Testosterone replacement therapy is all the rage among midlife men – and it’s stirring up debate among women and the medical community.
“I was 54, tired all the time, could barely be bothered leaving the house, my libido was gone and I was miserable.” Not the words, as you might expect, of a midlife menopausal woman, but those of legendary Happy Mondays hellraisers Shaun Ryder, who is just one of a growing number of men open about the effects of their own midlife hormonal changes. Some, including Ryder, refer to it as the male menopause.
“It’s a real thing and I should know because I’ve been through it,” he told me on the phone this morning. “I did a routine blood test 14 years ago and the doctor found that my testosterone levels were at zero. It explained the way I had been feeling completely. I’ve been having hormone replacement therapy ever since and it’s changed my whole life for the better.”
For middle-aged men, the testosterone replacement patch is becoming as much of an essential accessory as an iPhone or smart watch. Erectile problems, belly fat, a feeling of constant exhaustion: this is what we middle-aged men moan about to each other in quiet moments. We’re all desperate for solutions.
Suddenly, testosterone replacement therapy is all the rage. I am 48 and have recently sent away my finger prick test to Superdrug to establish whether low testosterone is to blame for my increased tiredness and brain fog. To be honest, I am praying that the results prove I have a deficiency so that I can start taking the treatment.
Some call it male menopause, some, the andropause – but this increasingly reported midlife hormone slump is nothing if not controversial. This week, an NHS Trust in the East Midlands was in the news for offering up to 12 months’ paid leave to a male staffer affected by symptoms of low testosterone. Tina Richardson, the deputy director of human resources at East Midlands Ambulance Service, was quoted as saying: “As well as having menopause guidance we also support anyone within the organisation who is affected directly or indirectly by the symptoms of andropause.”
Social media erupted with incredulity – as did most midlife women around the country. “I nearly threw up in my breakfast when I read it,” Dr Richard Quinton, a consultant endocrinologist told the Telegraph. Cancer specialist Prof Karol Sikora wrote on Twitter (now known as X): “A year of paid leave for the ‘male menopause?’ Absolutely ridiculous and would not be tolerated in any sensible country.” While fellow Twitter user Virgina Gerwat wrote in response: “Stop the world I want to get off.”
Because first, the science. The overwhelming view of the medical establishment is that the male menopause does not exist. The NHS calls the term “unhelpful and misleading”. Dr Channa Jayasena, is a consultant in reproductive endocrinology at Imperial College, London, and the author of a landmark paper published on Thursday in The Lancet, talking about the effects of testosterone replacement therapy on men over the age of 50.
“We don’t believe there is such a thing as the male menopause,” he says. “Yes, there are often changes in testosterone levels in men over 50 but it is gradual and only 2 per cent of men suffer any illness as a result of the condition.”
In contrast, all women who have periods will experience the menopause, which is characterised by an abrupt drop in hormone levels when ovulation stops, usually between the ages of 45 and 55. The symptoms are clear and experienced by the majority of women.
But low testosterone – or “low T” as it’s known in American TV adverts – affects a quarter of UK men, according to the British Society Of Sexual Medicine. Common symptoms include fatigue, brain fog, decreased sex drive, weight gain and low mood. In other words, the characteristics and concerns of most middle-aged men in the country. Recent studies have shown low levels of testosterone in men is associated with higher risk of developing Type 2 diabetes. Not everyone who demonstrates these symptoms necessarily has testosterone deficiency, but a growing number are exploring testosterone replacement therapy to combat their midlife malaise.
“There are decades of data on the adverse effects of low testosterone in men,” says Dr Jeff Foster, a GP specialising in men’s health and co-founder of H3health, a clinic for men over 40. “The only debate is around what we call the condition.”
Dr Foster argues that comparing testosterone deficiency in middle-aged men to the female menopause is misleading. “It’s not a contest to see who suffers the most,” he says. “The two conditions are very different, but it is nevertheless important for men to understand the problems associated with low testosterone.”
Stephen Webb, a former star of Gogglebox and a Dancing On Ice contestant, was 50 when he realised he was testosterone deficient. “I wasn’t myself and had been gaining weight so I went to the GP and then a therapist to find out what was wrong, but nothing seemed to help,” he says. “Eventually I got tested and realised I had the testosterone levels of a 75-year-old. They were rock bottom. I started to get a testosterone replacement injection every ten days and almost immediately my energy levels shot up and my mood improved. I was running five miles every morning and then going to a spin class. It was too much so I had to cut my dosage down to every two weeks to make me less manic.”
Webb, like Ryder, is now passionate about spreading the word to other middle-aged men. “I’ve encouraged mates to get tested and now they’ve got treatment and their lives have improved all round,” says Ryder.
Perhaps it is the debate around terminology that has stopped testosterone deficiency getting the validity it might deserve. “If a woman in her fifties goes to the GP and reports symptoms like brain fog and fatigue, they will be quickly diagnosed as experiencing the menopause,” says Dr Foster. “But if a man of the same age reports those symptoms, he is far less likely to be tested for low testosterone. So, he goes off and spends his money on a combination of Viagra, antidepressants and other over-the-counter supplements.”
Of course, the suffering experienced by women during the menopause is very real, widespread, and often distressing – which is why so many have understandably reacted with cynicism to men appropriating the term for themselves. “Why are men getting time off for it when women managed for several centuries with just a paper fan, taking a jumper off and sitting next to the office window?” wrote Allison Pearson.
The NHS considers normal testosterone levels to between 10 and 30 nmol/L depending on age. Anyone with levels below that could qualify for replacement therapy, which is given via regular injections or the application of a gel or cream.
Dr Jayasena concedes that the treatment can improve the quality of life for some men. But he remains cautious about the broader benefits of the treatment. “Most of these problems among middle-aged men are to do with general poor health,” says Dr Jayasena. “If you slow down in middle age, stop exercising, eat badly and drink too much you will gain weight and be more likely to get ill. You might also see a drop in testosterone. Low testosterone is a symptom of poor general health, not the cause of it.”
Maybe so, but for many lazy middle-aged men (like me) the idea of a quick testosterone jab every couple of weeks sounds like a rather more attractive solution to midlife malaise than circuit training and kale smoothies.
