Category: Masculinity

The Will to Change: Men, Masculinity, and Love Paperback

By bell hooks (2004)

From Amazon.com: “From the New York Times bestselling author of All About Love, a brave and astonishing work that challenges patriarchal culture and encourages men to reclaim the best part of themselves.

Everyone needs to love and be loved—even men. But to know love, men must be able to look at the ways that patriarchal culture keeps them from knowing themselves, from being in touch with their feelings, from loving.

In The Will to Change, bell hooks gets to the heart of the matter and shows men how to express the emotions that are a fundamental part of who they are—whatever their age, marital status, ethnicity, or sexual orientation. But toxic masculinity punishes those fundamental emotions, and it’s so deeply ingrained in our society that it’s hard for men to not comply—but hooks wants to help change that.

With trademark candor and fierce intelligence, hooks addresses the most common concerns of men, such as fear of intimacy and loss of their patriarchal place in society, in new and challenging ways. She believes men can find the way to spiritual unity by getting back in touch with the emotionally open part of themselves—and lay claim to the rich and rewarding inner lives that have historically been the exclusive province of women.”

Book Review – Real Boys: Rescuing Our Sons from the Myths of Boyhood

By William Pollack

Trish Anderson

Workshop: Youth and Violence: The High Cost of Alienation

November 6, 1999

Instructor: Melissa Maguire

Pollack, William.  (1998).  Real Boys: Rescuing Our Sons from the Myths of Boyhood. 

Henry Holt & Co: New York.

Statistics and Studies Show …

Suicide, in the United States, has tripled among fifteen to twenty four year olds between nineteen fifty and nineteen ninety; it’s now the third leading cause of death in this age group. Male suicide is four times that of females among Americans of all ages. Dr. C. Wayne Sells, a specialist with the Department of Pediatrics at the University of California says that the major causes of mortality and morbidity among teenagers has shifted from infectious to behavioral etiologies. Young people actually have more to fear from their own behavior than from disease!

A Danish study demonstrated that boys who suffered both birth complications and early childhood separation or rejection were most likely to become adult violent offenders.

The National Association of School Psychologists estimates that in the United States, one hundred sixty thousand children miss school every day because they fear being bullied.

Inside the educational system:

              -Boys are twice as likely as girls to be labeled learning disabled;

              -Boys make up sixty seven per cent of “special education”classes;

-Boys are up to ten times more likely to be diagnosed with serious emotional disorders, especially Attention Deficit Disorder.

       Outside the educational system:

-Boys rates of depression are shockingly high, they’re four to six times more likely to commit suicide, and three times more likely than girls to be victimized by violent crime.

The American Medical Association determined that one in ten boys has been kicked in the groin by age sixteen (one fourth of which caused injury). Most boys don’t tell their parents and within a year of the injury about twenty five per cent of them showed signs of depression. These boys didn’t consider a kick in the groin to be simply a routine part of boyhood – it really bothered them. They felt shame and were disturbed by the violence, but felt they couldn’t talk about these feelings.

These statistics and studies can be found in William Pollack’s insightful and provocative book called, Real Boys: Rescuing Our Sons from the Myths of Boyhood (1998)  (Real Boys).  The first time I heard of William Pollack was on an Oprah Winfrey show that came about in response to recent school shootings perpetrated by grammar school to high school age boys. Pollack explained that, “… boys don’t cry tears, they cry bullets.” I was taken by this because it fit with what I had always believed as a feminist – that sexism, with it’s inherent and inappropriate stereotypical gender roles, harms boys as much as girls.  Real Boys has eloquently validated my gut belief. 

Pollack is a clinical psychologist and co-director of the Center for Men at McLean Hospital, an assistant clinical professor of psychiatry at Harvard Medical School, and a founding member and Fellow of the Society for the Psychological Study of Men and Masculinity of the American Psychological Association.  Much of Real Boys was taken from a recent study by Pollack and his colleagues at Harvard Medical School called, “Listening to Boys’Voices.”  Much of this research supports his experience as a psychologist with men and adolescents boys. 

According to Pollack, boys are in a desperate crisis. Even normal  boys are being confused by societal mixed messages about what’s expected of masculinity. This has resulted in many boys who have a sense of disconnection and sadness that they aren’t likely to have the ability to name. Recent research shows that boys aren’t doing as well in school as they had before, and when compared to girls. Boys self-esteem has recently been found to be remarkably low with rates of depression and suicide that are rising in a frightening manner. 

Pollack says despite feeling desperately lonely and afraid, boys hide behind a mask of masculinity that hides their true feelings in order to present an image of toughness, stoicism, and strength. Behind the mask of masculinity is the shame and trauma of separation They’re held captive in gender straightjackets that limits their emotional range and even their ability to think and behave as freely and openly as they could. By perpetuating these macho stereotypes, society is judging boys behavior against outmoded notions of masculinity that lack relevance in today’s world. Most of us are at a disadvantage talking about boys because all our views have been distorted by the societal myths we’ve internalized. These powerful stereotypes affect boys in profound ways; they hinder their development and their ability to function optimally. They affect our parenting of boys and our relationships with them.

Pollack believes that boys are separated emotionally from their mothers prematurely (usually around six and again in adolescence) because mothers are expected to “cut the apron strings” that connect her to her son and with his family. This forced premature separation is so common that it seems normal. As early as age five or six, boys are expected to be independent in situations they aren’t ready to handle, such as school or camp.

Teenage boys are given a second shove into new schools, competitive

sports, jobs, dating, travel, and more before many are ready. In the teen years society also becomes concerned and confused about the mother-son relationship. We’re unsure about how intimate a mom should be with her sexually mature son. As a result, parents are encouraged by society to push boys away from their families, especially the nurturing female realm. Society believes this separation is needed and good for boys; if they aren’t pushed out of the nest they’ll never fly.

Pollack thinks that both sexes should be allowed to separate from their mothers and families at their own natural pace. Boys will make the leap when they’re ready and will do it better if they feel there is someone there to catch them in case they fall. We have expected them to be independent of the family too abruptly, with too little preparation, too little emotional support, not enough opportunity to express their feelings, and frequently without the option of going back or changing course. We frequently don’t tolerate stalling or whining because it’s believed that this disconnection is essential for boys to “make the break” in order to become men. Pollack thinks this separation is so profoundly harmful to boys that he calls it an emotional trauma. We don’t expect the same of girls, and if we treated girls this way, most of us wouldn’t question it’s being traumatic.

Pollack believes that boys have been made to feel ashamed of having feelings of vulnerability and so they mask their emotions and true selves. This unnecessary disconnection from their family, and then from their selves, causes boys to feel alone, helpless, and fearful.  Society’s prevailing myths leave no room for such emotions, as a result boys feel they’re not measuring up. They don’t have a way to talk about their perceived failure, and thus feel shame, but aren’t able to talk about either feelings.  As a boy internalizes society’s hardened image of masculinity, he looses touch with himself because his sensitivity is forced to submerge. At the very same time, modern society exerts contradictory expectations of being sensitive in relationships. They’re told they need to be “new men,” show respect for girls, share their feelings, and shed their “macho” assumptions about male power. The double standard says be sensitive nice “New Age” guys, but still be cool aloof dudes. They’re confused about how to be manly, yet empathic, cool but open, and strong yet vulnerable. Society facilitates these messages through what Pollack calls, the Boy Code,  that is so ingrained in society that it’s invisible. All behavioral qualities we normally attribute to girls, empathy, sensitivity, and compassion – are also basis male traits. The use of shame in the toughening up process gives boys the message to be ashamed and guilty about feelings of vulnerability, weakness, fear, and despair.

At birth and for several months afterward, boys are actually more emotionally expressive than girl babies. Researchers showed that twenty one month old boys have well developed natural, hard wired abilities to feel empathy for others who are in pain. By age five or six most of this emotional expressiveness has been forced underground and they’re much less likely to express hurt or distress to parents or teachers. They’re far less attuned to feelings of hurt and pain in others, and began to loose their capacity to express their own emotions in words.

Society’s pressure to avoid feelings and behaviors that might bring them shame pushes them to wear a mask of bravado – this self-hardening process is what makes boys violent.  Most violent behavior is and always has been the work of males, both cross-culturally and trans-historically because anger has been the only emotion acceptable for males. Boys phobia about revealing their shame leads them to overcompensate by showing the opposite. Throughout boyhood the strings are pulled tighter and tighter so that either the straightjacket snaps or the boy does.

This shaming of boys for emotionality is controlling, pervasive and corrosive to their spirits. The process of shame-hardening includes: discipline, toughening up, acting like a “real man”, being independent, keeping emotions in check with powerful phrases like – “big boys don’t cry,” and threats about being seen as a “mama’s boy.” Even when these messages aren’t said directly, they dominate the subtle way boys are treated and as a result, how they come to perceive of themselves.

Even when girls feel their voices stifled in public, they generally feel comfortable speaking in private to one another about their pain and insecurity. Despite boys seeming bravado they find it hard to express their genuine selves even with friends and family. No matter how loud they brag about their abilities, boys may not be expressing what’s really in their hearts and souls. It’s a common joke that males don’t reach out for directions when they’re lost. It’s not funny that many boys feel they can’t reach out for the emotional compass they desperately need.

Girls are sensitive to shame, but boys are shame-phobic; they’re exquisitely, yet unconsciously, attuned to any signal of “loss of face” and will do about anything it takes to avoid shame. Rather than expose themselves to potent embarrassment, they engage in a variety of behaviors that range from avoiding dependency to impulsive action, from bravado and rage-filled outbursts to intense violence.    

Pollack claims that when boys “act out” by using disorderly conduct, they’re dealing with the pain of separation and shame. He believes that an overwhelming number of elementary school boys diagnosed with conduct disorders or with attention deficit disorder are misbehaving, not because they have a biological imbalance or deficit, but because they’re seeking attention to replace the void left by being separated from their parents. Problems paying attention or regulating impulses may not be “faulty wiring” or “testosterone poisoning,” but accumulated emotional wounds and years of paralyzing shame. Boys aggressiveness and violence is often expressing something far from a macho desire for power or vindication, but a longing to be nurtured, listened to, and understood.  They need to engage in all the needy, dependent behaviors they’ve been told are girl-like and forbidden. The diagnosis of hyperactivity is frequently made on the basis of a check list of behaviors that in reality reflect boys grief over loosing emotional connection – a loss that cannot be fully expressed or mourned, but expresses itself through action and anger. Through the language of these behaviors, boys are trying to give us a wake up call to their pain and desperation. Their feelings will not be cured with medications or behavior modification.

What “real” boys really need from infancy forward –  and what mothers in their hearts are longing to offer – is complete and unconditional empathy and understanding for a full range of their emotions.  When boys become hardened, they become willing to endure emotional and physical pain – even to risk their lives, if it means winning approval of their peers. They can become so hardened that they are literally anesthetized against the pain they are coping with.

The phrase “boys will be boys” actually says they’re prisoners of their biology, that their behavior is pre-determined and an inherent part of their nature. “Typical” boy behavior is assumed to involve insensitivity and risk-taking.  Sadly, “… boys will be boys” is not used when a boy sits with a dying parent, feels guilty for breaking up with a girlfriend, or gives his crying mom a hug.

Pollack’s research shows that in adolescence boys are ambivalent about becoming men because of mixed massages about masculinity from society, peers, and their families. They are told to be cool, confidant, and strong, and at the same time, egalitarian, sensitive, and open with feelings. They’re unsure whether becoming a man is going to be such a great experience. They might not see role models that appeal to them or that they feel is within their reach. Models might include men who were either slaved at hated jobs in order to support a family, or that ran away from family responsibilities all together. The confusion boys feel is hidden beneath macho posturing and under the weight of all of our misconceptions of toxicity about boys.

Failing to talk to teenage boys about what’s bothering them forces them to separate rather than giving them support as they learn to individuate. For some boys, retreat behind their mask can be so complete and consistent that it becomes hardened and fixed. Some may eventually find themselves unable to remove the mask and actually loose touch with their own genuine feelings.   

The mask makes it hard to discuss sexuality, and masculinity’s double standard pushes boys to prove themselves sexually, and then castigates them when they do. What’s worse this makes it more likely that a boy might take risks with alcohol or drugs. The mask makes it appear that everything is fine and may prevent parents from seeing (or accepting) that a boy is in fact already taking risks with drugs and alcohol to numb painful emotions.

When boys do adopt the required macho behaviors, many boys find that rather than being admired for their manly comportment, they’re actually rebuffed or rebuked. The result is adolescent boys who are on the defensive, sensing that others see them as insensitive, violent, and uncaring. These conflicting messages leave boys open to learning disabilities, severe depression and impulse and compulsive behaviors that range from substance abuse to unsafe sex, from acting out, violence or suicide. One teenage boy said it well, “People act like guys my age are up to no good half the time.” Another teen relates, “I guess it’s hard being a guy because there are so many things that a normal  person would do, that you’re not allowed or expected to do.” Adolescence is about individuation not separation. Teens want to discover a mature self in the context of loving relationships – stretching their psychological umbilical cord rather than severing it. 

Pollack sees violence as the final link in the chain that begins with disconnection.  Violence is about shame and honor. For many boys failing to “know how to fight” or refusing to fight when challenged – may be seen as disgraceful, as a sign of dubious masculinity. Striking out against others who are weaker, younger, or less skilled is about respecting the Boy Code rules that require him to do everything possible to protect their honor and prevent shame. Ironically, violence in boys also sometimes represents a vain attempt to reconnect with others, to make and keep friends, either by impressing peers, helping other boys to beat up another kid, or actually joining a gang. Violence may give some boys a false impression that they’re somehow closer to another boy; they actually have a sense of bonding through individual or collective acts of violence.

Pollack thinks that today’s bully is often, but not always, tomorrows violent offender. On the other hand, sometimes the quiet victim, the shy loner, or the troubled bystander suddenly turns violent in an unexpected eruption of rage.  Pollack believes that shame is what makes a boy snap. When enough shame collects inside him – when he feels disconnected, unpopular, less than masculine, maybe even hated – the boy tries to master his feelings and reconnect with others through violence. There is generally a triggering event for any violent act – a threat, a betrayal, or an insupportable loss. A boy’s risk for violence is often fueled by a reservoir of anger, fear, and shame, that gradually accumulated over the years since the trauma of separation from his parents.

While observing boys surrounding violent video/computer games, Pollack noted that as they watched the mayhem, other than a loud “yes” when a player got an enemy, there wasn’t much talking between the boys. They appeared entranced by the screen. The odd contrast he noted was that the boys seemed very connected to one another, were supportive of the player, and non-judgmental about his performance – in other words they were behaving very differently than the “big boys” on the screen!  Pollack posits that the reason boys like play revolving around frontier, outer space, and war games is because they’re admired for physical strength and emotional courage and ridiculed for physical weakness and emotional vulnerability.

Research at the National Institutes of Mental Health found that when kids watch kindness on TV they imitate it. Surely they’ll also imitate James Bond, the Terminator, Freddie Kruger, Beavis, or Darth Vader. Boys who watch a great deal of violence become desensitized to it and it seems like a “normal” part of life and does heighten the possibility that they will tolerate violence among their friends or from themselves.  Despite recent connections made between violence in movies and violence done by young people, Pollack warns against making a direct link to media violence and the inclination to personal violence. Sometimes exposure to media violence can satiate a natural appetite for it. Actually witnessing violence may frighten and even sicken or repel a boy and turn him away from it. Pollock doesn’t believe that a boy who is connected and loved and who is in a safe setting where he can express his emotions will be motivated to violence by that seen in the media.

Pollack’s Solutions & Tips

Pollack recommends we teach boys to release pent up anger and aggression through catharsis in a warm caring presence. Give them permission in an appropriate private space to vent his feelings openly and with inhibition. In your presence, invite them to scream, shout, cry, or voice whatever they need to as loudly or as vigorously as they need to purge painful feelings. Punching pillows or muffing sounds with a pillow can be used if noise is an issue. 

Violence prevention will be found in connection with friends, family, and parents. A boy who’s cared about will be more likely to care about others. When boys feel empathy for others and diminished personal shame, they can feel less shame about their own vulnerabilities and are less likely to commit violence. Boys need “violent-free zones” where they can safely remove their masks and speak about violence and fighting without fear of suffering shame, belittlement or retaliation.

Sports and non-violent high energy physical activity can be a transformative healthy expression of feelings as long as strict limits are set and proper safety equipment is utilized. It offers boys a positive healthy way to express a wide range of emotions, bond as friends, and boost their self-esteem; violence is a futile attempt to obtain similar these social benefits they desperately need. We must teach them that power need not mean power over others, but power with others. To do this we need to acknowledge the pain they’ve suffered, allow them to speak their feelings, and rid them of the seeds of shame that too often grow into the thorns of violence.

Tips to parents and families:

       -Discuss the complexities of adolescence honestly

       -Make regular “dates” with your son

       -Don’t wait to talk to him about sex, drugs, or other tricky subjects

       -Provide frequent affirmations

       -Show that you understand the adolescent crucible, share you own adolescent feelings of vulnerability

       -Listen empathetically

       -Make your home a safe place

       -Give boys your undivided attention at least once a day

       -Encourage the expression of a full range of emotions

       -When a boy expresses vulnerable feelings, avoid teasing or taunting him

       -Avoid using shaming language

       -Look beyond anger, aggression, and rambunctiousness

       -Express you love and empathy openly and generously

       -Let boys know they don’t need to become “sturdy oaks”

       -Create a model of masculinity that’s broad and inclusive

To mothers:

       -Talk openly about the Boy Code and teach others about the problem of the Boy Code

       -Teach your son about masculinity by talking about men you love and why you love them

       -Rotate parenting responsibilities

       -When your son is hurting, don’t hesitate to ask him whether he’d like to talk

       -Avoid shaming your boy if he refuses to talk, honor his need for timed-silence

       -When your boy seeks reconnection, try your best to be there for him

       -Experiment with connection through action

       -Don’t hold back

To fathers:

       -Stay attached no matter what and reconnect after separation

       -Stand by mom

       -Remember it’s who he is rather than what he does

       -Develop your own style of fatherhood

       -Don’t be a policeman dad

       -Show, rather than tell

       -Be aware of your own “father longings”

       -Real men show emotions

Viagra: What Does the Future Hold for the Relationships of Older Americans?

National Louis University

Research Evaluation & Methodology

Summer 1998

Dr. Christopher Clemmer

Group project by: Joyce Sweeney, Trish Anderson, Linda Israel, Marissa Green, Debbie Anthony

Introduction

The problem:  will Viagra have a negative impact on the emotional relationships of older Americans? AARP discourages the use of the term elderly and uses, instead, the term older Americans, young seniors, and older seniors. This concept is also supported by Journals on Gerontology. This project has taken us into some old and new territory. We chose this topic because of its challenge, and our belief in the value of working collaboratively to mirror an actual research project.  We were not disappointed.

Sex in the “golden year” has been a mystery, if not a surprise. Today’s older Americans grew up in a time when sex, at any age, was a secret. As gerontologist Ruth Weg states, “Anyone can be sexually responsive given adequate stimulation, but genital response is only one measure of the total sexual experience” (1). In other words, physiologically aging need not hamper sexual activity, more sexually significant may be one’s feelings about one’s self and one’s mate, one’s expectations, general physical condition, alcohol and drug intake, mood, living situation, ability to communicate about sex, and whether one has a partner.

“Sexuality is very much tied to the rest of the culture,” states anthropologist Jay Sokoowski, of the University of Maryland, “Among the Asisataic Indians, where women are repressed, sex represents male domination and women embrace menopause as an excuse not to engage in sex. On the other hand, he states, in socially equalition cultures, such as the South Pacific Islands, sex is openly discussed from childhood, it is engaged in for pleasure as well as procreation, and it continues, for both men and women throughout life” (2).

In our society, sexuality, in older people, has been the object of ridicule and pity. The underlying assumption is that continued sexual desire is pathetic and inappropriate, since sexual function, we have assumed, is diminished and unsatisfactory. In the late 1940’s Kinsey blew this myth wide open and opened the door to questioning this concept, through his Kinsey Report. In 1970, Masters and Johnson, emotional issues rather than organic problems are the main cause of impotence. Their treatment programs focused on appropriate sex information and facilitating verbal, emotional, and physical communication with the older sex partners. Health problems of older individuals have often been dismissed as unavoidable by products of aging, or treated with drugs that have had a negative impact on the psyche or have led to impotence – generally considered insignificant in older people by the medical professions.

Our paper will explore the available research on Viagra and the theoretical underpinnings of our question, “will Viagra have an impact on the emotional relations of older people?” Our research, via a review of the literature, and interviews with people in the medical field, has provided us with a historical sketch of Viagra since it became available to Americans in March of 1998.  We find that our research has raised more questions than it has answered and strongly indicate a need for additional study. As time progresses, and we have the opportunity for analysis of further research, we will have more credible statistics to support or disprove our hypotheses, that Viagra does have emotional consequences for older Americans. The data, available at this time, indicates that some harm is apparent and is consistent with the need for supplemental investigation.

Literature Review

Myths & Taboos

Meredith E. Drench and Rita H. Losee (1996) explored sexuality, psychosocial issues, and sexual capacities of older adults (sixty five and older) in connection with the rehabilitation nurse’s role in providing sexual counseling. Despite many deeply ingrained stereotypes, many elders can and do have sexual enjoyment (Drench & Losee 1996; Richardson 1995). Our society has internalized images of older adults as slow moving and sweet (Drench & Losee 1996).  Joan P. Byers (1983) discussed a survey of health professionals in which they used the following phrases to describe sex among the elderly: hard to imagine, nonexistent, discouraged by society, normal, impossible, slow, healthy, and, not very often. People erroneously assume that older adults: don’t desire sex, couldn’t do it if they wanted to, are too fragile physically and might hurt themselves, are unattractive and undesirable sexually, and the thought of older adults being sexual is perverse (Byers 1983). Elderly men are the blunt of jokes and often referred to as dirty old men (Byers 1983; Semmens 2 1997). Women who were once considered attractive girls, and mature interesting women are cast into sexual oblivion after fifty (Byers 1983; Richardson 1995).

Older adults who deviate from internalized taboos against their having a continuing appetite for and ability to maintain sexual relations are seen as abnormal or foolish (Drench & Losee 1996). This lack of understanding and insensitivity can lead to frustration and conflict among older people (Drench & Losee 1996). The notion that aging automatically means a loss of sexuality distorts our attitudes, norms, and values and can cause older adults to miss out on the physical contact they need (Drench & Losee 1996). Some older adults may repress their sexual feelings simply to avoid the disapproval and rejection as a result of taboos and stereotypes (Drench & Losee 1996).

In the nineteen sixties and early seventies, many long term care facilities actually restricted contact between the sexes to public areas so they could be monitored by staff (Byers 1983). Even married older adults were separated and if a spouse visited they were seldom allowed privacy (Byers 1983). These practices were unjust and required older adults to conform, give out their sexuality, and suffer with feelings of guilt because of remaining sexual feelings (Byers 1983).

Medicare guidelines now require nursing homes to provide private spaces for married couples (Drench & Losee 1996; Byers 1983). Some long term care facilities provide privacy for men and women whether they’re married or not (Drench & Losee 1996). Despite this progress, the sexuality of older clients still sometimes conflicts with attitudes of healthcare workers (Drench & Losee 1996).

Women’s Physical Changes

Aging brings a gradual decrease in the duration and intensity of physiological responses to sexual stimulation requiring more and longer stimulation during intercourse (Byers 1983; Richardson 1995). However, all four phases (excitement, plateau, orgasm and resolution) of sexual response still occur (Byers 1983). Orgasms may be shorter, less intense and might take longer to accomplish (Drench & Losee 1996; Richardson 1995). Unlike the male refractory period which increases, women can become aroused again without delay (Drench & Losee 1996).

Masters and Johnson’s studies showed that the main physical changes that aging females experience is due to losses of estrogen (Byers 1983; Semmens 1 1997). With age vaginal mucosa thins, lubrication diminishes, the vagina loses some elasticity and expansion, and shrinks in length and width (Drench & Losee 1996; Byers 1983). If intercourse is infrequent it could be uncomfortable (Drench & Losee 1996). Hence use it or lose it does apply here.

To continue sexual activity one needs to maintain regularity, be interested, and have emotional involvement among the partners (Drench & Losee 1996). Maintaining sexual relations also has some positive physical effects for older women: it helps maintain muscle tone, reduces the incidence of mild urinary incontinence, and regular sexual experience helps to retain their ability for multiple orgasms (Drench & Losee 1996). 

Men’s Physical Changes

Although the decrease in testosterone is slight compared to women’s great drop in estrogen, reduced secretions from the seminal vesicles and the prostate gland causes the semen to thin and reduces the amount of ejaculate (Drench & Losee 1996). Sperm remain active and can still be present in advanced age (Drench & Losee 1996). Older males have less ejaculatory tension, sexual flush, and perspiration which may lessen the intensity of pleasure, but doesn’t prevent sexual function even to age ninety (Drench & Losee 1996).

Older males need increased physical stimulation and time to get an erection (Drench & Losee 1996; Richardson 1995). After sixty, men are slower to get an erection, in penetrating a partner, and in ejaculating (Byers 1983). Erection is also lost faster after orgasm (Drench & Losee 1996. There is a greater time delay for recovery (hours or days) before older males are able to become erection again (Drench & Losee 1996; Richardson 1995). As men age there’s a greater frequency of intercourse without ejaculation along with less powerful ejaculation (Drench & Losee 1996).

According to the National Institutes of Health, erectile dysfunction is a myth of aging (Drench & Losee 1996). Potency is measured by erection not ejaculation and males don’t loose this ability solely through aging (Drench & Losee 1996). Men without partners are more likely to experience potency problems, many widowers regain their erectile function when they remarry (Drench & Losee 1996). Masters and Johnson found that the changes in aging males are quantitative rather than qualitative when compared to younger males (Byers 1983). The advantages are that older men can have better control of ejaculation and because arousal is slower, foreplay can be more leisurely (Byers 1983; Richardson 1995). From a partner’s point of view this can be a positive change. Men’s sexual responsiveness does decline, but the availability of partners and retention of youthful attitudes are significant factors in maintaining interest and activity (Drench & Losee 1996).

Psycho/Social Factors

Psychological factors in decreasing potency include: guilt or feelings of inadequacy, self-doubt, lack of knowledge, worries about masturbation or infidelity, fear of failure, fatigue, depression, boredom, worry over money, and the pressure to conform with cultural taboos about sex and aging may impact potency (Drench & Losee 1996). The mistaken notion about sexual activity being harmful after a heart attack, a hysterectomy, or a prostatectomy may also put a damper on one’s sex life (Byers 1983; Semmens 2 1997; Carter 1997).

Sexuality isn’t only about the physical act itself, it’s about love, caring, sharing and warmth expressed from one person to another; it helps us feel secure and comfortable (Byers 1983). Sexual appeal isn’t just about physical attraction, it’s includes assurance of one’s worth, validity, and ability to be loved (Drench & Losee 1996). These feelings can be extremely meaningful to older adults who have experienced many losses (Byers 1983).

A older adult experiencing depression is likely to have a decline in sexual interest and potency, but may erroneously attribute these symptoms as a natural part of the aging process (Drench & Losee 1996). For others, the nearness of or the risk of death may actually heighten sexual desire, which can then lead to guilt and shame (Drench & Losee 1996). A common cause of stopping sexual activity is the loss of a partner (Drench & Losee 1996). Enduring grief can preclude the pursuit of a new partner combined with the loss of confidence and familiarity, making new relationships threatening (Drench & Losee 1996). Many widows and widowers might not have been sexually active with their deceased partner for a long time, making it that much harder to start a new sexual relationship (Drench & Losee 1996). Older adults have had long experience with sexual taboos which can make it hard for them to talk about their sexual desires (Drench & Losee 1996). However, older men have had time to overcome inhibitions and have gained experience with lovemaking skills (Byers 1983).

Many factors can be involved in erectile dysfunction: lack of practice, unfamiliarity with a new partner, guilt, performance anxiety, diminished vascular flow, or delayed neurological reflexes which can then result in decreased self esteem and confidence (Drench & Losee 1996). Older widows have less sex after the loss of their partner than younger widows, but the sexual desire doesn’t differ by the age when one is widowed (Drench & Losee 1996).

Within our youth focused culture, older adults, especially women, are perceived as having lost sex appeal and are labeled as asexual (Drench & Losee 1996). Thus older women become self-conscious about their bodies which makes them avoid sexual contact (Drench & Losee 1996). Our society has focused on older adults who are sick and poor, rather than on the majority who are productive and healthy (Byers 1983). Youth oriented culture scorns signs of aging, seeing it as pathological rather than natural process, with hope that they can somehow prevent it in themselves (Byers 1983).

Drench and Losee (1996) assert that rehabilitation nurses play an important role in helping clients cope with age related changes. Sexual counseling provided for younger clients also needs to be provided for older adults (Drench & Losee 1996; Byers 1983). The rehabilitation nurse needs to be knowledgeable about sexual physiology, sexual needs, myths about elderly sexuality and be aware of their own and their older client attitudes and values around sexuality because older adults can be influenced by the attitudes of health professionals (Drench & Losee 1996; Byers 1983). (An implication for counseling is easily seen in this regard.) Patient education in a psychologically safe atmosphere is vital to discuss intimate issues such as fantasies, masturbation, and homosexuality which may need to be dealt with (Drench & Losee 1996; Byers 1983). A major role of the health professional may be in dispelling myths (Drench & Losee 1996) and assuaging guilt or moral apprehension (Byers 1983). Sexuality and its expression can enhance quality of life and is beginning to be recognized as an important part of the interpersonal relationships among older citizens (Drench & Losee 1996).

Studies

Byers (1983) discussed research done by Kinsey and others at the Center for the Study of Aging at Duke University. Although the elderly were only a small part of Kinsey’s study, they found that at sixty most males were capable sexually and women weren’t found to decline sexually until very late in life (Byers 1983). Longitudinal studies at Duke examined two hundred and fifty people age sixty to ninety four every three years over more than twenty years (Byers 1983). Fifteen percent of these people actually increased their sexual activity and interest as they aged (Byers 1983). Masters and Johnson’s research included interviews and observation of sexual acts (Byers 1983). Both researchers found that people in good health were able to enjoy sex beyond their seventies (Byers 1983). An older couple with a history of a good sex life is more likely to maintain vigor and interest, and is more likely to continue sexual activity with aging (Drench & Losee 1996; Byers 1983; Richardson 1995).

When a problem of sexual functioning does occur its cause usually fits within the following categories:

       -monotony in a repetitious sexual relationship

       -mental or physical fatigue

       -overindulgence in food or drink

       -preoccupation with career or economic pressure

       -physical or mental issues with one of the partners

       -performance anxiety relating to any of the above (Byers 1983).

One episode of impotence can alarm an older man so much that it discourages further attempts (Byers 1983). A prolonged illness of either partner can contribute to impotency (Byers 1983). Widowers may feel too guilty to remarry after the loss of their wife which may cause sexual difficulties (Byers 1983).

Although there are only a few studies of sexuality among older adults, one interesting study was done in nineteen eighty eight among upper middle class residents in ten California life-care communities (Richardson 1995). To be eligible for the study respondents couldn’t be on any regular medications or have daily medical or nursing needs (Richardson 1995). Although the average age of participants was eighty six, seventy percent of the males and fifty percent of the females thought often or very often about being close to or intimate with the opposite sex (Richardson 1995). Despite the fact that twenty nine percent of the men and fourteen percent of the women were married, fifty three percent of men and twenty five percent of women had regular sex partners (Richardson 1995).

Another study, with two hundred and fifty residents in fifteen nursing homes, found that although ninety one percent of the residents hadn’t been sexually active in the previous month, seventeen percent wanted to be, if they had a partner and the privacy to be active (Richardson 1995).  Despite some physical changes, older adults can and do continue, sexual interest and capacity even into the their nineties (Drench & Losee 1996).

The Meaning of Life

Patricia M. Burbank’s nineteen ninety two exploratory study explored the meaning of life among older adults. Most of us think of the meaning of life as an important, but elusive concept from the  domains of philosophy and theology (Burbank 1992). However, the meaning of life is a major concern to many nurses. Burbank (1992) cites J. Fitzpatrick (1983), “Those who have no meaning do not continue to live” (3) and posited that the meaning of life is intimately connected to our health. Studies have found a positive connection between depression and the loss of meaning in life which the authors view as a mental construct and a primary motivational life force (Burbank 1992).

The theoretical framework that guided Burbank’s (1992) study was symbolic interaction, which is a broad perspective within social psychology, useful in understanding people’s behavior in society. Meaning is seen as the central notion in symbolic interaction and refers to the meaning of symbols and situations (Burbank 1992). Rather than simply responding to events and situations, people give them meaning, and our responses are based on those meanings (Burbank 1992).

Burbank (1992) administered a questionnaire to eighty one older adults over sixty two (most respondents were White females in their mid seventies) who were affiliated with a senior center, some were home bound and required assistance to complete the questionnaire (The Fulfillment of Meaning Scale which is a likert type scale) (Burbank 1988). The study found that within a symbolic interaction perspective relationships are vital (Burbank 1992). Interaction with others is how we define situations and our meanings stem out of these situations, thus making relationships and interaction crucial to how we give and maintain meaning to situations (Burbank 1992). The majority of participants said relationships were what gave meaning to their lives (Burbank 1992). Burbank (1992) recommends that nurses become more aware of what’s meaningful to older adult clients and plan nursing interventions in ways that support or improve meaning for their clients (Burbank 1992). If life holds meaning through relationships, what happens when Viagra is added to the relationships of older adults?

And Then There Was Viagra …

Viagra, whose chemical name is sildenafil citrate is manufactured by Pfizer Labs, Inc (Pfizer 1998). Viagra is indicated for erectile dysfunction (Pfizer 1998). At recommended doses, Viagra has no effect without sexual stimulation (Pfizer  1998). It’s metabolized by the liver and is excreted mostly as metabolite in feces (Pfizer 1998). It’s absorbed orally with maximum plasma concentrations in thirty to one hundred twenty minutes (Pfizer 1998). If taken with a high fat meal absorption is slower (Pfizer Labs 1998). In eight double blind, placebo controlled crossover studies with patients with organic and psychogenic erectile dysfunction, sexual stimulation resulted in improved erectile ability as assessed by penile plethysmography after Viagra compared to placebo (Pfizer 1998). Most studies tested after sixty minutes (Pfizer 1998). Single doses of up to one hundred milligrams failed to produce electrocardiographic changes in normal male volunteers (Pfizer 1998).

Clinical studies assessed its effect on the abilities on men with erectile dysfunction to engage in sex and in many cases specifically to achieve and maintain an erection sufficient to perform satisfactory sexual activity (Pfizer 1998). Clients using Viagra demonstrated statistically significant improvement when compared to placebo in all twenty one studies (Pfizer 1998). At the end of the long term study (one year) eighty eight percent reported improved erections (Pfizer 1998). A review of the population subgroups showed efficacy regardless of baseline severity, etiology, race, or age (Pfizer 1998). Viagra was effective in patients with histories of coronary artery disease, coronary artery by pass surgery, high blood pressure, peripheral vascular disease, diabetes, radical prostatectomy, prostatic trans-urethral resection, depression and antidepressant or antipsychotic drugs, spinal cord injury, and antihypertensive, or diuretic drugs (Pfizer 1998).

A thorough medical history with physical exam are recommended to diagnose erectile dysfunction, determine its cause, and identify appropriate treatment before prescribing (Pfizer 1998). There is a degree of cardiac risk involved in sexual activity, thus it is suggested that physicians consider cardiovascular status prior to prescribing Viagra (Pfizer 1998). The most common side effects were reported from long term (over one year) studies in order of frequency are: headache, flushing, dyspepsia, nasal congestion, and urinary tract infection (Pfizer 1998). 

For most patients the recommended dose is fifty milligrams, taken as needed, one hour before sexual activity, but may also be taken from thirty minutes to four hours before sex (Pfizer 1998). Dosage may be increased up to one hundred milligrams or decreased to twenty five milligrams (Pfizer 1998). The maximum dosage frequency is once a day (Pfizer 1998). 

Popular Media Coverage

Popular magazines, newspapers, television, and talk radio shows abound with information and articles on Viagra. A New York Times article (May 1998), suggested that marriage and sex counselors are uneasy about men overhauling their sex lives without any guidelines regarding the potential earthquake they may be introducing into their emotional lives (Nordheimer 1998).

A Washington Post article (May, 1998) suggested that Viagra may have a downside for some couples (Wee 1998). One woman said she and her husband had sex five nights a week in their twenties, but after thirty three years of marriage, they might have sex on Saturday nights if they’re not too tired (Wee 1998). Although they may go weeks without sex, they still enjoy it once they get going (Wee 1998). They now have a deep and comfortable relationship without the sex (Wee 1998). The article relates the view of urologist, Myron Murdock, National Medical Director of the Impotence Institute of America (involved in Viagra clinical trials), who warns, that as time passes, we’re going to see some complex psychological things happening in the relationships of patients using Viagra (Wee 1998). Murdock predicts that some impotent men will discontinue Viagra due to the increased stress and anxiety that sex adds to their relationships, stress and anxiety they’re not able to cope with (Wee 1998).

A Chicago Tribune (May 1998) article questions what effect the “Viagra frenzy” (4) might have in marital bedrooms where sleep has been the primary activity for years (Condor & Black 1998). For the men Viagra has helped and for Pfizer stockholders, Viagra is a sweet miracle (Condor & Black 1998). But the article asks, as we do, what issues about aging and sexuality in our American culture is Viagra bringing out and how will it effect our senior’s relationships (Condor & Black 1998)? Which brings us to the kinds of questions we would like to ask about Viagra’s effect on the relationships of our grandparents, parents, our future sexual selves, and to our children. 

Hypothesis

The main object of our exploratory study is to determine the psychological effects that taking Viagra would have on relationships in elderly couples. The hypothesis is that taking Viagra will have psychological effects on older Americans’ ages 65 and older. Up to date there have been many studies done on the medical and or physical side effects of Viagra. In many of the articles we read the researchers talked about possible physical side effects such as heart problems and possible side effects of taking Viagra in combination with other medicines. From what we found however there has been very little research done on the possible psychological effects Viagra could have on older Americans’ relationships. The psychological effects of a drug are just as important as the physical ones are.

The aging process can be difficult for both men and women, but research has shown that men generally have a more difficult time adjusting to these changes.  Men are conditioned throughout their lives to be strong, in control and independent.  Men can be particularly devastated by the losses associated with aging, especially their capacity to have a sexual relationship.

Prior to the development of Viagra, older couples just took it for granted that they would no longer have that youthful, passionate sexual experience.  Now, Viagra offers these couples a “new lease on life,” or at least some of that lost passion. There are some concerns in the elderly community with regard to health risks as well as mental health risks and taking Viagra.

Dr. Steven Lamm, a teacher at the New York University School of Medicine and is author of The Virility Solution states, “this drug touches the core of malehood” (5).  He also states that “some couples are going to be disappointed that this hasn’t enhanced their intimacy, and for many that will throw their relationships out of synch” (5).

There are many possible psychological  effects that could take place after taking Viagra. Couples that have not been able to perform sexually for years many times learn to be intimate in other ways other than just sex. In many of the articles we read the couples referred to their relationship as a strong companionship that they have grown to love on a new level. Putting Viagra on the market adds a pressure to one or both partners about having sex again. Many women may also feel pressure to abide by this because of a fear that their husbands may stray from the marriage and have an affair. Another possible psychological outcome could be a great disappointment on the actual effects Viagra will have on a couple.

Another words many people may think that by taking this “magic” pill many of their intimacy and or sexual “issues” will just vanish. Unfortunately a pill can not do that, any underlying intimacy or communication problems that were there prior to taking Viagra will still be there after the fact. If these types of issues are not addressed to couples prior to taking this drug it could potentially cause great anxieties and new “issues” in the relationship.

It does seem hopeful that the psychological effects of Viagra on relationships could in fact be the next step. In one of the articles we read it talked about this being the next step in research. For individuals to truly benefit from this drug the psychological as well as the physical effects should be studied

Our approach is a holistic one that would place equal importance on the mind and body working together. Couples who are thinking of taking this drug need to be aware of the potential negative effects it could have on their relationship if they are taking it for the wrong reasons. For instance if they think that it will help underlying sexual issues of any kind, it won’t. Couples should have a realistic understanding of what Viagra will and won’t do for their marriage. That is not to say that Viagra’s effects are all negative. In fact it is quite the opposite as long as couples know the possible effects. Many experts agree that taking Viagra could in fact be magical, for committed caring couples whose sex life has been put on hold for many years.  A way to test our hypothesis would be to give confidential questionnaires to older Americans after taking Viagra. We have documented how we would go about doing this in the next section.

Methodology

We have selected the use of questionnaires as our form of research and data collection. We feel the nature of our questions are very sensitive and people might feel less threatened and more prone to giving accurate information. We will request the medical professional administering the Viagra give an open-end form of the questionnaire to the patient upon initial prescription of Viagra. This will be used as a pretest to form the more closed-end questions we will be using on the research questionnaire. We will request the health professional follow up with the research questionnaire approximately six months to a year after the treatment begins and request their cooperation. They would be accompanied by a post-paid, addressed envelope for return. This would help insure patient confidentiality and anonymity. We will be using two identical questionnaires, one to be completed by the male prescribed Viagra and one completed by his partner. They will be consecutively numbered 1a, 1b, 2a, 2b, etc, so that information can be tracked by couple. By using this split-ballot type questionnaire, we hope to get an accurate picture of the relationship changes, if any, from both perspectives.

Questions will be both closed-ended and open-ended, with a comment section provided at the end of the questionnaire for elaboration. Information requested will include relationship and general health problems prior to Viagra use, and relationship and specific health problems after Viagra use. We will also request information regarding any new effects on health or relationship since Viagra. Questionnaire respondents will be asked if they would be willing to participate in any future interviews conducted. A representative sample of the questionnaire is included at the end of this paper.

SONG

What goes up must come down

If I take Viagra will my life turn around

Talkin bout my troubles is a crying shame

That’s why this Viagra gonna give me some fame

You got no passion … you got no hope

Praying for a miracle so I can cope

Talkin bout my troubles and I never learn

Give me some Viagra, let my maleness return

Chorus:

What if my wife tells me not tonight

When I finally get this erection

What if I can’t perform tonight

I’ll end up in a deep depression …………

Someone is waiting just for me

If it’s not my spouse I’ll pay a fee

Could be a problem, don’t you see

Research for Viagra should include psychology …..…

This is my story, I wanted you to know

What can happen if it starts to grow

I hope and I pray there’ll come a day

When Viagra gonna work for me in every way

Chorus:

What if my wife tells me not tonight

When I finally get this erection

What if I can’t perform tonight

I’ll end up in a deep depression …………

What goes up must come down

If I take Viagra will my life turn around

Talkin bout my troubles is a crying shame

That’s why this Viagra gonna give me some fame

End Notes

1     Weg, Ruth (1989, Sept/Oct).  The Biological Facts: Myth Versus Reality. Geriatric Nursing. p. 305.

2     Sokolowski, Jay. (1982, July/Aug). Sexual Behavior of the Aged.  Gerontologic Review. vol. 15, pp. 214-215.

3     Burbank, Patricia M.  (1992, Sept). An Exploratory Study: Assessing the Meaning of Life Among Older Adult Clients.  Journal of Gerontological Nursing. pp. 19.

4     Condor, Bob. & Black, Lisa. (1998, May 3). Couples Adjusting to Life with Viagra. Chicago Tribune. Sec 1, p.5, col 5.

5     Berkowitz, Harry., Vincent, Stuart., & Talan, Jamie. (1998, May 3). Little Pill Big Stir: As Demand for Potent Viagra Grows, So Do Concerns. Newsday, Internet.

Work Cited

Burbank, Patricia M. (1992, Sept). An Exploratory Study: Assessing the Meaning of Life Among Older Adult Clients. Journal of Gerontological Nursing. pp. 19-28.

Byers, Joan P. (1983, Sept/Oct). Sexuality and the Elderly. Geriatric Nursing. pp. 293-297.  

Carter, Ann, M.D. (1997). Sexuality and Age: How Does Age Affect Sexuality? First Search: HealthRefCtr. Clinical Reference Systems Ltd, p. 2235.

Condor, Bob & Black, Lisa. (1998, May 3). Couples Adjusting to Life with Viagra. Chicago Tribune. Sec 1, p.1, col 5.

Drench, Meredith E. & Losee, Rita H. (1996, May/June). Sexuality and Sexual Capacities of Elderly People. Rehabilitation Nursing. vol. 21, n 3, pp. 118-123.

Nordheimer, Jon. (1998, May 10). Some Couples May Find Viagra a Home Wrecker. New York Times. sec 9, p.2, col 1.  

Pfizer Labs, Inc. (1998, May). Viagra  (sildenafil citrate) tablets. Drug Information Insert. Description, Clinical Pharmacology, Indications and Uses, Contraindications, Precautions, Adverse Reactions,        Overdosage, Dosage and Administration, and How Supplied.

Richardson, James P. (1995). Sexuality in the Nursing Home Patient. American Family Physician. v 51, n 1, pp. 121 (4).

1-Semmens, P. James, M.D. (1997, Dec). Older Adults and Problems with Sexuality. First Search: HealthRefCtr. Clinical Reference Systems Ltd., p. 2153.

2-Semmens, P. James, M.D. (1997, Dec). Psychological and Social Problems of Midlife Sexuality. First Search: HealthRefCtr. Clinical Reference Systems Ltd, p. 2624.

Sokolowski, Jay. (1982, July/Aug). Sexual Behavior of the Aged. Gerontologic Review. vol. 5, pp.  214-215.

Wee, Eric, L. (1998, May 6). Viagra? Not Tonight, Dear. For Some Couples, the Anti-impotence Drug Has a Downside.  Washington Post.  Sec D, p. 1, col 3.

Weg, Ruth (1989, Sept/Oct). The Biological Facts: Myth Versus Reality. Geriatric Nursing. p. 305

Questionnaire Critique: Is His Testosterone Low? Are Men Actually: The Moodier Sex?

Research Evaluation & Methodology

Rev. Dr. Christopher L. Clemmer

June 30,1998

Assignment

Claire, Paul. (1997). Men: The Moodier Sex? American Health for Women. v.16, n.10, pp. 31).

The Questionnaire: Is His Testosterone Low?

       If a man in your life always seems to be in a bad mood, he may have a testosterone deficiency. To find out, have him take the following quiz, developed by John E. Morley, M.D., director of geriatric medicine at St. Louis University School of Medicine.

1.    Do you have a decreased sex drive?                              Yes [ ]   No [ ]

2.    Have your erections gotten weaker in the last few years?           Yes [ ]   No [ ]         

3.    Do you lack energy?                                               Yes [ ]   No [ ]

4.    Has your strength or endurance decreased?           Yes [ ]   No [ ]

5.    Have you gotten shorter in the last few years?           Yes [ ]   No [ ]

6.    Have you lost interest in things you once enjoyed? Yes [ ]   No [ ]   

7.    Are you often sad and/or grumpy?                           Yes [ ]   No [ ]

8.    Has your sports performance suffered recently, even though you’re not injured?                                                            Yes [ ]   No           

9.    Do you fall asleep after dining?                                  Yes [ ]   No [ ]

10. Have you been performing poorly at work?           Yes [ ]   No [ ]

SCORING: A “yes” to the first or second question, along with at least two other affirmatives, suggests your partner may have a testosterone deficiency and should consult his doctor.

Writer Paul Claire specializes in men’s health issues.  Copyright: 1997 RD Publications Inc.

Claire, Paul. (1997). Men: The Moodier Sex?  American Health for Women, v.16, n.10, pp.31(2)

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My Questionnaire Critique: Is His Testosterone Low?

1. Originator of questionnaire

According to Paul Claire (1997), the questionnaire was developed by John E. Morley MD, director of Geriatric Medicine at St. Louis University School of Medicine. (See attached article and questionnaire).

2. Expressed purpose of questionnaire

To assess for male testosterone deficiency at home.

3. What type of questions does it use?

The questions are closed, with forced choice, yes or no responses required. 

4. What type of format does it use?

The format is a relatively simple list of ten questions aimed at finding symptoms of testosterone deficiency. The format does not follow a typical slow warm up to start, then the sensitive questions, and then a cool down with easier questions. It starts right out asking about the person’s sex drive and erection strength. It’s designed to be used in the home by a wife who judges that their husband, “always seems to be in a bad mood.” If a wife finds that her spouse does seem to have bad moods, it then suggests that she have him take the questionnaire.

5. What is the best question?

I’m resistive to identifying a best question because I find the questionnaire troubling. If I must, I suppose the best question would be the first, “Do you have a decreased sex drive?” It stands to rule out whether a man fits the stereotypical norm of always being interested in sex and if he’s not there must be something wrong with him. It’s also most tied to testosterone deficiency in our minds, whether it’s true or not. It certainly gets right to the vulnerable part of male ego. When placed with the next question, “Have your erections gotten weaker …? it gets at a dreaded fear a man might have, making him fair game to want to grab a pill that offers an easy cure that will bring back their ability to live up to their proscribed stereotypical role. It’s not the best question for identifying a medical problem of making a diagnosis at home. It’s actually the best marketing question for those who seek to sell their product … which is testosterone. I’m curious whether Dr. Morley has a connection with the manufacturers of testosterone.

6. What is the worst question?

Do you lack energy? This is so obscure. There could be a myriad of reasons why a man might lack energy, many of them certainly might not necessarily having anything to do with their testosterone level. Lacking energy can range from normal variations, low thyroid hormone, cancer, slow undiagnosed internal bleeding, depression, grief, or from a sense of feeling inadequate about not living up to societal norms of masculinity itself.     

7. Do you find any problems with the questionnaire?

Yes, I have many problems with this questionnaire. First of all, I have a problem with it being in a magazine for the average person to use because the questions are so general and could have so many complex ramifications. It’s frightening to think that a woman might actually use this questionnaire to evaluate her husband’s symptoms and send him off a doctor seeking a prescription. So many of the questions could relate to so many other problems other than a low testosterone level. In the state of cost cutting in health care it would certainly be cheap for a doctor to address a patient’s symptoms with a prescription in response to a wife’s urging after utilizing this questionnaire.

A man’s depression could be missed, an undiagnosed silent disease could go on and maybe even be made worse by taking testosterone because he failed this questionnaire. As a nurse for over thirty years, I know that doctors do attempt to meet public demands for the latest fads in treatment and to solve complex problems simply and effortlessly with a pill – it looks like an easy fix that holds the potential to cause serious harm to men.   

Secondly, “bad moods” are very subjective initial criteria to start a wife out looking for a testosterone deficiency. Thirdly, attaching these symptoms with sexuality places them with sex role stereotypes and then connects them to a simple medical cure in a pill. If a man answered these questions positively the results could be seen as a prescription to fulfill the stereotype of real men. According to this questionnaire real men:

       1.    Have a high sex drive and perform well sexually

       2.    Have strong erections

       3.    Have lots of energy

       4.    Have strength and endurance

       5.    Are tall

       6.    Have high interest in sex and sports

       7.    Are happy, and not crabby

       8.    Perform well in sports

       9.    Stay awake after dinner

       10.  Perform well at work

The questions seem to be powerful marketing tools that offer hope of curing this apparent deficiency, while at the same time, offering profit to drug manufacturers. Because testosterone is a prescription medication it also means men must visit their doctor’s, thus keeping the doctor’s bank account filled too. Many in the general public believe whatever doctors say simply because they’re doctors. Since this questionnaire was written by a doctor, the questionnaire itself has the potential to plant seeds in people’s minds that if they have these symptoms, they must have a testosterone deficiency.

Instructions for scoring the questionnaire claim that a “yes” to the first or second question along with two other “yes” answers suggests testosterone deficiency. If I go back and answer these questions for my ex-husband during the early nineteen eighties it would look like this:

He had a decreased sex drive, he started falling asleep after dinner, and he was extremely worried about his performance at work. According to the quiz he was a candidate to receive testosterone. For the previous ten years, my husband had a very high sex interest, never fell asleep after meals, and felt confident about his performance at work. In the early eighties he worked for Illinois Bell which went through a divestiture that threatened most workers jobs. He couldn’t sleep worrying about losing his job, so he was tired after eating. It’s hard for a man who cares about his family’s economic well-being to remain focused on sex, not matter how interested he might be. This was the cause of his symptoms, not a lack of testosterone, not his sexuality, his manhood, or any disease pathology.  

8. What could you do to make it better?

Not have it at all or not have it in a magazine for the average person’s use. It might be more appropriate in The Journal of the American Medical Association or The New England Journal of Medicine to offer the possibility of testosterone deficiency to doctors attempting to diagnosis a patient with these types of complaints. With the possibility of testosterone deficiency in the back of their minds, doctors can then look at the man and his symptoms holistically within the context of the medical history, physical exam, and present life situation – not just a list of symptoms alone.

This questionnaire puts the symptoms in a framework that connects male hormone deficiency and sexuality, which can be misleading. I’m concerned about this questionnaire offering flimsy hope and easy solutions to complex medical, psychological and societal problems.

9. Would you trust the conclusions of this questionnaire?

Absolutely not. I’m concerned about the ramifications of this questionnaire because it could be used as a list defining and focusing on how a male should be. As if sexual performance and energy level are valid measures of who a man is. Stereotypical sports and sexual behaviors are not what make a man a man. The worst part with this questionnaire is that it connects male sexuality and sports performance with an easy fix – just take this pill. In a culture in which some men are willing to risk their lives by taking steroids to build their bodies and enhance their sports performance, this is a dangerous questionnaire.

Estrogen replacements first came out in the early nineteen sixties. I remember their being touted as a way for women to regain their sexual potential. To keep their appearance youthful and beautiful, to maintain their energy, and to maintain or increase their libido. These hormone replacements were used on women before adequate research was done to learn about any possible negative effects. That research has only recently begun to be done – it’s still a controversial issue whether women should use estrogen replacements.

I hope this same thing doesn’t happen to men. I hope our cultural focus on staying young and sexually potent doesn’t lead men to an untested pill that may have serious adverse effects on their health. Adequate research on potential physical side effects, along with public and private discourse, and reflection on what drug will mean in men’s lives should be our priority.

Feminists are critical of how women have been sexualized in our culture. This new societal focus on male sexuality is doing the same thing to men which I find sad and worrisome. Neither sex should be sexualized in this manner. It’s just as morally wrong to set up standards for male performance as it has been to place expectations on women to focus on making themselves beautiful, sexually attractive and responsive to males. I believe that just as women are much more than their sexuality, men are much more than their erectile ability or disability. These questions set up a list of criteria for how males should be. It fails to consider so many other complex and often invisible aspects of life that may lead to these symptoms. What the questions may do is send men and their wives to doctor’s offices looking for magic potions to fix male physicality without also looking at the psychology, spirituality and humanness of the men.

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Are Men Actually: The Moodier Sex?

Claire, Paul. (1997). Men: The Moodier Sex? American Health for Women. v.16, n.10, pp. 31).

Most men will deny it, but new research shows they are every bit as moody as women. Experts tell you how to handle six common male dispositions. Although society often assumes that moodiness is a “woman thing,” science is slowly confirming what we’ve long suspected: His mood swings can be just as frequent and diverse as yours. The male hormone testosterone is chiefly responsible, says San Diego psychiatrist Theresa L. Crenshaw, M.D., a pioneer in this developing area of study. The hormone fluctuates throughout his life, gradually declining after age 40; it also has daily highs and lows.

Since a man’s testosterone level can make him feel not only sexual but also depressed, aggressive, lonely, happy or irritable, its ebb and flow can significantly sharpen or dull these moods, says Dr. Crenshaw, author of The Alchemy of Love and Lust, “Almost all hormones, male or female, have rhythms,” she explains.

“Monumental changes in these rhythms can occur over brief periods. Since testosterone is a complex hormone, we don’t fully understand how it works. But all men experience these shifts in hormone levels.”

The shifts are especially noticeable during stressful times, because as tension increases, testosterone decreases. Although many people associate high testosterone levels with aggression and irritability, low levels cause these symptoms too, says Ted Quigley, M.D., a reproductive endocrinologist in San Diego. In a 1996 Swedish study, the testosterone levels of 50 men were measured on each of the two days before the potentially stressful situation of participating in clinical research. Between measurements, the mean testosterone level of the group fell nearly 50%.

“The trouble is, men aren’t focused on their changing moods,” explains Dr. Quigley. “To make matters worse, it’s often difficult to get them to discuss with friends and family what they’re feeling.” Such blindness and denial can cause many problems in a relationship, because one of the keys to a successful and happy partnership is being able to understand and adjust to a mate’s changing temperaments.

Experts warn that the stress of the holidays often makes men and women more temperamental, so we’ve compiled this guide to the six most common mood shifts your man Is likely to exhibit, along with advice on how to get through each one. Consider it your small role in maintaining peace on Earth this holiday season.

ANXIETY The cause: This mood is typically triggered by apprehension–the gnawing fear that he’ll never fulfill work or home responsibilities, says James Levine, Ed.D., director of the Fatherhood Project at the Families and Work Institute in New York City and author of Working Fathers: New Strategies for Balancing Work and Family. “Men have redefined what it means to be a success,” Dr. Levine says. “They’re still concerned about doing well at work, but they also want to build strong relationships at home. As a result, men have more to worry about.”<p> The effects: Some men become irritable, withdrawn or compulsive (drinking too much, working overtime), says Ronald Podell, M.D., an assistant clinical professor of psychiatry at UCLA.

Others may experience physical symptoms such as headaches and stomach upset. Still others may simply vent by yelling and cursing when things get tense. What he can do: Commiserate with his friends. Once he realizes he’s not the only guy on the planet with these concerns, he’ll feel better and be able to brainstorm solutions to ease the stress in his life, says Dr. Levine.

What you can do: Don’t let his bad mood infect you. Resist obsessing about his maddening actions or words and instead say, “Your behavior has changed, your way of speaking to me has changed, and I’m having trouble with that. What’s it all about?” Once he begins to discuss the problem with you, don’t interrupt him with a solution, advises Dr. Levine. Wait until you’ve given him time to talk.

MILD DEPRESSION The cause: The blues often stem from what Dr. Podell calls a “misery gap,” the perception of what a person had hoped life would be like vs. the reality of what it is. While the anxious man has yet to realize he can’t meet all the expectations, the depressed guy sees the difference between what he can and can’t do and is saddened by it.

The effects: Mild depression normally creates reclusiveness and/or irritability in men. He wants to be alone, and when you ask him why, he snaps at you.

What he can do: Exercise and eat right. Negative moods such as depression are often compounded by stress and fatigue, typically brought on by a lack of sleep, a poor diet, too much alcohol and inactivity, explains Robert E. Thayer, Ph.D., a professor of psychology at California State University in Long Beach and author of The Origin of Everyday Moods.

What you can do: Make sure you both eat healthful food. And after dinner, suggest going for a brisk walk or a bike ride. Such simple things should help lift his mood (and yours). If the depression persists for more than two weeks, it may signal a more severe problem, so consider professional help. For a referral to a psychiatrist who specializes in depression, contact the American Psychiatric Association in Washington at 202-6000.

LONELINESS The cause: Loneliness is more common during the holiday season because it’s often triggered by memories of festivities with a now deceased parent or other loved ones.

The effects: This mood can be similar to depression but generally comes and goes.

What he can do: Make an effort to think positively during low-energy periods. A man’s natural energy level tends to be low when he awakens, then rises slowly to its high point in the late morning or early afternoon, says Dr. Thayer. Male energy declines again in mid to late afternoon, briefly rebounds a bit in the early evening, and drops to its lowest level toward bedtime.

What you can do: Don’t bring up troubling matters or try to handle stressful situations at low-energy times. Any loneliness that creeps in won’t be as bothersome to him if you can steer, him away from dwelling on it when he’s naturally down.

ANGER The cause: Men are brought up to become angry and resentful when they feel sad or depressed. It’s their way of protecting themselves from their own feelings, says Dr. Podell.

The effects: He blows up over small things such as a flat tire or a Lakers loss.

What he can do: Examine the roots of his feelings. Once he addresses the real issue, his angry outbursts should diminish.

What you can do: Don’t get drawn into an argument or tell him it’s silly to be upset; that will only fuel the anger. In a calmer moment, help him address the real problem.

EUPHORIA The cause: This extremely upbeat mood is usually prompted by celebrating with friends and relatives, getting that annual bonus check, and, of course, watching kids experience the excitement of the holidays.

The effects: The signs are obvious, but one that isn’t so easy to recognize (at least until it’s too late) is overspending. Impulsiveness can also spill over into your social life; for instance your partner may say yes to three cocktail parties in one night.

What he can do: Enjoy this seasonal high, but resist making major decisions on the spur of the moment.

What you can do: No matter how Scrooge-like it may seem, set a holiday budget (including ceilings on gifts for each other), and review your social calendar at the end of each week. Cut back where necessary. Other than that, you can let this mood infect you.

ROMANCE The cause: That twinkle in his eye may be a result of all those good smells emanating from your kitchen. Alan R. Hirsch, M.D., neurological director of the Smell and Taste Treatment and Research Foundation in Chicago, found that the scent of baking cinnamon buns makes men more amorous. He speculates that the odor triggers warm, nostalgic feelings, and that other homey aromas might do the same.

The effects. You get flowers, chocolates and lots of romance.

What he can do: Have another bun. What you can do: Keep baking.

Men Need To Talk About Their Sexual Abuse | Seth Shelley | TEDxUNBC

December 13, 2017

TEDx Talks

Pastor Seth Shelley takes us on an emotional and at times difficult journey about male sexual violence. He brings forward his own story of sexual assault to ask men to open up about their personal stories too. Recorded at TEDxUNBC in Prince George, BC. Seth speaks to an issue common around the world, sexual assault. However, it is men who also need to share their stories of abuse. Far too many men are silent about their own stories of trauma and eventual healing. It is our society’s ideas around masculinity which prevent men from opening up, and steal their narratives from them. Only through sharing with friends and family do we reclaim our stories for ourselves. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx Graduating from Summit Pacific Bible College in 2012 with a BA in Religion, Seth has pastored in Western Canada for the past 5 years. Currently he is the Associate Pastor at Timbers Community Church in Prince George, BC where his role is to provide counselling services, preform weddings and funerals, organize events for the community and a variety of other things. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

10 Things Men Do That Make Their Depression Worse

10 Things Men Do That Make Their Depression Worse

By John D. Moore, PhD
~ 4 min read

At blogs.psychcentral.com

https://blogs.psychcentral.com/life-goals/2017/08/men-depression-worse/?utm_source=Psych+Central+Weekly+Newsletter&utm_campaign=12484be6ff-GEN_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_c648d0eafd-12484be6ff-29826629

Knights Without Armour: A Guide to the Inner Lives of Men

By Aaron R. Kipnis, PhD. (2004)

From Amazon.com: “Knights Without Armor: A Guide to The Inner Lives of Men By Aaron R. Kipnis, Ph.D. A powerful volume and helpful guide – Publishers Weekly Thoughtful and provocative – San Francisco Chronicle Kipnis’ elegant portraits of men offer poignant support for his claims – Los Angeles Times A fresh vision that points the way for a new male psychology (from foreword by Robert A. Johnson) From the publisher: This completely revised and new edition offers any reader real insights into the often-private thoughts of men. It represents many years of practice, research and consulting devoted to educating parents, teachers and counselors about key aspects of male psychology that are often poorly understood in treatment and education. For women who want to better understand their relationships with men and for men who want to hear some straight talk from men who are courageously revisioning their lives, this book will be quite helpful. Dr Aaron Kipnis is a psychologist and full time professor in Santa Barbara, CA. He is the author of Angry Young Men, What Women and Men Really Want, and many other works about the inner lives of men and boys. For more information, online articles, vitae and press kit please visit: www.malepsych.com or his academic site www.online.pacfica.edu/kipnis”