08/22/2014 03:15 pm ET Updated Oct 22, 2014

Bullies on the Playground of Recreational Sex

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What healthy 50-plus man doesn't worry that his vibrant sexual performance will come to an inglorious end? Hundreds of thousands of erectile dysfunction web-based articles and comments don't begin to match the number of men who live in fear of ED. A typical heading (this one is from WebMD) reads, "Every Man's Worry: Erection and Ejaculation Problems."

Blame anxiety about impending dysfunction on scornful women, locker room braggarts, masturbation, pornography or size-matters myths, but the ED medications and low-testosterone replacement industries, with their aggressive ad campaigns, have special distinction in shaping men's attitudes about what constitutes manhood.

ED medication and Low-T replacement therapy are not the same, but they are two sides of a coin. Drugs such as Viagra, Cialis and Staxyn may be prescribed, the Mayo Clinic says, to men who cannot "get or keep an erection firm enough for intercourse." Low-T therapies are for men with conditions that include low libido, low energy, decreased muscle mass, unwanted body changes (e.g., weight gain) and depression.

ED and Low-T advertise differently. The ubiquitous and unabashed ED message, that real men have rock-hard erections, is delivered by rugged, denim-clad actors who promise that the man who pharmaceutically re-ignites his "readiness" will return unparalleled pleasure to his female partner (the women in these ads are beside themselves with grateful anticipation).

Low-T advertisers' approach seems subtler, though it isn't, because it employs the same lure used on women in the heyday of estrogen therapies -- a promise of eternal youth. Low-T ads invoke the fear of andropause (endocrinologists call it hypogonadism). Low-T therapy, promising more energy, improved libido, improved sexual function, it seems, should be right for every man. "No man escapes andropause," claims the blurb on "It will happen to everyone," and if the site's claims are right, "the decline" starts in -- a man's late 20s.

For women, the estrogen bubble was deflated in 2002, after studies suggested that its users were headed for conditions worse than anxiety and vaginal dryness. Male-targeted medications are on track for similarly grim predictions.

In January, the FDA released a statement saying it is "investigating the risk of stroke, heart attack, and death" related to Low-T products. The Mayo Clinic list of Low-T therapy downsides includes contributing to sleep apnea, stimulating noncancerous growth of the prostate, enlarging breasts, limiting sperm production, stimulating growth of existing prostate cancer, blood clots and an increased risk of a heart attack.

Dr. Steven Woloshin is a researcher at the Dartmouth Institute for Health Policy and Clinical Practice. He and his colleague, Dr. Lisa Schwartz, are studying how exaggerations and distortions create false fears and false hopes, driving men to demand Low-T medications. Doctors are "giving men hormones that we don't know they need for a disease we don't know they have," the research team has said.

Drs. Woloshin and Schwartz point out that testosterone drugs were initially developed "for treating men with a reduced ability to produce testosterone because of such things as trauma, chemotherapy, genetic abnormalities or undescended testicles. For these men, testosterone replacement provides a clear quality-of-life benefit."

Today at least 1 out of 25 men over 60 is on some form of Low-T medication. If this number reflected just those for whom the drug was originally intended we might live in a world in which a more relaxed approach to sexuality prevailed.

Relentless advertising has helped to create a gray market for ED drugs, so it's not known how many men use them, but raised questions about the dangers of purely recreational use of these pills by men who don't have ED. Their web search revealed six million hits on some 7,000 Internet vendors.

Low-T therapy for borderline cases is also under fire. Dr. John La Puma, director of a California men's health clinic, is quoted in a recent AARP Bulletin article, warning that "testosterone replacement shuts down the body's own production." If the testicles shrink as a result, he says, replacement therapy will necessarily become a forever thing.

We might ask why men are this desperate for erectile perfection. There is more to the sexual pleasure equation. Sex therapists, counselors and senior sex advocates are working to change the attitude that penetration is the gold standard -- for some the only standard -- of sexual pleasure.

Healthy men and women are enjoying passionate non-pharmaceutical sex well into their eighties, and if mid-lifers won't credit such anomalies, they might at least concede that the sexual ecstasy we all crave should not be tied inextricably to the Big It.

Sienna Jae Fein blogs at