Life After 50: A Harvard Study of Male Sexuality

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Q. Glen, Are there any studies of Sexuality for Men after 50?

A.Even the most optimistic men know that the clock ticks for all of us. With each passing year, our bodies change, as does our behavior.

It’s certainly no surprise that male sexuality changes over time. Some 400 years ago Shakespeare asked, “Is it not strange that desire should so many years outlive performance?” Still, a major Harvard study of male sexual function in maturity does contain some surprises. It reports that sexual dysfunction is common and increases rapidly as men age. But it also says that simple lifestyle choices can slow the tick of the clock for many of us.

The Harvard study

Until Viagra burst onto the scene in 1998, few men were willing to discuss sexual problems. But the little blue pill and Senator Bob Dole changed all that, and researchers took advantage of the new openness to conduct a study of age and male sexuality.

The subjects were 31,742 men between the ages of 53 and 90. As members of the Health Professionals Follow-up Study, all were dentists, optometrists, osteopaths, podiatrists, pharmacists, or veterinarians. That makes them knowledgeable observers and reliable reporters of their health, but they do not reflect the broader U.S. population in terms of education, income, and race.

Since it began in 1986, the study has been gathering an enormous amount of information, and in 2000, it added sexuality to its semiannual surveys. Each man answered questions about his sexual desire, his ability to sustain an erection satisfactorily for intercourse, his ability to reach orgasm, and his overall sexual function. Because the database also contains details about each man’s general health, medications, and health habits, the scientists were able to evaluate sexuality in terms of health and lifestyle as well as age.

The toll of time

One of the striking results of the study was that men with prostate cancer are 10–15 times more likely to experience sexual dysfunction than men without the disease. In nearly all cases, the sexual difficulties stem from the treatment rather than the cancer itself. But since the incidence of prostate cancer increases steadily with age, it could skew the results of the analysis. To avoid confusion, the study excluded men with prostate cancer from the final tabulation, though it did include all other medical conditions.

Even in men without prostate cancer, the prevalence of sexual problems was very high: 29% reported moderate or severe difficulties. But not all age groups were equally affected; major problems rose from 10% in men younger than 59 years to 23% in 60- to 69-year-olds, 47% in 70- to 79-year-olds, and 64% in men 80 and over.

Each aspect of sexual function showed progressive problems with age. Fully a third of the men reported moderate to severe erectile dysfunction; but only 2% remembered that their difficulty began before the age of 40 and only 4% reported that it developed between 40 and 49. After 50, the number of men with the problem rose steeply from 26% between 50 and 59 all the way to 61% after 70. And as usual, Shakespeare got it right; although libido also decreased with age, sexual desire was preserved substantially better than erectile function.

Testosterone and male sexuality The male hormone testosterone is necessary for the development of male genital structures during fetal life. It triggers the dramatic events of puberty, and it is necessary for libido, sexual function, and fertility throughout maturity. Testosterone levels peak at about age 17, then remain high for the next few decades. But after the age of 40, testosterone levels fall by about 1% a year. That doesn’t sound like much, but by the age of 70 or so, it adds up to a 30% decline. Testosterone levels fall just as many men begin to experience sexual dysfunction. But that doesn’t make testosterone responsible for the problem. In fact, most men have plenty of testosterone to spare, so levels remain in the normal range in at least 75% of senior citizens. Testosterone patches and gels are increasingly popular among older men; doctors write more than a million such prescriptions a year, and the number is increasing rapidly. In addition, many men take weaker male hormones such as dehydroepiandrosterone (DHEA) and androstenedione (Andro) that are sold with­out a prescription as “dietary supplements.” It’s not a good idea. There is no evidence that male hormones will improve sexual performance in healthy men, and by stimulating the prostate, they may do more harm than good. Men who are truly testosterone deficient (hypogonadism) have diminished sexual interest and desire as well as erectile dysfunction. They can benefit from testosterone replacement therapy, but only after careful medical tests establish a diagnosis of testicular insufficiency.

The toll of illness

Sexuality is not the only thing that changes with age. Chronic illnesses also become more common, and in each age group, sexual dysfunction was most prevalent in men with illnesses such as diabetes, hypertension, heart disease, cancer (other than prostate cancer), and stroke.

All in all, men who remain well are less likely to develop sexual dysfunction with age than men who fall ill. And men who take good care of themselves enjoy substantial protection from both illness and sexual decline.

The benefits of healthful choices

No man chooses to get sick, but many choose behaviors that boost their odds of becoming ill. Although the health professionals who participated in the study should have known better, some didn’t — and they paid the price in terms of impaired sexual function as well as illness. The risk of sexual problems was linked to smoking, obesity, heavy drinking, and the time spent watching television. In contrast, regular physical exercise and moderate alcohol consumption help preserve good sexual function. In this respect, the study agrees with earlier research showing that erectile dysfunction can be prevented.

Age and sexuality

The Harvard study of male sexuality and age is the largest of its kind and provides important confirmation of earlier research as well as additional interesting information. Chronic illness and the medications used to treat them account for many of the sexual problems of older men; depression can also take a toll. But even in healthy men, a slow change in sexuality begins in middle age and continues throughout life. Whereas most older men retain an interest in sex, it is generally a far cry from the preoccupation with sex that is so common in youth.

Although interest is retained, desire tends to wane; many older men think about sex but do not have the drive to put theory into practice. And even when the spirit is willing, the flesh may be weak; male sexual performance typically declines more rapidly than either interest or desire. Most men experience decreased sexual responsiveness with increasing age. Erections occur more slowly, and they depend more on physical stimulation than erotic thoughts. Even when erections develop, most men in their sixties report that their penile rigidity is diminished and harder to sustain. The ejaculatory phase also changes with age. The muscular contractions of orgasm are less intense, ejaculation is slower and less urgent, and there is a longer refractory period following intercourse, when men cannot respond to sexual stimulation. Semen volume and sperm counts decline, as does fertility.

The study evaluated sexuality but not relationships. Sexual intercourse requires a partner, but male sexuality demonstrates age-related changes that do not depend on interpersonal factors. Nocturnal erections diminish with age; men between 45 and 54 average 3.3 erections per night; between 65 and 75, they average 2.3 erections. Nocturnal erections also tend to become briefer and less rigid with age.

Life may not begin at 80, but sex life doesn’t automatically end with advancing age. Many surveys report that the frequency of sexual activity declines, but they disagree about how often older couples have intercourse. In round numbers, 50%–80% of healthy couples over 70 report sexual activity on a regular basis, including weekly intercourse in about half of them.

The secret to preserving sexuality is to stay healthy and to build healthy relationships — and both require a series of wise choices throughout life.

Reference: Harvard Medical

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