Male sexuality and male menopause are medical issues that, for many men, can be embarrassing. Yet over 20 million Americans are affected by erectile dysfunction, with many more men experiencing MALE MENOPAUSE. To help us answer some of these questions, I spoke with Dr. Harry Fisch, Professor of Clinical Urology at Columbia University Medical Center, to give us his thoughts on this subject.

Q: What is male menopause?

A: "Male menopause" is a term used to describe the physical and mental changes that occur in men with aging. These changes largely correspond to a decrease in testosterone levels. The term "male menopause" is a little awkward, because changes in men do not occur at a specific age. Some of the symptoms are weight gain, low sex drive, erectile dysfunction, infertility, decreased muscle mass and strength, excessive tiredness and depression.

Q: Do all men get male menopuase?

A: Yes, but to different degrees. Some men have higher testosterone levels than others and a decline in testosterone level occurs at a slower rate than others. The biological clock ticks differently in some men. Some men have a rapid decline in testosterone levels (a quicker clock), while some men’s testosterone levels decline much slower (a slower and better clock). In general, testosterone levels decline after the age of 30, but in some it can start in their 20’s.

Q: Can we prevent male menopause?

A: No, but it is possible to slow down the clock so that we maintain high levels of testosterone, even into our 50’s, 60’s, 70’s and 80’s.

Q: Is it similar to female menopause?

A: Loss of testosterone in men occurs much more gradually than the drop of estrogen levels and ovarian function in women, making it quite different. Since there is no drop-off, the term "menopause for men" can be misinterpreted. A better term is "Andropause" or even better, "Hypogonadism in Aging Men" (after the age of 20).

Q: What is the cause of erectile dysfunction?

A: While there are many causes, there is a heart-hormone connection. In other words, what’s bad for the heart is bad for the penis. Any factor that hurts heart function, such as elevated cholesterol, smoking, diabetes and weight gain, adversely affects the penis (erection), just as it adversely affects the heart. The blood vessels in the heart are similar to the vessels in the penis. All of these factors are correlated with lower testosterone levels.

Q: What are the current treatment options for erectile dysfunction?

A: The key is to treat the underlying condition! Amazingly, Viagra and the other similar drugs do not work well in many men. The culprit is low testosterone levels. Viagra and the like do not work well in men with low testosterone. A complete workup, similar to a cardiac evaluation, is important before any drugs are given. Options such as testosterone replacement, where appropriate, will make diet and exercise more likely to be effective. Other options include penile prosthesis and injection of medication directly into the penis.

Q: How can men improve their libido?

A: Great question. Viagra does NOT improve libido. The most common treatment is to increase testosterone levels in men. Usually, both medication and lifestyle changes are necessary.

Q: Tell us some facts about your book "The Male Biological Clock: The Startling News About Aging, Sexuality, and Fertility in Men."

A: Some of the more interesting facts are:
- Men with large bellies have a lower testosterone level than those with a flat stomach.
- Size matters. That is, the size of the testicles. Men with smaller testicles tend to have a lower testosterone level and lower sperm count.
- Many times, when men say they are bored with their careers, their wives, or their general lot in life, they are actually suffering from low testosterone. I call this phenomenon “menoporche” because I’ve seen guys who think buying a hot new car like a Porche will give them a shot of sex appeal or attractiveness, when, in fact, they would be better off getting their testosterone levels checked.
- Low testosterone levels are associated with depression.
- Men who are overweight can have low (or lower) testosterone level.
- There are treatments for most of the conditions associated with low testosterone that are overlooked by many doctors.
- Most men with low testosterone levels cannot lose weight or keep it off.
- The best diet is, “No wheat, No weight.” Avoid breads, pizza, pasta, cookies and cake. Guaranteed weight loss. Increase testosterone and exercise will be easier and you will see dramatic changes in health, weight and sex drive.

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Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. Click here for more information on Dr. Manny's work with Hackensack University Medical Center. Visit AskDrManny.com for more.