He's Not That Into You Anymore? He May Have Low Testosterone

Men's testosterone levels start to dip in middle age -- and that can affect libido, mood, and overall health. Here's what to do.

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Your man might be a sex machine now, but don't be surprised if he seems to be running on fumes as he gets older. Around age 40, some men start to have a progressive drop in testosterone, and that can really stall a guy's sex drive as well as indicate and even lead to other health problems.

When men reach their fifth decade, their testosterone -- the hormone that gives them their appetite for sex -- can begin to dip by about 1% to 1.5% per year, every year. That may not sound like much, but over time, the decline can have unpleasant consequences in some men.

Not only can this hormonal drop contribute to erectile dysfunction and ruin the mood for sex, but it can also affect your man's attitude in general -- low testosterone levels can be associated with depressed moods, low energy, motivation, and self-confidence. It can also lead to low bone density, increasing his risks of osteoporosis. Low testosterone can also lead to reduced muscle mass and increased body fat, all of which can contribute to obesity, diabetes, and metabolic syndrome.

"I look at testosterone as jet fuel," says Edmund Sabanegh, MD, chair of the urology department and director of the Center for Male Infertility at the Cleveland Clinic in Ohio. "It keeps men running. Diminished mental clarity, motivation, drive -- all of these things can be related to low testosterone."

How Low Testosterone Affects Relationships

The more time between the beginning of symptoms and diagnosis and treatment, the greater the chances that your partner's low testosterone will impact your relationship. He's frustrated that he can't get an erection and his interest in sex has gone AWOL. That may leave you worrying that he's not that into you anymore.

So, what's happening in his body can dampen both his mood and yours. As Irvine, Calif.–based sex therapist Stephanie Buehler, PsyD, puts it: "It's a point where the biological and the psychological converge."

Learning that the problem is a physical one often comes as a relief for both guy and girl, Buehler says, but by that point, some damage to the relationship may have already been done. "There's a psychological adjustment period," she says. "She can say to herself, 'It isn't me. There was something physical, and we missed it.' But for some couples the confusion, the hurt, and the angry feelings may require some repair work. Usually, that is done quickly."

Usually, but not always. The longer the problem has been building up, Buehler says, the longer it can take to figure out and address. Typically, she works with couples for four to six sessions to work out any lingering kinks in their relationship.


Treatments for Low Testosterone

For most men with symptoms, low testosterone is easy to treat, and in most cases, medication can boost testosterone back into normal range and improve many of his symptoms. Just don't leave it up to your man to seek help. Left to their own devices, some men are unlikely to make an appointment. "The spouse is often the driver behind decisions to see a doctor," Sabanegh says. "The man is embarrassed, so the wife has to insist."

Treatment comes in many forms: testosterone injections given every one to three weeks; patches and gels applied every day or two; or 12-hour "buccal" tablets placed between the gums and upper lip, where they slowly dissolve. The newest treatment, says Sabanegh, is subcutaneous (under the skin) implants. Once in place, they will maintain your man's testosterone levels for up to six months.

There are potential side effects common to all testosterone replacement therapies. If your guy already suffers from sleep apnea, for example, boosting his testosterone may worsen it. Over the long term, testosterone therapy can have an impact on his prostate. While there's no clear link between testosterone treatment and prostate cancer, according to Sabanegh, boosting testosterone can accelerate the normal growth of his prostate, an age-related condition called benign prostate hyperplasia. An enlarged prostate can make urinating difficult and can lead to bladder infections.

And if you are pregnant or trying to get pregnant, he needs to stop his testosterone. "In some men," Sabanegh says, "testosterone treatment will turn off the body's own testicular function -- both sperm production as well as testosterone production." 

Treatment requires commitment. He'll be able to get it up and keep it up -- his testosterone as well as his, um, manly hydraulics -- only as long as he stays faithful to his medication. But that's a small price to pay for the two of you to get your groove back.

Keeping Your Sex Life Alive -- Despite Low Testosterone

When testosterone is on the wane and intercourse is problematic, you can find other satisfying ways to be sexually intimate. "People shouldn't be so coito-centric," says Buehler. "You don't have to have an erection to have sex, so don't let your man feel he can't do anything for you."

Encouraging words. Let him know you love him regardless. That, says Buehler, is powerful comfort.

Try out some toys. Sex should be fun. Just make sure he knows that no toy can replace him.

Experiment. Make this an opportunity to try new things and to broaden your ideas of what gives you both pleasure.

WebMD Magazine - Feature Reviewed by Brunilda Nazario, MD on May 26, 2010


Edmund Sabanegh, MD, chairman of the Department of Urology; director, Center for Male Infertility, Cleveland Clinic, Cleveland, Ohio.
Stephanie Buehler, MPW, PsyD, CST, psychologist, sex therapist, the Buehler Institute, Irvine, Calif.
The Hormone Foundation: "Low Testosterone and Men's Health."

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