Chapter 15 & 16

Recently, there has been a dramatic surge of interest in testosterone replacement therapy (TRT).

For many decades, it was thought that TRT increased the risk of prostate cancer; however, recent studies and research reviews indicate that is not the case (Debruyne & others, 2017; Yassin & others, 2017). Recent research indicates that TRT can improve sexual functioning, muscle strength, and bone health (Gray, McHale, & Carre, 2017; Hackett & others, 2017; Hassan & Barkin, 2016; Kaya & others, 2017; Mayo Clinic, 2017; Williams & Cho, 2017). A recent study found that TRT was associated with increased longevity in men with a low level of testosterone (Comhaire, 2016). Another recent study indicated that TRT-related benefits in quality of life and sexual function were maintained for 36 months after initial treatment.

In the past, the age structure of the population could be represented by a pyramid, with the largest percentage of the population in the childhood years. Today, the percentages of people at different ages in the life span are more similar, creating what is called the "rectangularization" of the age distribution

The rectangularization has been created by health advances that promote longevity, low fertility rates, and the aging of the baby-boom cohort

An increasing problem in middle and late adulthood is metabolic syndrome

a condition characterized by hypertension, obesity, and insulin resistance (Ladeiras-Lopes & others, 2018; Mora-Rodriguez & others, 2017). Researchers have found that chronic stress exposure is linked to metabolic syndrome (Bergmann & others, 2017). Metabolic syndrome often leads to the development of diabetes and cardiovascular disease (Masmiquel & others, 2016; Savadatti & others, 2018). Weight loss and exercise are strongly recommended as part of the treatment of metabolic syndrome.

Chronic Disorder

characterized by a slow onset and a long duration. Chronic disorders are rare in early adulthood, increase in middle adulthood, and become common in late adulthood. Chronic disorders account for 86 percent of total health care spending in the United States (Qin & others, 2015). Overall, arthritis is the leading chronic disorder in middle age, followed by hypertension, but the frequency of chronic disorders in middle age varies by gender.

MIddle adulthood

the developmental period that begins at approximately 40 to 45 years of age and extends to about 60 to 65 years of age. For many people, middle adulthood is a time of declining physical skills and expanding responsibility; a period in which people become more conscious of the youngold polarity and the shrinking amount of time left in life; a point when individuals seek to transmit something meaningful to the next generation; and a time when people reach and maintain satisfaction in their careers.

Roy Baumeister and Kathleen Vohs (2002, pp. 610-611) argue that this quest can be understood in terms of four main needs for meaning that guide how people try to make sense of their lives:

• Need for purpose. "Present events draw meaning from their connection with future events." Purposes can be divided into (1) goals and (2) fulfillments. Life can be oriented toward a future anticipated state, such as living happily ever after or being in love. • Need for values. This "can lend a sense of goodness or positive characterization of life and justify certain courses of action. Values enable people to decide whether certain acts are right or wrong." Frankl's (1984) view of meaning in life emphasized values as the main form of meaning that people need. • Need for a sense of efficacy. This involves the "belief that one can make a difference. A life that had purposes and values but no efficacy would be tragic. The person might know what is desirable but could not do anything with that knowledge." With a sense of efficacy, people believe that they can control their environment, which has positive physical and mental health benefits (Bandura, 2012). • Need for self-worth. Most individuals want to be "good, worthy persons. Self-worth can be pursued individually."