Is ‘manopause’ a myth?
Mid-life hormonal changes common, but it’s murky when it comes to men
To many women, it may sound less like an undertreated medical condition and more just a description of the average middle-aged man. The symptoms — if that is what they are — include being overweight, moody and no longer much of a tiger in bed.
But are man-boobs, grumpiness and a low libido really just a sign that a man has let himself go? What if he were to tell his partner that like her, he had now reached “a certain age” and was going through menopause?
The answer, as far as his other half is concerned, may well be a dirty look and a warning to never — EVER — try that one again. After all, don’t women find menopause hard enough, without men muscling in?
All the same, talk of so-called “manopause” is certainly on the rise. Like women, men, too, experience declining hormones in middle age, which can cause loss of sex drive, weight gain, sweats and irritability. If they want a bit of sympathy though, they may want to think up a new name for it.
“Referring to it as the male menopause or ‘manopause’ is a bad idea, as women rightly feel that’s an appropriation of a specifically female complaint,” says Andrew Carruthers, managing director of the Centre for Men’s Health, a clinic that offers testosterone replacement therapy, or TRT.
“But, while men often think of hormonal changes as a ‘women’s thing ’, it can happen to them, too.”
Indeed, if the booming industry in TRT is anything to go by, it’s happening rather a lot. In the U.S., 13 million males now undergo TRT, as a treatment once associated with bodybuilders and cage fighters goes mainstream.
The global industry in TRT is driven in the U.S. by aggressive marketing campaigns aimed at the average American male’s inner Marlboro Man. Advertisements for AndroGel, for example, depict a well-preserved, middle-aged man cruising off with a beautiful woman in a sports car. Other, less subtle ads ask: “When did it become OK for men to become softer, lazier and weaker?” A free month’s trial is available to men who text WIMP to a hotline.
Yet established medical opinion still doubts that “male menopause” exists, or that treatment is always necessary.
Britain’s National Health Service (NHS) website, for example, refers to it as an “unhelpful term,” pointing out that, unlike women, men do not routinely face a dramatic drop in hormones in middle age, or specific changes such as the end of periods. It adds that many of the symptoms — especially weight gain and loss of sex drive — are more likely to be caused by a poor diet and lack of exercise.
Indeed, male hormones do typically decline much more gradually, at about two per cent a year from the age of 30 or 40. There is, however, a medically recognized condition known as the andropause or hypogonadism where testosterone drops much more than normal.
So what exactly counts as low testosterone levels? Guidance issued last year by the British Society for Sexual Medicine suggests that levels of less than eight nanomoles per litre of blood should require TRT, while more than 12 should not. But there is a grey zone in between, where treatment is often at a doctor’s discretion. Carruthers believes that doctors are sometimes too dismissive.
“If a man in his 50s complains about a low libido, there’s a tendency for his doctor to say: ‘What do you expect, you’re too old to be a sex god anymore,’” he says. “But if that’s harming the patient’s sex life, why not at least investigate? After all, we don’t tell people they don’t need glasses or hip replacements as they get older.”
In 2015, a widely reported study produced by his clinic concluded that one in five men may potentially suffer from testosterone deficiency. However, other estimates put the figure at only around one in 10, with only one in 50 likely to benefit from treatment.
There is also skepticism about claims made by private clinics with a financial interest in offering treatment. “Doctors should be more aware of the possibility of testosterone deficiency in a small minority of middle-aged and older men and be more prepared to measure testosterone levels,” says Prof. Frederick Wu, an endocrinologist at Manchester University. But NHS guidelines, he insists, are based on sound scientific evidence. TRT, he adds, is not “a remedy for symptoms associated with aging.”
Terry Maguire, a community pharmacist and medical blogger, also points out that TRT can cause short-term increases in the risk of heart disease, which is often an associated cause of low libido in the first place.
“Erectile dysfunction doesn’t have a good correlation with low testosterone — it’s usually down to problems with arteries, which affect the flow of blood around the body,” he says. “If you want to improve men’s libido, you’re much better looking at exercise, diet and lifestyle first. That may sound boring, but it’s important.”
Still, he fears that with “Big Pharma” now involved, the use of TRT may increase. So even if there are those who feel it’s just a case of “manspreading” in medicine, the “manopause” may be here to stay — myth or otherwise.