The Male Brain

  John sat down in my office with a sigh and explained that he'd been dating an interior designer named Kate for the past six months. He said, "Everything's going great with Kate, but my oldest daughter, Rachel, is really upset. I'm not sure if it's because Kate and I are getting more serious or because Kate's just six years older than Rachel." At this point, John started shifting in his chair and raking his hands through his salt-and-pepper hair. Frowning, he said, "Kate is young, but I've never met anyone like her before. I feel so close to her already."

  John said that with Kate he even liked doing things that he used to avoid with women, like holding hands and cuddling. The tenderness he felt for her was new for him. Men in their fifties and sixties, like John, are beginning to make less testosterone and vasopressin, and researchers have shown that the ratio of estrogen to testosterone increases as men get older. Hormonally the mature male brain is becoming more like the mature female brain. Some scientists believe that with a different balance of fuels running a man's brain, he may become more responsive to his oxytocin, the cuddling and bonding hormone.

  As a matter of fact, in studies in which researchers gave oxytocin to men, it improved their ability to empathize and enhanced their capacity to read subtle facial expressions. (Welcome to our world, guys!) Thus, because older men have lower levels of testosterone and vasopressin, estrogen and oxytocin may have a more dramatic effect on them. It certainly seemed that way for John, now that he'd met Kate.

  If we could have watched John's brain as he sat across from Kate at their favorite restaurant, we'd have seen many circuits responding just as they had in his thirties. His visual cortex would be lighting up and registering how beautiful Kate was. And when she looked at him admiringly, his RCZ--rostral cingulated zone, the area that registers others' opinions of us--would have activated, signaling that she looked up to him. When she toasted him for winning a competitive business contract, we'd see his reward circuits, the NAc and the VTA, pulsing with activity. But as he reached across the table to touch Kate's hand, he first carefully studied her face and gazed into her eyes, looking for clues about how she really felt.

  As dinner continued, his visual cortex would activate again and again as his eyes returned to her full lips and slender neck. Soon we'd see his sexual brain circuits light up. And as he looked forward to the night ahead, we'd see his reward circuits flashing brightly with eager expectation.

  But as the topic turned to his daughters and the future, we'd see his ACC, the anxiety and worrywart center, activate. He said, "Kate, you know how I feel about you, but I have to wonder if our age difference is too big. You know, you have your whole life ahead of you."

  When Kate firmly reassured him, "I don't want a younger man. I want you, John," we'd see his ACC calm down. And when she said, "I've never had anybody listen to me and understand me like you do. Guys my own age can't do that," we'd see his reward center turning back on. This was music to his ears.

  KINDER AND GENTLER

  John's changing hormone levels were ushering in a kinder, gentler man. He still lost his temper when he got stuck behind "Sunday" drivers, but overall he was a little more patient and tolerant. His mature male brain was beginning to see the world more as it had when he was a boy, before the hormonal changes at puberty stimulated his circuits for anger and defense. And because he now had less testosterone, his oxytocin was having a bigger calming effect on his brain. This makes men a little less territorial, and they no longer feel compelled to fight so hard for their place in the pecking order. At this age, men even begin to risk showing more emotions without being so concerned about losing face. And they may also find themselves becoming more physically affectionate.

  While cuddling had always seemed silly to John, now that his oxytocin was having a greater effect, he liked it. The skin-to-skin spooning that Kate liked to do before going to sleep now made him feel warm and content. John was no longer the unemotional robot that his ex-wife used to complain about. His new brain fuels were laying the groundwork for greater intimacy. And he said the sexual intimacy was the best he'd ever experienced. He found that with a younger woman, his sexual desire was reignited without using porn for the first time in twenty years. He was surprised by how much he liked pleasing Kate sexually; it was almost more important to him than his own pleasure. This was also new for him. Now he could slow down sexually, be a better listener, and be more affectionate. This hormonal turn of events can make men John's age become more like the ideal man that women say they want.

  ESTABLISHED RANK

  John's mature male brain was also changing his attitude at work. He had achieved the status of top dog in his industry years earlier, and now he could coast a little. His brain circuits for dominance and the drive to outdo other men were less intense as his testosterone production declined. He still fought for the Fortune 500 accounts, but victory at all costs was no longer worth it to him. During a man's midlife transition, he often isn't as motivated about fighting his way up the ladder. He knows his value. This development, which is usually attributed solely to psychological maturation, is also fostered by a new biological reality.

  This also happens in other mature male animals when they reach this stage of life. Researchers have found that mature alpha-male silverback gorillas provide protection and leadership, maintain group stability, and mediate conflict. And they continue to offer companionship and protection to females long after their breeding years with them have subsided. Researchers found that the females in groups without a mature male silverback felt less protected and were less safe at night. So, instead of sleeping in their preferred, comfortable ground nest, these females had to sleep high up in trees for protection. Human females also can feel an attraction to the protection and security that a mature male offers. And for this reason, when it comes to choosing a mate, many younger women see the benefits of a well-established older man.

  MEN STAY FERTILE FOR LIFE

  When John brought Kate to my office to talk about smoothing things over with Rachel, it was easy to see why he was so enchanted by her. Kate was a lively five-six brunette, with a trim waistline, generous bustline, and pretty face. And it was clear by the way she looked at him with adoration that she was devoted to him. What John probably didn't know was that his mature brain found Kate's adoration almost as enticing as her breasts. He was being biologically bewitched to bond with her. And Kate was bonding with him, too. But for her female brain, bonding meant more than being lovers.

  We were discussing the importance of giving Rachel time to come around when Kate said enthusiastically, "Of course we have to do what's best for John's daughters, just like we'll do what's best for our own kids someday."

  My mind went blank for a moment. I had heard nothing from John about starting a new family, so feeling a bit tongue-tied, I turned to see his response.

  The look on his face said it all. This was news to him, too.

  Suddenly my office felt too small. All three of us knew this could be a deal breaker. Men who have already raised one family are often reluctant to do it all again. But some men do just that. We've all seen older men pushing baby strollers and wondered, Is he the father or the grandfather? The truth is that men can have a second, third, or fourth chance at fertility that women simply don't have.

  In fact, the ability of older younger women, called the factor," may be partly responsible for our species' long lifespan. Scientists at Stanford University found that this factor explains why humans live so long, even though, in theory, a female has outlived her evolutionary purpose by midlife when she is no longer fertile. Because men and women share most of the same gene pool, they both potentially benefit from any longevity genes in the other sex. Scientists argue that it's these late-life fertility genes that women share with men that explain women's longer lives.

  men to reproduce with "late-life male fertility

  At fifty-eight, John was certainly still fertile. But he and Kate had plenty to think about, not least of which was working things out wit
h Rachel--if they stayed together. This was a major decision for John, so I wasn't surprised when he told me a couple of weeks later that he was losing sleep over it. He said, "I'm crazy about her, but I don't want more kids. And Kate won't be happy without them. I've decided I have to let her go."

  THE LONELY HEARTS CLUB

  A few months after John told me that he and Kate split up, I got a call from his other daughter, Mandy. "Rachel and I are both worried about Dad," she said. "When he's not working, he mopes around the house. When I ask him what's wrong, he just gives me 'that look' that means the conversation's over."

  John didn't want to go out by himself, and he hadn't met anyone new, so he was spending most of his evenings at home alone. Since he'd stopped having fun, his brain's reward centers were short-circuiting. John's hermit lifestyle wasn't giving his brain the social workout it needed, and his daughters could tell it had become a vicious circle as he became more cranky and withdrawn. Without Kate around, his social-approval circuits weren't being activated either. In brain-scan studies of older males, researchers have found that the brain's pleasure and reward areas, the VTA and the NAc, remain more active in men who are social.

  The next week, when John came in to see me, he said, "My daughters think I'm depressed, but I don't think I am. I'm fine when I'm working. It's only when I go home to an empty house that I feel like crap. I know it sounds pathetic, but the only time I don't feel lousy is when I'm remembering the good times I had with Kate. But then I feel even worse because I don't have her anymore. You know I've never been one to mope around much."

  Like John, many men who are lonely think it's a weakness, but it's actually a key survival mechanism. Mother Nature has purposely wired the state of loneliness into the human brain to cause pain so humans will avoid it. In primitive cultures, being isolated from your tribe could be a death sentence, because individuals could rarely survive on their own. And in today's modern world, researchers are finding that loneliness can still be deadly. People who are lonely die sooner than their same-age peers who are not lonely. They found that about one in five Americans experiences loneliness and that it can be as detrimental to your health, in the long run, as smoking.

  When men live alone and become isolated--which they do more often than women--their daily routines can become repetitive habits that get deeply engraved into their brain circuits. Soon, if

  routine, they get irritated

  someone disrupts their because their brain's

  social-flexibility circuits are weakened from disuse. This is the story of grumpy old men. It's also the story of grumpy old mice. Researchers have found that male mice need females around to keep certain other circuits active. It has long been known that females can influence a variety of responses in male physiology and psychology. Males of many species fare better with female companionship. And researchers found that older male mice that were living with females retained their reproductive abilities longer. But it isn't just the male gonads that can benefit from female companionship--it's their brains too. In humans, researchers found that specific brain circuits are not activated as much in people who are socially isolated. When brain areas aren't used enough, they atrophy. Isolation is bad for the brain. And although John wasn't a grumpy old man yet, loneliness was clearly bad for him.

  I watched an array of emotions flash across John's face as he processed what I had just said about his brain, his gonads, and loneliness. And then he said, "Maybe having another baby or two wouldn't be so bad after all, if it means being with Kate the rest of my life."

  What John didn't know was that having a baby with Kate was probably the best way for their brains and bodies to biologically pair-bond and stay together for the long run. Regardless of their age difference, Kate and John would be working with their pair-bonding brain circuits by starting a family. And soon, once they were back together, his biggest concern became staying healthy so he'd be around to raise and take care of his new family. Thus, I shared with him that, aside from inheriting good genes, a man's best chance for longevity is to sleep deeply, stay strong, avoid tobacco, and get married and stay married. For unknown reasons, married men live 1.7 years longer than single men. But as my patient Tom joked when he and his wife, Diane, were in marriage counseling, "Those extra years better be damned good!"

  BIOLOGICAL CHANGE OF LIFE

  Tom and Diane made a handsome couple: he with his trim physique, graying hair, and healthy complexion; she with her petite athletic figure, bouncing pageboy haircut, and sparkling eyes. They had initially come to see me when Diane's hormonal transition at menopause had decreased her sex drive. Her female brain was suddenly getting a lot less sex hormones, and she was experiencing a new biological reality that her husband couldn't relate to. Tom had always been a loving husband and father, but what he didn't know was that the combination of Diane's hormones and his lack of attention was making things worse with her libido. Diane had been angry because Tom's work always seemed to come before her. During the menopause, one wrong word or even just a look from Tom could send her slamming doors throughout the house and taking refuge in her greenhouse for a private sobfest. Her interest in sex was deader than a doornail.

  On the other hand, Tom had long resented that Diane didn't appreciate how hard he worked to provide her and the kids with the lifestyle she wanted. Only when Tom was at his wit's end from being sexually rejected by her had he finally agreed to come to counseling. Working through their issues at that time had helped them to decide on some compromises and to renegotiate parts of their "marriage contract." Tom agreed to work less, and Diane agreed to be more attentive to his sexual needs. For some reason, many couples think they can't renegotiate the unwritten marriage contract--or "revisit the prenup," as I put it. To them I say, "Of course you can. Your life depends on it."

  For Tom and Diane, the couples counseling and Diane's hormone-replacement therapy made all the difference. Consequently, I hadn't seen them in a few years. But now Diane was calling to say she thought Tom had better come in to see me, this time about his hormones.

  Hormones in the brain and the penis are what make a man a man. They activate the sex-specific brain circuits required for male-typical thoughts and behaviors. When the male brain and body start making less of these hormones, he enters the so-called andropause, or male menopause. A century ago, andropause was relatively rare, because men didn't live long enough to experience it. Even in the late nineteenth and early twentieth centuries, the average age of death for men in the United States was forty-five. Nowadays, thank goodness, there's plenty of life after andropause. Men in the United States can expect to live decades after their hormones start to decline. But according to researchers, many men aren't happy unless this stage of life also includes sex. And for Tom, this was where the rubber met the road.

  Over the phone, Diane explained to me that there were a few times lately when Tom couldn't get a firm enough erection to have intercourse. She said, "I personally don't think it's that big a deal. I mean he is sixty-four. The first two times it happened, he was upset about it, but he thought maybe he was just tired. But when it happened last night, he got up, got dressed, and stormed out to his woodshop. Do you think it could be hormones?"

  Based on Diane's description, I agreed that Tom's testosterone could be low, but it could also be many other things. So I suggested that he come into the office to discuss what was going on and see how I might help.

  Women can't imagine how changes in sexual function can affect a man's self-perception so much at this stage in life. He's the same man he's always been, and yet he's not. The body part that has brought him the most pleasure, the very symbol of his manhood, may no longer be reliable. As Tom sat down in my office, I could tell this was clearly taking a big toll on him. He said, in his usual get-down-to-business manner, "I'm sure Diane's filled you in. What do you think I should do?"

  Tom was in good health, so I wanted to know what else might have changed since the trouble in the bedroom began. He said his last
checkup and tests with his primary-care doctor were normal, even though he was feeling tired all the time and his thinking wasn't as sharp as it used to be. He complained that he'd lost strength, even though he exercised, and he noticed that his beard wasn't growing as fast as it used to. Otherwise, he said, he was "as good as ever." After hearing Tom's symptoms, I suspected that his testosterone level might be low and recommended that he get it tested.

  The hormone tests confirmed that Tom was going through andropause. On average, men go through this hormonal transition between age fifty and sixty-five. During this stage, their testicles produce one third to a half the testosterone that they produced in their twenties. It was a good thing Tom came in, because this was a biological problem that was quickly becoming a marital problem.

  As it turned out, Tom's testosterone level was substantially lower

  Researchers have

  than average for a man his age. found that when this hormone

  dramatically decreases, the brain and spinal cord don't get as much stimulation as they need to keep his sexual thoughts and organs working at full capacity. At all ages, the male brain, spinal nerves, and penis need testosterone to function.

  Although Tom was discouraged by his penis's lack of reliability, he confided that on the positive side of the coin, he didn't mind being a little less sexually driven. He was glad that the "I need it now or I will die" urges that he used to have in his younger years had subsided. Now he could wait. But when the waiting was over, he wanted to be ready for action.

  He said, "I was hoping that staying in shape would keep things going down there. Now I'm not so sure. My brother's doctor started him on testosterone replacement a few months ago, and he swears by it. Does that stuff do any good?"