Introduction
Andropause is the common term for menopause in older men, which is characterized by a decrease in testosterone levels. Many elderly men with andropause have difficulty or are embarrassed to talk about sexual topics, which causes a lack of information or wrong beliefs and attitudes towards this issue, especially among families. Although aging causes changes in the quality of sexual life of the elderly with andropause, it should not avoid marital relations in the elderly. The existing studies in Iran have not had a deep and special attention to these issues and the factors affecting them are not well known. Therefore, this study aims to qualitatively investigate the factors affecting the quality of sexual life of elderly men with andropause in Iran. 

Methods
This is a qualitative study conducted in 2022 using the content analysis method. Using a purposeful sampling method, 14 elderly men with andropause were selected from among those who visited five health centers in different areas of Mashhad city in Iran. The inclusion criteria were age ≥60 years, living in Mashhad for at least one year, having Iranian nationality, having a health-related file in health centers with recorded data, consent to participate in the interview, having andropause symptoms with moderate or severe degrees using the 25-item male andropause symptoms self-assessment questionnaire (MASSQ-25) and low level and high scores of sexual life quality scores using the sexual quality of life-male (SQOL-M) questionnaire. The number of participants was not known from the beginning and the sampling continued until data saturation. Data were collected using a semi-structured interview. Each interview lasted between 20 and 45 minutes. Data analysis was done at the same time as sampling by using the conventional content analysis method. MAXQD software was used for data management. The analysis process was done by summarizing the semantic units and converting them into codes, subcategories, categories, and themes. In the interpretation of the data, both obvious and hidden data were taken into consideration. 

Results
The mean age of the participants was 70 years؛ 8 had primary education, 3 had middle school education, 1 had a high school diploma, and 2 were illiterate. Eleven people preferred an empty room (such as the examination room of health centers) for the interview, two people chose the urban parks, and one preferred the workplace for the interview. After examining the codes and identifying the similarities and reducing them based on the overlapping rule, the main codes were finally extracted. The findings included 290 codes, 19 subcategories, 9 categories, and 3 themes. The themes were perceived sexual impotence, non-sexual feelings and experiences, and the desire to have an active sexual life. The categories included organic disorder, sexual decline, sexual impotence beliefs, negative perceptions of sexual life, sexual role conflict, lack of sexual intimacy, sense of freedom from the sexual role, sense of male superiority, and expectations from treatment. The subcategories included signs and symptoms of andropause, chronic diseases, decreased sex appeal, considering decreased libido as normal, inability to have sex, difficulty having sex, fear of having sex, dissatisfaction with sexual life, belief in the lack of control over the quality of sexual life, role disorder, interpersonal communications, partner compatibility, worry, stress, and lack of relaxation in menopausal wives, dissatisfaction with lack of cooperation, creating new life opportunities, correcting erectile dysfunction, solving sexual problems, patriarchal attitudes, and normative belief of absence of menopause in men. The findings indicated the accuracy of the data obtained from this qualitative study, since all four criteria of Guba and Lincoln, including credibility, transferability, confirmability, and dependability, were met. 

Conclusion
The result of in-depth interviews with the elderly with andropause showed the components that can be addressed (the perceived sexual impotence, non-sexual feelings and experiences, and the desire for active sexual life) by officials and researchers for facilitating appropriate planning in this area. The experts, researchers, and related officials should focus more on the care programs for these people. It is recommended to screen older people in terms of andropause symptoms and provide specialized services to them by creating a team of experts consisting of andrologists, urologists, psychologists, psychiatrists, and sex therapists. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Tabriz University of Medical Sciences (Code: IR.TBZMED.REC.1400.015). The study objectives and methods were explained to the participants. They were free to leave the study at any time and were assured of the confidentiality of their information.

Funding
This article was extracted from the PhD thesis of Mojtabi Mohammadi registered by the Department of Geriatric Health, Faculty of Health, Tabriz University of Medical Sciences.

Authors' contributions
The authors contributed equally to preparing this paper.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the elderly who participated in the present study, as well as the officials of the health centers in Mashhad for their cooperation in this study.

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