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DR MAX: I believe the 'manopause' DOES exist - and men suffering from it should get HRT By DR MAX PEMBERTON Published: 20:40 EST, 17 November 2024 | Updated: 20:41 EST, 17 November 2024 e-mail View comments What is it about the male psyche that means men often become curmudgeons as they age? We all know a once perfectly pleasant man whose inner Victor Meldrew emerged as soon as he hit 50. The grumpy old man isn’t a well-recognised trope for nothing. But could something else be going on? Could it actually be that they have a medical problem? For years we’ve assumed that misanthropic old men were just a fact of life.
We put their moods down to missing their purpose in life or thinking the world is moving on too fast for their liking. But increasingly there’s a view that they could be suffering from an hormonal imbalance called the andropause. This controversial condition – also known as the ‘manopause’ – is a result of low testosterone, and has inevitably attracted a lot of sniggering debate.
Some even say it’s a condition made up by men trying to muscle in on all the attention women are getting over the menopause . Yet it’s also been estimated by scientists that as many as one in five males over the age of 65 could be experiencing symptoms. And, yes, these are similar to the female menopause, including low libido, irritability, tiredness, sweating and generalised aches and pains.
One study put the figure at 840,000 men in the UK currently in the grip of symptomatic andropause, with only 19,000 currently receiving treatment in the shape of testosterone replacement therapy – most commonly a gel applied daily to the skin. Indeed, the ‘manopause’ is increasingly gaining traction as a legitimate condition. Last week it was revealed that NHS bosses are offering middle-aged male workers special uniforms, bespoke desk space, and up to a year’s paid leave from work to help them cope with it.
'Increasingly, there's a view that older men could be suffering from an hormonal imbalance called the andropause,' writes Dr Max Pemberton 'While acknowledging that a genuine change occurs as men age, some experts argue it has a psychological, rather than hormonal, basis' So is it a real thing? In women the menopause is triggered by the sudden fall in sex hormones – oestrogen and progesterone – which occurs when the ovaries shut down. In males, however, there is no similar, dramatic decline in testosterone, but rather a natural, gradual reduction with age – a fall of about 0.5 per cent a year.
Advocates of testosterone replacement therapy (TRT) say the fact it offers men a new lease of life, eradicating symptoms while improving mood and libido, is proof that the manopause exists. Yet many doctors are sceptical. While acknowledging that a genuine change occurs as men age, experts argue it has a psychological, rather than hormonal, basis.
Marriage problems, changes in social status, job dissatisfaction, lack of exercise and the long-term effects of alcohol and smoking can all result in similar symptoms to those attributed to the andropause. They also suggest that some of the symptoms may be the result of other, underlying medical conditions such as thyroid problems, anaemia or depression. Professor John McKinlay of the New England Research Institute has argued that there is ‘no empirical research to support the syndrome’ and advises those with lower testosterone levels to increase physical activity and go on a diet, since obesity itself reduces levels of testosterone.
‘We are medicalising lifestyle problems and the natural process of ageing,’ he says. And the fact is testosterone treatment is not without risks. Side effects include possible breast growth, acne, sleep problems and enlargement of the prostate.
Some studies have even linked testosterone therapy with prostate cancer. Critics also point to the fact that men may complain of symptoms while their blood tests show normal levels of testosterone. Conversely, men whose blood tests show low levels don’t necessarily experience problems.
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and HRT won't fix it My view is that a version of the menopause does exist in men – but very far from all. Over the years I’ve undoubtedly seen ‘grumpy old men’ whose lives have been transformed by TRT. Men who have been diagnosed as ‘depressed’ have suddenly seen their mood lift and they no longer need antidepressants.
It’s happened enough that I now test the testosterone levels of middle-aged patients who come to me with changes to their mood but no past history of depression and no clear explanation for the deterioration in their personal lives. Their wives often say that something isn’t quite right; that their husbands have lost their va-va-voom, and appear a miserable, moody version of their old selves, and – ta da – when their testosterone is checked, it is indeed too low. I can’t help but feel this is similar to how many menopausal women have had their low mood misdiagnosed as ‘depression’, only for it to improve when they start HRT.
Whether men really need major adjustments to their working environment is another thing. But certainly the resistance to the idea that men would benefit from hormone treatment does seem to smack of the resistance that women faced for years with regard to HRT. The drug Champix has been relaunched on the NHS to help smokers quit.
Concerns have been raised about side effects. But smoking kills half of all smokers, so giving up - using any method - can be a life saver. Talk to your doctor! Davina's tumour shock Davina McCall revealed last week that she was undergoing emergency surgery after a benign tumour called a colloid cyst had been found in her brain Davina McCall revealed last week that she was undergoing emergency surgery after a benign tumour called a colloid cyst had been found in her brain.
Even though the outcomes are generally very good for this kind of operation, being told you need it must still come as an enormous shock. What I’ve noticed in people when something like this happens is that they go into a ‘survival mode’. They hardly have time to process their diagnosis before surgery is scheduled.
People fuss around them and there are lots of offers of help. It’s often not until long after the operation, when the anxiety and drama has died down, that it really hits them and they suddenly realise the seriousness and enormity of what they’ve been through. I’ve seen many people who have this delayed reaction and subsequently need a lot of support.
At this point, however, many people assume they are fine and have moved their attention elsewhere, or even forgotten about it. It’s good to always check in with someone a few months after something big like this to let them know that, even though the initial panic is over, you’re still thinking about them and there for them if they need a hand, or a shoulder to cry on. Faced with a medical condition that promises only a steady, grim deterioration, I think most doctors would take the quick way out.
But should assisted dying be made legal, as is currently being proposed? Dr Max Prescribes: The Anxious Generation Social psychologist Johnathan Haidt’s excellent book takes a sobering look at the epidemic of anxiety in children who have grown up online, their childhood diminished and impoverished by an addiction to smartphones. It’s a call to arms to make fundamental changes in the way we allow children to grow up in the technological age – and well worth a read. Advertisement My biggest concern is the potential for such legislation to be abused or to alter the way those with severe disabilities or terminal illness are perceived and treated.
For those reasons, I’m wary of fully supporting physician-assisted suicide. The only solution I can see is that each case would have to be discussed in a court of law – that this becomes a legal decision, not a medical one. What I take serious issue with is the idea put forward by critics of assisted dying that the debate itself isn’t necessary because modern medicine means we can all live long, pain-free lives.
Control of physical pain is not the determining factor in someone’s quality of life. It is the emotional pain, for which no analgesia exists, that is often the deciding factor in people wishing to die in such cases. Antidepressants won’t make you walk again.
Talking therapies can help in changing the attitudes to an illness or disability, but they can’t bring back your old life. There is no analgesia that can deaden the gnawing sense of loss, of powerlessness and helplessness, the frustration, the indignity. Certainly many people with debilitating and terminal conditions lead fulfilling and meaningful lives but equally there are those who do not.
While I am wracked by indecision about whether I would want to live in a country that helps people to die, I feel equally as uncomfortable with the vocal cohorts of people - from self-proclaimed ethicists to religious enthusiasts – who feel obliged to pass judgement on someone else’s existence. By all means argue that assisted suicide is open to abuse. But do not propose to know what it feels like to lie in a bed, staring at the ceiling day in and day out, being turned by carers as they wash you and change your sheets, longing for the life you had but which now is out of reach.
Don’t tell me that doesn’t hurt. Don’t tell me doctors can control tha t sort of pain. NHS Davina McCall Share or comment on this article: DR MAX: I believe the 'manopause' DOES exist - and men suffering from it should get HRT e-mail Add comment.
