Feeling Tired? Hot? Irritable? It Could Be The Andropause (AKA The “Manopause”)

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Feeling Tired? Hot? Irritable? It Could Be The Andropause (AKA The “Manopause”)

Words by Mr Josh Sims

27 November 2020

Frankly, I just couldn’t be arsed. Of course, I expected middle age to be challenging: work, marriage and kids all take their strain when you’re no longer in the first flush of youth. Suddenly the historic norm of getting married and having children sooner rather than later made a lot of practical sense.

But this was something extra. Any get up and go had been totally usurped by sit down and stop. Enthusiasm, even for the things I was passionate about, more or less evaporated. Passing time in box-set oblivion seemed so much easier. 

There was more. I was deep in some malaise, with a general, persistent tiredness. My short-term memory occasionally failed me, in a way one might attribute to older age, but which seemed rather early at the age of 46. I felt unseasonably hot a lot of the time. And then, offering a less than entertaining counterpoint to the standard lackadaisical mode, came bouts of irritability. High-risk jokes about pre-menstrual mood swings aimed at my wife suddenly seemed rather hypocritical. At least she had something she could blame. I was just an obstreperous, sometimes angry, sometimes sad – and increasingly old – git. 

It was my learned doctor that gave it a rather more guilt-relieving name: the andropause, sometimes jokily referred to – though not in medical circles, I should add – as the “manopause”. Not in medical circles because the idea of the “male menopause” is not without its controversy, in part because there are differences in attitude between public and private healthcare as to its prevalence and impact, and in part because it’s a very different experience to the female menopause.

The latter is experienced by all women and marked by a definitive drop-off in the production of oestrogen, with many unpleasant side-effects. The former doesn’t affect all men and tracks a more gradual progress through mid-life, when testosterone levels start a natural decline. All the same, for those who suffer it – whatever you call it, and the NHS doesn’t give it a specific label, noting only that the effects can be attributed to different issues – the cascade of mental and physical effects are hard to deny.

Indeed, my uncharacteristic lack of energy, together with pronounced irritability, were minor effects given the possible range of symptoms. You can lose muscle – about three to five per cent of your muscle every 10 years after the age of 30, it’s estimated. You might put on weight, or rather your body fat is redistributed, such that you start to develop a bit of a belly, or a couple of moobs. Your sex drive can dribble away. 

“There’s been a shift in attitudes to mid-life, such that we expect to remain vital throughout our lives, whereas a couple of generations ago, it wasn’t uncommon to be a grandfather at 50,” notes Dr Ghazala Aziz-Scott of the Marion Gluck Clinic, a UK-based clinic specialising in hormone treatments. “The fact is that decline in many hormones, testosterone but others too, affects men in the run up to middle age. It’s just that some men – and there are genetic factors in play too here – see them drop off faster and with more obvious effect.”

This is, Dr Aziz-Scott adds, an area of growing research. And, she stresses, it’s certainly one that needs much more awareness, given that, with ever greater longevity, a man might live with this condition for decades. Yet there remains skepticism as to whether the male menopause actually exists.

“The ‘male menopause’ just isn’t as well recognised as the female menopause,” explains Dr Clive Morrison of the Centre for Men’s Health in London. “It’s a less clearly defined event for some men. And we’re not really sure why it happens. And also because of culture, which is still broadly has a temperance attitude to sex, we don’t like to talk about problems that, even passingly, seem to have a sexual element. The male menopause is confused with the stigma around loss of libido, even though that’s only one possible symptom. But this is more about your mojo. It’s about your quality of life.”

How to get that back, though? Eating a low-carb, high-protein diet is a good step – both in terms of limiting body fat and increasing energy levels. Regular weight training, too. You need to move more – at a minimum just taking good, regular long walks. You need to address the stress rather than normalise it. And you need to avoid those behaviours – any late-night blue-screen viewing, for example – that inhibit getting a good eight hours’ sleep every night. 

But I’d also need a load more testosterone, right? After all, far from the misconception of testosterone as being all about sex, its decline – which for men is typically at a slow and steady rate of two per cent per year from their late thirties – is also linked to many physiological changes. Not for nothing do some experts dub the andropause Testosterone Deficiency Syndrome.

Research by the Centre for Men’s Health – which, like any private clinic, profits from treating the “menopause”, of course – suggests that actually 20 per cent of men in the UK over the age of 50 could be suffering from testosterone and other hormonal deficiencies, but only one per cent of them get treatment. 

Getting testosterone treatment on the NHS isn’t easy, anyway. Go private and it’s not cheap – some £100 per month. And this won’t cure you exactly, either. It doesn’t help every man and there can be unwelcome side-effects, too. Indeed, getting testosterone boosters may diminish your body’s ability to produce testosterone naturally, so you have to really buy into the idea. This is not a decision to take lightly. 

“The andropause is a real thing, but, as with many aspects of male sexual health, there’s a lot we don’t understand”

One man who has found personal success with testosterone treatment is Dr Chris Airey, medical director of the Optimale men’s health clinic argues. And he speaks from personal experience. The ex-Royal Marine and keen sportsman found himself, a couple of years ago, at the age of 37, feeling listless and out-of-sorts. He has four kids, from toddler to teen, so it was tempting to put it down to that. 

“As a doctor, I was aware of the role of hormones, of course,” he says. “But for me there’d been a rapid decline in how I felt. And the way I felt just wasn’t right. I was very tired all the time and had no interest in anything much. So, I got my levels checked.” These were found to be on the border between acceptable and low – so, after careful consideration, he plumped for injections. “Treatment isn’t for everybody. But now I feel fantastic – more motivated. I feel that I can enjoy life again,” he says enthusiastically.

Still, how the andropause and testosterone affect one another is still somewhat of a mystery. “The andropause is a real thing, but, as with many aspects of male sexual health, there’s a lot we don’t understand,” says Professor Jim Hotaling, director of men’s health at the University of Utah. “It’s why andropausal men get misdiagnosed as depressive, when you can have all of the symptoms of the andropause and not be depressive at all. But this is a big business too now, and a lot of clinics want to put every patient they see on testosterone – typically delivered via the daily application of a topical gel or a periodic injection – as a quick fix to ‘manage their hormones’, when they don’t need it. Our understanding is getting better, but there’s a long way to go.”

Indeed, current thinking has it that subtle shifts in testosterone levels are more part of a broader package of metabolic changes in various key hormone levels – check out that plasma gonadotropin, and that prolactin, or the adrenal hormone DHEA – with consequences similar to those experienced by menopausal women. As it turns out, my testosterone levels were within the normal range, though there’s no way of knowing if they were markedly higher earlier in life and if, consequently, I had suffered some drop, regardless. That result was a relief on the one hand – but also left me with no smoking gun as to the why I felt the way I did. 

In the end, testosterone treatment wasn’t for me. The commitment – financial and in terms of time – just wasn’t one I was ready to make without a clear need. At least, not yet. I’ll keep an eye on my levels, which you can do with a simple blood test. But, given that lack of clarity, that I couldn’t just solve everything with an occasional injection, I felt beholden to doing everything else that I could to help myself out. 

So, I paid more attention to diet and got a lot more exercise. Out went the box-set addiction – instead I made a point of getting eight hours of sleep every night, heading to bed even when I felt wide awake. Anyone might benefit from doing the same, of course, but the result for me was noticeable. My mood lifted considerably – my wife stopped saying I was being “a bit of a dick” quite so often. I set time aside for some old hobbies and made myself do them – and the more I did, the more I wanted to. My energy levels were more stable. Tending to the kids, as I told them, became less of a chore. 

Not everything improved. I’m still prone to the occasional unfathomable malaise, and there are occasions when people around me are shivering with cold while I feel positively tropical. But then that has its advantages at this time of year. 

I know, it can all sound a little vague. Maybe this idea of the male menopause is all talk and no substance. And you might well think that, until it comes to you. Then, I’d wager, your conversion to the idea of the manopause will come on like a hot flush.