Aging changes in the male reproductive system may include changes in testicular tissue, sperm production, and erectile function. These changes usually occur gradually.
Andropause; Male reproductive changes
Unlike women, men do not experience a major, rapid (over several months) change in fertility as they age (like menopause). Instead, changes occur gradually during a process that some people call 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. There may be problems with erectile function. However, this is a general slowing, rather than a complete lack of function.
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.
The prostate gland enlarges with age as some of the prostate tissue is replaced with a scarlike tissue. This condition, called benign prostatic hypertrophy (BPH), affects about 50% of men. This may cause problems with slowed 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 in some men. Sexual responses may become slower and less intense. This may be related to decreased testosterone level, but it may also result from psychological or social changes related to aging (such as the lack of a willing partner), illness, chronic conditions, or medications.
Aging by itself does not prevent a man from being able to enjoy sexual relationships.
Erectile dysfunction (ED) may be a concern for aging men. It is normal for erections to occur less frequently than when a man was younger, and aging men often have less ability to experience repeated ejaculation. However, ED is most often the result of a medical or psychological problem rather than simple aging, and 90% of ED 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 enough of an erection for intercourse. Disorders such as diabetes can also cause ED.
Erectile dysfunction that is caused by medications or illness is often successfully treated. Talk to your primary health care provider or a urologist if you are concerned about this condition.
BPH may eventually interfere with urination. The enlarged prostate partially blocks the tube that drains the urinary bladder (urethra). Changes in the prostate gland make elderly men more likely to have urinary tract infections.
Backup of urine into the kidneys (vesicoureteral reflux) may develop if the bladder is not fully drained. If this is not treated, it can eventually lead to kidney failure.
Prostate gland infections or inflammation ( prostatitis) may also occur.
Prostate cancer becomes more common as men age. It is one of the most frequent causes of cancer death in men. Bladder cancer is also a common cancer in older men. Testicular cancers are possible, but these occur more often in younger men.
Many physical age-related changes, such as prostate enlargement or testicular atrophy, are not preventable. Getting treatment for health disorders (such as high blood pressure and diabetes) that lead to changes in urinary and sexual health may prevent later problems with urinary and sexual function.
Changes in sexual response are most often related to factors other than simple aging. Older men are more likely to have good sex if they have continued to have sexual activity during middle age.
Minaker KL. Common clinical sequelae of aging. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 23.