Sex and Aging


Does anyone else find it odd that the Cialis commercial uses two bathtubs to infer intimacy? I think a single bathtub with two people sounds like more fun than one bathtub per person. As the commercial suggests, increased age puts a damper on intimacy.

How does the aging process affect sex hormone production? (Hint- It doesn’t make your levels go up!) In men, testosterone (T) levels begin to drop at age 30 and continue to decrease approximately 1% per year. Estrogen (estradiol) levels in women don’t have a severe drop until menopause (average age 52). Estradiol is a down-stream product of testosterone. Women make the majority of their estradiol from testosterone. Testosterone is converted into estradiol by the enzyme aromatase. Testosterone levels begin to drop in women as early as age 20 to 25, and are ½ normal by age 40.

All doctors are educated on decreasing sex hormone production in women. Hormone replacement therapy (HRT) has been used for years to slow vaginal atrophy, restore vaginal lubrication, and maintain the sex drive.  Hormone replacement therapy in men is a different story…

I had a six-month personal history of increased fatigue to the point that after our kids were put to bed at 08:30 I was going to bed by 09:30 due to exhaustion. I didn’t have a problem with sexual dysfunction, but you don’t have a lot of sex when you are always tired. We finally ordered blood tests and my testosterone level was low. What!!! I was only 40 when my low T was diagnosed.

Andropause, or MANopause (not a medical term) describes the normal decrease in testosterone production in men. Typical signs of low “T” in men and women include fatigue, depression, loss of muscle mass, and decreased libido. I would venture that most men and women over age 50 that tire more easily and start to notice a decrease in muscle mass just attribute the signs to getting older. Unfortunately, the testosterone blood test values are so broad that a “low-normal” level can create the above symptoms. Hopeless or terminal diagnosis? Not at all. Within a week of starting replacement I was back to my early morning workout routine with a return to my former energy levels.

Doc- you’re saying that if I am above age 30 and have symptoms of low testosterone you would recommend starting hormone replacement? Even though I had my levels checked and they were in the normal range? Hormone replacement is a personal decision. Very rarely do I actually recommend patients start BHRT. I discuss their symptoms, review lab results, and review the likely results of starting replacement. We don’t know if your lab results are normal for YOU. We don’t have baseline lab levels at age 14, 18, and 22 when your body was stabilizing hormone production.

Sex and the sex drive revolve around hormonal responses. As we age, our physiologic hormone levels decline and sex can become more of a chore than a recreational pursuit. Restoring hormone levels to normal is possible, and can make a BIG difference (no pun intended).

Low T made it personal for me. Take a look at the most common symptoms and count how many you have. Low energy or fatigue, poor sleep, anxiety, depression, difficulty concentrating and remembering, headaches, difficulty losing weight, loss of muscle mass, and low libido. Erectile dysfunction in men is a late sign and typically doesn’t occur until after other symptoms have been present for a while.

Questions about bioidentical hormone replacement therapy? Call or stop by and make an appointment for a complimentary consultation with me. As for me? I’m sinking back under the water of our bathtub built for two. My wife is getting impatient…

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not an expert on bathtubs or plumbing fixtures, but he will be happy to help you with your “medical plumbing emergencies.” Comments or questions? Email us at: