by John Toscano

Created on: April 23, 2008   Last Updated: December 15, 2010

There is a growing trend to attach a label to any condition which in some way represents a deviation from conventional medical normality, as if such a thing existed. Menopause in women is a distinct process with clearly identifiable physiological markers, whereas in males we see a steady decline in testosterone levels of about 1% per year throughout adult life.

This fall has an effect which most men perceive at some stage in their lives. By the early thirties, levels will usually have fallen significantly but the effect may barely be noticed. It is typically from the mid-forties onwards that many men notice reduced sexual drive, along with loss of muscle mass, tiredness and depression. There is no clear start or end to these changes, which continue inexorably into old age, though some men maintain functionally adequate testosterone levels into their seventies.

Is it reasonable to place, by analogy with women, a menopause label on a slow change happening for over half a man's life? The label is convenient, particularly if you are the partner of a man who, in his mid-forties, begins to despair at the vagaries, even pointlessness, of his not-so-fulfilling life and starts to behave in a restless or eccentric manner. Applying labels may help us rationalise changes but there is a danger that in identifying male menopause as a specific period of change we give it more significance than it deserves.

The real health issue here is not about a dubiously named menopausal change but dealing with falling testosterone levels. The changes may be slow but the effects are insidious and become increasingly hard to ignore. I write from experience; I have passed through my mid-forties and had to come to terms with gradually reduced energy levels, as well as experiencing genuine depression for the first time in my life. The latter is particularly relevant because the link between falling testosterone and depression is well-established.

For men adversely affected by these changes, plenty can be done. In addition to sensible habits, like regular exercise, healthy eating, not smoking and avoiding stress, there is a more radical option, which is Hormone Replacement Therapy. HRT, using testosterone supplements, should only be given under medical supervision, as there are potential side-effects, including an increased risk of prostatic cancer, but many studies show this therapy can be effective.

I wish

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