25. The benefits and drawbacks of androgen supplementation for the elderly and precautions for sexual hygiene in old age.

The benefits and drawbacks of androgen supplementation for sexual function in the elderly

As men age, their testicular function gradually declines, leading to a decrease in androgen secretion and changes in sexual function. So, can androgen supplementation improve sexual function?

For men with normal endogenous testosterone secretion, exogenous supplementation of male hormones will not enhance libido or sexual performance. On the contrary, long-term use of large or moderate doses of male hormones can inhibit the hypothalamus-pituitary-testicular axis through negative feedback mechanisms, leading to testicular atrophy and reduced or absent sperm production.

In older men, testosterone levels decrease. Exogenous testosterone supplementation, both theoretically and based on actual research, seems to improve sexual function in some individuals. However, double-blind studies have failed to confirm the enhancing effect of male hormones on sexual function in older men. The reason is that when these individuals were given a placebo dose with no pharmacological effect (and were suggested to the subjects that they were taking testosterone), the same effect of enhanced sexual function was observed. Therefore, it is believed that the improved sexual function observed in some older men after testosterone supplementation is actually a result of their superstitious belief in testosterone, or psychological reliance.

The vast majority of elderly men have had extensive sexual experience, unlike those with congenital testicular hypoplasia and low sexual function. Long-term use of sex hormones not only has inconsistent effects but also poses health risks, such as benign prostatic hyperplasia and gynecomastia (male breast development) caused by the metabolism of exogenous androgens into estrogens.

Therefore, in general, the use of male hormone preparations by older men is more harmful than beneficial and should not be attempted lightly. This is because the decline in sex hormone levels in men is much slower than in women with age, and most men can adapt to this change.

Of course, in some men, androgen levels decline more rapidly with age, reaching very low levels in old age. Some men over 50 experience a decline in physical strength and sexual function, along with symptoms of male menopause such as dizziness, mood swings, and other signs of male menopause. In these cases, androgen supplementation can be used to increase androgen levels in the blood. This can not only improve symptoms of menopause such as depression, headaches, insomnia, and anxiety, but also enhance libido. Androgen supplementation is appropriate for these individuals, but it should be used under the guidance and close monitoring of a doctor to avoid side effects.

Currently, research on sex hormone supplementation in the elderly is not yet in-depth. Issues such as how to determine the indications, objective indicators of efficacy, and prevention of side effects have not yet been properly resolved. However, we firmly believe that with the development of medical science, the mystery of the relationship between sex hormones and human aging will be completely unveiled, and people will certainly further utilize sex hormones to play their due role in rejuvenating the human body.

Precautions for sexual hygiene in the elderly

The term "old age" here refers to people over 50 years old. During old age, sexual function begins to decline due to a decrease in endocrine hormones. However, individual differences exist due to variations in physical condition, psychological state, and living environment.

The sexual habits of elderly couples are often carried over from their youth, and these habits have a significant impact on their sex life in old age. If they have maintained a harmonious and regular sex life since their youth, their sexual activity will likely continue into old age, even into a very old age. However, if a man has been indifferent to sex in his youth for various reasons, it is unlikely that he will be able to "revive" his sex life in old age.

Many elderly people suffer from hypertension, coronary heart disease, heart failure, and other chronic illnesses. So how should they approach their sex life?

Due to the influence of thousands of years of traditional beliefs, abstinence has long been considered a secret to longevity for the elderly. In fact, normal sexual activity is a physiological activity, and people who have fulfilling sex lives are bound to feel physically and mentally comfortable, emotionally stable, and conducive to restoring their health.

Foreign scholars have conducted surveys on blood pressure, heart rate, and other parameters during sexual activity in healthy individuals, patients with coronary heart disease, and patients with myocardial infarction. These studies indicate that sexual activity is equivalent to a moderate-intensity exercise session. For patients with coronary heart disease, it does not exceed the cardiac load during a grade II exercise test on an electrocardiogram, or the effort exerted by their heart is equivalent to the cardiac activity required to cross two roads at a certain walking speed-a task that most elderly people can manage. Therefore, aside from certain anatomical and physiological impairments, most sexual dysfunctions in elderly patients are caused by psychological factors such as fear and depression.

Elderly patients with coronary heart disease should avoid vigorous and excessively prolonged sexual activity; instead, they should proceed slowly and gradually. Excessive exertion can trigger arrhythmia in patients with coronary heart disease. During intercourse, choose positions that allow for relaxation, such as the woman-on-top, side-lying, or sitting positions, as these require less physical exertion. Additionally, patients should avoid intercourse immediately after a large meal or drink. After a large meal, blood is concentrated in the digestive system, which can affect the function of the circulatory system. Alcohol can reduce cardiac index and stroke volume in heart patients.

Elderly people with hypertension should avoid excessive sexual activity. For those experiencing mental stress, a small amount of sedatives may be taken. The frequency and duration of sexual activity should be controlled, as it puts a strain on the nervous system and cardiovascular system. Patients with very high blood pressure should abstain from sexual activity altogether to prevent stroke caused by ruptured blood vessels in the brain due to excessively high blood pressure.

To reduce the mental and physical strain of sexual intercourse for the elderly, mutual caressing is recommended as the primary method. Human sexual desire is divided into two types: the desire to expel and the desire for contact. The desire to expel is the natural fullness of the body under the influence of sex hormones during sexual maturity, and the desire to expel this fullness, such as through erection and ejaculation. The desire for contact refers to the wish for physical contact between partners; it is not affected by age and exists throughout life. Therefore, due to the decline in physical and mental health, the elderly can utilize the desire for contact-that is, close physical contact, hugging, caressing, and mutual stimulation of the sexual organs-to maintain the affection between husband and wife for a long time. These behaviors can also be called quasi-sexual intercourse behaviors.