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You're The Man!

"Prolonging virility"
By: Marc Evans Abat, MD, FPCP, FPCGMYou're The Man!

The dictionary defines virility as "the quality of having strength, energy, and a strong sex drive, or manliness".  The image of the so called "virility", even for senior men, is everywhere!  You see images on social media of a sleeve popping bicep muscled senior model strutting down the runway, or a web advertisement of older men with chiseled abs together with younger women admiring their "manhood".  Occasionally, I do get senior patients whose physiques are comparable to someone younger, still, compete in triathlons, and continuously brag of their "exploits" every time they come in for a check-up.   Truth be told, the concept of virility covers a wide spectrum that is influenced by multiple factors not just current state of health and well-being, but also by cultural norms, societal pressures, and evolving interpersonal relationships.

Aging, no doubt, introduces many changes in the male body.  Muscle mass, strength and endurance decrease in varying rates among older persons.  If pronounced, this is called sarcopenia and is especially prominent in those with less muscle mass.    There are changes in the joints, including decreasing cartilage elasticity and synovial fluid.  A dip in cardiovascular endurance due to hardening of the heart valves and blood vessels may be evident.   Efficiency in the use of energy of the heart muscle is minimized. The respiratory system has less staying power that is attributed to an increased stiffness of the lungs and the chest wall, and due to an inadequate gaseous exchange. 

The male reproductive system also undergoes changes as one advance in years.  The most common of which is an enlargement of the prostate gland.  A noticeable decline in testosterone levels may well be associated with aging or as a consequence of a medical condition.  A reduction in the amount of seminal fluid being secreted may lead to less fluid ejaculated during sexual intercourse.  Sperm production slows down, which translates to a low sperm count, in turn, may affect the ability to fertilize a female egg during ovulation. 

An important area of discussion as one age is the increasing incidence and prevalence of diseases.  These include cardiovascular diseases (e.g. hypertension, coronary artery disease, and heart failure), pulmonary diseases (e.g. bronchitis, emphysema), type 2 diabetes, obesity, and osteoarthritis.  These diseases and polypharmacy (the simultaneous use of multiple drugs by a single patient, for one or more conditions) may affect virility.    

What do these all add up to?

  • The overall decline in physical functionality - Exercises:  like weightlifting, running, or mountain biking may become increasingly difficult to do.  Sexual performance may be affected.  Reason being a decrease in muscle mass, strength, and endurance worsened by a diminution in exercise capacity of the heart or secondary to a pulmonary disease.
  • Erectile dysfunction - due to age-related changes in the blood vessels of the penis, from diseases that affect the blood vessels like type 2 diabetes, effects of vices like smoking, or related to medications being taken.  Poor erectile quality puts a heavy toll on the male psyche, especially in aspects of being unable to provide satisfactory sexual contact.
  • Male libido may be affected - due to a decline in testosterone levels, an overall lack of energy or fatigue related to disease, and effect of medications being taken (e.g. antihypertensive medications or medications for the prostate) or may also be a psychological consequence of being in a less-than-optimal state of health.  Decreasing libido also directly affects how the female partner receives sexual pleasure and may result in undue stress in the sexual relationship of a couple.
  • Mood disorders - particularly depression, may arise as a symptom of testosterone deficiency.  It can also be a consequence of the previously mentioned co-morbid conditions. 

 What should one do to maintain or prolong his virility?

  1. One of the most important aspects is to ensure an excellent baseline health even in the younger years.  The benefits of this are carried over as one age and considerably attenuates up to some extent the effects of aging.
  2. Exercise, particularly strength training, helps promote muscle mass, strength, and endurance.  The benefits can still be achieved even if strength training is done in the senior years.  With exercise, the functional decline is prevented, hence most activities, including those related to sex, can be performed with satisfaction.
  3. Early and adequate control of all co-morbid conditions is crucial to prevent permanent complications that can affect all aspects of virility.  Close coordinated care with your physician is important to discuss treatment goals, especially to avoid or minimize medications that may affect virility.
  4. Cessation of vices that adversely affect virility.  Smoking may look “macho” but it hurts your body, especially your “manhood” much more.
  5. For those who still suffer from erectile dysfunction, but are in general good health, safe medications called phosphodiesterase-5 inhibitors can be used 30 minutes prior to sexual contact, to help improve erection quality and duration.  It is not recommended taking untested or unproven supplements, or worse, those with serious adverse reactions like priapism (excessively long and painful erections).  Be very careful before popping a pill from that shady street hawker, quirky herbalist or pervy buddy.

Consider all of these points in helping maintain your virility.  Your health is important to us because YOU’RE THE MAN!

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