Man Down: The Truth About Male Menopause

So, "male menopause" — dramatic name, complicated reality. The good news is there's actually a lot more to say about it than just libido and erectile dysfunction. The less good news is that most men will blame their hormones when the culprit is more likely the three pints and the 5am doomscrolling.

Let's start with the symptoms, because this is where it gets interesting. Men in their late 40s to early 50s can experience depression, loss of sex drive, erectile dysfunction, mood swings, irritability, loss of muscle mass, fat redistribution, lack of energy, insomnia and poor concentration. www Sound familiar? We thought so.

Here's the twist though. This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone, similar to female menopause. This is not true. www Testosterone declines gradually — just 0.4% per year uroweb — which is rather different from the hormonal cliff edge most of us fell off.

In fact, in many cases the symptoms are nothing to do with hormones at all. Stress, depression, anxiety, poor diet, lack of sleep, too much alcohol, smoking and low self-esteem can all be responsible. www So before anyone reaches for a testosterone prescription, it's worth ruling out the obvious.

When hormones genuinely are the issue, the condition is called Late Onset Hypogonadism (LOH). This is an uncommon and specific medical condition — not a normal part of ageing www — and affects between 2.1 and 5.7% of men aged 40–79. uroweb Compare that to the 75% of us dealing with hot flushes, and the "male menopause" comparison starts to look a little shaky.

Obesity, type 2 diabetes and cardiovascular disease all increase the risk, and weight loss alone can restore testosterone levels by reducing oestrogen produced by body fat. uroweb Lifestyle first, medication second — a principle that should sound very familiar by now.

If testosterone replacement therapy (TRT) is considered, the evidence beyond improving sexual function is weak — mood, cognition and muscle benefits are limited. uroweb There are also cardiovascular risks including blood clots, and potential heart and stroke implications, all of which need a proper conversation with a doctor. Men trying to conceive or with a history of breast or prostate cancer cannot take it at all. uroweb

Bottom line: the symptoms are real, the causes are varied, and testosterone is rarely the whole story.

A friendly reminder: I'm sharing what I've learned, not prescribing what you should do. Always chat with your GP about what's right for your unique situation!

‍

‍