The Male Biological Clock

By Paul Shin, M.D.

I hear the catchphrase “my clock is ticking” said in reference to almost every couple I meet in the office. Rarely, though, do men utter those words. The concept of a biological clock, particularly regarding reproduction, has long been considered an exclusively female problem. Examples of men such as Charlie Chaplin and Strom Thurmond, both of whom fathered children across multiple decades, are often held out as prima facie evidence that the only ticking sound a couple might hear emanates from the uterus.

Perhaps it is a paternalistic remnant of days past, or just a social bias that since women have to be pregnant and birth children (and thank the heavens above for that because I don’t think men, including me, could do it), that any problems with reproduction should be the purview of women as well. As it turns out, there is a male biological clock.

There has been an explosion of medications, products, advice, and services focused on “the aging male.” When I am stuck on a plane marooned on a tarmac, my attention turns to the magazines in front of me. The most obvious question is, “Who buys all this crap for their house?” But, coming in a close second, is “Who is that chiseled old guy/doctor who is asking for my credit card number so I can look like him?”

From its broadest perspective, the battle for control of the male biological clock is fought on several fronts—sexual function and vitality, general medical health, longevity, and reproduction. One of the defining characteristics of the men’s health movement is that it is itself poorly defined.

From a reproductive perspective, it is clear that all men go through some manner of decline as they age. Andropause, “man”-opause, and other clever nicknames describe the decrease in circulating hormones as well as the ultimate effects of age on the body’s functions. Unlike menopause, which has discrete physical changes and signs that happen within a short window of time, “man”opause” is a longer term proposition, manifesting changes in a subtle but continuously progressive manner.

As male reproductive specialists, we still do not have a great idea of how quickly a man’s reproductive potential changes as he ages. This is due to several factors—not all men get a semen analysis, particularly in their later years. There is tremendous variation in analyses from man to man and from time to time, and couples who don’t have trouble conceiving never come to our medical attention.

Current literature would indicate two major issues with older fathers—1) male partners over 40 years old are at risk for delayed pregnancy and decreased overall fecundity 2) there is a higher risk of disorders on the behavioral spectrum—Asperger’s syndrome, autism, etc. Whilst neither of these are absolute certainties, and each are still relatively rare events, proper reproductive counseling for couples with older male partners is imperative.

Whether it is wellness, vitality, sexual function, or reproduction, no discussion about the male biological clock is complete without also discussing hormone replacement therapy.

Advertisements for testosterone replacement therapy are in virtually every form of media – the web, print, television, and radio. The drive to feel well, maintain strength and exercise levels, and perform well during sexual activity are popular yet somewhat crude measurements in the overall assessment of a man’s health. The use of testosterone replacement has expanded to address many different indications, from the very physical (muscle mass, bone density) to the psychological (decreased libido and energy levels). The dilemma confronting older men wishing to father children is how to strike a balance between treating the signs and symptoms of age-related low testosterone and the detrimental effects of testosterone on semen parameters.

Consultation with a reproductive urological specialist can be a very helpful means of navigating this path. While a man’s biological clock may not tick as loudly and as quickly as a woman’s, it still ticks. The unique set of challenges requires a more diligent approach to treatment than simply addressing a number on a blood test.

Paul Shin, M.D. is a board-certified urologist at Shady Grove Fertility. He was part of the cast of the popular Path2Parenthood web series, “ Urologist Nerds Drinking Beer .”

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