Testosterone deficiency (hypogonadism)
Some men develop depression, loss of sex drive, erectile dysfunction and other physical and emotional symptoms when they reach their late 40s to early 50s.
Other symptoms common in men this age are:
loss of muscle mass
fat redistribution, such as developing a large belly or "man boobs" (gynaecomastia)
tiredness and a general lack of enthusiasm or energy
poor concentration and short-term memory
These symptoms can interfere with everyday life and happiness, so it's important to find the underlying cause and work out what can be done to resolve it.
Is there such a thing as a 'male menopause'?
The "male menopause" (sometimes called the "andropause") is an unhelpful term sometimes used in the media to explain the above symptoms.
This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, similar to what occurs in the female menopause. This is not true. Although testosterone levels fall as men age, the decline is steady – less than 2% a year from around the age of 30-40 – and this is unlikely to cause any problems in itself.
A testosterone deficiency that develops later in life (also known as late-onset hypogonadism) can sometimes be responsible for these symptoms, but in many cases the symptoms are nothing to do with hormones.
Personal or lifestyle issues
Lifestyle factors or psychological problems are often responsible for many of the symptoms described above.
For example, erectile dysfunction, loss of libido and mood swings are often the result of stress, depression or anxiety. These psychological problems are typically brought on by work or relationship issues, divorce, money problems or worrying about ageing parents.
A "midlife crisis" can also be responsible. This can happen when men think they've reached life's halfway stage. Anxieties over what they’ve accomplished so far, either in their job or personal life, can lead to a period of depression. In men, this usually happens between the ages of 35 and 50, and can last up to 10 years.
Other possible causes of the above symptoms include:
lack of sleep
lack of exercise
drinking too much alcohol
In some cases, where lifestyle or psychological problems do not seem to be responsible, the symptoms of the "male menopause" may be the result of an underlying medical problem, where the testes produce few or no hormones. This is known as hypogonadism.
Hypogonadism is sometimes present from birth, which can cause symptoms like delayed puberty and small testes.
Hypogonadism can also occasionally develop later in life, particularly in men who are obese or have type 2 diabetes. This is known as late-onset hypogonadism and it can cause the "male menopause" symptoms mentioned above. However, this is an uncommon and specific medical condition that is not a normal part of ageing.
A diagnosis of late-onset hypogonadism can usually be made based on your symptoms and the results of blood tests used to measure your testosterone levels.
What to do
If you are experiencing any of the above symptoms, see your GP. They will ask about your work and personal life, to see if your symptoms may be caused by a mental health issue, such as stress or anxiety.
If stress or anxiety are affecting you, you may benefit from medication or a talking therapy, such as cognitive behavioural therapy (CBT). Exercise and relaxation can also help. Read about stress management, treating anxiety and help for low mood and depression.
Do I need HRT?
Your GP may also order a blood test to measure your testosterone levels. If the results suggest you have a testosterone deficiency, you may be referred to an endocrinologist (a specialist in hormone problems).
If the specialist confirms this diagnosis, you may be offered testosterone replacement treatment in the form of tablets, patches, gels, implants or injections to correct the hormone deficiency, which should relieve your symptoms.
Male sexual dysfunction
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Testosterone deficiency hypogonadism