Women often embrace aging with a flourish—they suddenly wear purple or don red hats or become more outspoken and less obsessive. Men don’t react quite the same way.

Dr. Robert Schwalbe, 65, knows aging presents conflict for men. He is a psychoanalyst and psychotherapist in New York City who treats only men and focuses on the issue of aging. He regularly counsels those struggling to adjust to roles and bodies and relationships that have changed, and he has written a book about it: Sixty, Sexy, and Successful: A Guide for Aging Male Baby Boomers. The 60s and beyond, he notes, can be the most rewarding or the most miserable period in a man’s life.

What makes them miserable? “Men will often think, ‘I have time for that—I won’t think about that now,’ whether it’s career choices or marriage or relationships with children or social relationships. They let things go because of habits. I say, watch out for habits because they become your behavior.” Then, in their late 50s and early 60s, physical and psychological changes complicate their lives, and they can’t deal with paying attention to that unsatisfying job or troubled marriage.

“Women accept aging far better than men do,” he said. “I believe that has to do with the menopause issue. They prepare for the aging issue. They hear about it from their mothers, their sisters, their friends. They know the signs. Men don’t.” The unraveling of the physical stuff offers hints—they’re not as effective on the golf course or tennis court, their vision or hearing changes, regular checkups take on more urgency. “The body and mind are not as strident as they once were,” he said. “So they’ll fight that. They’ll cause themselves physical and mental injury.”

And, of course, there’s “the big one,” he said: sexual changes.

“Behavior in the bedroom, which most men could always count on, suddenly they can’t count on with the same assurance as 10 years ago. It’s not unusual for men to experience a level of impotency,” he said. “That can cause a great deal of depression and anxiety.” While medication for erectile dysfunction is a good thing, it’s a “temporary fix” that doesn’t deal with the larger issue, which is the man’s feelings about the fact that he can’t perform the way he once did.

And then men will go and react to what aging is throwing at them by doing “all sorts of stupid things,” Schwalbe said. “There’s nothing worse than a man in his 60s who tries to look and dress like he’s in his 30s. I see this in New York. . . . Men are trying to compete with their grown children. They’ll look at their wives (who have accepted aging) and say, ‘I don’t want to live with an old lady.’ He feels she is reflective of him.”

Rather than try and mimic youth, men should look to some of the “great role models” Schwalbe says are out there, such as Sylvester Stallone, Harrison Ford, and Bill Clinton, who “are still very effective and don’t hide their age.”

All in all, “there’s a lot of psychological adjustment once men are into the boomer period. There are risks of depression and diminished life satisfaction.”

Throw the economy into the mix, and the aging experience can turn downright ugly.

“Ten years ago, there was so much optimism,” he said. “The key to everything was money and what money can acquire. . . . Men in their 50s thought about more toys to acquire and more trips to take.”

Not so these days. The stability, the guarantees, aren’t there anymore. And yet, with the role of father come and gone, job identification is often everything to a man. “Men use their jobs as identifiers,” he said. “One of the first things men ask each other is, ‘What do you do?’” So a man who loses his job “can go into a terrible tailspin.”

These days, “Men can’t say they worked all their lives and achieved something,” he said. “The only people I know who are doing very well are bankruptcy lawyers. People in the blue collar labor force are going through an insecure time in their life. Mix that up with aging, and a certain amount of neurosis steps in. They have a lot of self-doubts and exhibit destructive behavior.”