God gave men both a penis and a brain, but unfortunately not enough blood supply to run both at the same time.
—ROBIN WILLIAMS
When I was about sixty, I blew out my knee having sex. When I’ve told this story to groups, the looks I see in response suggest that the audience is thinking, “Man, I’d love to have sex like that!” I wish this story became more exciting but it doesn’t. It was routine sex, the kind couples have after they have been together for a long time. Sex had grown predictable. It was Sunday-night-after-the-news sex. “I kinda want to but I have a full day tomorrow, so let’s do it quickly.” It was good sex, just not unusual or extraordinary. Let’s face it: if I hadn’t injured my knee, I wouldn’t be writing about the sex at all. The most painful part of that experience, however, was recognizing that my body was becoming more fragile and vulnerable.
Shrinking time forces men who have passed the middle of their lives to take inventory. They begin to feel that not much time remains to catch up to where they might have expected to be by midlife. Social views, personal values, and ambitions evolve, and the focus changes from concern for self to concern for others. Men can no longer hide from the fact that they’ve made some bad choices and likely will do so again. The decision to come out in midlife causes others to accuse them of acting childishly, not dealing with reality, abandoning moral values, and most devastating of all, selfishly hurting their families. Some even shame these men for leaving the ones they love exposed and vulnerable. Helplessness, hopelessness, and a feeling of loss of control may lead to depression.
Victor Hugo said, “Forty is the old age of youth; fifty is the youth of old age.” Is sixty, then, the midlife of old age? Developing pain in my arthritic right shoulder produced more of a crisis for me than coming out. I was hit with the emotional tsunami of being an old man. Old age began to dominate my thinking and influence everything I did. It resurrected my anxieties that had been dormant for many years about being fifteen years older than Doug. I tried Viagra, but it only made me feel as if my penis belonged to someone else; I had no pleasurable sexual sensation while using it. It helped me sustain an erection, but what’s the point of an anesthetized erection? All I could think about was a body in decline. All around me I could hear doors of lost opportunities slamming shut, and I wasn’t even sure that I wanted to open any of the few doors that were in front of me.
Attention to my minor medical problems precipitated an absorption in the other realities related to late life: fear of institutional living, financial insecurity, loss of family of origin and family of choice, lack of independence and mobility, and the possibility of discrimination in accessing social services and entitlements like Medicare. I have observed bizarre dynamics develop in families during times of grief, especially when families of origin and families of choice fight over end-of-life issues and inheritances. Although Doug and my family have always gotten along extremely well, I began to wonder how their grief following my death will alter their relationships and whether my family and our gay friends would be there to support Doug when I died.
As I pondered these things, I learned that the younger partner in a mixed generational gay couple in our social group was dying. Until I learned about their situation, I had never considered that I might be the one forced into the caregiving role. I could be the one left alone. Could I find the will and compassion to assume the role of Doug’s care provider? Was my love strong enough? Would I begin to resent him if his demands were very high?
Wrinkling and graying served as constant reminders that my body wasn’t what it once was. The mature man begins to realize that he has fallen below earlier physical peaks of performance as his bodily powers decline. Aches and pains plague him and death asserts itself. Although fortunately I have never felt as old as my birth date tells me I truly am, situations remind me with increasing frequency that I am growing older. Once Doug and I were buying tickets for a movie, and the attendant very diplomatically asked, “Will either of you require the senior discount?” For a long time, I resisted accepting those discounts. Midlife punishes us for youthful indiscretions, and the punishments just keep coming.
As one ages, each physical problem cascades into a series of physical deteriorations. As an old injury to my shoulder grew more and more arthritic, I began to have more and more pain and an increasing loss of range of motion of my dominant right arm. Doug had to assist me to get my belt through the back loops of my trousers, and I had difficulty with those most intimate elements of personal hygiene. I learned to compensate for these problems, but one problem seemed to have no redress: during sexual activity, I would have pain.
Midlife punishes us for youthful indiscretions, and the punishments just keep coming.
Men who are seeking long-term relationships occasionally question how soon to introduce sex into a relationship. No answer is universally correct. Many gay relationships, both Romantic and platonic, have been established following a casual sexual encounter. Doug and I spent the first night we met together, and we have spent almost every night together in the nearly thirty years since we met. Gay couples sometimes have difficulty in deciding what night to set as their anniversary. Doug once said, tongue in cheek, that gay couples should mark their anniversary as the second night they sleep together; the first night is a hookup, but the second is the beginning of a new relationship.
After a couple has been together several years, sexual excitement ebbs. By then every new technique will have either been tried, or at a minimum, suggested. I don’t mean to imply that sex is reduced to monotony, but as couples become more and more familiar with each other, sex doesn’t hold many surprises. The dopamine rushes don’t match those when the relationship was young. Sexual frequency declines as the length of the relationship extends. Whether gay or straight, the more time partners share a sexual relationship, the more perfunctory it can become.
Dan Ariely, who wrote The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home, addresses the issue of emotional leveling. He describes how pleasure can deviate in either a positive or negative direction from the baseline, but over time it always returns to the baseline.1 About three months after I’d purchased my most recent new car, I began throwing empty Diet Coke cans in the backseat, just like I did with the old car. Neither the excitement of new Romance nor the painful consequences of a broken relationship endure forever. The inability to accept the emotional leveling in relationships condemns a person to always chasing the high that comes with the next new man only to be disappointed when the high once again doesn’t last.
Like a stone thrown into a pond, the effects of my knee injury rippled far beyond the point where it broke the surface. My body was aging. I thought about sex less frequently, and sometimes when I thought about sex, I tried to dismiss it. When there was a choice between sleep and sex, I opted for sleep. I had more difficulty achieving and maintaining an erection, and when I lost an erection during sex, I felt defeated and beat myself up about it severely. I became dissatisfied not only with my sex life but my life in general. According to a 2008 study by Carmita Abdo and her colleagues published in the Journal of Sexual Medicine, erectile dysfunction and reduced sexual satisfaction are linked to lower life satisfaction and a compromised quality of life. Sexual dysfunction lowers self-esteem and can lead to depression, anxiety, anger, and shame. It also results in obsessive concerns about performance.2
Scientists neglect the study of human sexuality. Funding isn’t available, and subjects who will speak openly about their sexuality are difficult to find. We know very little about some of the fundamental questions related to sexual desire and arousal and how desire affects judgment. The origins of sexual identity are heatedly debated, and studies of homoerotic arousal, desire, and sexual activity make some people green around the gills. In particular, we know almost nothing about why people who understand sexual risks choose to act in ways that are potentially destructive. Freud and Kinsey both hypothesized that sex is a universal drive, and now neuroimaging has substantiated an anatomical location for that drive. But can science really answer the questions of who we are and why we do the things we do?
Sexuality exceeds the boundaries of a universal biological drive; cultural forces shape it, socialization modifies it, and environmental influences impact it. Ariely wrote, “In the same way that the chemical composition of broccoli or pecan pie is not going to help us better understand what the real thing tastes like, breaking people up into their individual attributes is not very helpful in figuring out what it might be like to spend time or live with them.”3
Back in the days before reliable birth control existed, abstinence was promoted for all adolescents, as well as for adults, as a means to limit family size. When I was young, we were admonished, “Don’t go getting some girl pregnant you would never want to be the mother of your children. Your life will be miserable.” Abstinence-only programs became a political centerpiece during President George W. Bush’s administration from 2001–2009 when funding for these programs tripled. Teens were asked to take an abstinence pledge, but from that expensive experiment we learned that despite such programs, teens were not only just as likely to have intercourse but ultimately were more likely to take part in sex without condoms, and rates of teen pregnancy and STDs increased.
While I was in medical school, the contraceptive pill was introduced, and women were finally released to have sex for pleasure, too. Now I had no reason to hold back, but in reality, I lost one more excuse for avoiding sex with women. For the first time, at age twenty-three, I began having sex with a woman. I struggled with putting on that first condom, thinking I should have practiced ahead of time. Real men should know how to condomize a penis.
As I was writing this chapter on sexuality, in the back of my mind were the accusations made by a young gay man. He had been quite harsh in his criticism, saying that it wasn’t possible that I had no idea I was gay until I was forty. He went on to say that my marriage was a sham and that I had just been a hypocrite using my wife and kids to protect my secret. I began to wonder if he might have been right. I decided I needed to know from Lynn how she had experienced our sex life; basically I wanted to know if she felt I was totally present in our sexual relationship. I asked her if my lack of confidence about being a man was apparent to her during the years of our marriage. She responded, “When we were first married, we were both sexually inexperienced. I know you were an excellent lover.” I was reassured that indeed we had loved each other—and in many ways we still do. She did not feel that I had used her to shield myself against the assaults from my own doubts. As my anxieties lifted, I could return to my writing.
Men typically believe they know far more about their sexual functioning than they actually do, and they fail to admit when they don’t know much. Drive, vigor, and performance form the core of men’s sexuality. Society dictates that a man must always be ready, always be successful, and never leave a job half finished. A man fails with anything less. Although men learn the basics of sex experientially, they often do not understand some of the common explanations for failure and how their sexuality changes as they age. In order to understand sexual dysfunction, one must first grasp the fundamentals of normal sexual function. Four major domains constitute male sexual response: sex drive, erectile functioning, ejaculatory functioning, and general sexual satisfaction.
The Massachusetts Male Aging Study, a rare random sampling of ordinary men from a community in Massachusetts, studied a complex set of sexual variables, both physical (e.g., erections and masturbation) and emotional/cognitive (e.g., desires, fantasies, and satisfaction). The study, conducted from 1987 to 2004, found that older men reported lower erectile function, including less frequent erections, fewer morning erections, and trouble achieving and maintaining erections. The prevalence of erectile dysfunction (ED) increases with age, but ED is not an inevitable consequence of aging.4
Most of the age-related effects on drive, erections, and ejaculation begin past the age of fifty and increase over time. Although sexual function declines with age, sexual satisfaction often does not. Men do not seem to worry much about ejaculation, even though in older men ejaculation diminishes and sometimes may not occur at all during sexual activity. Men in their sixties reported levels of sexual satisfaction comparable to men in their forties.5
Aging brings on changes, but not necessarily for the worse. Body changes, hormonal changes, the need for medication, the onset of disability or illness, changes of sex partner, and changes in life responsibilities may all interfere with sexual function, but they do not eliminate sexual pleasure. In reporting on their work in Sexuality across the Life Course, John McKinlay and Henry Feldman cautioned that older men should not be held to a level of interest and performance more appropriate to younger men. Healthcare providers and therapists must be taught that older men are not only interested in sex but capable of having good sex. That said, goals must be set realistically.6
Men in their sixties reported levels of sexual satisfaction comparable to men in their forties.
Many studies have shown that many men in their late seventies and eighties remain sexually active. For older men, frequency of sex diminishes, but when men learn that sensuality, touch, and emotional intimacy are all forms of sexual expression, they discover that sex can be satisfying and may even be better than it was when they were younger and equated good sex only with a powerful orgasm. The younger men I interviewed generally believed that older men emphasize emotional intimacy more than genital sex. They begin to cherish their relationships and put more time into them than younger men do. Although penetrating sex and ejaculation may become less frequent, kissing, caressing, and more prolonged sexual intimacy may contribute to greater sexual satisfaction and quality of life in old age. It may take a little longer to stoke the fire, but the flames may go higher.
For all men, sexual performance consists of a complex interaction of mood, health, thought, and physiological mechanisms. Sex drive is an innate force that motivates and impels a person toward sex partners and relationships. Often nudity, erotica, or the prospect of a willing partner facilitate the period of sexual excitement and provoke the thought “I need to have sex.”
Sexual excitement taps into the memory banks of the amygdala and the hippocampus of the brain, producing arousal. If sex were purely a rational act, we would foresee all of the potential alternatives, analyze and calculate their value, and choose to respond in a way that maximizes our immediate and long-term interests. Instead, when these areas engage the prefrontal cortex to plan the appropriate response, our hormones often show an appalling lack of respect for the logic and reasoning of the prefrontal cortex.
As illustrated in figure 5, male sexual response includes five stages: excitement, plateau, climax, resolution, and refractory period. For the young male, progression through these stages often occurs rather quickly, and the resolution and refractory stages are often quite brief, leading to the possibility of multiple climaxes or ejaculations over a short period of time. As men age, the time it takes to progress through the stages extends and can be characterized by starts, stops, and even some reversals, and climax or ejaculation is not a guaranteed outcome.
Figure 5: Diagram: Male sexual response
During the excitement phase, a man experiences the sensation that his penis is beginning to swell. Physical touch to an erogenous area enhances arousal. Dopamine, the pleasure molecule, floods into the brain in anticipation of a pleasurable conclusion. As excitement intensifies and as prospects of success increase, the penis grows in size and firmness according to the degree of stimulation. Increased blood flow to the penis engorges the spongy tissue on the underside of the penis that contains the urethra, which leads from the bladder to the opening in the head of the penis. In response to touch and sometimes to arousal alone, the scrotum pulls the enlarging testicles toward the body. The tension of the muscles in the body increases, heart rate accelerates, and blood pressure rises.
During the plateau phase, the head of the penis continues to enlarge, and the testicles are drawn even closer to the body. A clear lubricating seminal fluid called preejaculate or precum begins to flow at varying rates from the head of the penis. A big price is paid for mechanical and indifferent sex because of a lack of dopamine buildup. Men who learn to prolong the plateau phase with extended periods of cuddling and body contact greatly increase their pleasure. At first, sexual pleasure does not insist on pushing one toward climax or orgasm, but similar to a tightening spring, the strength of the urge intensifies. Then, like a set mousetrap, the spring seeks to uncoil. This need to release the tension interferes with rational thought and has ensnared countless numbers of men.
As the plateau stage progresses, a man experiences a feeling deep within the pelvis that an orgasm is on its way and that ejaculation is inevitable, a feeling often celebrated with a verbal announcement. Almost immediately the genital muscles begin to contract, expelling semen with varying degrees of force through the urethra. During the resolution phase, blood leaves the penis in a process called detumescence. The penis shrinks to about half its erect size. Sexual activity concludes with a refractory period during which no amount of stimulation can produce an erection.
Aging modifies these stages. In adolescence, young men are in a perpetual state of excitement with an almost petrified erection. A young man might walk around most of the day with an erection, even when its evidence is quite embarrassing. As men mature, the excitement phase is longer and less intense; it generally requires richer fantasies and a higher degree of direct stimulation to the genital area. Unfortunately, the excitement phase is also more easily interrupted. One comedian joked that his wife wanted to have sex every day for thirty days to try to get pregnant. He responded, “I’m thirty-nine years old. The only way I could have sex thirty times in thirty days would be with thirty different women.”
An older man, if distracted during the excitement phase, may lose some or all of his erection several times, only to regain it if he once again experiences a renewed sense of sexual excitement. Often, however, loss of an erection replaces excitement with despair. For an older man, orgasms shorten and they lack youthful insistence. Expulsive force and volume of seminal fluid decrease with age, and detumescence occurs more quickly. The refractory period, during which no erection can occur, lasts longer.
Fatigue, work, depression, finances, and illness also undermine excitement. Although at first I didn’t recognize it, pain from my torn meniscus should have been only a temporary distraction. Instead, fears about failure displaced all sense of pleasure. My focus shifted from pleasure to ruminating about my performance failure.
Erectile difficulty happens to every man. Impotence is the persistent inability to get and hold an erection of adequate firmness to permit satisfactory sexual performance in the absence of any significant psychological problems. Although the term impotence remains in use outside of the United States, in America in the 1990s it was deemed pejorative. It connoted weakness rather than just dysfunction. Men dread this indictment because it hints at a permanent loss of all masculine capabilities. After former US senator Bob Dole became the pitchman for the blue, diamond-shaped Viagra pill, ED generally replaced the term impotence. ED implies reversibility, and the term has attenuated the emotional significance of erectile difficulties.
Erectile dysfunction can occur at any age, but it is more common in men that are older. Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their fifties, 60 percent of men in their sixties). By the age of seventy, about 15 percent of men have complete erectile dysfunction.7 While a man who fails to have an erection more than 50 percent of the time carries a clinical diagnosis of ED, a man who fails to have an erection less than 20 percent of the time does not. ED occurs when something interferes with the reflex activation of the system that enhances blood flow to the penis. These interferences are often physical changes in the body, such as vascular insufficiency, neurological problems, diabetes, high blood pressure, lack of exercise, medications, hormonal changes, alcohol and drugs, and cigarette smoking. Psychological problems rather than physical ones account for about two-thirds of sexual dysfunction. The negative impact of ED on quality of life is independent of its explanation.
Some reports suggest that ED occurs in as high as 90 percent of depressed people, most commonly expressed as a lack of interest in anything that once gave them pleasure. Unfortunately, many of the medications used to treat depression also reduce libido. Other psychological factors that impact libido include a lack of good sexual information, negative attitudes toward sexual expression, low levels of general happiness, and low self-esteem. The length and the quality of a relationship are also important psychological factors. Unresolved anger, especially if directed at the partner, can lead to significant problems with ED. People who are passive also suffer more problems. Some struggle with ED mostly because of the lack of an available partner.
I dislike the term sexual performance because it suggests that an audience is there to offer a standing ovation. The outcome of sexual performance should be pleasure rather than applause. Performance anxiety complicates sexual functioning significantly. Men who are preoccupied with performance to the exclusion of emotional intimacy may be devastated by the loss of an erection during sex. Social messages browbeat men into believing that real men don’t fail at sex. When performance is the primary criterion for judging success of male sexual functioning, erectile failure generates considerable anxiety. Anxiety, acting like an antiaphrodisiac, further blocks the spontaneous flow of sexual thoughts and feelings.
The outcome of sexual performance should be pleasure rather than applause.
Men sometimes refer to their penises as tools. This is not surprising because in male sexuality the emphasis is on instrumentality. Functional measures and frequency dominate social ideals of masculinity and count more than intimacy and the bonds of sexual connectedness. Memories of earlier failures replace excitement with anxiety, causing men to avoid sex and another possible failure. After having erectile failure, men frequently begin to perform sexual autopsies on their performance and pleasurable sexual interaction becomes virtually impossible. Have you ever been afraid you were about to run out of gas so you drove faster and faster to get to your destination? Speedy sex is a counterproductive strategy. Sexual performance anxiety is like putting the pedal to the metal. Many men, after they have that fleeting fear of losing their erection, force sex faster and faster, further compounding the problem. Unless this emotional ambush is resisted, it can lead to loss of self-esteem, relationship discord, and greater sexual dysfunction.
After I tore up my knee having sex, a complex set of factors blunted my sexual functioning. A lack of confidence in being a man formed the bedrock of my difficulties. I experienced both the physical changes of aging and a preoccupation with the meaning of those changes. My worries expanded beyond the boundaries of reality. Instead of recognizing that my erections could be restored, fear of failure set in immediately. I obsessively analyzed my failures. I focused solely on the difficulty with my physical performance to the exclusion of the joy of emotional intimacy. Everything I did propelled me toward failure.
Preoccupation with erectile functioning has not gone unnoticed by the health products industry. One young man, writing on a health blog about the blue Viagra pill, praised it as a wonder drug. He said that it has brought about a change in sexual morality and sexual behavior throughout the world: “This isn’t just another drug; it’s the magic bullet we’ve been waiting for.” Following its introduction, the brand name, Viagra, immediately became part of our sexual lexicon.
Viagra was a drug marketer’s dream. With its promise to allow men to have sex anywhere, anytime, and with anyone, the use of Viagra exploded. With the iconic image of the Marlboro man fixed in our brains, men began to use the blue magic bullet not only for ED but to guarantee a world-class erection every time. The promotion of sexual enhancement products burgeoned as the pharmaceutical industry played upon our fears. Pharmaceutical companies added Cialis and Levitra to the formularies. The Food and Drug Administration mandated that product information contain a precaution about priapism, a continuous and painful erection. Priapism may seem like the answer to men’s prayers, albeit not to those who have experienced it. Clever marketing converted what is seen as one of the risks of these products to an apparent strength. Men began to hope they might be the one to have an erection that lasted three hours and fifty-nine minutes. As use of Viagra expanded beyond ED to sexual enhancement, some men have conditioned themselves to believe they cannot have an acceptable erection without it.
All gay men think and talk about is sex, or so some believe. Although we struggle to shed that stereotype, in some ways sex does define us. We are each quite unique, but we do have one thing in common: we want to have sex with someone of our own gender. Older men who are just beginning to explore man-on-man sex may experience sexual excitement much as they did in their adolescence and to a much greater degree than they did in their familiar heterosexual relationships. After I accepted my being gay, I experienced sexuality in a new and exciting way. I thought of sex constantly, and I began to feel as sexual as I did when I was a teenager. I was eager to make up for lost time. For men of all ages who come out, sexuality overshadows everything as they experience what has been referred to as a coming out crash. The penis is turned on autopilot as hormones erase all rational thought. In his role as Edward Cole in The Bucket List, Jack Nicholson advised older men of three things: “Never pass up a bathroom. Never pass up a hard-on. Never trust a fart.”8 Older men know precisely what he meant.
When I met Roberto, I had been married for sixteen years. Although my wife and I had a good sexual relationship, by then nothing surprised us. Aldous Huxley is quoted as saying, “Habit converts luxurious enjoyments into dull and daily necessities.” Through the process of emotional leveling, the excitement of any new relationship returns to baseline. My relationship with Roberto was an entirely new sexual experience, with passion and intensity, but after my sexual relationship with Roberto I established an entirely new baseline.
Popular culture equates testosterone with virility and a macho male physique. A doctor speaking at a medical conference I attended hyped testosterone replacement therapy (TRT) as “the amazing, medically proven” way to reverse aging. He promised that it would revitalize sexuality, strength, and stamina. He assured us that we would lose weight and gain muscle mass, and our memory and mental focus would improve. Apparently, TRT guarantees us that we will all bathe in the fountain of youth in the twenty-first century. But growth in its reputation and its increased use has outstripped scientific evidence of its potential benefits and risks.
Testosterone, sometimes referred to as androgen, is a hormone produced in large amounts in the testicles (testes), with smaller amounts produced in the distant adrenal glands. As anyone who has been an adolescent boy knows, production peaks in the teens and early twenties. Men don’t run out of testosterone, but it does decline with age. Levels of testosterone continue to remain high between ages twenty and thirty, but somewhere around age thirty-five, levels begin to decline and continue to slide as we age. Diseases like diabetes and liver disease, chronic alcohol use, and some cancer treatments also reduce testosterone levels. Symptoms attributed to testosterone deficiency include decreased sexual function, lower vitality, loss of muscle mass and strength, increased fat, depression, anemia, and cardiovascular disease. These symptoms, however, can occur with normal levels of testosterone, and in some cases the symptoms may not occur even when testosterone levels are low.
Dr. Abraham Morgentaler, in his book Testosterone for Life: Recharge Your Vitality, Sex Drive, Muscle Mass, and Overall Health, writes, “Testosterone is critical, not only for how the brain responds to sexual thoughts and stimulation, but also for the proper function of the penis, by affecting its ability to get hard, to release the necessary chemical signals, and to maintain the proper types of cells that are essential for good erectile function.”9 Symptoms of testosterone deficiency include decreased sexual function, lower vitality, loss of muscle mass and strength, increased fat mass, and mood changes and depression. The possibility that TRT might be an antiaging tonic appeals particularly to older men, whose sexual functioning sags along with their muscles and energy.
Doctors debate the topic of male menopause. I don’t like the term because the physiological changes that occur for men are distinctly different than they are for women. In women, menopause occurs when hormone production stops completely, ending their period of fertility. For men, hormone production falls, but it does not stop. Testosterone helps maintain sex drive and sperm production, but most men are capable of impregnating well into late life.
When we think about the characteristics of testosterone, we usually think about its sexual power rather than its potential impact on mental processes, but all of our body’s attributes change with age. Unfortunately, mental functions are no exception. We can learn new truths; it just takes a little longer. New information is processed less carefully and details often slip away. Memory is the most fragile of mental functioning, and testosterone and memory begin their decline at about the same time.
In my sixth decade, I was hit by an emotional tsunami. The decline in my sexual performance resurrected all of my earlier fears about an unfinished masculinity. Men fix machines and they don’t fail at sex, and worrying about failing at sex just about guaranteed that I would. I had never experienced a significant loss of sexual interest or satisfaction. Then I remembered the presentation on testosterone and began to consider that lowered testosterone levels might account for some of the problems I was having. My doctor ordered tests for testosterone level, thyroid function, and prostate specific antigen, which most men know of as PSA. After warning me of the risks, which include sleep apnea, acne, enlargement of the prostate, growth of any existing prostate cancer, testicle shrinkage, deep vein blood clots, breast enlargement, and possibly an increased risk of heart disease, my doctor recommend TRT. Remembering Jack Nicholson’s advice about never passing up a hard-on, I readily agreed.
In many cases TRT helps relieve the symptoms of testosterone decline, whether it comes from aging or other causes, but it remains unclear whether or not restoring testosterone to youthful levels is of benefit. The primary impact of TRT on sexual function is related to increased sexual drive. Having more interest in sex has the added benefit of restoring some lost confidence in sexual functioning. A few studies have found some connection between higher testosterone levels and better performance on cognitive tests. Therapy can restore testosterone levels without improving the symptoms attributed to testosterone decline.
TRT can be administered through injections, patches, or a gel that is spread on the skin. One of the most effective forms of treatment is injection of long-acting testosterone pellets under the skin of the buttocks, but injections are inconvenient, and therapeutic levels and symptom relief may fluctuate between the injections. Patches are applied nightly. The gel in rubbed onto the skin of the abdomen, chest, arms, and shoulders. The gel is less irritating than the patches, but the TRT agent can be transferred through skin-to-skin contact to a sexual partner or even to a pet.
I opted for the TRT gel, and almost immediately I began to feel some improvement. How much of my response was placebo and how much was an effect of the TRT is hard to say. I knew that something convincing was happening. I thought more about sex, I was more successful at it, and the success restored my confidence. Even my aches and pains became more of a nuisance than a barrier to sex. I began to believe I could ride out the tsunami.
Just as Viagra is not a magic bullet, TRT is not the gunpowder for the problems of aging. Lifestyle changes that focus on diet and exercise must accompany TRT. When sexual dysfunction is primarily related to psychological factors, counseling may be required and in some cases antidepressants may be prescribed.
An entire industry has developed around TRT, but it will never return you to your sexual prime. TRT may cost several hundred dollars a month, and it may not be covered by all insurance plans. Claims for feeling sexier, stronger, and healthier are exaggerated, but claims about reversing low energy and improving muscle strength and libido have been proven. Improvement in sexual confidence creates an improved mood and a sense of well-being, which contributes to better sexual performance. TRT didn’t fix my aging body, but awakening with morning wood still brings a smile to my face.
In a New York Times article, Benedict Carey wrote, “The nation that invented Viagra and ‘Sex in the City’ is still queasy about exploring sexual desire and arousal, even when this knowledge is central to protecting the public’s health. . . . Researchers say they still know precious little about fundamental questions, including how sexual desire affects judgment, how young people develop a sexual identity, why so many people take sexual risks, how personality and mood affect sexual health and how the explosion of sexual material on the Internet and trysts arranged online affect behavior.”10 Research on the subject of why people are attracted to a particular type of individual, however, has reached a consensus about a few things:
• Physical attractiveness is important for friendship, marriage, and financial success.
• Attractiveness begins at a very young age.
• Younger people are more attractive than older people.
• Age has a greater impact on women than men and a greater impact on gay men than straight men.
Even as we discover more about the biology of the brain, the concept of the unconscious is experiencing a renaissance. As Malcolm Gladwell suggests in Blink: The Power of Thinking Without Thinking, we always believe more data will lead to better decisions, but excessive analysis paralyzes us. We undervalue decisions based on feelings. Gladwell states that the unconscious finds patterns in situations and behaviors based on little information, something he calls “thin slicing.” The unconscious leaps to conclusions much like a computer that processes a great deal of data quickly. Gladwell believes decisions made very quickly can be every bit as good as decisions made cautiously and deliberately.11
Most animals choose their mates in a nonrandom fashion through what is called assortative mating. Some animals favor mates with certain characteristics, such as traits that they possess themselves or, alternatively, traits they feel they lack. In this process, they reduce their field of selection of potential mates. Similarly, whether in a gay bar or Internet chat room, a gay man will scan his environment. Within a few seconds, he will unconsciously sort through all available men, narrowing his choices into his short list of prospects—without ever realizing he has been engaged in a selection process.
To impress a potential mate, male animals spread their feathers or puff up their chests to appear to be the strongest, most masculine, and most attractive they can be. In their mating rituals, men also exaggerate their virtues and minimize their weaknesses and vulnerabilities. They deceive others about those things that they feel make them unattractive. For gay men, cruising for casual sex frequently focuses on something sexually explicit such as a hand that lies on the crotch, moving ever so slightly. When the pursued man responds in a sexual way, sexual arousal is heightened. The interaction progressively focuses more and more on sex, dislocating any rational thought. Any search for information about who the two are as individuals is ignored. Those who are searching for a relationship that is more than just sex may be left feeling a little empty.
On a business trip to Washington DC, I left an O Street male strip club late at night to return to my hotel. A younger man who had left a little before me walked in the opposite direction. He looked over his shoulder at me, sensing that I was looking back at him. He walked a few more paces, stopped, and looked back at me again. I was still watching him. He then leaned against a car, lit a cigarette, and continued to look in my direction. In this brief nonverbal mating dance, we had communicated just enough.
I am fifteen years older than my husband, Doug, but we rarely talk about it. When we first began seeing each other nearly thirty years ago, I felt insecure about the age difference, and I was quite certain that he would sooner or later dump me for a man closer to his own age. One day I mentioned my concerns to him, and he replied, “I’ve always been attracted to older men.” At first I had trouble believing that, but I dismissed my concerns and we didn’t talk about it, at least until I approached retirement.
My growing older seemed to expand the age difference because as my body sagged and wrinkled, I saw myself as increasingly undesirable. Dormant and patched-over fears of abandonment crept back into my mind. Would Doug jump ship for a younger man? If I became physically unable to be his lover, would he find what genteel folks call a friend with benefits but what gay men often call a fuck buddy? Would his loyalty then shift to this new playmate? If my future includes needing a level of care that I cannot reciprocate, will he begin to resent me? When I retire, can he find a decent job in his midfifties?
I had always wanted to make sure he will be financially secure when I die. Then one day I was struck by the thought What if he dies first? Am I prepared to live my life alone as an old man?
In The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home, Dan Ariely writes, “To a large degree, beautiful people date other beautiful people, and ‘aesthetically challenged’ individuals date others like them.” He goes on: “In terms of what they were looking for in a Romantic partner, those who were more attractive cared more about attractiveness, while the less attractive people cared more about other characteristics (intelligence, sense of humor, and kindness). . . . The aesthetically challenged people were much more interested in going on another date with those they thought had a sense of humor or some other nonphysical characteristic, while the attractive people were much more likely to want to go on a date with someone they evaluated as good-looking.”12
But Ariely’s comments suggest that there is some universal definition of what constitutes a beautiful person. When I was in my midsixties, feeling old and fat, I was walking down the sidewalk in my swimsuit at a gay resort. Coming toward me was a man, probably in his midforties, who I thought was beautiful. As we met, he stopped, touched his index finger beneath my chin, slid his finger all the way down to the base of my happy trail, and said, “Delicious.” Without any further conversation, we both kept walking in the opposite directions.
In that instant on the sidewalk, I began to understand that each of us has our own internalized idea of what makes someone delicious, what constitutes a beautiful person. He found beauty in my aging body with its sags and wrinkles, my white hair and protruding belly, while I found beauty in his youth, his masculinity, and his vigor. While I was feeling “aesthetically challenged,” he did not see me as I saw myself; what I saw as a weakness, he saw as a strength. Ariely did admit that his observations had significant exceptions, and he added this disclaimer: “We are also a scent, a sparkle of the eye, a sweep of the hand, the sound of a laugh, and the knit of a brow—ineffable qualities that can’t easily be captured in a database.”
Intergenerational relationships (IGRs) are relationships between two people where the younger person is above the age of consent and where the older person is at least fifteen to twenty years older than the younger person. In writing the first edition of this book, I could not find any meaningful statistics about how often IGRs occur in relationships of gay men nor could I find any significant research on the nature of IGRs. Most in the straight world don’t know gay IGRs exist, and many in the gay community don’t understand them and even look upon them suspiciously.
Although I am now married to a man fifteen years younger than me, I had difficulty understanding IGRs. Why would a hard-bodied young man whose appearance approached that of the idealized gay man find himself physically attracted to someone who looks like Dick Cheney, politics aside? A young man I corresponded with said, “I am going through a kind of second coming out and have started psychoanalysis in order to understand my patterns of relationships and my choice of partners, who are always much older than me.” Psychoanalysis is unlikely to reveal the answer.
We demand an explanation from these younger men who are drawn to older men, but why does it matter? Older men are rarely asked to defend their choice of a younger man. The older man has chosen up; the younger man chose down. The fact is that research hasn’t determined why we are drawn to the people we’re attracted to, and most likely, the explanations are very complex.
After speaking to a group of gay men, one tall, lean, and handsome young man told me about his sexual attractions. He said he is only attracted to heavier men with big bellies and hairy chests. Unconscious forces operating in his brain thin slice his sexual attractions to include only older men with mature bodies; younger men hold no appeal. When I asked another young man about his attraction to older men, he replied, “I like older men because they have all of their corners rounded off.” It brought to my mind a class I’d taken on antiques. The instructor said that buying old furniture is a better investment than buying new furniture. “With new furniture, you hate to get it scratched, and its value goes down. But a mark on an old piece of furniture just adds more character.”
When I was writing my blog, MagneticFire, it seemed as if, almost daily, younger men asked me, “Why do I find myself only attracted to men who are much older than I am?” Many of these young men don’t understand their attraction and often feel backed into a corner to defend their choice. Frequently they have looked for an answer in their relationship with their father or their grandfather, just as I had done for an explanation of my attraction to men. Sometimes they say, “My relationship with my father [or grandfather] was so wonderful; I just want to try to recreate that with a partner.” At other times, they say, “I had no relationship with a father figure, and I think my attraction to older men is to fill that void.” When two contradictory hypotheses attempt to explain the same phenomenon, neither hypothesis is likely to be true. Explaining this attraction on the basis of their relationship with their fathers or grandfathers is far too simplistic.
“I like older men because they have all of their corners rounded off.”
Family and friends of men in IGRs may confront them with their belief that this relationship cannot be based on love but must be based on other motivations. Often these younger men protest, “I am fully capable of taking care of myself. I don’t need a sugar daddy.” As I talked with these young men, I repeatedly heard things like, “I don’t need stuff! I want more than an orgasm. I want a relationship with someone who is sensitive, caring, and Romantic—self-assured and satisfied with his life.” They want relationships based on emotions rather than material things, something they feel they can only find with a mature man. One of my gay friends is in a relationship with a man who is forty years older than he is, and he’s tired of defending his relationship. Although his family has come to accept their relationship, his gay friends are the most critical. One of his friends asked him, “What does a young, good-looking guy like you see in an old man who is well past his expiration date?”
Each of us has a chronological age, but we also have a physical age, a sexual age, and a psychological age. Older men who are attracted to younger men can’t explain their choice either, although they often say that they feel much younger than their chronological age and emotionally in sync with the younger man. If an older man is attracted to a masculine man with ripped muscles, it’s reasonable to assume that he would find it difficult to believe the claim that a muscular young man finds his too-fat, too-short, too-wrinkled body attractive. Some older men, loathing the impact of aging, resist the idea that younger men will find them attractive even to the point of being suspicious of the younger man’s motives. One commented, “I do not need to raise another son. I don’t need a helpless kid to protect.” Other older men express fears of abandonment because they may be unable to satisfy the younger man’s greater sexual appetites.
Each of us has a chronological age, but we also have a physical age, a sexual age, and a psychological age.
All stereotypes have validity for some but not all. While some young men may be seeking a sugar daddy, and some older men may wish for an Adonis-like trophy, often people mistakenly assume that all IGRs are based on one partner’s exploitation of the other. What both the younger man and older man fail to recognize is that their own physical and psychological attributes may be exactly what will show up in the other’s thin slices.
Almost all of the younger men I interviewed said they had never been attracted to men of their own age. One young gay man I interviewed explained, “All those guys who are under sixty years old might as well have vaginas because I have no interest in them.” Another older man who had always been attracted to men older than he is said, “As I’ve grown older, the men I am attracted to are also older. Soon I will have no place to cruise but in a nursing home.”
Young men describe older men they find physically attractive as lovely, gorgeous, possessing raw beauty, representing manliness, or more simply, “They just make me horny.” For younger MSM who are attracted to older men, a big belly symbolizes sexuality in the same way that large breasts symbolize sexuality for some young heterosexual men. The younger men often respond, however, that they find other essential characteristics of the relationship to be even more important than sexual compatibility, and the words wisdom and life experience come up frequently.
Older men are sometimes described as daddies, a word that connotes the qualities of maturity, stability, and emotional safety. Daddies are seen as nonthreatening, while the sharp edges of their contemporaries are more menacing. When someone first referred to me as a daddy, I became very uncomfortable. I have two daughters who now call me Dad, but when they were young they called me Daddy. Using the word daddy in an erotic context seemed somewhat perverse. As my understanding of IGRs grew, I began to see the word daddy as a kind of metaphor for a wise and experienced man with white hair and rounded features. Later I learned that heterosexual couples also sometimes used daddy in an eroticized way. Although referring to a sexual partner as daddy makes some people uncomfortable, it is a term of endearment rather than suggestive of some deeply Freudian maladjustment.
We project our own attractions and expectations onto a prospective mate, expecting that the things they love and cherish are exactly the same as our own. If an aging man hates the changes in his body, he expects that any potential partner would abhor them just as much. If his sexual drive and potency have diminished, he may not trust that the younger man will find his interest in slow and sensual lovemaking desirable. Why would anyone want a fat and indolent man on a sexual decline?
In Archives of Sexual Behavior, Michael Seto writes, “We have an incomplete understanding of how human sexuality is oriented if we focus only on gender as the important dimension. . . . Age is important as well.” Seto uses the term chronophilia to describe sexual attraction that targets specific age groups. He notes, however, that in addressing age, he is not talking only about chronological but also sexual and physical maturity. Sexual attraction is drawn from a person’s level of sexual maturity, body size and shape, secondary sexual characteristics, and other visible features like gray or white hair, but Seto also includes psychological features that emphasize wisdom, maturity, and experience. Seto broadens the definition of sexual orientation to include age.13
What happens in our heads and how we behave are often not in alignment, but pornography provides a window into our culture’s collective minds. Most porn is accessed through the Internet and is accessible to almost everyone, including those who might not otherwise be able to explore their erotic interests. Since my research has been skewed in the direction of exploring IGRs, I began to wonder just how common age might be a part of sexual orientation. Although not much is known about IGRs, gay or straight, I did a Google search for the rather crude but quite specific “DILF,” defined in the Urban Dictionary as “Dad I’d like to fuck,” with synonyms such as “who’s your daddy?,” “cradle robber,” and “your friend’s dad.”14 Within moments I had over 1.4 million references. Tumblr, a microblogging and social networking website, has an entire section devoted to DILF, and a search of “Silver Daddies,” a popular chat site for MSM with intergenerational erotic interests found over 154,000 profiles. These sites cross geographic and cultural boundaries. For a topic of such broad popular interest, it is surprising how little we know about IGRs.
When we think of sexual orientation, we usually think of the continuum of gay, straight, and bisexual, but sexual orientation is a deep-seated attraction toward a certain kind of person. Erotic desire includes attention, attraction, fantasy, thoughts, urges, genital arousal, and behavior. Variations of sexual desire like dominance and submission, sadism and masochism, chubbies and chubby chasers, and bears and cubs complicate the idea of sexual orientation. Sexual desire may also include fetishes that extend from toes and noses to jocks and socks. These desires may manifest at different times and in different ways, and our decision whether or not to act on them can be influenced by a lack of opportunity or permissibility. Not all sexual behaviors are legal or morally acceptable.
The most studied aspect of sexual orientation is gender, with age being the second most studied, but age has been studied almost exclusively in the context of pedophilia. Huge gaps exist in our knowledge of maturity as it relates to sexual orientation. In Seto’s thorough review of age as a sexual orientation, he wrote, “I am not aware of any empirical research on individuals attracted to middle-age [or older] persons.”15 But my interviews with younger men attracted to older men absolutely confirm Seto’s claim that the erotic aspects of aging include wisdom, maturity, and experience. A person’s chronological age tells us very little about him.
Huge gaps exist in our knowledge of maturity as it relates to sexual orientation.
Humans have a powerful need to attach to a spouse, family, friends, pets, and even objects. Physiological and environmental cues drive us to interact socially. Paul J. Zak, in an article called “The Neurobiology of Trust,” reported that the hormone oxytocin enhances an individual’s propensity to trust a stranger when that person exhibits nonthreatening signals. Oxytocin has been dubbed the cuddle hormone. It promotes social interaction, bonding, and Romantic love in addition to its key procreative functions such as uterine contractions and lactation. As oxytocin rises, anxiety over interacting with strangers is reduced. A safe, nurturing environment may stimulate the release of more oxytocin.16 Since nurturing is a recurring theme in IGRs, could variable levels of oxytocin account for younger men’s attraction to older men? We know so little about what drives sexual attraction.
So what is the relationship between sexual orientation and sexual identity? Sexual orientation is more fluid and multidimensional; sexual identity is narrower and more fixed, develops at an early age, and is more stable over time. How then can I say I have a gay identity if I didn’t come out until age forty? How can young men attracted to older men incorporate that they are gay and attracted to older men? First of all, although we all have a fairly well-defined sexual orientation—defined in the broadest sense—we may choose to act outside of that orientation. My story and many stories of other mature MSM are about men who have chosen to act outside of how their erotic attractions are directed. When all of the elements of our sexuality come together and become fixed and stable over time, we develop our sexual identity. When I finally accepted that I am attracted to men, learned what kind of men I am attracted to, and knew what I liked and didn’t like sexually, it was as if I had come home to a reality where I wanted to stay. But saying “I am gay” does not define all of who I am as a person, nor does it even define all of who I am sexually.
We obsessively analyze the reasons for our choices, emphasizing categorization rather than accepting the great diversity of same-sex attractions. Explanations for all the elements of our sexual attractions are complex and probably unknowable. All research runs the risk of reductionism. When it focuses on genital sexual activity alone without considering attraction, affection, and affiliation, it falls short in identifying our sexual orientation and our sexual identity.
In Sexual Behavior in the Human Male, Alfred Kinsey wrote:
Males do not represent two discrete populations, heterosexual and homosexual. The world is not to be divided into sheep and goats. Not all things are black nor all things white. Nature rarely deals with discrete categories. Only the human mind invents categories and tries to force facts into separated pigeon-holes. The living world is a continuum in each and every one of its aspects. The sooner we learn this concerning human sexual behavior, the sooner we shall reach a sound understanding of the realities of sex.17
Emotions always accompany behavior. Concentrating exclusively on genital sex causes us to miss the real significance in relationships. Sex is a nice, momentary pleasure, but having someone who cares about you and is there to support you, even if it is just a close friendship, is much more valuable in any long-term view. One wise young man that I interviewed summed it up nicely when he said, “Don’t question the whys. They will be answered in the growth of the relationship. Decisions will be made as we grow together or apart. He likes you, you like him, and you’re both legal. Go for it. Life experience is the issue, not age.”