In general, middle age has done pretty well by me. I’m not one of those people who, on the treasure map of life, turned the corner onto Midlife Beach only to unearth an iron chest of complaints. I’ve never for a moment thought that life ended at 40, and any time I’ve seen those “Over the Hill” balloons in card stores I’ve found a way, when the clerk isn’t looking, to give them a slow leak.
On the other hand, I should also say that I don’t think life begins at 40, or, slipping further along the timeline, that 50 is the new 40. On the contrary, when I went through nearly two years of recession-era unemployment, it became quite clear to me that 50 is actually the new 70. But age, as my doctor, my therapist, and Cher have all reminded me, is relative. Biologically, I’m told I have the body mass index, circulation, and cholesterol of a much younger man, and, as any number of ex-boyfriends will attest, emotionally I’m about 17.
My prostate, however, is apparently in its late 90s. If you’ve ever been to a party with even a handful of middle-aged men, you’ve certainly at some point overheard at least one of them say, “I won’t bore you with the whole, long story about my prostate.” I take a similar oath here, but a little background is nonetheless necessary. My prostate has been drawing undue attention to itself for over 10 years now, through a couple of cities, a number of doctors, several insurance plans, and two biopsies. (After my first prostate biopsy, I nearly reported the urologist to Amnesty International.) No cancer has been found, but my PSA level—from a test discredited by a government agency just a few weeks ago—remains erratic and generally too high. Diagnoses have been inconclusive. My urologist in Chicago finally declared, “I don’t know what to say: You just have a crummy prostate.”
My prostate has continued to be crummy in New York, maybe even gotten crummier. A couple years ago the urologist here was talking about another biopsy when a loving God made my insurance run out (I think I still owe Him a candle or something), and it was a year and a half before I was insured again. When I went back to my regular doctor last spring, he said of course we needed to “readdress the prostate issue,” which I told him was fine as long as the readdressing was as noninvasive as possible and another biopsy was a second, third, or even fourth opinion down the road. So he sent me to some colleague of his who apparently is doing exciting work in prostates.
He does his exciting work from a well-appointed office on the Upper East Side. Cool jazz drifts softly from unseen speakers; the carpet is plush, the artwork a notch or so above the usual office stuff: cheerful, mindless. The receptionist, an elderly woman with cat’s-eye glasses, says little but with a distinct accent, and regards the entire clientele with an Eastern European disdain. After several visits and several tests, the doctor recommended that I start taking a medication that would reduce the swelling of my prostate and thereby lower my PSA. He said he takes it himself. There have been very good results with it. He said I should google it.
“There are, however,” he said, “a few side effects.”
I’ve been on other medications for other things, and the side effects have just about always been the same: dry mouth and death. But this is the first time I’ve taken anything that played around with my testosterone. The doctor said I should expect my hair to get thicker—”Which isn’t bad at all,” he added, stroking his own. He said I might also experience some enlargement of the breasts. This too I took, within reason, to be positive. A guy once said I had the body of a dyke ballerina, and I’m certainly not averse to a little enhancement in the chest area. However: As much as I admire Dolly Parton’s work…
“And what’re the bad things?” I asked.
“Well…” he said.
A number of men taking the drug reported lowered libido and erectile dysfunction.
Whenever I’m given disturbing news by a doctor—and I consider just about anything a doctor tells me disturbing—I like to think I conduct myself as a rational adult. I keep my face neutral, maintain eye contact, ask medically pertinent questions, perhaps even make light of whatever horrible disease he’s obliquely referred to. I pay the receptionist, smile, make my next appointment. It’s not until I’m at least half a block away from the office that, even if the news has only been that I need a blood test, I start planning my funeral. By the time I’m getting my post-doctor bravery smoothie, I’m figuring out where I want my ashes strewn (Coney Island at the fall equinox).
I pursued a program of regular “self-testing” with an ardor I hadn’t known since I was 15.
Getting onto the train, I was well into a stage-two panic. “I can’t have loss of libido!” I thought over and over again. “I can’t have loss of libido. I’ve written porn, for God’s sake!” I couldn’t even imagine what loss of libido was; I wondered what it would feel like, look like. I pictured myself drooping in the corner of some dismal café, a cold espresso on the table in front of me, the lemon peel untouched. Somewhere across the café young people, sexy people, would laugh, would reach across the table and hold hands, lean against each other in a booth. And I would look down at the faux-marble tabletop and think how like faux-marble my heart had become.
I didn’t even want to think about erectile dysfunction. I just didn’t even want to think about it, didn’t want to imagine what it’d be like at all. I told myself I didn’t have all the facts. I didn’t know how many men on the drug reported erectile dysfunction. And I didn’t know who they were. They could all have been liars, for all I knew. They could’ve been erectiley dysfunctional long beforehand and just blamed it on the pill. Besides, the doctor said he takes it and he’s fine. I don’t think he would lie to me. Then again, I also have to be realistic: He was a referral from my primary care guy. This was maybe my fourth visit. It’s not like he was going to tell me he hadn’t gotten it up for three years.
I raised my eyes (possibly in prayer), and they landed on an ad directly across from me, to the left of something for payday loans, the right of a dermatologist in Queens. In the foreground of the ad there was a photo of a man and woman in bed, a sheet discreetly draped over their primary sex characteristics. The man was on his side, his back to the woman. His hand was gripping the edge of the pillowcase, and his face had that look Superman gets when he’s near green Kryptonite. The woman was behind him, leaning a little over his shoulder with a concerned yet supportive look. Above them floated a question in Spanish. I know it was a question because it had those great Spanish question marks bracketing the sentence, surrounding it in mystery, that upside-down one at the beginning hinting at the chaos the question could bring. I love those question marks. If I spoke Spanish, I think I would just ask questions all the time.
The question here was something about “disfunción erectile.” “¿Blah-blah-blah disfunción erectile?” I wasn’t sure what the verb was leading into it. “Suffer from” was the first thing that came to mind. The guy definitely looked like he was suffering. Then I thought: “plagued by.” Then: “crippled by.” Then: “¿Do you think you might die from disfunción erectile?” I know you don’t die from erectile dysfunction. But you can die from embarrassment. It happens all the time. Doctors just write something else on the death certificate. The guy on the ad looked like he could die from embarrassment at any moment. And yeah, the woman looked concerned and supportive, but the ad didn’t have thought balloons, and inside, on some level, I was sure she was questioning his hombre-hood. The ad got me so upset that I couldn’t remember where I’d phoned in the prescription. I knew it was a Duane Reade, and I knew it was within two blocks of my apartment. So I just went to all three. And when I got home, I lit a stick of musk incense and took my first pill.
I’ve been on the medication a little over two months now. It’s one of those drugs that has to build up in your system, and the doctor said it would be weeks before I saw any side effects, if I saw them at all. And I’m seeing them. My hair is now the consistency of clothesline rope. The last time I went to the barber, I blunted two pairs of his best scissors. I’m pleased to report that my breasts are not resting near the keyboard as I type, but I’m just as pleased to report that my ballerina days are over. I was wearing a T-shirt one day and a guy on the train checked out my chest and smiled. I felt so used.
I hate to think that “All Things Considered” is making me go limp.
I was so freaked out about the erectile dysfunction thing that I pursued a program of regular “self-testing” with an ardor I hadn’t known since I was 15, and everything seems to be in working order. Better than working order, actually. I’m so terrified of the dysfunction that I’m functioning at a level I haven’t seen in years, and my new fear is that the drug may be propelling me into a virility that’s largely delusional. I talk to the doctor about it. He always asks about my hardness. It turns out hardness is somewhat a specialty of his (the cool jazz should have tipped me off). He’s coauthored a several books about virility in general and hardness specifically, which has changed my perception of him entirely. When I first went to him, I thought of him as an internist. Now I call him my hardness doctor. “When you have an erection, are you hard enough?” he asks. I tell him it’s a meaningless question: No one is ever hard enough.
But while the flesh is able, I’m afraid it’s not willing; the spirit, I have to admit, is weak. I can function, but there’s little lately that compels me to do so. A guy I’ve had sex with a bunch of times emailed to have sex again, and I didn’t want to be bothered. The guy on the train who smiled at my chest? I didn’t smile back. And just in general, my life has felt considerably less sexy. The hardness doctor pooh-poohed the idea of lowered libido. “What’s libido?” he sneered, stroking his hair. I stroked mine back and said I didn’t know. Sex drive, he said, is subject to a zillion factors: work, family, personality, stress. Age. (He stroked again.) Even prolonged exposure to bright lights or elevated sound levels can affect libido. My roommate listens to NPR all day at a level normally associated with Nine Inch Nails, but I hate to think that All Things Considered is making me go limp. The doctor said I shouldn’t worry, and cut the dosage in half.
So if you’re on the train some morning and you see a middle-aged guy with really thick hair and a good chest regarding you with undue appreciation, do him a favor: Smile. Better yet: Wink.
Don’t worry: It’s not like he’s gonna get hard.