Unlike women, who abruptly stop being fertile with menopause, men do not experience a sudden change in fertility as they age. Instead, changes occur gradually during a process that some people refer to as andropause.

Aging changes in the male reproductive system occur primarily in the testes. Testicular tissue mass decreases and the level of the male sex hormone testosterone stays the same or decreases very slightly. Erectile function may also be impaired

Fertility:

The tubes that carry sperm may become less elastic (a process called sclerosis). The testes continue to produce sperm, but the rate of sperm cell production slows. The epididymis, seminal vesicles, and prostate gland lose some of their surface cells but continue to produce the fluid that helps carry sperm.

Urinary function:

The prostate gland enlarges with age as some of the prostate tissue is replaced with a scarlike fibrotic tissue. This condition, called benign prostatic hypertrophy (BPH), affects about 50% of men. This may cause problems with urination as well as with ejaculation.

In both men and women, reproductive system changes are closely related to changes in the urinary system.

EFFECT OF CHANGES
Fertility varies from man to man, and age is not a good predictor of male fertility. Prostate function is not closely related to fertility, and a man can father children even if his prostate gland has been removed. Some fairly old men can (and do) father children.

The volume of fluid ejaculated usually remains the same, but there are fewer living sperm in the fluid.

Decreases in the sex drive (libido) may occur for some men. Sexual responses may become slower and less intense. This may be related to decreased testosterone level, but it can also result from psychological or social changes related to aging (such as lack of a willing partner), illness, chronic conditions, and medications.

Aging by itself does not necessarily prevent a man from being able to enjoy sexual relationships.

COMMON PROBLEMS
Impotence may be a concern for aging men. It is normal for erections to occur less frequently than when younger, and aging men often have less ability to experience repeated ejaculation. However, impotence is most often the result of a medical or psychological problem rather than simple aging, and 90% of impotence is believed to be of medical rather than psychological origin.

Medications (especially those used to treat hypertension and certain other conditions) can cause some men to be unable to develop or maintain an erection that is sufficient for intercourse. Disorders such as diabetes mellitus can also cause impotence.

If impotence occurs, it can often be treated. Some medications can be changed, and other impotence treatments may be helpful. The primary health care provider or a urologist should be consulted if a man is concerned about impotence.

BPH can eventually interfere with urination. The enlarged prostate partially blocks the tube that drains the urinary bladder (urethra). Changes in the prostate gland predispose elderly men to urinary tract infections.

Vesicoureteral reflux (backup of urine into the kidneys) can develop if the bladder is unable to drain adequately, eventually resulting in kidney failure.

Prostate gland infections or inflammation (various forms of prostatitis) may also occur.

Prostate cancer becomes more common as men age. It is one of the most frequent causes of cancer death for men. Bladder cancer is also a common cancer in older men. Testicular cancers are possible, but these more often occur in younger men.

PREVENTION
Many physical age-related changes, such as prostate enlargement or testicular atrophy, are not preventable. Early and proper treatment of underlying health disorders such as hypertension and diabetes that can be responsible for changes in urinary and sexual health may prevent later problems with urinary and sexual function.

Impotence that is caused by medications or illness is often successfully treated. Sexual response changes are most frequently related to factors other than simple aging. Satisfactory sex in older men is more likely if sexual activity has continued during middle age.

RELATED TOPICS

• Aging changes in hormone production
• Aging changes in organs, tissues, and cells
• Aging changes in the female reproductive system
• Aging changes in the kidneys