‘Manopause’ versus the inner Marlboro Man
It is not only women who feel the results of ageing. Men can suffer a number of failing resources as father-time catches up with them
To many women, it may sound less like an under-treated 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 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 filthy look and a warning to never — EVER — try that one again.
After all, don’t women find the menopause hard enough, without men muscling in?
Isn’t “man flu” enough for them?
All the same, talk of the socalled “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 sympathetic hearing, 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,” said Andrew Carruthers, MD of the Centre for Men’s Health, a clinic offering testosterone replacement therapy (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 US, 13 million males now undergo TRT, as a treatment once associated mainly with bodybuilders and cage fighters goes mainstream.
Earlier in October, researchers in California unveiled plans for a stem-cell cure, by which testosterone-deficient patients will be given new, hormone-generating cells in the body.
The global industry in TRT is worth almost £2bn (R37.4bn) a year, driven in the US by aggressive marketing campaigns aimed at the average American male’s inner Marlboro Man.
Advertisements for AndroGel, for example, depict a wellpreserved, middle-aged man cruising off with a beautiful woman in a sports car.
Other, less subtle adverts 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.
Britain, despite much tougher rules on advertising, is catching up on the trend.
Testosterone home-testing kits are now on sale in chemists, while the National Health Service (NHS) spends £20m (R374.4m) a year on TRT.
It has also had celebrity endorsement of singer Robbie
Williams, who took TRT after doctors told him he had the testosterone levels of a “100year-old man”.
Yet established medical opinion still doubts the male menopause exists, or that treatment is always necessary.
The 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 poor diet and lack of exercise.
Indeed, male hormones do typically decline much more gradually, at about 2% a year from the age of 30 or 40.
There is, however, a medically recognised condition known as the andropause or hypogonadism (yes, as in “gonads”) where testosterone drops much more than normal.
One man who suffered from this condition is Ian Storey, the 61-year-old professional opera singer, who noticed while on tour in the US nine years ago that he was feeling “overwhelmingly tired”.
A regular gym-goer, at first he blamed it on his gruelling touring schedule, until he happened to mention it one day to a man at an opera venue.
“The guy said: ‘It sounds like it might be the andropause’,” Storey recalled.
“I’d never heard of it, and he said it had been quite a fight to get public recognition for it in the US.
“But he said he’d had it too, and TRT had helped.”
Sure enough, when he returned to the UK, a blood test confirmed low testosterone levels.
Two years later, after courses of NHS-prescribed hormone gels and patches, he felt as if his body had been “reset” again.
“It wasn’t something I felt embarrassed about anyway,” he added.
“But I’m happy to talk about it because there may be other men out there with the same problem.”
So what exactly counts as low testosterone levels? Guidance issued in 2018 by the British Society for Sexual Medicine suggests levels of less than eight nanomoles a litre of blood should require TRT, while more than 12 should not.
But there is a grey zone, where treatment is often at doctors’ discretion.
Carruthers believes GPs are sometimes too dismissive.
“If a man in his 50s complains about a low libido, there’ sa tendency for his GP to say: ‘What do you expect, you’re too old to be a sex god any more’,” he said.
“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 one in five men may potentially suffer from testosterone deficiency.
However, other estimates put the figure at only about one in 10, with only one in 50 likely to benefit from treatment.
There is also scepticism 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,” an endocrinologist at Manchester University, Professor Frederick Wu, said.
But NHS guidelines, he insists, are based on sound scientific evidence.
TRT, he added, is not “a remedy for symptoms associated with ageing”.
Terry Maguire, a community pharmacist and medical blogger, also points out 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 round the body,” he said.
“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. —
After all, we don’t tell people they don’t need glasses or hip replacements as they get older
While men often think of hormonal changes as a ‘women’s thing’, it can happen to them, too