The Male Brain (16 page)

This also happens in other mature male animals when they reach this stage of life. Researchers have found that mature alpha-male silverback gorillas provide protection and leadership, maintain
group stability, and mediate conflict
. And they continue to offer companionship and protection to females long after their breeding years with them have subsided. Researchers found that the females in groups without a mature male silverback felt less protected and were less safe at night. So, instead of sleeping in their preferred, comfortable ground nest, these females had to sleep high
up in trees for protection
. Human females also can feel an attraction to the protection and security that a mature male offers. And for this reason, when it comes to choosing a mate, many younger women see the benefits of a well-established older man.

When John brought Kate to my office to talk about smoothing things over with Rachel, it was easy to see why he was so enchanted by her. Kate was a lively five-six brunette, with a trim waistline, generous bustline, and pretty face. And it was clear by the way she looked at him with adoration that she was devoted to him. What John probably didn't know was that his mature brain found Kate's adoration almost as enticing as her breasts. He was being biologically bewitched to bond with her. And Kate was bonding with him, too. But for her female brain, bonding
meant more than being lovers
.

We were discussing the importance of giving Rachel time to come around when Kate said enthusiastically, "Of course we have to do what's best for John's daughters, just like we'll do what's best for our own kids someday."

My mind went blank for a moment. I had heard nothing from John about starting a new family, so feeling a bit tongue-tied, I turned to see his response.
The look on his face said it all. This was news to him, too.

Suddenly my office felt too small. All three of us knew this could be a deal breaker. Men who have already raised one family are often reluctant to do it all again. But some men do just that. We've all seen older men pushing baby strollers and wondered,
Is he the father or the grandfather?
The truth is that men can have a second, third, or fourth chance at fertility that women simply don't have.

In fact, the ability of older younger women, called the factor," may be partly responsible for our species' long lifespan. Scientists at Stanford University found that this factor explains why humans live so long, even though, in theory, a female has outlived her evolutionary purpose by midlife when
she is no longer fertile
. Because men and women share most of the same gene pool, they both potentially benefit from any longevity genes in the other sex. Scientists argue that it's these late-life fertility genes that women share with men that explain women's longer lives.
men to reproduce with "late-life male fertility

At fifty-eight, John was certainly still fertile. But he and Kate had plenty to think about, not least of which was working things out with Rachel--if they stayed together. This was a major decision for John, so I wasn't surprised when he told me a couple of weeks later that he was losing sleep over it. He said, "I'm crazy about her, but I don't want more kids. And Kate won't be happy without them. I've decided I have to let her go."

A few months after John told me that he and Kate split up, I got a call from his other daughter, Mandy. "Rachel and I are both worried about Dad," she said. "When he's not working, he mopes around the house. When I ask him what's wrong, he just gives me 'that look' that means the conversation's over."

John didn't want to go out by himself, and he hadn't met anyone new, so he was spending most of his evenings at home alone. Since he'd stopped having fun, his brain's reward centers were short-circuiting. John's hermit lifestyle wasn't giving his brain the social workout it needed, and his daughters could tell it had become a vicious circle as he became more cranky and withdrawn. Without Kate around, his social-approval circuits weren't being activated either. In brain-scan studies of older males, researchers have found that the brain's pleasure and reward areas, the VTA and the NAc, remain more active
in men who are social
.

The next week, when John came in to see me, he said, "My daughters think I'm depressed, but I don't think I am. I'm fine when I'm working. It's only when I go home to an empty house that I feel like crap. I know it sounds pathetic, but the only time I don't feel lousy is when I'm remembering the good times I had with Kate. But
then
I feel even worse because I don't have her anymore. You know I've never been one to mope around much."

Like John, many men who are lonely think it's a weakness, but it's actually a key survival mechanism. Mother Nature has purposely wired the state of loneliness into the human brain to cause pain so humans will avoid it. In primitive cultures, being isolated from your tribe could be a death sentence, because individuals could rarely survive on their own. And in today's modern world, researchers are finding that loneliness can still be deadly. People who are lonely die sooner than their same-age peers who are not lonely. They found that about one in five Americans experiences loneliness and that it can be as detrimental to your health, in
the long run, as smoking
.

When men live alone and become isolated--which they do more often than women--their daily routines can become repetitive habits that get deeply
engraved into their brain circuits
. Soon, if
routine, they get irritated
someone disrupts their because their brain's

It's also the story of grumpy old mice. Researchers have found that male mice need females around to keep certain other circuits active. It has long been known that females can influence a variety of responses in male physiology and psychology. Males of many species fare better with female companionship. And researchers found that older male mice that were living with females
retained their reproductive abilities longer
. But it isn't just the male gonads that can benefit from female companionship--it's their brains too. In humans, researchers found that specific brain circuits are not activated as much in
people who are socially isolated
. When brain areas aren't used enough, they atrophy. Isolation is bad for the brain. And although John wasn't a grumpy old man yet, loneliness was clearly bad for him.

I watched an array of emotions flash across John's face as he processed what I had just said about his brain, his gonads, and loneliness. And then he said, "Maybe having another baby or two wouldn't be so bad after all, if it means being with Kate the rest of my life."

What John didn't know was that having a baby with Kate was probably the best way for their brains and bodies to biologically pair-bond and stay together for the long run. Regardless of their age difference, Kate and John would be working
with
their pair-bonding brain circuits by starting a family. And soon, once they were back together, his biggest concern became staying healthy so he'd be around to raise and take care of his new family. Thus, I shared with him that, aside from inheriting good genes, a man's best chance for longevity is to sleep deeply, stay strong, avoid tobacco, and
get married and stay married
. For unknown reasons, married
men live 1.7 years longer
than single men. But as my patient Tom joked when he and his wife, Diane, were in marriage counseling, "Those extra years better be damned good!"

Tom and Diane made a handsome couple: he with his trim physique, graying hair, and healthy complexion; she with her petite athletic figure, bouncing pageboy haircut, and sparkling eyes. They had initially come to see me when Diane's hormonal transition at menopause had decreased her sex drive. Her female brain was suddenly getting a lot less sex hormones, and she was experiencing a new biological reality that her husband couldn't relate to. Tom had always been a loving husband and father, but what he didn't know was that the combination of Diane's hormones and his lack of attention was making things worse with her libido. Diane had been angry because Tom's work always seemed to come before her. During the menopause, one wrong word or even just a look from Tom could send her slamming doors throughout the house and taking refuge in her greenhouse for a private sobfest. Her interest in sex was deader than a doornail.

On the other hand, Tom had long resented that Diane didn't appreciate how hard he worked to provide her and the kids with the lifestyle she wanted. Only when Tom was at his wit's end from being sexually rejected by her had he finally agreed to come to counseling. Working through their issues at that time had helped them to decide on some compromises and to renegotiate parts of their "marriage contract." Tom agreed to work less, and Diane agreed to be more attentive to his sexual needs. For some reason, many couples think they can't renegotiate the unwritten marriage contract--or "revisit the prenup," as I put it. To them I say, "Of course you can. Your life depends on it."

For Tom and Diane, the couples counseling and Diane's hormone-replacement therapy made all the difference. Consequently, I hadn't seen them in a few years. But now Diane was calling to say she thought Tom had better come in to see me, this time about
his
hormones.

Hormones in the brain and the penis are what
make a man a man
. They activate the sex-specific brain circuits required for male-typical thoughts and behaviors. When the male brain and body start making less of these hormones, he enters the
so-called andropause, or male menopause
. A century ago, andropause was relatively rare, because men didn't live long enough to experience it. Even in the late nineteenth and early twentieth centuries, the average age of death for men in the United States was forty-five. Nowadays, thank goodness, there's plenty of life after andropause. Men in the United States can expect to live decades after their hormones start to decline. But according to researchers, many men aren't happy unless this stage
of life also includes sex
. And for Tom, this was where the rubber met the road.

Over the phone, Diane explained to me that there were a few times lately when Tom couldn't get a firm enough erection to have intercourse. She said, "I personally don't think it's that big a deal. I mean he
is
sixty-four. The first two times it happened, he was upset about it, but he thought maybe he was just tired. But when it happened last night, he got up, got dressed, and stormed out to his woodshop. Do you think it could be hormones?"

Based on Diane's description, I agreed that Tom's testosterone could be low, but it could also be many other things. So I suggested that he come into the office to discuss what was going on and see how I might help.

Women can't imagine how changes in sexual function can affect a man's self-perception so much
at this stage in life
. He's the same man he's always been, and yet he's not. The body part that has brought him the most pleasure, the very symbol of his manhood, may no longer be reliable. As Tom sat down in my office, I could tell this was clearly taking a big toll on him. He said, in his usual get-down-to-business manner, "I'm sure Diane's filled you in. What do you think I should do?"

Tom was in good health, so I wanted to know what else might have changed since the trouble in the bedroom began. He said his last checkup and tests with his primary-care doctor were normal, even though he was feeling tired all the time and his thinking wasn't as sharp as it used to be. He complained that he'd lost strength, even though he exercised, and he noticed that his beard wasn't growing as fast as it used to. Otherwise, he said, he was "as good as ever." After hearing Tom's symptoms, I suspected that his testosterone level might be low and recommended that he get it tested.
The hormone tests confirmed that Tom was going through andropause. On average, men go through this hormonal transition between age fifty and sixty-five. During this stage, their testicles produce one third to a half the testosterone that
they produced in their twenties
. It was a good thing Tom came in, because this was a biological problem that was
quickly becoming a marital problem
.

As it turned out, Tom's testosterone level was substantially lower
Researchers have
than average for a man his age. found that when this hormone

dramatically decreases, the brain and spinal cord don't get as much stimulation as they need to keep his sexual thoughts and
organs working at full capacity
. At all ages, the male brain, spinal nerves, and penis need testosterone to function.

Although Tom was discouraged by his penis's lack of reliability, he confided that on the positive side of the coin, he didn't mind being a little less sexually driven. He was glad that the "I need it now or I will die" urges that he used to have in his younger years had subsided. Now he could wait. But when the waiting was over, he wanted to be ready for action.

He said, "I was hoping that staying in shape would keep things going down there. Now I'm not so sure. My brother's doctor started him on testosterone replacement a few months ago, and he swears by it. Does that stuff do any good?"
Although studies in the United States are few and far between, researchers in the Netherlands found that giving testosterone to men with abnormally low levels improved the men's physical and mental health. They found that it revived libido and penile function too. In addition, the men in the study had better muscle elasticity and bone density. They also reported improvements in their mood and their cognitive ability. And as a bonus, the study showed that increasing
testosterone can kick-start abdominal weight loss
.

I told Tom that research does show that exercising and staying sexually active can help men make more androgens, like dehydroepiandrosterone (DHEA) and testosterone. But for some
men, that's still not enough
. Being tired all the time and having foggy thinking aren't a natural part of getting older. When those symptoms are caused by abnormally low levels of androgens, some men get good
results from androgen-replacement therapy
. But its safety is still controversial,
and it's not for everyone
. For many men,
there may be other answers
.