Packed with songs like “Puff, My God I’m Dragging” and “Staying Awake,” “Menopause the Musical” hits home with women going through midlife changes. But for men entering the time of change, the pop-culture equivalent is…non-existent. There are no fun spoofs about stiffer joints, enlarged prostates or diminished interest in sex. Those things are often spoken of more in murmurs. 

“The aging male is not a topic that gets a lot of press, whereas menopause does,” says Stephen Scheinthal, DO, chairman of Rowan Medicine’s department of psychiatry who treats many men in the throes of such changes. 

While the symptoms they experience are sometimes labeled as “male menopause,” the differences may help explain why no catchy songs about it exist – and why men rarely seek treatment for hormone-related maladies.  

For women, ovulation ends and hormone levels plummet over a relatively short time. In men, however, testosterone production declines more gradually and over a number of years. It doesn’t involve a complete shutdown of reproductive organs as it does in women, and it isn’t as uniform.  

“Not all men have lowered testosterone,” says Joseph Fallon, MD, chief of Rowan Medicine’s endocrine division. Rather, testosterone may drop off at increments of 1-3 percent for around 20 percent of men in their 60s and 50 percent of men in their 80s, he says. Loss of bone mass, energy and muscle strength, as well as trouble with urinating as a result of an enlarged prostate, are common symptoms of lowered testosterone. Sexual complications may arise due to lowered hormone levels, too – but men are sometimes not aware that’s the reason.   

Take Steve, 57, of Hammonton, who was experiencing classic symptoms of an enlarged prostate – urinating more often, and in smaller spurts, like a leaky faucet – for a number of years before he finally decided to see a doctor. It only dawned on him after hearing author David Sedaris talk about his own prostate issues – a conversational aside on a New Yorker podcast.  

“I guess I just didn’t really think about it as an issue,” he says, “until I heard someone else describe it.”  

After the fact, he realized there were other signs he was ignoring too. 

“I never used to stretch before my workouts, but now I have to,” he says, especially after tearing his quad muscles a few years ago. A former wrestler accustomed to dropping pounds, he had begun having a harder time losing weight too. Adding to that, sex became less exciting and less of a priority. “Desire and physical performance seemed separate for me,” he says.  

While testosterone levels vary greatly among men, in general their bodies start to change around the time they hit the half-century mark, says Allen Seftel, MD, head of the urology division at Cooper University Healthcare. 

“Their prostate usually changes,” he says. “They start getting up more frequently at night to urinate. As far as sexual issues, people will start to see a mild drop in their sex drive and a drop in their sexual function. Erections aren’t as hard, aren’t as firm as they used to be.” 

Even before these changes begin, however, men are less likely to seek treatment than women. In part, the mindset that men are supposed to be self-reliant, tough and emotionally restrained still holds. 

“We tend to see men come to the doctor when they are uncomfortable and bothered,” Seftel notes.  

One reason males may not seek treatment sooner when their desire takes a plunge, he says, is that menopausal women often become less interested in sex too.  

“Their partners may be happy to not have sexual activity,” says Seftel. “So these men have to be self-motivated.”   

For some, erectile dysfunction is an urgent issue – although low testosterone is not always the culprit. “Base level health is key,” says Fallon.  

Obesity, smoking, high blood pressure and high cholesterol are all contributors to lowered sexual function. For many men, the change in their sexual life is the motivating factor in changing their lifestyle for the better. But they have to be committed to changes that could include diet, life style and activity level, Fallon says. 

“Don’t walk in expecting the doctor to just give you a pill that will solve all your problems,” he says. 

The biggest hurdle to treating male menopause is often a man’s reluctance to open up. Some are too intimidated or embarrassed to discuss sexual topics with their doctors, Seftel says. 

Others get a nudge from their partner. 

“We see guys being driven to the doctor by their wives, where they may not have taken initiative on their own,” says Fallon. 

Treatment can include medication to correct low testosterone or prescriptions to help with erectile dysfunction, like Viagra, Cialis, and Libitros – commonly known thanks to a heavy rotation of commercials.   

Less well known are penile vacuum pumps and penile injections to achieve erection, or even prostheses, says Seftel. These treatments are not covered by all insurance, though, and can be very pricey.  

For Steve, when sex became less exciting and less of a priority, his doctor gave him a prescription for Viagra. But the pill didn’t seem to help. In fact, it backfired. When he got up to go to the bathroom at night, he fainted, hitting his head on the bathtub. Steve suffered a concussion – which he thinks was a result of a misfire in the way the drug affects blood flow. 

He didn’t hurt himself too badly, he says, but it was enough to turn him off of Viagra. He and his wife are happy, despite the change in their sex life.  

Scheinthal says it’s not uncommon for sex to take on new forms as people age. 

“What people don’t realize is that often the desire doesn’t change, it may be how that interaction occurs that changes,” he says. “People may want more physical touch and companionship. Maybe it’s holding hands, cuddling, tactile stimulation. All can be just as pleasurable as penetration. People are still interested in sex, but it may require more creativity.” 

Scheinthal notes there are plenty of older men and women with robust sex lives. He treats many couples who see a renaissance in their sex life once the stresses of kids and work are out of the picture, as well as newly single men who experiment in later life. 

In fact, nearly half of people in the United States diagnosed with HIV in 2016 were over 50, according to the Centers for Disease Control and Prevention, and retirement communities are seeing spikes in sexually transmitted diseases in recent years, according to the AARP. Without the fear of pregnancy and lowered concern for future illness, condom use may be less common, says Scheinthal.   

“Sex is a part of life and it’s not a part of aging that goes away, even though there are medical complications that may change the lens on what it looks like,” he says. “But it doesn’t go away.”