Misunderstood, moody, snappy, tired, night sweats, feeling that life is passing by too fast?
No, it’s not your menopause we’re talking about. It’s his. And he’s not necessarily just grumpy – he has hormones too.
While women’s first symptoms tend to be erratic periods thanks to fluctuations in hormones, the beginning of the male menopause may be detected in trips to car showrooms or an investment in a £1,000 titanium road bike and a wardrobe of designer Lycra. Surprisingly, this is potentially due to natural changes in the endocrine system.
Dr Jeff Foster, a GP at Spire Parkway Hospital, explains, “Male testosterone levels start to drop from the mid-thirties onwards, just like oestrogen in women. If a man has a high level to start with, he may not notice anything. But if he was already not producing very much, he will feel a sort of quietus. This is because we need testosterone to produce drive and motivation.”
Male menopause symptoms
When men do go to the doctor for help, says Grant Hamlet, who runs The Hamlet Clinic in central London, it’s usually due to fatigue. “They’re feeling tired with very little energy and may also be experiencing decreased libido.”
Dr Foster agrees: “Some men realise their morning erections have disappeared and then make an appointment. But I also see a lot of women who are concerned there’s something wrong with their husband, as he seems depressed.”
To diagnose the male menopause, doctors often measure levels of testosterone in the bloodstream. Results are given on a scale, as levels vary naturally between different men. In general, testosterone levels should be between 15 and 30 nmol/L, and doctors would consider treating levels below 12 nmol/L.
Therapy for the female menopause is straightforward hormone replacement via gels, injections or tablets, and patients can often feel the benefits within four weeks of starting treatment.
“When you start giving a man more testosterone, symptoms will go away,” says Doctor Foster. “And, the practice is becoming more common – doctors wrote 374,457 prescriptions for testosterone replacement therapy in 2016. The most proven way to increase one’s testosterone level is firstly to eat well, exercise regularly and replace or substitute with either a topical or injected form of testosterone.”
Results of male menopause treatment
One patient came in because his wife worried that his fogginess and night sweats were signs of dementia. “All he needed was testosterone supplements and he was back to normal,” says Dr Foster. “He told me he could feel his brain working again. That the fog had lifted.”
Another patient took HRT and used it as the impetus to overhaul his lifestyle and diet, reversing his type 2 diabetes as a result. “But the biggest difference I have seen,” says Dr Foster, “is with a patient who had given up having sex in his fifties. He and his wife had resigned themselves to it – they were both menopausal. When I saw him he was in his seventies, but thanks to testosterone replacement therapy and Viagra to get the blood flowing, he’s now as virile as he ever was.”
Women are often prescribed Prozac or low doses of other antidepressants to help with menopausal symptoms – a 2017 Healthspan survey found that 40% of women who visited their GP for menopausal symptoms were prescribed antidepressants.
So would men also benefit? “We often find that men coming to seek help from us are already on antidepressants,” says Dr Hamlet, “and may have already been for counselling and have found that these have not had much of a beneficial effect. All of our male patients who’ve been on antidepressants and have been placed on testosterone have come off the antidepressants eventually.”
The NHS recommends talking to the GP if there are symptoms of low mood lasting longer than two weeks, feeling hopeless, sleeping too much or too little, and losing concentration when doing everyday things like reading the paper or watching TV. It suggests cognitive behavioural therapy (CBT) can help.