For her documentary Sex, Myths and the Menopause, TV presenter Davina McCall was highly praised – and rightly so – for busting myths around the life-altering hormonal changes that women go through at midlife. I watched it not only because my mum went through premature menopause aged 38 in the 1980s, when the topic was barely discussed, but because I too have been hit by crashing hormones in recent years.
So when I saw a TV commentator giggling while making a glib comment about men “who think they also go through the menopause”, I was irritated. What’s the value in raising awareness of one health issue while undermining another? Davina calls on men to be more aware of the problems women suffer over menopause and she’s right, but it’s equally vital to realise that men themselves might need support for hormone depletion. Most of us are oblivious to that possibility. I certainly had no idea there was such a thing as “andropause” until a few years ago.
This widespread ignorance is partly a result of myths surrounding masculinity. We grow up hearing virility is something that accompanies us into our golden years, with popular culture full of jocular “randy old dog” clichés. Recent headlines picturing megastars like Al Pacino and Robert De Niro becoming dads in their dotage are a perfect example. The story runs: if you own a pair of testicles you’ll only age on the outside, because under the bonnet all is forever hunky-dory.
But around the age of 51 I started to feel distinctly less myself. Initially it was unusual fatigue and disturbed sleep. The gym workouts I’d been doing for years became tougher and took longer to recover from, along with new aches and pains. I felt like I was running on empty, but put it down to work-related stress, while most friends I discussed it with teased that I was “no spring chicken”. A few months in, new symptoms included night sweats, irritability, feeling highly emotional, anxiety, brain fog and the need to nap at any given opportunity. I put my tanking sex drive down to my overstretched schedule, but when morning glory became morning dreary, I decided to see my GP.
A plethora of pathological checks all came back normal. In the absence of irregularities, my doctor shifted the consultation to a psychological analysis. “This could be mild depression,” he said, and suggested talking therapy or a mild antidepressant. Yes, I was depressed. But only because of my physical symptoms.
I usually avoid Dr Google due to its predilection for worst-case scenarios but, unconvinced by my GP’s assessment, I headed straight there. I found an article by Amelia Hill in The Guardian telling the story of Dr Stefaan Vossen who struggled with symptoms very similar to mine, aged 41. His GP had said it was just “part of normal life”. It took Vossen a year to discover he had low testosterone, yet within a month of starting treatment he was back to his old self. I returned to my own doctor with this evidence.
“We only run hormone tests on men who are trying to conceive,” the GP told me. “Are you?” I wasn’t, but was happy to have my swimmers rated for the sake of a proper diagnosis, so I said yes. The test came back showing that my testosterone levels were scraping the bottom of the normal range. And my oestradiol, a form of oestrogen (men have that female hormone too) was also extremely low.
The doctor explained that patients have to be well below the normal range (or transitioning) to qualify for any form of testosterone treatment on the NHS, but “male menopause” is not recognised. Yet, according to research conducted by the Centre for Men’s Health, twenty per cent of men over 50 (two million) across the UK suffer from testosterone deficiency syndrome. Only one per cent have been diagnosed and treated.
When morning glory became morning dreary, I decided to see my GP
The vitality we feel, whatever our gender, is largely due to our sex hormones being within set ranges and working together in harmony. This optimal balance governs everything from mood and cognitive function to energy levels and physical performance. It’s like a choir of the body’s own chemicals: when one of them is flat, you will feel it. Sharply.
For women, the definitive marker for menopause is the permanent end of menstruation. There is no comparable turning point for men. Symptoms like severe fatigue and loss of libido could be attributed to so many causes that it muddies the waters. Add lack of awareness to the equation and the result is millions of men being told they’re just old and depressed. Even worse, they might be put on antidepressants they don’t need.
With a “no” from the NHS, I looked at going private and researched endocrinologists. My heart sank at the costs involved. Some listed an initial consultation as high as £700, with treatment adding up to thousands over the year. It was well beyond what I could afford, so I reread Hill’s article. This time I noted it mentioned “TRT”, or testosterone replacement therapy. So I scoured for a “TRT clinic near me” and finally found an affordable doctor, who started me on an injection called Nebido, administered in-clinic every three months. There was other medication to take at home and monitoring through blood tests and physical examinations before each new injection. A regular prostate health check was also obligatory.
My symptoms improved within a month or so, with energy levels rising steadily and libido (no surprise it rhymes with the name of the injection) improving a tad more than I would have wanted. After a year on this protocol, I was noticing a swing between the boost I got the few weeks after the injection and the depletion of benefits in the run-up to the next one. The happy medium zone was about a month in and lasted only three weeks or so. After six months of this I went back to Google.
That’s when I found Dr Doug Savage and the Leger Clinic, through an article on the Propane Fitness blog. During the appointment, he explained that while Nebido was effective, it was a primitive form of treatment that initially floods your body with testosterone, but then fizzles out over the weeks. He recommended the more stable approach of small doses throughout the week. The choice is between injections or a gel you can rub daily on your arm, which you risk sweating off or applying in inconsistent amounts. Unafraid of needles, I opted for self-administered micro-needle injections – totally painless and more importantly, dosage-accurate.
I was in good hands: Dr Savage has been practising for over 30 years, specialising in sexual medicine, testosterone deficiency and menopause. The Leger Clinic has an “Outstanding” rating by the CQC. He took the time to answer my questions in detail for this article.
Why do you think hormonal deficiency in men is still not seen as a real issue in mainstream medicine?
The first problem is that testosterone has a bad reputation. It is extremely important to stress that there is a world of difference between testosterone deficiency and all the challenging symptoms that affect a man’s quality of life and often those around them, and the people with normal testosterone levels who use it to boost muscle development, ie anabolic steroids. There is a massive steroid abuse problem.
The difficulty for most GPs is that their local laboratory gives a normal range of approximately 7 to 30 nmol/L (nanomoles per litre) and this bears no relationship to any quality guidelines anywhere in the world, most of which now state that levels under 12 warrant treatment. Even British endocrinologists, who tend to be extremely conservative about levels, in their latest guidelines state that levels under 11 may be abnormal. However, many seem not to be keen to treat at that level unless the patient has a classical cause of hypogonadism such as a pituitary tumour. There are no NICE guidelines relating to testosterone deficiency.
Are more men coming to you for TRT as compared with five or ten years ago?
Yes, there are definitely more men coming forward because it is now easier to get information on forums and social media. There are younger people enquiring as well, and more frighteningly with very low testosterone levels even in their twenties, without classic causes. It is suspected that endocrine disrupting chemicals found in the environment have produced a marked reduction in male fertility and testosterone levels.
What will it take for age-related testosterone deficiency to be taken more seriously?
We need a serious champion to campaign on behalf of these men. Look what happened when the plight of women and the menopause hit the media and how things have now, quite rightly, changed massively for women suffering with symptoms of the menopause.
A month into the new treatment, I finally found what I nicknamed the Goldi-bollocks zone. No more sharp peaks and troughs in energy and moods, and an on-point libido. Another six months on (at the time of writing), everything is still stable. Friends have asked if I feel twenty again. The simple answer is no. TRT isn’t a cure-all. It has, however, got rid of the horrendous, debilitating fatigue, brain fog and lack of motivation. Daytime naps are now an occasional luxury rather than a daily necessity. So while it’s not perfect, it has given me back the zest for life that had vanished before starting the treatment and I would certainly recommend it.
When morning glory became morning dreary, I decided to see my GP
If you’re experiencing similar issues, where do you start? The first step is a blood test. This doesn’t require an expensive clinic. One option is Medichecks, which offers remote blood testing, either through a kit in the post or at one of their partner labs.
TRT is available through many private clinics who offer a wide range of costs. I am not affiliated with the Leger Clinic other than as a patient but you might find the following tips helpful. Before choosing a clinic, make sure they are CQC registered, have staff members who are doctors clearly experienced in the field of testosterone deficiency and men’s health, and compare overall costs including consultation, ongoing supervision of your care, and the price of medication. You’ll then be able to make a more informed decision.
There are many “natural testosterone boosters” on the market. I couldn’t find any studies proving their efficacy and it turns out to be an unregulated industry using ingredients that could cause health issues. As one user put it on a testosterone forum: “Bro, if that crap works, do you think anyone would be taking the real stuff?” I agree bro, they wouldn’t.
In Davina’s documentary, one contributor suggested that “if men went through the menopause, there would be a cure by now.” I get the spirit of that comment, but it’s utter nonsense. Men are renowned for not seeking medical attention, especially if it concerns anything below the belt. It took a tongue-in-cheek cancer-awareness campaign a few years ago, with Robbie Williams throwing footballs and ball-related puns around, to get men to check themselves for testicular abnormalities.
As Dr Savage said, we need a celebrity to champion this issue, but a poster boy for low testosterone will not be appearing anytime soon. For now, let’s stop calling it either “the male menopause” which puts it in competition with women, or the awkward-sounding “andropause”. Maybe just TD, or testosterone deficiency, until a better term is coined – because that’s what it is. Awareness is the first step, so let’s talk about it more and acknowledge it as a real issue for millions of men. And put those myths about masculinity to bed.
More info on TRT at legerclinic.co.uk
Khaled Bazzi is Creative Director at Perspective
