As testosterone levels decline with age, it can lead to some problems which are often attributed to age alone.  Symptoms which have been associated with a deficiency of testosterone include:

1. Decreased sexual function
2. Lower vitality
3. Loss of muscle mass and strength
4. Increased fat mass
5. Memory loss
6. Mood changes and depression
7. Loss of bone density
8. Anemia
9. Cardiovascular disease

These symptoms are sometimes associated with testosterone deficiency, but can be present with normal levels of testosterone, and in some cases, may not occur significantly even when testosterone levels are low.

Testosterone, sometimes referred to as “androgen,” is a hormone produced in large amounts in the testicles (testes) with smaller amounts produced in the adrenal glands.  (In women, some is produced in the ovaries.) 

As anyone who has been an adolescent boy knows, production peaks in the teens and early 20’s.  (Remember the fear of getting an erection while reciting in front of the class or of having one during your football physical?)

The issue of “male menopause” is one which doctors debate.  In women, menopause occurs when hormone production stops completely, but for men, hormone production falls, but it does not stop. Men don’t run out of testosterone, but it does decline with age. Levels of testosterone continue to remain high between ages 20 to 40, but somewhere about 45-50, levels begin to decline, with a fairly dramatic decline occurring after age 70.  Testosterone and memory begin their decline at about the same time.  Testosterone levels also can be reduced with some diseases like diabetes and liver disease, chronic alcohol use and some cancer treatments.

When we think about the characteristics of testosterone, we usually think about its sexual power rather than its potential impact on mental processes.  All the body’s attributes change with age, unfortunately, and mental functions are no exception.  As one gets older, new learning is slower, new information is processed less carefully and details often slip away.  Memory is the most fragile of mental functioning.  Research suggests that testosterone levels may affect men’s cognitive performance. 

The promises that testosterone might be an anti-aging tonic are particularly appealing for men who are maturing and experiencing some decline in their sexual functioning, sagging muscles and energy.  Still, the iconic image of the Marlboro man  is fixed in our brains, Viagra is used like “poppers,” and the promotion of “sexual enhancement” products has exploded, as industry plays upon our fears.  (This early Marlboro Man ad from 1955 features the slogan: “The filter doesn’t get between you and the flavor!”) 

Talking about sexual function and gay men runs some risk because there are those who think that sex is all gay men think about and talk about.  Although we do struggle to shed that stereotype, in some ways sex does define us.  After all it is homo-SEXUALITY, not homo-PHILIA.  Sometimes, even when the “philia” is functioning perfectly well, the sexual part does not.

Testosterone helps maintain sex drive and sperm production and most men are capable of impregnating well into late life.   One of the interesting findings in my research of mature men who have sex with men is that although sexual function may decline with age, sexual satisfaction often does not decline.

In Part II, I will address the specific changes related to sexual functioning.