David Thomas: Manopause? There's a pill for that

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Testosterone supplement business worth $2 billion a year as men strive to stay young, writes David Thomas

The gym has become the new temple for the modern over-40s man. Photo / Getty Images
The gym has become the new temple for the modern over-40s man. Photo / Getty Images

There's a hot new drug called TRT that its users take to make them feel more energetic, more alive, more aggressive and sexier, too. As with so many performance-boosters, it is catnip to financial traders. "TRT is extremely popular on Wall Street and increasingly in Canary Wharf, too," says one UK-based City worker.

Now, in the surest sign that the drug has gone mainstream, it's on the cover of Time magazine, which claims that the TRT business is worth US$2 billion ($2.36 billion) a year in the United States alone, after a tenfold growth in the first decade of this century.

So what is the actual substance lurking behind those initials? Well, the first "T" stands for testosterone, and "RT" for "replacement therapy". We're talking about hormone replacement therapy for men. Testosterone decline sets in from around the age of 30, with one in seven men over 50 thought to have low "T" - a phenomenon known as andropause.

Middle-aged men are scoring testosterone - a class C drug and illegal without a prescription - for the same reasons their female peers are drawn to HRT.

As time goes by and sex hormones drop, the middle-aged can feel that their bodies are getting flabbier, their libidos are flagging and their get up and go has got up and gone. For women, this is summed up as the menopause. Now, the male of the species has a word for his equivalent. Welcome to the manopause.

The signs of manopausal manhood are all around us. Streets are clogged with middle-aged men in Lycra - or Mamils - desperately trying to channel their inner Sir Bradley Wiggins as they squeeze into entirely unsuitable, skin-tight clothing and thrash the pedals of their $2000 racing bikes (the opportunity to spend fortunes on exciting new kit is, of course, one of Mamildom's great attractions).

When not on their bikes, the fitness-crazed over-40s are heading to the gym. According to a recent survey, men in their 40s, inspired by their beefcaked movie-star contemporaries such as Hugh Jackman, 45, Gerard Butler, 44, and Dwayne Johnson (once the wrestler known as The Rock), 42, are the fastest-growing sector of the bodybuilding market. Meanwhile, though men still account for just 10 per cent of plastic surgery procedures in the UK, the number of male patients is growing fast.

Sports stars such as Wayne Rooney and actors including James Nesbitt have made hair transplants more socially acceptable, Simon Cowell swears by his Botox, and a growing number of male celebrities have clearly had - even if they will not admit it - facelifts, collagen injections, new hair and new teeth.


Simon Cowell isn't embarrassed to admit he uses Botox. Photo / AP

To Mark Simpson, the writer and style-spotter who coined the term "metrosexual" for the preening 90s male - as well as his successor, the spornosexual, who takes body obsession to new heights - manopause mania reflects changes in society's view of ageing and in masculinity itself. Simpson, who is 49 and admits that "I go to the gym and worship at the temple of the selfie", points out that "middle age used to be a time when men could enjoy their accomplishments and their families and maybe coast a bit. But now that security's gone. Today, there are only two ages of man: young man and old man. So you have to stay young as long as possible." He agrees that the financial independence of women, and the way many are keeping their looks, figures and libidos, has created a pressure for men to keep up.

But, he points out: "Of course, most straight men care very much what women think of them, but it's not the case that everything they do is calculated to get women into bed. In the end, it's about how men feel about themselves, and what other men think of them."

The proof of this can be seen in the men's magazine market. The top-selling title in the UK is not a lads' mag filled with pictures of semi-naked babes, but Men's Health, whose target reader is 35 and whose typical cover features an improbably six-packed, chiselled male model and headlines that scream "Huge arms, lean abs", "Gain muscle, lose pounds" and "Get a body like this".

So is this little more than an attack of vanity among a feminised generation that has lost the ability to act like real men? Simpson insists not. "People tend to think of narcissism, especially among men, as an idle, dissipating, poisonous force. But actually, narcissism is self-care as well as self-love, and without it no creature can survive." Not surprisingly perhaps, Mike Shallcross, deputy editor of Men's Health, agrees there is a beneficial side to the manopause. "Men no longer equate settling down with giving up. They're becoming more health-conscious, more aware of their appearance, and more aware of the value of free time and they want to use it more actively.

"Also, there's a shift in working patterns. More men are in jobs where they have to look better groomed, and where youth is equated with vitality and ambition. As for the Mamils, Shallcross points out that "stuff like cycling is great exercise, and probably makes men look better than they would if they just waddled to the pub and back. But it's also fun and a good way to spend time with mates. Maybe just that in itself is enough to make them feel younger." But what if getting on your bike isn't enough? What if you want to follow the TRT crowd? The same Time article, looking at the boom in testosterone patches, gels and supplements, admits there has been little research into its benefits and dangers, noting possible side-effects such as heart attacks, strokes and blood clots.

Some doctors, however, do see a role for TRT. Dr Michael Perring is managing director of Optimal Health in the UK, which promises "the best possible health to which you can realistically aspire".

Perring prescribes TRT, with the caveat that "discrimination is needed for who takes it, and in what dose". He believes one reason for its popularity is that you can feel the benefit quickly. "So I may say to a patient: 'We'll do a deal. You will feel more energy ... and then you'll increase your physical activity."'

And there lies the key to a successful manopause: a better, healthier life has nothing to do with a prescription. Dr Perring sums it up in one word: engagement -"in relationships, purpose, mental challenge and physical activity".

And also, perhaps, acceptance. "I am rather enjoying the sensation of being middle-middle aged," says Nicholas Coleridge, president of Conde Nast magazines, whose titles include GQ, which has long extolled the benefits of a strong, well-groomed body.

"You feel less anxiety, care less what others think, know what you like and who you like. I am planning to live to precisely 100, so I am 57 per cent of the way through my life." And when you look at it like that, the manopause is just one stop on a much longer, happier journey.

- Daily Telegraph UK

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