Should YOU put your husband on HRT?
Flagging libido. Tired all the time. Beer belly. Yes, he’s hit the manopause. So . . .
DR CHERRY Armstrong is assessing whether I need hormone replacement therapy (HRT).
In the chic consulting room of a private medical clinic, she asks whether I am tired all the time, lacking in concentration, focus and get-upand-go and suffering from ‘increased central obesity’, which, I think, is the medical term for ‘beer belly’ or ‘spare tyre’. Being a middle-class, 52-year-old man with a stressful, but mostly sedentary, life, I answer ‘yes’ to all the above.
As she takes a blood sample, Dr Armstrong tells me that most men do not notice the ‘andropause’ — the gradual, natural decline in their testosterone levels as they get older — and put their decreased libido, depression or diminished tolerance for exercise down to other factors.
‘After the age of 30, there is a 10% reduction in production,’ says Dr Armstrong. ‘Symptoms of a testosterone deficiency are gradual and insidious. Many men just regard some of these symptoms as “part of growing old” and accept them.’
But now, more and more men are looking for a medical top-up of testosterone, even though potential side-effects — which, Dr Armstrong says, she can mostly protect against — include ‘growing breasts, mood swings, hot flushes’, shrinkage of the testicles and infertility.
Men have become increasingly health and diet-conscious,, and now they are encroaching on what has been until now the largely female preserve of hormone replacement. It seems the andropause is the new menopause and TRT is the new HRT for men.
We’re not talking about ageing millionaires trying to stave off the passage of time and keep up with their younger trophy wives, either. Dr Armstrong’s consulting room is not in Switzerland, but in the comfortable London commuter belt of Weybridge in Surrey.
A GP who works for half the week in a public hospital and whose specialist interest is dermatology, Dr Armstrong set up the Light Touch Clinic in 2009. Here she offers a range of medical and cosmetic treatments and procedures, including Bioidentical Hormone Replacement Therapy, to a predominantly female clientele.
Last year she launched a Men’s Wellness Clinic within Light Touch. It took a holistic approach to health, offering a medical checkup and advice on diet, exercise, sleep and stress reduction with registered nutritional health therapist and functional medicine practitioner Helen Williams. And, where necessary, Testosterone Replacement Therapy (TRT).
‘The clinic has been providing this service for more than a year — and it is becoming increasingly popular,’ says Dr Armstrong. ‘The ratio of women [having bioidenticals, which can include progesterone, oestrogen and testosterone] to men [having testosterone] is 70:30. But the number of men consulting us on TRT has increased by 25 % in the past six months.’
Men who attend Light Touch will immediately feel a little lighter — mostly in the wallet area. An initial consultation with Dr Armstrong and a blood test cost €340 apiece and then there’s the treatment, which starts at €340 a month. It’s €285 for the first consultation with Helen Williams and €140 per 30minute session after that.
But, then again, as Dr Armstrong puts it, ‘we are in an affluent area’. Most of her male clients are ‘middle to upper-class, from a whole range of professions’ and aged between 40 and 65. A lot ask for HRT on arrival, having researched it beforehand.
Men who wouldn’t have shared anything more intimate than a joke at the golf club and who bought a new convertible when their libidos needed boosting, are now discussing diets and the state of their prostates with each other.
‘Men are much more informed than they were ten years ago, through the media, advice at the gym, talking more openly with each other and also from their wives, who read magazines regarding their husband’s health,’ says Dr Armstrong.
Indeed, wifely nagging plays a part: ‘We have female patients on bioidenticals who suggest their husband should have a check-up for testosterone deficiency.’ Testosterone replacement therapy has been around in the US for more than ten years and there are conferences around the world focused on research and development in the field, she adds.
In Ireland, it was initially used for specific medical problems such as hypogonadism (the inability of the body to synthesise sex hormones) but over the past few years it has been used increasingly for healthy men with andropause symptoms. Various forms of testosterone are available, but the bioidentical version used at Light Touch is mostly plant-based and chemically similar to those naturally produced in the body, which minimises side-effects.
THE testosterone is administered through weekly injections at the clinic, although creams, which are applied to the upper or inner arms, buttocks, upper or inner thighs, are an alternative.
Not that Dr Armstrong hands out testosterone treatment like sweets. ‘You shouldn’t treat people whose levels are within the normal range,’ she says.
‘If you give someone testosterone, their body believes it is producing enough, so stops producing it naturally in the testes. So you have shrinkage of the testes and a reduction in sperm production that can make you infertile.’ Gulp. Um, Okay.
She stresses again that most of the side-effects — notably the risk of growing breasts or of infertility — can be countered with drugs called ‘inhibitors’ and that the testosterone dose can be ‘tweaked’ if symptoms such as mood swings, acne or hair problems develop. So that’s all right, then.
While it sounds daunting, some men swear by it. John Walker*, a 41-year-old driver, started taking TRT four months ago. ‘I was fed up with my total lack of energy. I’d gained weight and struggled to lose it again and I wasn’t particularly interested in sex — even though I had girlfriends,’ he says.
Dr Armstrong put him on a weekly course of TRT injections and ‘almost immediately I felt more awake. Interestingly, I had more confidence, too, and the fat began to melt away.’
He was prescribed anti-oestrogen pills because, paradoxically, TRT can increase oestrogen levels in men, leading to feminising sideeffects such as ‘man boobs’.
‘You think of a man taking testosterone supplements as very macho and extra competitive — but I’ve not felt like that at all,’ adds John. ‘I just feel happy because I’m not constantly tired.’
John admits it’s not a topic he brings up voluntarily at the pub, but says he has told friends about his treatment. ‘Despite the eyewatering cost, I can honestly say
TRT has made a really positive change to my life — especially my self-esteem. And yes, I’ve ditched the Viagra!’
Dr Armstrong is keen to point out that testosterone is not a ‘magic bullet’ that can cure all ills and she will only prescribe TRT as part of a holistic approach to a client’s ‘wellness’. Rather than merely treating symptoms, this involves looking at all aspects of diet, exercise, mental wellbeing and lifestyle, to examine the root cause of their health issues.
A report in 2017 estimated that the global wellness market was worth $3.7trillion and, like with exercise, grooming and diet before it, the share of the market dedicated to men is increasing. It’s not such a leap for men already investing in expensive moisturiser or pricey cycling gear to pay for a wellness check-up.
My own consultation with Dr Armstrong and then Helen Williams was comprehensive. Before she took my blood, Dr Armstrong asked me how much I exercise (quite a lot), how much I drink (also, sadly, quite a lot) and how well I eat (quite well a lot of the time, quite badly when I’m busy).
She listened to my chest and lungs and measured my height (5 ft 11 in) and weight (14 st 8 lb). She examined my prostate, too — another thing you wearyingly get used to as a man in his 50s — and told me it was fine.
Her colleague Helen’s analysis of my lifestyle revealed both good and bad news. On the plus side, I do between four and ten hours of exercise a week — a mix of gym, swimming, cycling, yoga and Pilates — which is good for both mental and physical wellbeing.
This not only provides a structure and a reason to get out of the house during my working week as a freelance journalist, but also means I am stronger and calmer than I was in my 40s.
When we’re home together, my wife and I usually make our food from scratch — mostly chicken or fish with vegetables and, very rarely, red meat. We also take supplements and vitamins to ward off dementia and arthritis.
ALTHOUGH I am sometimes tired, I have quite a lot of energy and engage heartily with life. And I still have a reasonably healthy libido.
Now the bad news. I feel depressed every Monday morning. I’m a stone overweight. My work involves evenings out, which means I often grab food on the go and get to bed late.
Even in middle-age, I find it hard to persuade myself to go to bed early, convinced I will miss something. Often, I am looking at my iPad or phone in the hours immediately before sleeping.
I drink pretty much every day and at least double the recommended weekly allowance, although my wife and I do give up alcohol every February.
Meanwhile, my job, which mostly involves meeting strangers and asking them very personal questions, can be stressful.
As Helen explains, stress causes the body to generate the fight-orflight hormone cortisol, flooding the body with energy. And, since we’re not using that energy for its primal purpose, it gets ‘packed away’ as glucose and fat.
She advises me to introduce meditation, through smartphone apps such as Calm or Headspace, or by doing breathing exercises. ‘Go to bed earlier,’ she adds.
I should also not look at a phone or iPad screen for two hours before bed because the blue light they produce adversely affects melatonin, which aids restful sleep. If this proves impossible, then I should invest in blue lightblocking glasses (from €21.50 ,
amazon.co.uk). ‘Really attractive!’ says Helen.
But do I need testosterone? Dr Armstrong has the results of my blood test. They show that my liver function, kidneys, calcium and vitamin D levels are all fine and that I am not at any imminent risk of diabetes or prostate, bowel or pancreatic cancer.
‘Your testosterone is in the lower limits of normal,’ she says. ‘However, since you don’t have symptoms, I won’t treat you.’
My tiredness and occasional lack of focus and low mood are just part of the wear and tear of life and my extra weight a result of my lifestyle, rather than a testosterone deficiency.
Dr Armstrong advises me to cut down on alcohol and follow Helen’s advice on diet and optimising energy levels.
And maybe if I do, I won’t find myself rubbing testosterone cream on my buttocks and wondering if my testicles are about to start shrinking.
As Helen says, the sort of stuff she suggests men factor into their lives is not rocket science, just good advice.
It’s time I opened my heart and my mind to wellness. Resistance is futile.
Some names have been changed, for TRT see fitzwilliamprivateclinic.ie