Although no longer at the peak level of their young adult years, middle‐aged adults still report good health and physical functioning, However, as a result of the passage of time, middle adults undergo various physical changes. Decades of exposure and use take their toll on the body as wrinkles develop, organs no longer function as efficiently as they once did, and lung and heart capacities decrease. Other changes include decreases in strength, coordination, reaction time, sensation (sight, hearing, taste, smell, touch), and fine motor skills. Also common among middle adults are the conditions of presbyopia
(farsightedness or difficulty reading) and presbycusis
(difficulty hearing high‐pitched sounds). Still, none of these changes is usually so dramatic that the middle adult cannot compensate by wearing glasses to read, taking greater care when engaging in complex motor tasks, driving more carefully, or slowing down at the gym. Of course, people age at different rates, so some 40 year olds may feel middle‐aged long before their 50‐year‐old counterparts. Most people, however, describe feeling that they have reached midlife by their mid‐50s.
The biopsychosocial changes that accompany midlife—specifically, menopause (the cessation of menstruation) in women and the male climacteric (male menopause) in men—appear to be major turning points in terms of the decline that eventually typifies older adulthood. None of the biological declines of middle and late adulthood needs to be an obstacle to enjoying all aspects of life, including sex. For example, too often society has erroneously determined that menopause inevitably means the end of female sexuality. However, while menopause gives rise to uncomfortable symptoms, such as hot flashes, headaches, irritability, dizziness, and swelling in parts of the body, post‐menopausal women frequently report improved sexual enjoyment and desire, perhaps because they no longer worry about menstruation and pregnancy. For these same reasons, women who have undergone a hysterectomy, or surgical removal of the uterus, frequently report improved sexual response.
Men also experience biological changes as they age, although none is as distinct and pronounced as female menopause. Testosterone production lessens, which creates physical symptoms, such as weakness, poor appetite, and inability to focus on specific tasks for extended periods. However, this reduction in testosterone does not fully explain the psychological symptoms of anxiety and depression that may accompany middle adulthood, indicating that the male climacteric probably has more to do with emotional rather than physical events. During middle age, men are faced with the realization that they are no longer 20 years old and that they are not going to accomplish all they wanted to in life. They may also feel less sexually attractive and appealing, as they discover that seemingly overnight they have gained extra weight around the waist, are balding, and are feeling less energetic than they used to.
Because of society's emphasis on youthfulness and physical appearances, middle‐aged men and women may sometimes suffer from diminished self‐esteem. Women, for instance, experience the American double standard of aging: Men who are graying are perceived as distinguished, mature, and sexy, while women who are graying are viewed as being over the hill or past their prime. This double standard, coupled with actual physical changes and decline, does little to help middle adults avoid a midlife crisis.