Manopause: HRT to men


At the age of 45, Reg Edge began to worry that he was suffering from a terminal illness. The normally super-efficient electronics engineering boss was suffering from memory loss, swollen joints, night sweats, extreme exhaustion and loss of libido.

Indeed, his behaviour was so out of character that his wife Anita, a computer programmer, thought he must have fallen for someone else. Certainly, as she pointed out, he was no longer interested in her.

‘I could barely drag myself out of bed in the morning,’ says Reg. ‘I felt like a zombie. I no longer wanted sex, had no energy whatsoever and my memory was so bad I had to write simple instructions on my hand, such as “Lock office door”.’

The successful businessman was in turmoil. ‘I’m 6ft tall, weigh 12st, and haven’t suffered a day’s illness in my life. Suddenly I no longer felt like myself. And as well as physical symptoms, my personality changed. I’d blow my top at the slightest provocation. At first, I put it down to work stress, but then I thought I must be really ill.’

The World Health Organisation refuses to recognise ‘andropause’ as a medical condition and many GPs remain sceptical about whether it actually exists

Eventually, after suffering for more than a year, Reg went to see his GP, who did a battery of tests for everything from ME to Aids.

In fact, as Reg later discovered, he  was suffering from a classic case of the male menopause, or the ‘andropause’ as it has been dubbed by scientists.

This is a condition still mired in controversy — the World Health Organisation refuses to recognise it as a medical condition and many GPs remain sceptical about whether it actually exists. But a pioneering London clinic, the Centre for Men’s Health, argues that not only is it all too real, but cases are on the rise.

‘Our latest research of more than 10,000 men reveals that 20 per cent of men over 50 have been affected by the male menopause,’ says Dr Malcolm Carruthers, who runs the centre.

‘Testosterone deficiency syndrome is a common and serious condition that  is not being diagnosed or treated. This is a condition that can wreck lives if left untreated, and also shorten lifespan because of its proven link to heart disease, obesity and diabetes.’

Like women, as men age their hormones levels begin to alter. In women, the difference is clear and unarguable — their reproductive system ceases to function and the hormones oestrogen and progesterone dip, causing hot flushes, irritability and tiredness.

For men, the change is much more gradual, but their testosterone levels, which determine virility, aggressiveness and energy, begin to fall.

Many men remain reluctant to admit they may be suffering from the male menopause as they see it as a threat to their masculinity.

Symptom: Many men report a complete loss of libido, leading to marriage problems (posed by models)

They are particularly mortified at having to admit to erectile dysfunction, which is one of the most common symptoms. So they suffer in silence, according to Dr Carruthers — damaging not only their health, but their family life and happiness.

Businessman Reg, now 66, says: ‘The loss of libido was awful. My wife Anita and I had always had a great sex life, but it became irrelevant to me. I didn’t even notice if women were attractive.

‘Then, one day, as I was driving into work, I heard Dr Carruthers being interviewed on Woman’s Hour, and I thought: “He’s describing my symptoms.” ’

When he visited the doctor’s Harley Street clinic, blood tests revealed that Reg’s testosterone level was less than ten pg/ml (picograms per milliliter of ‘free’ or available testosterone) — the normal range for men is 14 to 40 pg/ml.

Men who are testosterone-deficient are more likely to develop diabetes, heart disease, obesity, osteoporosis and Alzheimer’s

‘Dr Carruthers said I had the testosterone level of a 70-year-old man — and I was still only in my 40s,’  Reg says.

He was given a testosterone implant, and the results were extraordinary.

‘Within two weeks, my depression had lifted,’ he says. ‘I felt sharp, bright, and full of energy.’ His libido took longer to respond — several months — but it did eventually return.

‘I don’t get my testosterone replacement on prescription — I now use a gel that costs me about £50 every two months. I know I still need it — if I run low, the symptoms immediately start to come back. I have no side-effects whatsoever and I will stay on TRT (testosterone replacement therapy) as long as I can. It is no exaggeration to say that it has given me my life, and my relationship, back.’

Dr Carruthers says: ‘We’re now seeing a growing global awareness of the important role that testosterone plays in maintaining men’s health and quality of later life. With age, testosterone levels fall and we now know this leads to loss of energy, libido, erectile dysfunction, irritability, joint pain, memory impairment and depression.’

Grumpy old men, in other words, may have a medical explanation for their behaviour. There is also a more serious link, as it has been proven that men who are testosterone-deficient are more likely to develop diabetes, heart disease, obesity, osteoporosis and Alzheimer’s.

Yet even doctors can fail to recognise the symptoms. Dr Doug Savage — who is separated from his wife and has two grown-up children — is a GP specialising in sexual medicine and andrology (male health), yet even he didn’t realise he was suffering from the male menopause.

Dr Savage, 58, says: ‘It’s ironic that I would be treating men with testosterone deficiency, and yet failed to see I was suffering from the very same thing.’

Four years ago he noticed he was becoming profoundly tired. ‘As a hill walker and a very active man, I couldn’t understand it — my health had previously been so robust.

‘I would fall asleep in my chair between patients. My family dreaded me taking them on long journeys as I had started to nod off at the wheel. I was also losing interest in sex, and suffering from erectile dysfunction, which was very hard to accept.’

Exhausted: Some men report nodding off everywhere and being too tired to function normally

While walking in the Lake District three years ago, he realised he could not walk up even a gentle slope.

‘I thought I was having a heart attack — my heart was racing and I was exhausted.
‘Back home, I went to see a GP friend, and he ran all the blood tests on me. He was initially reluctant, but I made him add testosterone deficiency to  the tests.’

When the results came back, they revealed Dr Savage’s testosterone level was just nine pg/ml. ‘I was very shocked, but also relieved — at last I had an explanation for the severity of my symptoms,’ he says.

‘I was beginning to feel like an old man and I was only 41. I was also feeling depressed, but put that down to hitting my 40s.’

He was given Testogel (the gel form of TRT) and now, three years later, his hormone levels are at a healthy 18 pg/ml — well within the ‘normal range’.

He says: ‘I’m now full of energy — so energetic that I recently walked one of the Munro mountains in Scotland at more than 3,000ft with my daughter.’

Fellow GP Dr Don Hegarty, 55, from Chislehurst, Kent, was just 41 when he began suffering from the male menopause. Married to Sifa, 49, he works as an occupational health physician and between them they have three grown-up children.

‘I was very young to be going through the symptoms, but they were ruining my quality of life,’ he says. ‘I felt profoundly tired in the afternoons — I could nod off anywhere. I couldn’t concentrate and my memory was impaired. I also had lots of muscle aches.

‘In short, I was beginning to feel like an old man and I was only 41. I was also feeling depressed, but put that down to hitting my 40s.’

Then there was the loss of libido, which was having a profound impact on his relationship with his wife.

‘I read an article on testosterone deficiency, and I realised what all these vague symptoms added  up to.’ Dr Hegarty was prescribed Restandol, a tablet form of TRT. ‘Within a few months, I realised I had more energy and could concentrate better. It isn’t a blinding flash, just a gradual improvement.

‘I didn’t turn into an Olympic sex god overnight, but it brought back my sex drive and my ability to maintain an erection, which had been really worrying me.’

He now uses Testogel, which he rubs into his shoulders and armpits. ‘I have a check-up twice a year and I have managed to get it on NHS prescription. Unlike HRT, you can stay on this for ever and I’ve no intention of stopping.

‘Now I’m up at 5.30 every morning, work all day and see a personal trainer three times a week. I am fitter than I’ve ever been.’

While female hormones tend to plateau after a period of several years in the menopause, men’s testosterone levels continue to deplete well into old age.
For this reason, most men remain on TRT on a permanent basis — and if they stop taking it, they experience the return of all their troubling symptoms within a very short time.

Success: ‘Suddenly I felt like a young man again. My libido is what is used to be and that makes a big difference to my relationship.’ (Posed by models)

Former fishing boat captain Ian McDonald believes TRT saved  his life.
The 74-year-old, who now works as a photographer and is married to Lilian, 73, says his male menopause was so profound he considered suicide. He says: ‘I was a typical alpha male, skipper of a fishing boat for 23 years, never ill.

‘But when I hit 55, my health went downhill. I became exhausted, woke every night dripping with sweat, my whole body ached and I was utterly depressed.

‘When I went to see my GP he was so worried he sent me straight to the Royal Infirmary in Aberdeen.

‘I was given a full health check, and they decided I was simply depressed.’
So Ian was offered Prozac — which he refused. ‘I’d read somewhere about men having menopauses, too, and I thought it was worth getting my hormone levels checked.’

When his blood tests came back, they revealed his testosterone level had ‘dropped off the bottom of the scale’. His wife was as relieved as he was to have a proper diagnosis.

The time has come when global thinking on the need to diagnose and treat testosterone deficiency should move from debate to action.

Before the treatment, Ian would fly into irrational rages, and once kicked the wall in the kitchen so hard it made a hole.

‘The treatment made such a difference to me — it was   like turning the clock back 20 years or being re-born. I got my life back.

‘I felt like a young man again and today I am firing on all cylinders. My libido is what is used to be and that, of course, makes a big difference to my relationship.’

But not everyone is a fan of testosterone therapy and there are concerns about its side-effects.

A Dutch study has identified heightened aggression in male patients taking TRT, and it has also been linked to increased incidents of prostate cancer — which is affected by testosterone levels — and male pattern baldness. Some patients also report headaches and weight gain.

Professor Ashley Grossman, a consultant endocrinologist at St Bartholomew’s Hospital in London says he’s concerned that promoting the idea of the male menopause has become a useful way to make more money for drug companies and private clinics.

He insists that falling testosterone levels are no more than a natural sign of ageing in men.

‘Women suffer a sharp fall in the hormone oestrogen when they go through the menopause, and men need to realise that testosterone levels naturally fall by 2 per cent a year from the age of 40,’ he says.

But Dr Carruthers is adamant. ‘This is clinical condition — and one for which men can receive treatment,’ he says.

‘Like climate change, the time has come when global thinking on the need to diagnose and treat testosterone deficiency should move from debate to action.
‘By ignoring the problem we’re putting men, and their wives, through needless misery.