Risk and consequence

Got the blood test results yesterday. Would you believe it’s four years since the last ones? Time flies when you’re having chronic degradation of your biological functions, doesn’t it? The best news was that I’m still not a diabetic, and that for a male in his late fifties, my PSA is normal, so no finger up the bum – not for medical reasons at least.
Cholesterol 8.3. Yes, that’s up on four years ago. So few scores increase these days, one thinks it’s something of an achievement – would that blood tests included IQ results – but then again, perhaps not.
So, what the hell is 8.3? Yes, Yes, it obviously combines good scores and bad scores – like getting 93% for your three point turn in the driving test, only to fail by running over a small child on a pedestrian crossing. It means that the doctor advises I go on statins.
What their records don’t show is that I was on them some years ago because I knew my cholesterol number was high and rather than get a prescription, which at the time would have cost me €45 per month to buy, I stopped into a pharmacy off the Ramblas in sunny Barcelona while weekending on rich creamy food and lots of drink, and bought a month’s supply for €2.50. Having a slightly older brother-in-law who also self-prescribes helps – like having an older brother who smokes I guess. Anyway, having bought a month’s worth, I decided to buy a couple of years’ worth and started self-medicating. After about two years of noticing precisely nothing from taking them, and failing to have another blood test, I went to India, and in a fit of holistic meaningfulness (something which India engenders), gave them up. A few months later, having blood tests for some other reason, I was told my Cholesterol had risen to about 7 from about 6. Who’s counting?
Back on the statins, and another year later, stopped again – I’m quoted as admitting to feeling under pressure to give them up because one side-effect reported in some medical journal is that they’re supposed to dampen your ardour, not so as to make you soft in your old age, but just to take away the urge. Did I notice this side effect? No, I can’t say I did, in retrospect, and even if there was statistically a shift in activity levels over a four year period, I’d have put it down to the chronic degradation of biological functions (again). But let’s not post-rationalise something so fundamental to one’s well-being as sex. If I was less driven, then I would risk a coronary to keep my mojo.
Two years later and 8.3 raises the question: what are the cons of statins, and do they outweigh the pros? The pro is singular, as far as I’m concerned. It is a reduction from 8.3 to something less – who knows what is appropriate, for an old git with so many other issues in his life, most of them from the neck up. Let’s say we get the number from 8 to 6 with the help of statins. Let’s say we don’t suffer from the myriad of other side-effects which include, incidentally, diabetes caused by raised blood sugar, muscle pain, diarrhoea and stomach problems, loss of memory and not to mention the pain in the bum caused by buying and taking a drug permanently …
Change your diet, I hear the multitudes cry. Get rid of all those cholesterol-inducing foods. Well, yes, I do have to admit to a passion for full fat cheese, bacon and other processed meats, and I will bite that bullet, if I must, but then I also love avocado, spinach, nuts, oats and dark chocolate – yes, chocolate actually reduces cholesterol.
But the issue is numbers. After all, like all probabilities, they’re only possibilities, risks. A score of 8.3 raises the level of risk of coronary. WebMD says:
190 mg/dL and above represents a high risk for heart disease and is a strong indicator that the individual can benefit from intensive treatment, including life style changes, diet, and statin therapy for reducing that risk.
For LDL levels that are equal to or less than 189 mg/dL, the guidelines recommend strategies for lowering LDL by 30% to 50% depending on what other risk factors you have that can affect the health of your heart and blood vessels.
Risk management. That’s the question. How do you look at risk as you move from the thrills and spills benefits of a life driven by the need for risk to the fears which go with risking the precious 8889 days left? Maybe it’s time to stop wondering about these things and accept that a healthy person is one who enjoys life and risks enough to be stimulated and stimulating, that so much else matters more than biological degradation… But interestingly, health is the number one worry for most people once they’re past the mid-point.
Fuck it. Back onto the statins!

Doctor (2015)

I’ve got an early appointment but
there’s already a woman in the waiting room;
Small, solid and pale, tired looking.
She reminds me of the queen,
the world on her shoulders,
looking straight ahead,
absorbing her suffering.
She’s counting under her breath.

I think my heart is going to misbehave, you know:
pain in the chest,
down the left arm,
palpitations.
Classic: cut down when I’ve finally begun to get there.

We’re both looking for our fifty euro reassurance.
She thinks it’s mild for the time of year.
She smiles like a mother.
I’m thinking of Freud standing naked at the easel,
eighty, sinewy, staring intensely, wielding his brush,
ready for the fight.

He tells me it’s probably my back:
tension, too much coffee, wine, cheese.
But we’re not getting any younger.
I stopped taking the statin,
it took away my sex drive.
He’s older than me – he takes it,
but its OK to stop, he says,
half the world is on it,
but you seem healthy, for your age.

As I’m leaving, I see her
climbing into an ambulance.

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Tempus Fugit

− Hi. Can I ask you something?
− I don’t see why not.
− How long do I have?
− You want an accurate answer or will I make it up to make you feel immortal?
− No, the truth of course.
− OK, 24 years, 123 days, 4 hours and 16 minutes. 8889 days or 213,000 hours, 12.8 million minutes. Accurate enough?
− Yes, thanks. 8889 days doesn’t sound that much. 24 years ago I was already 35, and it doesn’t seem that long ago.
− True, and don’t forget how time seems to gather pace as you age.
− Thanks a bunch! So that’ll make me just under 84 when I shuttle off, which bears out the theory about knowing when you will die.
− What’s that? Not that God-awful idea in Tuesdays with Morrie? The one where you note the first day you spent more time looking back than looking forward and double it? Pile of crap, you know. Do you want to know how it ends?
− No, I don’t think so, thanks.
− So, why did you ask how long?
− I was reading about climate change and the prediction that Ireland will be overwhelmed with floods and storms and baking hot summers within the next few years and I was wondering whether it would be in my lifetime.
− It will.
− OK, so what am I going to do with the 24 years and some? I’ve been wondering if it’s all downhill from now.
− Well, let’s see. You currently spend 16.7% of your time watching television. And that’s actually 24.6% of your waking time. Can you go downhill from that?
− Sure. Not all of that is a waste – though nearly all. I’m assuming there will still be TV in 24 years, and that it will still be full of reality shows and soaps and movie re-runs?
− Yes, and news will be available on premium-rate channels which you’ll be vetted for before you can subscribe. Except during elections, when it will predominate on the soaps channels. There’ll be the ‘live war’ channel, and a whole raft of live disasters channels, mostly featuring storms, hurricanes, floods and suchlike
− And will I spend 16.7% of my time watching TV in 20 years time?
− No, 25%, which will amount to one third of your waking life. You’ll actually be sat in front of the holographic 3D light box on your coffee table, as it will be then, for one in every three minutes of your conscious existence. The quality of the input will have gone down, and your lack of processing will have gone up, so you’ll effectively be vegetating.
− What else will I be doing that I don’t do now?
− Well, you currently sleep 31% of your time, and that’ll drop to 25%, as you’ll need less. Not to mention the time you currently spend on the toilet, 1.7% of your waking time, will treble. You currently read 4.2% of your time, and I’d be lying if I said you’ll become a literary leviathan by then. You’ll try to read for half the amount of time you do now – you just won’t have the attention span. You currently spend 6.3% of your time eating, which is taken up with one hot meal and two snacks a day, with conversation and pace to them. This will remain the same, though you will eat less and more slowly, and the conversation will be desultory, or non-existent, depending on whether you outlive your wife.
− I hadn’t thought of being alone. Will I be? Alone? Wouldn’t that have a big impact on my use of time?
− Yes, but you don’t get to know about anyone else, so let’s make the assumption you go before she does.
− OK, let’s. What about exercise? I must spend an average of an hour a day in the gym or walking the dog?
− You currently spend 4.2% of your time on that, and it will halve, as you become less able to walk, though you’ll still try, but it will take you ages to get anywhere, so it will take 2% of your time. The gym membership will lapse pretty soon.
− So I make pots – I spend 4.2% of my time in the pottery – not a lot, I know, but I guess that falls away.
− Yes, and the 8% you spend earning your living on the computer. That goes pretty soon too, though you’d have it continue, you pass your sell-by date. Pretty ignominious really, but let’s not dwell on how everything falls away. You’re depressed enough already.
− What else?
− You spend time maintaining your home, cleaning (though that hardly counts), washing, doing paperwork and emailing, shopping, driving and lots of little things. Sex takes 0.3% of your time now, and you can guess how much that’ll be in 20 year’ time.
− Thanks. Let’s not dwell on that slippery slope.
− You currently spend 4% of your time doing nothing. On a good day. In 20 years’ time that’s trebled, and while your down-time now is infused with thoughts and ideas, creative nuggets, angst and schemes, it will be infused with confusion and numbness, blank spots and desperate attempts to recall names.
− Fuck. So it is all down-hill from here on in? Does it have to be? Shouldn’t I have one last fling? Another joust at the windmills of life? Take on a big challenge? Bite off more than I can chew?
− You really do fancy yourself as Don Quixote, don’t you. I was thinking more of Sancho Panza…
− Or maybe Brando in On the Waterfront: “I coulda been a contender. I coulda been somebody, instead of a bum, which is what I am, let’s face it.”
− What I’ve told you is what will happen if nothing else changes. How it might be if the context stays the same and you don’t make anything happen. There are two options. Either you try and make changes, rather than strutting and fretting your last 213,000 hours upon the stage, or the world will change so fundamentally that whatever you think you’re going to do will be changed for you.
− And?
− And I’m not going to tell you how the world will change that will affect your life, but rest assured it will. I’m going to say that regardless of how the world is going to change – the climate, the migration of your species, the religious violence, the political violence, the economic injustice blaadie blaadie blaa – you’re going to have to make your own changes. Start with the hours in the day. Start with the minutes if you prefer, but make some changes, because the life force will not always be so strong. The opportunities for change will not be so great.
− OK, so. Any suggestions?
− That’s for another day, if you can spare some of that wasted time to think about it.

Tapas

“What do you think of this rabbit?” he pointed to the remains of the carcass on the deep blue glass plate, surrounded by scrapings of mashed potato and rich gravy.
“It’s amazing, isn’t it. We had it last time we were here. It’s the best thing on the menu. Do you want that piece of chirizo Tanya?
“Thank you but I’m not going to eat any more. You go ahead” Vera skewers the slice of chirizo and, moves her fork to include a piece of Manchego and a grape.
“Andalusian, it says. Probably caught outside Belgooly. Scrumptious though. Great choice. I’ve never had rabbit. All those cute little furry things with big eyes. Did you try the duck?”
“Don’t worry, these Andalusian rabbits are really ugly.”
“So say again. You want to invite only people you want, and no family? Then you’re talking about finding somewhere for sixty people. I can’t hear more than one person at a time.”
“I organized my 50th and that was a great venue, and it didn’t cost an arm and a leg. You should decide who you want first. That’s what makes a good party, not the venue or the food.”
“The mini- burgers are great”
“I’ve had one. You have that half.”
“No, I’m stuffed. The thing is we need to think about this. It’s a year off and can’t we just elope?”
“Darling, you know I would be happy to keep this between us, but… Can I have another glass of this wine?”
“Sorry sir we don’t do that one by the glass.”
“OK, we’ll have a bottle then.”
“No, Dan, we’ll never get through another.
“How about the Malbec, sir. It’s similar and we do that by the glass. I’ll get you a taste of the Malbec. It’s very popular.” The waitress, or is she the owner, returns with a small wine glass a quarter full of red and Dan tastes the wine in an exaggerated gargling, swirling it from cheek to cheek.
“I’ll have another glass of that. Adam?”
“No, thanks, I’m driving.”
“We can get a cab”
“No, it’s fine. I’m fine. I’ve only had a glass.”
“Can I bring you the desert menu?”
“Not for me. Vera? Dan?”
“No.”
“No thanks.”
“I think we’d like a moment, if that’s OK?”
The waitress reaches between Adam and Vera and her perfume cuts through the not insubstantial aroma of rabbit and duck and she tries to get her thumbnail under the edge of the slate serving dish without success. Adam smiles up at her and reaching across the slate, pulls it from the far side towards him and to the edge of the table so she can lift it by its edge. He wonders why restaurants use slates for serving. They must be so impractical, unhygienic and easily damaged, and their only redeeming feature is that they present the food well. Tapas somehow looks more generous.
“Can we have the bill please?”
They barely see the total before it’s whisked up and split. They’re drunk enough to make round numbers of everything substantially higher than the specific, just so that the four-way split is easy to calculate. They all drop €50 notes onto the small silver dish while focusing on the free custard tartlets which have been brought on a separate dish to the table, as a substitute for desert, a freebie from the grateful restaurant owner who’s finally getting full houses and profits, and recognizes the value of regulars over tourists. They had the table in the corner by the window, even though this time they hadn’t remembered to ask. The problem has only been that Vera, sitting next to the restaurant door, is the one most susceptible to the cold and every third customer doesn’t shut it after them. Adam has been up and down like a bloody yoyo throughout the meal, closing the door. Being solicitous. He feels it is incumbent on him to be responsible, given that he’s the driver, the least drunk. The host.
Returning from the toilet, Adam realizes that the party for a year hence, in his and Dan’s joint honour, has been planned and booked by Tanya, the party organisation expert. It’s a game.
“I don’t like the sound of that.”
“It’ll cost you”
“I’m not going to be organised. Can’t we just change the subject? It’s a year away. Let’s leave it.”
“You’re just so negative. All I was doing was talking.” They often row like this. It’s not about the party. It’s about control. It’s always about control and power and respect and each other’s share of the limited attention span Dan offers.
“Maybe we can do several different things spread out over a few weeks?”
“All year I was thinking.”
“Maybe you should elope.”
“I don’t fancy him.”

Thursday

Why do insurance companies specialize in making drivers who are looking for quotes feel guilty? So you’ve got three years no claims discount? Why only three? – Well, I probably had an accident a few years ago – in fact I had a prang about six years ago and it was disputed and took three years to settle and then they took away my no claims. What’s that about – a problem? I have to ask what they want. Business without risk of course. Only three years without a claim – he isn’t one of those drivers who is ultra-cautious and polishes his car on Sundays and never breaks the speed limit. How many penalty points do you have? None? Are you kidding me? You don’t sound like the sort of guy to have none. In this day and age? Of course you must have some, but if you’re going to lie to me, that’s fine because we now have the perfect get-out clause on your policy – you lied, it’s null and void.
Deaf in my right ear. Have been so for some years, but today and yesterday it’s assumed deafening proportions. It’s that underwater feeling when the water just won’t come out. With the hearing aids in there’s a little sound, but it’s fairly little. I start to wonder if this is in fact not an ear infection (most likely explanation as my tear duct is also sore) but another step – a quantum drop – in the ever deteriorating body. Does it matter being 59? Does it matter that I can’t hear everything, that the sight is second-rate, that there are always aches? And what other performance characteristics are measurably worse. We’re in the Lancaster, we’re ditching. The film is grey and grainy. The dials – there are many – are flicking back and forth – the biggest one has years on it and that’s steadily emptying like the fuel gauge as kerosene streams from engine four. Then there’s the memory gauge… holding steady at half mast. The crew is watching my piloting skills with frowns on their faces. Shouldn’t the assistant pilot take over? Are we going to crash land or ditch in the sea? But hang on, the gauge is faulty – the hearing is fine, it’s just that the hearing aid is blocked. The memory gauge, is that broken – not a chance – the memory is fucked.
Do you expect the world to come and get you? Do you think anyone wants to see another’s self-pity and destructive doubt written large in front of them? Of course not. It acts like a mirror. They work hard to keep the wagon rolling, and then you leap out in front of them like death and it causes their horses to shy and the wagon to swerve off the trail.

Being 59

59 should be an uneventful birthday. Forgettable. I had no hopes or expectations, nothing to suggest it mattered. The weekend was taken up with someone else’s 60th, which encapsulated all the horrors and pleasures of marking next year. The party lasted for twelve hours, the drinking for 16. The preparation lasted for three months and the clean-up may not end, as some stains are not removable.

I can’t help wondering whether 59 is well beyond one’s ‘natural life’. In the wild, or even in the middle ages, this would be considered a ‘ripe old age’, rather than just over the mid-point.
I’m dizzy with the thin air. I’m overflowing with emotions, which are unswitchoffable. The slightest hint of schmaltz and I’m teary. I can’t see anything ahead. It all seems to be behind me. Not least the writing. The achievement of a first, awarded on Friday, marked the closing chapter, not the opening of a new book. Fear. I feel fear that I’m not going to achieve anything as significant again. Not that the result has significance for anyone else. Just the old git doing what he does – setting himself goals and driving to attain them without real purpose. Just trying to prove himself again.
How do you move forward from this point? You’re in the process of being classified. People like/need to pin you to a colour. “He’s depressed. It’s a belated mid-life crisis. He’s not what he used to be. He really never dealt with the abuse. God, he’s so self-obsessed, narcissistic.”
Do you do what they say you should do? “Just turn up at the page.” “Go into the studio and make something you’re proud of.” ‘Keep writing and it will come”.
I felt something about the Kevin Barry method, which suggested the need for daily bowel movement. The constipated man sits patiently on the toilet seat and strains till he shits. Write 500 words before breakfast, without thinking and before doing anything else. That’s the morning pages.
Then take several hours to edit out four hundred, because most of what you say isn’t well said, or isn’t worth saying, or reading. Then spend the afternoon out taking exercise, breathing in the fresh air. Then go back to what you have saved and start to build on it. The foundations are strong enough for cognitive work. Find yourself by the end of the day with three or four hundred words worth keeping. Do that every day for a year and you will have 100,000 words. A book.
I thought this might be me, but I’m more of a stream of verbiage person than that, and somewhere closer to the Stephen King school. Sit and write two to four thousand words. Do that every day for four months without re-reading it too much. Get your 100,000 word draft finished and then start editing.
OK, so before the writing must come the idea. No? Surely you can’t start with nothing?
59 should have been an uneventful birthday, but he woke to find his world had changed. It was not just that his skin was green and scaly. That alone might have been attributable to the heavy drinking, or the fungal infection he thought he’d noticed in his groin over the last week. Nor that when he opened his mouth to thank his wife for her birthday present, he didn’t speak but rather squawked through a beak, like a parrot. That too might have been a hallucination brought on by the partying. It was the horrified look she gave when she turned on the bedroom light to greet him, took the wrapped jumper from her bedside cabinet and turned to him across the quilt.
“Fuck!” she leaped out of bed and ran naked from the room, only to re-appear briefly to check she had not been hallucinating.

59 should have been an uneventful birthday. It should have passed unobtrusively, shuffled by. Instead, it was a monumental traffic accident. A bloody tangle of vehicular wreckage and mangled limbs….

59 should have been. It was. It was in fact the quietest birthday he could remember. In the process of turning his life into a powerpoint presentation full of neat graphics and trend analyses, the liveliness of one’s birthdays is just one more smooth graph showing a Gompertz curve towards zero. This curve slides like a ski slope from the top of the hill, which, in my case was probably aged nine or ten, to the bottom, which may have come, but probably hasn’t – a year in which I die on my birthday perhaps? One in which the level of quietness is deafening.

Seize the day

I can spend the day in between self-belief and fear. There’s nothing to prove, and nobody sitting there in judgment, but the day is long and there is nothing to hang on to.
I might begin by believing that I can do what I want and with diligence and care, I can be good at it. I might believe that I am OK because others show me that’s what they believe. But I can fear the loss of that self-belief. I can fear the space I have between now and decrepitude, between disintegrating faculties and death. I can fear the judgment of those who thought me better.
So it’s a circle or maybe a spiral of self-analysis, assessment, evaluation and justification. The spiral rarely winds upwards.
I’m good at finding tasks which self-justify. Fillers, duties, amusements and identity markers. Make a dozen mugs. Go on Pinterest and find some clever new ideas someone else came up with for where to tuck the used teabag or how to stop that little tag on the end of the string from falling in the cup. Or even come up with a new mug idea, such as how to make two mugs lock together so they can easily be carried in one hand by an old man who needs his other hand to hold tight to the banisters when he’s taking his and his wife’s early morning cuppa up to bed.
You see? This self-justifying act fulfills so many things. It fills time. It potentially makes money, assuming said cups are popular, and it sends a warm feeling through the sentimental tunnels of love which allow us to see the old man and his wife of sixty years in their love nest.
I can spend the same day chasing people to chase me. That means either generating marketing messages for experiences people might want to tune in to, or it means asking existing customers to consider whether they want more of what they’ve had. There’s always a string of vaguely engaged ex-customers who have rosy memories, or need prodding to get on with the projects they’ve been meaning to start. I can go through the list of touch-points in my life and see who they touch, liaise, massage, re-visit.
Is that what we are? Marketable entities, which interface with our audience at touch-points? Perhaps that’s a valid way of looking at our place in the world, and a way of deciding what we need to do to affect it.
I can spend that same day in passive stimulation, which feels informative, perhaps inspiring, but is still ultimately passive. Reading, watching TED talks, surfing sites on Big Data and its implications for mankind. Whatever. I come away with a more replete brain, without anything good and new planted or attempted or thought about. Does this passive process affect my active process? Am I inspired to use it to change the way I treat the world? I’m not convinced, but then as someone hugely impressionable, perhaps I change through this. Thinking about Elena Ferrante or Johnathan Franzen, or the latest TED evangelist, I am undoubtedly moved, educated and inspired. It must rub off.
You can spend the day being needed. You can work hard to make a living. You can engage more thoroughly with those who love and interest you, because that is your modus operandi, your raison d’etre. You can be needy, vulnerable, assured, supportive, attractive and attracted. Why can’t I?
So this is a hiatus when it comes up and bites me in the face. This is the space between one meaningless gesture and another, or between one clear-cut journey and the path that peters out, between one false start and another, between one over-reaching dream-state and its concomitant fall to earth.

On Loss

I wonder whether we have to go through bereavement for each lost habit of our youth. That poses the question: what constitutes a habit, or behaviour, or need, or want which is worth grieving for? And what should we do to prepare for that process. I think this might be one of the fundamental issues of middle age.
Grief is a multifaceted response to loss, particularly to the loss of someone or something that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, and grief is the reaction to loss.

Between the prime of life and the crag end, we lose things and some of them have an emotional bond for us. We become bereaved, and sometimes we just can’t get over it. Classically, our pet loves – the football game, the motorbike ride, the tight jeans or the leather jacket – all become things of our past, to be envied and re-visited with varying levels of success. We might dress up like over-aged hippies or like the Fonz in Happy Days. We might buy that Harley we always fancied but couldn’t afford when younger, or we might simply behave like someone twenty years younger than we are, in a vain attempt to recapture our youth or someone else’s.

For me, one of the biggest losses of the last few years is my visibility to young and attractive women. The words are both relative, but it is clear that once one becomes middle-aged, or past one’s prime, or perhaps past one’s functional age for child giving or bearing, one becomes less visible. It suddenly becomes clear that one is transparent, out of the firing line, no longer under consideration.
That isn’t to say that flirting stops, or that attraction doesn’t exist, but the immediate, impersonal electric shock of ‘fancying and being fancied’ goes. Well, the second half does anyway. Younger people are still objects of attraction, though the sexual possibility of the attraction seems to fade, and older people might seem to younger people to carry intrigue or complexity, or maturity or material power, but we don’t carry the same physical energy.

So what else are we going to lose after we’re fifty, or sixty or older? Here’s some. Why not score them out of 10 on how important they are to your sense of wellbeing and therefore how much you should grieve their loss or fear their gain?

Smooth skin, soft curves. Strangely, middle age shows a lot in the face and sometimes in particular parts of the body, which become rounder and softer, while generally, our bodies don’t deteriorate as fast where they’re covered up as they do where they’re exposed. As a sun lover, I’ve got leathery skin and more wrinkles than if I’d hidden in the shade. For a lot of us, despite the exercise and some caution with the diet, we get the middle aged spread, and it’s harder to hold in the stomach muscles. Exercising becomes harder and less beneficial, as the muscle doesn’t develop so easily, and yet perhaps regular exercise is all that saves us from falling apart. For others, it’s all about the increasing amounts of spare skin, loose flesh, under-padded, without tone. It appears under the upper arm, or hanging under the arse, in bags under the eyes, or as double eyelids, above the knees, down the thigh. For those who don’t put on weight, we might become more boney and angular, our skin more leathery or like tissue paper.

Fertility – this isn’t all negative. The menopause is a double-edged sword worthy of its own chapter. For men, unless you’ve had the chop already, you’re still fertile into old age. I’m not sure how much that matters to younger women when they’re choosing whether to become involved with men over 50, but perhaps it’s there in the back of their minds.

Hair loss is common to both men and women, except in the ears and up the nose, which is more noticeable among men than women. Does hair loss in men affect their attractiveness to women? Does it undermine their sense of self-esteem? Clearly among young men it can be a big issue, and the transplant businesses are thriving. But the degree to which it is a negative force in mens’ lives after they reach 50 is questionable. Certainly it is an issue for some women, who spend inordinate amounts of money and time in trying to bulk up what they have.