When women look down the sexual road they know that just as surely as they once menstruated, they will menopause. They know that when their sexual responses and appetites start to go a bit haywire there is probably a biological explanation and that there is light at the end of the tunnel, by way of medication, literature, and support groups. Men are not so lucky. If their sexual prowess turns less than trustworthy after they hit 40 - erections collapse, desire dwindles - the possible causes are ill defined. Maybe it's the toll of endless stress or the tedium of being tied to the same partner or some disastrous disease... Or could it be - whisper the awful word - andropause? Which causes strong men to scurry surreptitiously to quacks who advertise in sleazy tabloids and on compound walls?


If we are talking of a predictable event that occurs in the life of every man, then andropause, that implies the total cessation of androgen or male hormones, does not exist. It only occurs in a few men as a result of an illness which affects their testicular function, but this is rare and far between.


In looking for signs of andropause scientists have zeroed in on the delicate balance of a man's reproductive system. Just as estrogen is the chemical key to feminity and is the hormones that wilt during menopause, testosterone is the sex hormone that switches on a man's organs, including his brain with masculine mode. For 20 to 30 years the testicles inject the bloodstream with enough of testosterone 24/7 to sustain a man's recreational pursuits.

The testicles are not alone in this activity. The pituitary, a pea sized gland at the base of the brain, responds to directions from the brain. The signals are purely hormonal. Lutenizing hormone (LH) controls the testicles' production of testosterone. When testosterone levels in the blood begin to plummet, the pituitary releases more LH. A second pituitary hormone, follicle stimulating hormone (FSH) is responsible for maintaining sperm production within the testicles.


Between 40 to 50 something begins to happen to alter the hormonal see-saw. For some mysterious reason, a man's testicles began to ignore the pituitary's chemical commands and decrease testosterone production very gradually at the rate of 1% a year. Some of the male hormone is transformed in fatty tissue into estrogen. The quantity is usually miniscule and rarely enough to cause a man to sprout breasts or sing soprano. However, this is one of the reasons testosterone levels dip in overweight men.


Actually it seems that the testicles have an impressive ability to resist the ravages of age. Researchers have noted that if they exclude from their studies men who are chronically ill, have psychiatric problems or who take certain medications, the testicles even in advanced age, continue to do their job almost as well as they did when they were young.

So instead of calling it Andropause or a full stop, we prefer the acronyun PADAM (Partial Androgen Deficiency in the Aging Male) which may explain the symptoms of fatigue, depression, low libido and sexual dysfunction in some middle aged men.


There are three

- Fertility or the ability to produce enough of sperm to impregnate a woman.

- Libido or the desire to have sex.

- Potency or the ability to have an erection and intercourse.

Testosterone is almost certainly necessary for all three, but the amount needed to sustain one may be quite different from the other two. You can be impotent but fertile and have a high libido. Or you can be potent but infertile with no inclination for sex.

The incidence of potency problems increases with age. However for testosterone to be the cause of either impotence or low libido, the levels have to be rock bottom. Healthy men who have problems with their sex lives and are not impotent due to penile circulatory or nerve problems, alcohol abuse or medication, very rarely have low levels of testosterone.

For these men the answer probably lies in their minds.


Several studies have shown that giving testosterone to men with normal or near-normal testosterone tends does not produce any improvement. It's a fashion these days to attribute a variety of hard-to-pin-down symptoms to dipping testosterone levels in middle aged men. They may range from depression to lack of concentration, nervousness, fatigue, anxiety, forgetfulness, aggression, vague aches and pains, lack of enjoyment, sleeplessness, or excessive sleep, low libido or erectile dysfunction (ED). In fact, 9 times out of 10, the cause this is psychosocial.

Middle aged men lose muscle and bone; have an increased risk for diabetes, arthritis, prostate problems and often experience fatigue depression and low libido. Quite often the spouse, who is nearing menopause experiences vaginal dryness, pain and bleeding on penetration, which reduces the couple's interest in sex. Underlining these are the non-sexual realities - fear of getting older and balder, losing muscle tone, threats from competitors at work, forced retirement and lost opportunities. During this period men's testosterone levels also drop, and in this quick-fix age it is tempting to lay the blame squarely, unfairly on falling testosterone levels and decide that testosterone replacement will solve every problem.

The current hype about Andropause has been pushed by the Pharmaceutical Industry, who is driven by the profits that will accrue if every middle aged takes testosterone pills for the rest of his life, to look and feel forever sexy. At present the medical studies available are too scanty to justify routine testing and supplements. Nobody knows whether a mild to moderate reduction in testosterone levels really has a significant effect on men's sexuality. Nor are there any proper studies that demonstrate benefit from hormone replacement in men with low testosterone. Routine use of testosterone in older men is neither indicated nor recommended at present.


In some men there is a sudden and drastic reduction in in-house testosterone, demonstrated dramatically in a reduction of testicular size and levels which are little more than half the normal. Only these men will benefit from testosterone supplement by injections and tablet. The doctor must evaluate lipid levels and the prostate before starting, because testosterone supplements may aggravate existing prostate cancer, can cause gynecomastia (enlarged breasts) in some; precipitate or worsen sleep apnea; and increase risk of heart disease.

If a low testosterone level is not the only determinant in impotence, what else is? Impotence or Erectile Dysfunction is the persistent inability of a man to achieve and maintain an erection strong enough for penetrative sex. A lot many factors go into an erection. Like

- The brain, which has a fine network of erogenous stimuli.

- The nerves, which pass messages from the brain to the penis.

- The blood vessels in the penis.

An erection occurs when the arteries supplying the penis dilate, thus increasing the blood flow to it. 70% of impotence cases are caused by a noxious brew of psychological causes, such as fear of age, inhibitions, ignorance, fear, stress, boredom, embarrassment, poor body image, depression, traumatic sexual escapades, pressure to perform, unrealistic expectations, performance anxiety and more.

30% suffer from physical causes where the blood vessels of the penis are damaged because of diabetes, hypertension, high cholesterol, spinal injury, excessive drinking and smoking. Contrary to public opinion, prescribed drugs such as anti hypertensive and antidepressants account for only 10% of these and only 1% are caused by hormonal imbalances. 40% of men at 40 have mild erectile dysfunction. 70% of men at 70 have severe erectile dysfunction.


It is psychological if

- You wake up with an erection

- You can masturbate perfectly well

- You have had satisfactory penetrative intercourse

- Your problem occurred suddenly

It is physical if

- Your erection is feeble and does not strengthen even while you sleep, wake up or masturbate

- You try and try but do not succeed

- The onset comes gradually, insidiously


If you have furred arteries in your penis it is likely that the blood vessels of your heart are unhealthy. So impotence can be a sign that a cardiogram is overdue. If testosterone replacement is not an option, what are the treatment choices available for impotence? There are injections, implants, pumps. Surgery is an option for some. And then of course there's Viagra. Tell us how this wonder pill works. Sildenafil Citrate, famous as Viagra, has spawned a clutch of cheaper, equally efficacious Indian clones, from Silagra to Penegra.

It blocks the enzyme E-phospho-diesterase Type V in the penis so that the penile blood vessels open out within an hour, helped by stimulation. It works for six to 8 hours. It is suitable for men who have a normal blood supply to the penis but cannot become dilated because of diabetes, hypertension, nerve damage, liver damage, performance anxiety and is 70% to 75% effective. What's more, it can be taken privately. 20% of users report minor symptoms - congestion of the nose and eyes, acidity, heaviness of the head - which are not life threatening. It is only dangerous for those on nitrates for Coronary Heart Disease, because the interaction can reduce blood pressure drastically. However it does not trigger heart attacks for any other reason.


By calling their condition impotence not andropause because impotence can be treated. Counseling, procedures, devices, and drugs mean that men no longer have to sacrifice sexuality to age.

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