THE AGEING MALE

Age and reproductive function

Except for testicular cancer, reproductive and sexual health disorders are more common as men get older.

Changes in reproductive health may include:

• Changes in fertility
• Changes in hormone levels
• Changes in prostate health
• Changes in erectile function

Other health disorders may also affect reproductive and sexual function. It is important to see your doctor if you experience any changes because this may be a symptom of another treatable health problem.

Changes in fertility with age

Sperm counts do lower slightly with age in healthy men, although it is well known that men in their 70s and beyond can still father children.  However some older men, particularly if they have other medical complications, may be less fertile.  If severe illness is also present, there are many other changes in reproductive function.

More information: Male Infertility

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Changes in hormone levels with age

Testosterone levels in men are highest between the ages of 20 to 30 years. Testosterone levels begin to fall from the age of 40 years dropping about 0.3% per year. Unlike women, whose oestrogen levels fall rapidly when they go through menopause, men’s testosterone levels fall much more gradually and over a longer period of time. Some men will experience a greater drop in these hormone levels.  It is estimated that by the age of 65 years 10% of men have low testosterone levels and by the age of 70 years this figure rises to over 20%.  The causes and extent of this problem in ageing men are unknown.

Low testosterone levels (androgen deficiency) can cause a range of symptoms such as tiredness, hot flushes, depression, decreased sex drive and thinning of bones or ‘osteoporosis’ which leads to an increased risk of fractures. It is difficult to predict low testosterone levels purely on the basis of symptoms. Research work is trying to find ways to identify older men who may be at risk of low testosterone levels.

Significant ill health of any cause can lead to a fall in testosterone; testosterone levels usually recover when the illness has passed.   Also, a reduced ability of the testis to make testosterone, combined with a reduction in the production of the hormone LH by the pituitary gland, can lead to a lowering in serum testosterone levels in men as they age.

More information: Low Testosterone  

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Changes in the prostate with age

The prostate relies on the male sex hormone, testosterone, to grow.  At puberty, when testosterone levels increase, the prostate grows about 8 times in size.  It continues to grow, doubling in size between 21 and 50 years and almost doubling again between 50 and 80 years.  The reasons for this ongoing increase are not fully understood.

As the prostate is located around the urethra, an enlargement of the prostate causes the urethra to narrow and puts pressure on the base of the bladder.  This can affect the passing of urine in a number of ways.  Prostate disease is more common in the older male; about 1 in 7 men aged 40 – 49 years report prostate disease compared with about 1 in 3 men over 70 years.

More information: Prostate Problems

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Changes in erectile function with age

There is no doubt that the ageing penis has less responsive muscle cells, which interfere with good erections.  Like the rest of the ageing body, muscle tone in the penis reduces with age, as do many other aspects of sexual function.  It can take longer for a man to get fully aroused.  It may take much longer before a second erection happens, compared to the experience when young, and usually the erection is not as firm.

It is common for an older man to still want and be able to achieve this within appropriate limitations.  There is still not enough information about the sexual habits and desires of older people to know how important this is to the overall quality of life.  What little is known suggests that for many older people, sexual activity is very important.

Erectile dysfunction is surprisingly common and becomes more prevalent in older men. There have been a number of surveys done both in Australia and other countries which show similar findings, that at least one in five men over the age of 40 have erectile problems, increasing to about two thirds of men over the age of 70 years¹.

More information: Erectile Problems

¹ Holden CA, McLachlan RI, Pitts M, Cumming R, Wittert G, Agius P, Handelsman DJ and de Kretser DM. Men in Australia Telephone Survey (MATeS): A national survey of the reproductive health and concerns of middle-aged and older Australian men. Lancet 2005; 366: 218-24

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