For years women have enjoyed the rejuvenating powers of hormone replacement therapy. With just a pill or a patch, many find energy levels are restored, sex drive returns and life takes a turn for the better. But what about men? When their libido takes a nose dive or they start getting night sweats - and some do - what can they do?
For 54-year-old Bernard Collen, hormone replacement therapy was the answer. 'I'd been feeling more and more tired and stressed for several years, but I just put this down to working long hours and not getting enough sleep,' he recalls. 'But when I was about 40 things took a turn for the worse. I kept getting black moods that I just couldn't shift. I felt irritable and I had absolutely no interest in sex. My wife thought I was having an affair.'
It was only when his marriage was on the brink of breaking up that Bernard decided to seek help. 'I didn't want to see my GP. How could I describe what was happening to me - I thought I'd just have to live with it. But my wife wanted me to see a specialist she had heard about, so I went to see Dr Malcolm Carruthers at his private clinic in Harley Street.' Blood tests revealed that Bernard's levels of active testosterone (testosterone that's free to act in the body), were low.
'I started off with testosterone tablets and effect was dramatic,' says Bernard. 'Within two weeks my life had completely turned around - it felt like a huge weight had been lifted off my shoulders. I felt more confident at work and I was interested in sex again. I've been taking replacement therapy for over 10 years now and I feel a lot better for it. The only problem is whenever I'm 'assertive' these days, my wife says there must be something wrong with my testosterone again - it's too easy to blame my hormones now.' A remarkable result - but should all tired, moody men be taking HRT? Not yet, says Dr Fred Wu, senior lecturer in endocrinology at the University of Manchester, but the day when they should may not be far away.
New research from North America shows that testosterone therapy not only helps relieve 'andropausal' symptoms, but has other health benefits too. The data, which is about to be published, shows testosterone replacement can boost bone strength, reduce body fat and even reduce cholesterol levels, keeping men leaner, and holding out the promise of lower risk of the brittle bone disease osteoporosis and of the biggest man-killer, heart disease.
In the bedroom, too, testosterone replacement promises to return libido at least to normal levels.
Dr Carruthers, who set up the UK's first andropause clinic, says testosterone boosting is particularly effective in men with erectile dysfunction who are already using Viagra.
'Testosterone therapy plus Viagra tackles the problem of poor sex drive as well as erection failure - after all, there's no point having a marvellous erection if you have no sexual desire.' But be warned. The hormone on its own is no cure for impotence. 'If anything it could make the problem worse,' says Dr Wu. 'Testosterone only improves sex drive, it doesn't cause erections. There would be nothing worse than restoring your libido, only to find you are unable to perform,' he warns.
For men who have a genuine hormone deficiency, there are already treatments available and Dr Wu reports a steady increase in the number of coming forward for treatment. This is quite surprising, since at his clinic, andropausal men endure a thick, oily injection of testosterone in their bottom every two to three weeks - proof perhaps that their symptoms are for real.
Dr Carruthers, on the other hand, prefers tablets or implants. 'Most men see a dramatic relief of symptoms just from the tablets alone,' he says.
One of the main concerns about testosterone therapy is the possibility that it may increase the risk of prostate cancer. But long-term studies are still needed to confirm safety, Dr Wu says the new results 'look encouraging' and show no evidence of prostate stimulation.
Another worry is that topping-up testosterone could make men more aggressive. But, research suggests high testosterone levels, in fact, have the opposite effect, producing feelings of euphoria rather than belligerence.
However, testosterone replacement is not appropriate for every man who thinks he's hit a mid-life low, says Dr Wu.
'There are lots of other reasons for feeling like this. And we still don't know for sure that testosterone treatment is safe in the long term. Until we do, men should only be treated by specialist endocrinologists who are able to monitor them closely and do regular checks for prostate cancer - just to be on the safe side.'
Have you hit the andropause yet?
From the age of 40 testosterone levels begin to fall in all men, but they rarely sink without a trace - there is always some testosterone floating around the body. Unlike the female menopause, the andropause is not inevitable. 'Many men with low testosterone levels feel absolutely fine,' says Dr Wu. But for those who are sensitive to the hormonal drop, common symptoms are:
Extreme lethargy
Loss of libido
Irritability
Muscle weakness and reduced stamina
Low moods.
After age 60, around 25 per cent of men have testosterone levels that are below what would be considered normal in younger men.
A blood test is essential before having any treatment. If you're suffering symptoms and the test shows low testosterone levels (7-12 nmol/L would be considered lowish), then replacement therapy may well be beneficial.
