AM ET 2008-04-25T13:12:27

Is there really such a thing as "male menopause"? Conventional wisdom says that menopause is a "woman's condition," but as men advance into their 40s they also experience a progressive decline in hormone levels, namely testosterone. The result can be andropause, which is estimated to affect about 5 million American men.

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The hormonal decline that men experience isn't nearly as abrupt as it is in women — it's more like walking down a hill than jumping off a cliff. However, waning testosterone is likely to make a guy moody, irritable and depressed.

(Upon hearing this list of symptoms, one woman joked of her husband, "Is it possible he's had menopause since he was 20?") A decrease in available testosterone also increases a man’s risk for heart disease, and makes him more prone to injury because of decreasing bone density.

Let's be clear: Andropause is not the same as a mid-life crisis, which is a psycho-social issue. And not all guys who experience aging — and the inevitable decline in testosterone that comes along with it — can be qualified as having andropause.

Andropause is a medical condition, diagnosed with a blood test by a physician that reveals testosterone levels below a certain level. If a diagnosis of andropause is warranted, treatment with testosterone replacement may be an option, depending on a man’s health history. Just as there are various hormone replacement therapies for women, there's also testosterone replacement therapy for men — and research is still ongoing into potential side effects.

However, the biggest, and most misunderstood, symptom of declining testosterone is a decrease in libido. Testosterone is truly the hormone that stokes the flames of desire. Many men confuse andropause with erectile dysfunction (ED), because they often occur around the same time. These men often turn to an ED medication, such as Viagra, to improve their erectile ability, which works for a time in most cases. However, as men get older, the gap between desire and arousal widens and many men become deeply disappointed when Viagra doesn't give them the desire to have sex. That's because Viagra doesn't boost testosterone levels.

The first issue for men, and their partners, is to accept the very concept of male menopause, talk about it as a couple, and, if they’re concerned, make an appointment with an endocrinologist to check hormone levels. But beyond medical therapies, it's also about knowing, understanding and accepting that sex evolves with the passage of life.

For guys who can embrace a deeper intimacy and open themselves up to a different experience of sex, the passage of time brings many rewards. Unfortunately, many men have a limited idea of sex, and they feel that if they're not having sex the way they were at age 20 or 30, then something must be wrong. It's too bad more men aren't open to sharing their experiences with each other, since changes in sexual function are so common. Fortunately, if women know what's going on and realize that hormonal decline can affect their partners, too, then they can take a proactive lead in starting a dialogue.

For more on this subject, consider reading Jed Diamond's "Surviving Male Menopause: A Guide for Women and Men."

Ian Kerner is a sex therapist, relationship counselor and New York Times best-selling author of numerous books, including the recently published “Sex Detox: A Program to Detoxify and Rejuvenate Your Love Life.” He was born and raised in New York City, where he lives with his wife, two young sons and plump Jack Russell terrier.

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