As a doctor who specializes in hormones and everything menopause and andropause, I hear a lot of the same problems over and over again and I thought it would be good in this newsletter edition to normalize a few of these.  My hope is that by putting these things out there, those of you who may be too shy or embarrassed to bring it up in a visit will find a sense of peace knowing that this is not just you but something that many people in their 40s and 50s experience.  Ok, so let’s name these common signs and symptoms.

“Sex is natural, sex is good…not everybody does it, but everybody should.” – George Michael

One of the most common complaints that women come to me with is libido, or lack thereof, to be more specific.  They say they feel bad; they love their partner and still find them attractive, but if it was up to them, they could go the rest of their life without sex.  The funny thing is, most women say that in the passion of the moment, they enjoy sex.  The problem is, the desire to copulate multiple times a day like they did as newlyweds has faded over the years as the stresses of adulthood start to pile up.  It’s hard to be intimate when the 6 year old wants to still sleep in bed with you!  

The other part of the whole sex issue is orgasms.  Both men and women find it more difficult to reach orgasm than they did when they were younger.  There can be lots of reasons including  pain with sex, atrophy of the clitoris which makes it less sensitive, hormonal decline in both estrogen and testosterone, weakness in the pelvic floor muscles, emotional stresses, medical conditions (including depression, diabetes, heart disease, etc.) and medications (including antidepressants/anti-anxiety, blood pressure and opioids).  Then there is the one that we all know about (because you can’t turn on the radio without hearing a commercial about it) and that is ED, or erectile dysfunction. 

Hey guys!  Erectile dysfunction affects women too.  Recent studies show that 52% of men in the US between 40 and 70 years old suffer from ED.  Now, let’s be honest.  This is a sensitive topic for a lot of guys and they don’t bring it up easily and a lot of doctors are uncomfortable broaching the subject, so this number is probably grossly underestimated.  

There are a wide range of pathologies that can be the underlying cause of ED, but sometimes the pressure of performing and not knowing if they will be able to when the time comes, can in itself make it hard to achieve and maintain a strong erection.  Good news guys, there are lots of options to help remedy this from pills to pumps and shockwave to injections and surgeries!  For women, if men are too quick to climax or cannot stay erect, they may find the experience uncomfortable or too quick and that is what prevents orgasm.  This is where a little foreplay can go a long way.  

Another uncomfortable topic that I hear a lot is incontinence.  This too happens for both men and women.  For the men, it usually presents as dribbling, trouble starting or stopping the flow of urine, a weak stream, or frequent night time urination.  For women, it usually presents as trouble holding urine when we jump, sneeze, cough, laugh, etc. 

There are many causes for incontinence that I will not get into here, but we do have a treatment.  Whether you had hard labor as a woman or you have had prostate issues as a guy, the Emsella chair provides an innovative and non-invasive treatment option.   I have spoken about this amazing device in previous newsletters, but this giant magnet can re-train and strengthen your pelvic floor so that leaking is a problem that you don’t have to think about anymore.  

The last thing I will try to normalize is mood and mental health during the menopause/andropause years.  This is a hard topic right now as we are coming out of a global pandemic in which people struggled emotionally with isolation, less physical and emotional outlets, the stress of home-schooling, and for some, unfortunately, loss of loved ones.  However, we are also seeing an aging population, with multiple resources citing the amount of people over 40 in the US being over 50%.  

Things we have to deal with at this age include health concerns in ourselves and our aging parents.  We start to look around and see people dying more than we did when we were younger.  Kids go off to school and grow up.  People start to think about retirement.  

Being an empty nester and the emotional tolls that this can take on many people as they have to change their identity from one of being a caregiver or breadwinner to one of having to find something to do with their days when not running around to meetings, working the daily grind, or shuttling kids off to practice, becomes a time of depression or anxiety.  

It is no wonder that antidepressants are some of the most prescribed drugs at this time in life, along with statin drugs (cholesterol lowering) and blood pressure medications.  Again, topics that have been addressed in other newsletters.  But, what you are hearing about more and more is hormone replacement therapy (HRT) for both men and women as a way to help our quality of life at this age.  

Seeing that the common denominator at 40-50 years old in both men and women is loss of hormones, it makes sense that we are seeing a rise in advertisements around HRT.  Yes, it is true that estrogen and progesterone have gotten a bad rap in the last 20 years, but more and more analysis of those studies suggest that well prescribed HRT can have more pros than cons.  

This is one of our specialties here at AIM.  We strive to keep our finger on the pulse with research and studies to make sure we are giving you the most up to date information on the safety and efficacy of the different options we offer here at AIM.  

We also listen to what you, as the patient, want.  That is why we are starting to make use of bHRT pellet therapies, starting with a robust training for our providers in June.  We have prescribed bHRT, Wiley protocol, Physiologic Restoration protocol and supplemental treatments for menopause and andropause for years, and this method of delivery is something that is gaining in popularity currently.  So, AIM will be offering hormone pellet therapy as another option in our toolbox for all your hormone needs.  

TLDR: getting older is normal  ☺  Ask your doctor what options you have to be the version of you that you want to be.  

Sooriyamoorthy T, Leslie SW. Erectile Dysfunction. [Updated 2022 Nov 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: