by Jane Fonda
According to its proponents, HT helps keep the brain healthy by preventing shrinkage, and it can lead to more brain-cell volume. HT can actually help the speed of brain functions, and studies have shown that when begun early in menopause, HT may be able to delay dementia symptoms. Additionally, say these advocates, estrogen helps preserve bone and works with other hormones to increase bone mass. The hormone also helps bones absorb calcium, but only as long as you use it: When you stop taking estrogen, the bone loss resumes. The Mayo Clinic does not recommend taking estrogen just to prevent bone loss, however, as the risks outweigh the benefits in many women.
Postmenopausal women who are not on HT and who are at heightened risk of developing osteoporosis are those who have suffered food addictions such as bulimia and anorexia, smokers, very slight women, those who have been particularly sedentary, those who have suffered from intestinal tract problems (which impede the absorption of calcium), and those who have experienced frequent fractures. These women should consider being screened for osteoporosis. The most up-to-date screening method is called a dual energy X‑ray absorptiometry test (DEXA). It is rather expensive and is currently covered by Medicare.
Dr. Warren, like other gynecologists I spoke with, feels that it is almost inevitable that postmenopausal women who are not on estrogen will suffer vaginal dryness and atrophy. As she described it, “There are three layers to the vagina. The top layer completely disappears and the other two layers shrink, and you lose collagen as well, so the vagina starts to shrink.” There are also urinary symptoms associated with age due to thinning of the urethral lining. Dr. Marianne Legato, in her book Eve’s Rib: The New Science of Gender-Specific Medicine and How It Can Save Your Life, says that a reliable way for doctors to determine if a woman has enough estrogen is to “examine a sample of her vaginal lining under the microscope: A well-estrogenized lining is many layers thick.”5 If there is a lack of estrogen, the vagina will no longer be plump and juicy, but it can be treated with vaginal estrogen that lubricates the bladder as well. One medication that I use is Vagifem. It acts on the vaginal tissues only and is not absorbed into the bloodstream. Vaginal estrogen creams and a vaginal ring with estrogen are also available. Dr. Warren notes that the creams should be given in low doses and that both they and the ring are thought to be low-risk when appropriately used.
When women choose to take HT, those who have a uterus should take both estrogen and progesterone, to protect them from endometrial cancer; those who have had their uterus removed should take estrogen only. Besides strengthening bone and improving the skin, the hair, the brain, and the health of the vagina (which reduces pain during intercourse), HT may also increase sexual desire.
I strongly urge older women to have their blood tested for hormone levels, not just estrogen but free testosterone as well. Testing for free testosterone is not an automatic. You have to ask for it, as doctors are just learning to test older women for testosterone deficiency. In discussing the bottoming out of sexual desire in women, The Psychiatric Annals: The Journal of Continuing Psychiatric Education re-ported, “It has been postulated that, ‘No matter how hard a woman might try to assemble the building blocks of healthy sexual functioning—the required amount of the hormones, a loving partner, adequate stimulation, possibly a good sexual fantasy—it cannot work if she does not have the basic foundation of enough testosterone.’ ”6
Dr. Brizendine has been prescribing testosterone replacement for her women patients since 1994. She says that sexual dysfunction in women is often an above-the-waist matter, residing in the brain. The upsides of testosterone replacement are increased libido and the sensitivity of the genitals, especially the clitoris; heightened energy; and better mood, mental acuity, and muscle and bone growth. The downsides may include lower voice, facial hair, body odor, acne, and thinning hair. The particular form of testosterone that can actually get into your brain and cause an upswing of libido is known as “free testosterone.” The normal range of free testosterone for a woman—the amount thought necessary to maintain her sexual interest—is 20 to 70 of what are called picograms per milliliter. “Here’s the thing,” says Dr. Brizendine. “If you were to start taking estrogen in the form of an oral birth control pill or oral hormone replacement, it goes straight to your liver and makes more of this big, sticky globular protein called SHBG, or sex hormone binding globulin. I think of it as a big, sticky teddy bear that goes around in your bloodstream and gobbles up all of your testosterone, and then your testosterone isn’t free anymore. So you may have a good total testosterone level as a woman, but if you don’t have any that is free, you don’t have any that can get into your brain. The normal range for your sex hormone binding globulin is 100 to 150. If you are getting a workup for low libido, you want to know the level of free testosterone, because that is what counts in terms of your sex drive in the brain.” (Remember: The brain is the biggest sex organ.) Dr. Marianne Legato writes, “Before you take testosterone, make sure your doctor has measured your serum lipids and that your HDL (high-density lipoprotein or ‘good cholesteral’) is over 45 mg/dl.”7
The hormones can be administered in several ways. Some women, like me, prefer the estrogen patch. The Vivelle-Dot seems to be a favorite. These patches provide transdermal creams, which may not go through the liver as much as oral doses. The Vivelle-Dot patch is small and transparent; the only way you see it is because it’s shiny. It also comes in different concentrations. If you don’t want to wear a patch, there are now very good gels, creams, and a spray that deliver estrogen through the skin. It’s not true for all women, but I took oral estrogen for six years and it went right through me—didn’t even register when they tested my blood levels—and it was probably creating those sticky teddy bear–like globulin proteins from the liver that killed off all my free testosterone. But who knew? Then, for many years, I used a low-dose Vivelle patch twice a week. But when a noninvasive cancer lump was discovered in my right breast (and removed), I had to stop all estrogen therapy.
Some women prefer and benefit from oral estrogen therapy because their good cholesterol (HDL) goes up. For some, the estrogen by itself is enough to raise their sex drive. For others, some testosterone, either in patch or gel form, will jump-start their libido and increase their energy and sense of overall well-being. For testosterone gel, you smooth a nickel-sized blob on your abdomen or inner thigh. It doesn’t take long to experience the results. Talk to your doctor!
The type of doctor we need to turn to for HT should be an ob-gyn who practices postmenopausal hormone replacement therapy, as opposed to one who specializes in pregnancies and deliveries. Dr. Michelle Warren calls such doctors “menopause-friendly” and says they can be internists as well.
Human Growth Hormone
While we are on the subject of hormones, let me say a few things about human growth hormone (HGH), which has become a popular drug at many anti-aging clinics. HGH is naturally produced in the pituitary gland, at the base of the brain, and serves to fuel growth throughout childhood. Around the time a person hits thirty, the pituitary gradually reduces the amount it produces. Injections of synthetic HGH stimulate the pituitary gland to produce more of the hormone, and this can increase muscle mass and reduce body fat. But there are no free lunches. HGH can be harmful, causing aching joints, fluid retention and swelling, and carpal tunnel syndrome; most important, its long-term use may cause cancer by fueling the growth of small tumors. We won’t even go into how expensive it is! As I said in Chapter 5, many doctors believe that the best way to stimulate growth hormones naturally is to get enough sleep, because that is when growth hormone and testosterone production peak.
In conclusion, hormone replacement therapy is a very individual matter—as are many of the current sexual-enhancement drugs—so please make sure you have a doctor who is knowledgeable, experienced, and up to date on the newest research when it comes to hormone therapy. And if you are still interested in making sexuality a part of your Third Act, why not consider paying a visit or two to
a sex therapist with your partner—just for a little tune‑up to your largest sex organ: your brain!
CHAPTER 15
Meeting New People When You’re Looking for Love
Love is everything it’s cracked up to be.… It really is worth fighting for, being brave for, risking everything for.
—ERICA JONG
IN THE NEW WORLD OF SERIOUS LONGEVITY, “TILL DEATH DO US part” has become profoundly challenging. Centuries ago, when that phrase was embedded in the marriage vows, we didn’t live eighty, ninety, even one hundred years. Face it: It is hard to find a mate who is not only right for us in the early, family-building years but still pleasingly appropriate for our middle and autumn decades. As I said in a previous chapter, I am a believer in the value of long-term commitment, but—as is true for many others, too—it hasn’t worked for me. This, then, is a chapter about ways to find new love.
Dr. Gloria Steiner is a friend of mine from Atlanta. When Gloria was fifty, her husband of thirty years told her that he was homosexual and wanted a divorce.
“I’m not at all judgmental—it wasn’t that,” Gloria told me. “I am still very fond of him, I respect him, and I’m glad he still lives close by. But I thought I would be with him forever. There was all that history—lost. That’s what made me sad. The loss. My sense of self before that was entirely different from my sense of self afterward. I was knocked off-kilter and was trying to come back to center. That took a while.”
“How did you do it?” I asked.
“About a year and a half after the divorce, I got into dancing and music. I adore music. Any kind of music. It became my salve and I lost myself in music, dancing.”
“How? Did you go to, like, Arthur Murray’s or—”
“No, no. I just went to a salsa place. I found people who loved to dance and I hung out with them and that made me feel alive.”
“And did you have actual dates?”
“Yes, but not many fix-ups. Mainly, I would go to the symphony and somebody would sit down next to me and we would get to talking, and we would have a common interest and we would go out.”
“So when you went dancing or to the symphony, you’d go alone?”
“A lot of times, yes. That is why I loved living in Atlanta. I never minded being alone. I have a lot of friends getting divorced who just can’t stand being alone. Just the thought of being alone makes them feel as though the whole world is looking at them.”
“I felt exactly that way for two years following the end of my second marriage, as though I were a leper,” I confessed to Gloria. “So for thirteen years you were single and dating?”
“Yes, but the dating part was uncomfortable for me. It was so different after thirty years of being married. And you are searching for your identity. You go out in these situations and you say to yourself, ‘Is this what my identity is now as a single woman? I don’t want this to be my identity. How do I work on a new identity?’ The thing I missed the most of anything about dating were the hugs. Hugs are so important, but once you encourage that, you encourage more than you want. They think you’re asking for the whole kit and caboodle. You can’t just ask for a good hug. So I got my hugs from my kids and got massages for the touching.”
When I met Gloria she was with an attractive man named Scott who I assumed was her husband. I was wrong. She and Scott have been lovers for almost four years, although they’ve known each other for ten or fifteen years. Scott and his wife had moved into Gloria’s building, and they would invite each other over for dinner. When Scott’s wife died of pancreatic cancer, Scott and Gloria got together.
“Do you live together?” I asked her.
“No, I live here on the twelfth floor, and he lives upstairs on the sixteenth.”
“Would you ever want to live with anybody, with your ex-husband or Scott or anyone else, again?”
“You know, I say no … but who knows? I really don’t. We spend a lot of time together, but it’s when we want to be together. It is really nice having your own space.”
“I guess he knows how to hug.”
“Oh, yes. He is wonderful.”
Clearly, getting out and about in situations where you are apt to meet like-minded people, the way Gloria did, is a good idea. So is telling everyone you know, including your children, that you’re looking to date.
Younger women and men who want to meet someone go to bars or clubs. I wouldn’t feel comfortable doing that, and I doubt most older women would either . . . or men, for that matter. That is a main reason why online dating has become such an important part of socializing in the Third Act. Frankly, I was stunned when a close friend of mine in Atlanta told me she’d been to a lunch with ten or so female corporate executives and that a number of them were dating or had married men they’d met online. With Internet services such as Match.com, PerfectMatch, and eHarmony, you can find out more about someone in a short amount of time because the process makes it so efficient. You can initiate, move things to the next step, or back out, all the while remaining invisible until you want to present yourself.
Mary Madden was sixty-two when I interviewed her in her attractive but not extravagant home in Atlanta. She had been divorced for fifteen years, and though she knew many people in Atlanta, she had never happened to meet anyone to date, nor been introduced to anyone. She had been a technology entrepreneur who started her own business and took it public; she now works with a turnaround firm, where she helps companies facing bankruptcy run more efficiently.
A few years before I met her, at age fifty-nine, Mary had gone on both eHarmony and Match.com, using them simultaneously. She explained, “A friend of mine who has her own business went on Match.com and met someone she then married. She told me, ‘You are going to have to go through seventeen or eighteen guys. So prepare yourself. It’s like making sales calls.’ She’s a salesperson and she was absolutely right. I corresponded briefly with seventeen men before I met the man I am with now.”
I learned from Mary that to start, you sign up for an account with one or more of the companies. She said they are not expensive and that one, the Right Stuff, is free if you can prove you attended an Ivy League school. Once you have opened the account, you are asked to fill out a questionnaire describing yourself. You may also decide to write an optional essay that goes into more depth about you as a person. For example, what are your likes and dislikes? What do you want out of life? Are exercise and staying fit important? Do you enjoy travel? Do you like spending time with your children and grandchildren … or not? (If a man wants to be with his grandkids every weekend and you don’t like kids, you may not want to waste your time developing a relationship with him.) Are you an avid reader?
Mary told me, “I put down that I read a lot and I listed all the things I read, and one guy sent me a response saying, ‘Well, the last thing I read was my automotive manual. But I am in south Georgia and I am an auto mechanic and I would really like to meet you.’ So, saying no to that one was easy.”
Mary also mentioned that a Jewish friend of hers from Los Angeles who had used JDate, the Jewish dating site, told her that her personal essay was too serious. “So I rewrote it to make it less serious,” Mary said. “I put in that I have been responsible for people all my life and right now I really do not want to be responsible. I just want to have a good time. This is actually what caught the eye of the man I ended up being with. He liked that. He is pretty independent. He doesn’t really want somebody taking care of him. Although we do take care of each other. I get him bananas and little stuff.”
Not all people post a picture. A friend of Mary’s has a business in Atlanta and felt she couldn’t let people know that she was looking to date online, so she never posted a picture of herself. “Yet she ended up meeting a highly placed corporate executive,” Mary told me, “and they have been together the last couple of months.” Since she didn’t share her friend’s concern, Mary did post a photo of herself along with the questionnaire; but after the JDate friend said the photo was a
lso too serious, Mary got a professional portrait taken.
In her book Prime: Adventures and Advice on Sex, Love, and the Sensual Years, the sociologist Dr. Pepper Schwartz says that you can decide when to post your picture. You can do it right away, or you may want to wait until you feel there are a few men who seem compatible and then ask them if they want to see your photo. “A crisp, clear, recent picture showing your face and body type is the safest, most honest way to proceed. But make sure it shows off your best attributes,” Pepper says. “If you are voluptuous, why waste your time (and the man’s) if he prefers slender, small-breasted women?” Pepper adds, “Likewise, you need to see a clear picture of any guy you are considering meeting. Men in sunglasses, or with blurry pics, or pics that don’t indicate their body type should be avoided.”1
If there seems to be an interest on both your parts from the posting and emails, the next step is a phone call to see if the man’s voice and attitude seem right for you. If there’s no phone chemistry, you probably won’t want to extend it into a meeting. Whatever you do, do not give out your phone number. The guy may turn out to be a real pain, and you’d have to change your number to get rid of him.
The man Mary has spent the last two and a half years with never even posted a profile, but he read Mary’s and emailed her out of the blue. “It was interesting,” Mary said, smiling as she remembered. “He said, ‘Reading your profile is like sitting in a movie theater in Connecticut watching Bull Durham and being the only one laughing.’ And I am going, ‘This is the weirdest thing I’ve gotten.’ And I don’t know why I answered, but I did. We emailed back and forth for a while, and then we met for a glass of wine and eventually started dating. But I did all these things—like, I called my friends and said, ‘I am meeting this guy for a glass of wine.’ I called when I came back home; I said, ‘I am back home.’ And I think I did the same thing on the second date.”
