Male menopause

Opinions are divided as to whether men can be said to have a ‘male menopause’. Unlike the female production of oestrogen, men’s output of the male sex hormone tends to fall very slowly, starting at the age of about 40 years, and taking 20 to 30 years to cease. Consequently, the male ‘andropause’, as it is sometimes called, is probably as much psychological as biological in nature. Even so, male menopausal ‘symptoms’ are sometimes remarkably similar to those women experience. Once again, a middle-aged man leading a full and varied life has better defences against feelings of physical or psychological stress at this time. Male ‘menopausal’ symptoms include muscle and joint pains, fatigue, inability to sleep, lack of concentration and a loss of self-confidence. Sweating attacks and chills may also occur. The physical symptoms do not respond significantly to treatment with the hormone testosterone.

Management of the mid-life crisis

What is sometimes termed the mid-life crisis – a kind of mental menopause – tends to occur when a middle-aged person becomes obsessed with the idea that life is sliding away without him or her having achieved their dreams or ambitions. An individual is more likely to feel this if his goals or aspirations were unrealistic in the first place, in earlier years. None of us can expect to continue looking young, feeling inexhaustibly energetic, and making occupational, financial or any other progress indefinitely; and it is inevitable for most people that the slow decline of their physical and mental performance will make later adulthood a time of less achievement than earlier years.

Realistic people are prepared to accept the changes of middle age with equanimity, enjoying the advantages that are unique to this time of life. There are those, however, for whom a sense of panic sometimes sets in. They start to thrash around looking for new jobs, new sex partners or new fashions to follow. This is not to say that middle age cannot be a time of new experiences: it can be, as we shall see. Some middle-aged men fear that if they do not have a last sexual fling it may subsequently be ‘too late’. Some women in their forties imagine, wrongly, that once the menopause arrives they will be less sexually attractive. Family life can also be stressful at this time of life. Children are likely to be in their teens, so that longstanding patterns of child-parent dependency are changing. Also, the children’s developing sexuality may be painful for parents who are themselves mourning the (often exaggerated) loss of their own. A couple who are active either sexually or in other ways are usually better equipped to come to terms with, and understand, their adolescent children’s sexual awakening and the problems that come in its wake. As offspring become independent and perhaps leave

An overwhelming majority of people over the age of 65 years experience some form of hearing difficulty. Hearing is determined by the sensitivity of the ear to tones of a particular pitch or frequency (measured in Hz) and sounds of a particular volume (measured in dB). The zone in which normal conversational speech occurs (C) is shown in this audiogram. At a young age the sensitivity of the ear (A) is the same for all tones. An unpleasant volume (B) is reached with very loud sounds in excess of 90 dB. In older people the ear’s sensitivity (Dl) decreases once sounds reach roughly 1,000 Hz and this may give rise to problems in conversational v In 1979, at fifty-five years of age, Jimmy Carter, then President of the United states, took part in a 10km crosscountry run but had to give up after 6km. In principle, a middle-aged person is certainly capable of running such distances but it requires somewhat more training than Carter was probably able to undertake at the time.

Home, many women who have immersed themselves almost exclusively in child-rearing and housekeeping find that their lives seem empty, which can lead to depression. Such feelings of despondency can be at least partly avoided if the woman is not left to shoulder all the burden of childcare in the first place; the experience of loss when children become independent can then be shared more equally between husband and wife. If her husband has helped with family chores and domestic responsibilities, a woman will have had more of a chance to establish other interests in earlier years, which she will be able to fall back on when the children have gone.