Why we need to start taking the male menopause seriously

Is it true that men go through a form of menopause too? Photo / 123rf

Why is so little noise being made about men’s midlife issues? In the months since her groundbreaking Channel 4 documentary first aired, Davina McCall has become a frank and tireless taboo-buster for middle-aged women undergoing what used to be coyly referred to as the “change of life”, courageously relating her early 50s experience of hot flushes, depression and mental fog, her subsequent hormone treatments and fluctuating sex life.

Davina’s brave and stigma-defying words have caused a 30 per cent surge in demand for hormone replacement treatments, while some of her famous friends, including Mariella Frostrup and Penny Lancaster, have helped the former Big Brother presenter and working mother campaign against prescription charges for HRT.

But what about male midlife issues? Perhaps this year’s World Menopause Day, held on October 18, should also be an opportunity for recognising midlife men’s hormonal travails?

The andropause is real enough, and so are the conditions associated with it: mood swings and irritability, loss of muscle mass and a reduced drive and ability to exercise, some unwanted fat redistribution, a general lack of enthusiasm and energy, difficulty sleeping and increased tiredness, occasional night sweats, poor concentration and short-term memory.

Millions of men will be affected to some extent by these issues – and millions of women will be affected by the moods of anxiety, grumpiness and fear projected by their male co-habitees. But still no significantly famous male figure has stepped forward to lead an awareness-raising campaign.

I could do it. Yes, it is true that my media profile does not match Davina’s, and I have significantly fewer Instagram followers, but I am 58 and can certainly tick off a good few of those symptoms. Besides, no one else is putting themselves forward ...

Why the reluctance? Mainly because, as a brand, the andropause triggers some very unwelcome connections. Hypogonadism, when the gonads produce few, if any, sex hormones, is the male “change of life”, and it is often accompanied by a range of (sometimes misdiagnosed) nasties: erectile dysfunction, gynaecomastia (aka man boobs) failing sexual potency, hot flushes, and a drop in libido and energy levels.

Testosterone, the male sex hormone at the heart of all this, has always suffered bad PR, having long been associated with the sort of guys who bump chests when they meet each other outside the gym. In the less-informed locker rooms of the US, a low testosterone level is taken to signify a lazier, less vital, more wussy and effeminate type of man.

Dr Jeff Foster, a men’s health specialist and a co-founder of the H3Health company targeting the well-being of 40-plus males, is fighting our corner. “The question I get asked the most is, ‘Is the male menopause real?’” he reveals. “And my answer is a definite ‘yes’.”

Where the andropause differs from the menopause, he explains, is that it is a more gradual, variable and less eventful process that creeps up slowly on males and can occur at different life stages. Testosterone – the male oestrogen – gradually increases in men to around the age of 30, then gradually decreases 1 or 2 per cent in each subsequent year – that is, declining by roughly 10 per cent over a decade.

"It can be freeing" @ThisisDavina and Lorraine talk honestly about the menopause and why it's important people are talking about it. 🙏#Lorraine pic.twitter.com/WbGEVClTGL

— Lorraine (@lorraine) October 13, 2022

This may sound undramatic and minor, but the cumulative effect on a man in his 50s – such as, say, me – can be quite profound. “Some men might have a really high testosterone at 30 and they may not notice a loss of testosterone until they’re 70. A guy’s peak might only have ever been at the bottom end of normal and then he might suddenly get symptoms – like, ‘Why am I tired all the time?’ – as early as his 30s.” (I can confirm that fatigue levels become something of a competitive sport among men in their 50s).

Testosterone, it appears, far from just being the stuff that makes your chest and face furry and gets you, ahem, ready for action in the morning, is central to the male’s daily function. “As a guy,” Dr Foster says, “testosterone makes you what you are. Yes, you can reduce or mitigate its loss by eating well, training hard, making sure you don’t have other risk factors in life (smoking, excessive alcohol intake). But if you understand how the male process works, then you also see how it matches with the female process. In just the same way that a lack of oestrogen affects women, when you take testosterone out of guys’ bodies, they feel dreadful.

“Testosterone deficiency in men mimics the menopause in women very closely.”

However, he says, the “manopause” is rarely considered worthy of investigation by UK GPs. “Most doctors don’t consider testosterone deficiency in their differential diagnosis for men with low energy,” Dr Foster claims. “Worse still is the fact that many of us [doctors] don’t even know that we should.” Recently, Foster’s consultancy saw a patient in his late 60s, who had been diagnosed with early stage dementia. “When the testosterone was replaced his brain fog lifted and the patient’s memory went back to normal.” Brain fog in midlife men parallels the menopause.

So if we’re having a manopause moment, should this include a call for testosterone replacement therapy to be made available to midlife men in the same way that HRT is for women?

It’s not that simple. One of the major issues to be overcome is that testosterone levels fluctuate naturally over a short period of time, just as “normal levels” of oestrogen fluctuate and change.

“They vary substantially over the course of a day,” explains Dr Richard Quinton, a consultant endocrinologist. The highest levels occur on waking, with the afternoon and early evening yielding lower levels. “And a big meal suppresses testosterone levels by 20-30 per cent.”

Men's testosterone levels drop after a certain age, sometimes as early as their 30s. Photo / 123rf

Low testosterone is associated with all sorts of chronic illnesses, from diabetes to dementia – but whether it is a cause or a symptom remains controversial.

“Every single form of acute and chronic physical and mental illness is also associated with lower testosterone levels as a normal physiological effect,” says Quinton. “This is not hypogonadism – decreased functional activity of the gonads, when the body is not producing enough of the testosterone hormone – but non-gonadal illness syndrome (NGIS).” Symptoms of this include obesity and a metabolic slowdown. “Genuine andropause is actually very rare, affecting fewer than 1.5 per cent of older men. Unfortunately, geriatricians and rheumatologists rarely test for it, let alone treat it.”

The testosterone industry is much more advanced in the US, though for every well-researched trial (the latest, in June 2022, was positive reporting that testosterone treatment presented little risk of cardiovascular damage), there are unhelpful doses of utter quackery – for example, a recent dispatch by Tucker Carlson on Fox News claiming that males experiencing the andropause should self-medicate with a new “bro-meopathic” treatment of “testicle tanning”. Shining infrared light on one’s denuded scrotum apparently being an effective way of treating reduced testosterone levels and rousing general vigour.

This is nonsense, according to Foster. But as a man who feels brittle and knackered, and often unable to recall a movie title, an actor or a friend’s name, I’d like to know if these symptoms are another step towards the onset of dementia, of if my own testosterone levels could offer an explanation – and even a solution.

So I took the test. The kit from UK health and beauty retailer Superdrug (they are also available on the NHS) arrived within 24 hours. I extracted a phial of blood via an almost painless, pinkie finger-pricking gizmo, and sent it back to the Superdrug doctor.

In 24 hours I received my results. Which, disappointingly – for the sake of the story, but not my wellbeing – were uneventful. The level of total testosterone was 15.1 nanomoles per litre, normal total testosterone levels being anywhere between 7.6 - 31.4 nmol /L. So, bang average, middle-aged man: that’s me.

But even if the andropause isn’t real, midlife grumpiness, forgetfulness and tiredness is – and that is a conversation that needs to happen. When, and only when, I am in the mood for it, that is.