Peter O’Brien can’t quite remember exactly when he began treatment for his low testosterone.
‘About five months ago,’ he says, waiting for the kettle to boil in the kitchen of his home just outside Bath.
His wife Lucy, however, can tell you precisely when it was. ‘It was February 16,’ she chips in, and they laugh.
She knows for certain because within three days of starting to apply testosterone gel to his skin, her 52-year-old husband, who hadn’t been himself for two years, suddenly rediscovered his interest in sex.
He’s not the only one.
A group of 65-year-old men experienced similar effects when they were given testosterone gel during a year-long study published last month in the Journal of Clinical Endocrinology & Metabolism.
As well as improved libido, the men reported having more frequent sex and night-time erections compared with those who were given a placebo gel.
It’s the kind of research that has men of a certain age asking themselves whether they should be having the treatment, too.
In fact, an improved sex life isn’t the only benefit of restoring testosterone — men with low levels can suffer a range of symptoms, including night sweats, joint pain, muscle loss, irritability, loss of memory and even depression.
Put simply, testosterone deficiency can make a man’s life as much of a misery as the menopause does for many women.
Fortunately, the solution is simple — a daily dose of testosterone, usually administered as a gel rubbed into the skin on the shoulders (where others are unlikely to come into contact with it).
Unfortunately, the medical profession is bitterly divided over who needs it.
The mainstream view is that only a small number of men with specific medical problems really need testosterone treatment — the remainder need to address their lifestyles.
But leading exponents of testosterone treatment say hundreds of thousands of men whose lives could be improved virtually overnight are being left to battle alone.
Even if a man is referred by his GP to a hospital endocrinologist for suspected testosterone deficiency, they say, he is very unlikely to find a sympathetic ear and so many are forced to go private.
IS THE MALE MENOPAUSE A MYTH?
There is no doubt that low testosterone can and does cause multiple problems — the sticking point is how low your testosterone needs to go in order to be treated.
The conventional approach is that only men with a specific medical problem, such as late-onset hypogonadism (LOH), need treatment.
According to the Society for Endocrinology, the organisation that represents hormone specialists, the number of men in the UK affected by LOH ‘is small’, around 2.1 per cent of men aged 40 or over.
The official NHS position echoes this — while acknowledging that a testosterone deficiency ‘can sometimes’ be responsible for symptoms such as loss of libido, mood swings, loss of muscle mass and energy, the NHS says this is actually a rare medical problem.
Furthermore, this kind of testosterone deficiency is certainly not a normal part of ageing (unlike the female menopause).
According to the NHS, while all men do suffer a small reduction in testosterone — less than 2 per cent a year from around the age of 30 to 40 — ‘this is unlikely to cause any problems in itself’.
Far more likely to be responsible for any symptoms, it says, are ‘lifestyle factors’, such as bad diet and lack of exercise — along with ‘psychological problems’, such as the ‘male midlife crisis’.
From this perspective, the so-called male menopause is nothing more than a great marketing tool.
One leading endocrinologist Good Health spoke to went even further.
‘The so-called male menopause doesn’t exist,’ says Richard Quinton, a consultant endocrinologist at Newcastle Hospitals Foundation NHS Trust and a spokesperson for the Society for Endocrinology, the branch of medicine that specialises in hormone imbalances.
‘It’s all commercially driven snake oil.’
But Peter would disagree. The owner of a successful software development company, he had retired early and was looking forward to spending time with his wife but shortly after turning 50 says he began to feel ‘something was wrong’.
It wasn’t, he insists, a reaction to hitting the big five-oh.
‘I really didn’t care about that. But I felt like I was about 70 — run-down, no energy and people who hadn’t seen me for a while said I suddenly looked older.’
He began to worry something was seriously wrong. After a series of blood tests, his doctor told him he was fine, but there was one thing that hadn’t been measured — his testosterone.
Peter had read about testosterone deficiency and asked his doctor whether that could be his problem — ‘but I got the impression he didn’t really want to get involved with that’.
Peter insisted and his testosterone level was measured and he was referred to an NHS endocrinologist.
‘I was told my levels were very low, but that was normal and I should just carry on. But I felt far from normal.’
Frustrated, he went to a private clinic where he was prescribed a daily dose of testosterone. ‘I quickly got my life back,’ he says.
TOO EMBARRASSED TO DISCUSS SEX PROBLEMS
But while Peter is more than happy to tell his story, it was on condition of anonymity. Peter is not his real name.
Like the other men having testosterone treatment who spoke to Good Health, he refused to go public and that, says Dr Clive Morrison, a doctor at the clinic where Peter was treated, is part of the problem preventing many more men benefiting from testosterone.
‘There is no stigma among women about the need for hormone replacement therapy, and consequently the vast majority who need it, get it,’ says Dr Morrison, who works with the Centre for Men’s Health.
‘Unfortunately, the opposite seems to be true for men. Many appear to think there is something almost shameful about even the slightest suggestion that they might benefit from similar treatment, from a similar age, to help correct a similar hormonal deficiency.’
Men ‘are particularly reticent about admitting that their sex drive and bedroom performance might have been compromised’, he says.
As a result, ‘very few of those who need it and could benefit greatly from it actually seek out testosterone therapy, and those who do rarely talk about it, perpetuating the stigma and leading to a significant degree of unnecessary suffering amongst middle-aged and older men’.
As well as stigma, another barrier to hormone treatment for men is whether symptoms alone rather than blood test results are enough.
One of those championing the cause of testosterone treatment is Dr Malcolm Carruthers, who originally trained as a GP and later founded the Centre for Men’s Health.
Dr Carruthers, who freely admits he has ‘wildly diverged’ from the mainstream view for the past 30 years, says that thousands of men in the UK over 50 could benefit from testosterone treatment, but that only 1 per cent of them are getting it.
ARE BLOOD TEST RESULTS MISLEADING?
As evidence, he cites his own clinical experience and research published in a series of papers in the journal The Ageing Male, by Lothar Heinemann, a doctor at the Berlin Centre for Epidemiology and Health Research.
Research by Dr Heinemann and colleagues concluded that in most European countries, as well as Australia, Russia and Japan, 20 per cent of men over 50 could be rated as deficient in testosterone on the basis of their symptoms alone.
Dr Carruthers and others believe that there is over-reliance on blood tests to diagnose low testosterone.
He says the blood tests are so imprecise and the definition of a ‘normal’ level so wide as to be almost meaningless, and that a man’s symptoms alone can usually tell the whole story.
This approach appears to have been vindicated by a paper Dr Carruthers published last year and which was co-authored by researchers at the urology department of University College Hospital, London, and the Alzheimer’s and Ageing Department at Edith Cowan University in Perth, Australia.
The study reported the long-term effects of testosterone therapy on 2,200 men (average age 54) treated at Dr Carruthers’s centre since 1989 and concluded that it was effective and safe.
Significantly many of the men in the study had suffered for between three and five years with symptoms including loss of libido and energy, erectile dysfunction, night sweats, joint pains, depression and irritability, but had been denied treatment by their doctors because blood tests had shown their testosterone levels to be ‘in the “normal” range’.
Another advocate of testosterone treatment is Dr Erika Schwartz, a U.S. doctor and author of the best-selling book The Hormone Solution. She argues that men ‘need help with hormones just as much as women do’.
‘The male menopause has never been in the spotlight because men who experience it have been reluctant to acknowledge its existence [and] the medical profession has not been keen to address this obvious similarity to female menopause’.
She told Good Health: ‘Almost every day I see 60-year-olds who tell me testosterone therapy is magical and they’ve got their lives back.’
Her own husband, Ken Chandler, now in his mid-60s and an executive editor of a U.S. news website, has testosterone treatment.
‘It has made me livelier. I think I look better than I did at 50 and I have much more energy and focus. And it’s certainly improved my sex drive,’ he told Good Health.
IS YOUR MAN BORING AND FLABBY?
The tragedy, says Dr Schwartz, is that the solution is so easy — a daily dose of testosterone — but ‘unfortunately men have certain ego issues and they see male menopause as a failure instead of another stage in life’.
‘All you have to do is look at most men in their 50s and 60s, and how they look will tell you where they stand hormonally: they are overweight, their eyes are no longer shining, they’re not interested or interesting, they are boring and depressed and they have flab not muscle.’
All this, she says, is too readily dismissed by many in the medical profession as ‘just part of the ageing process — but what if they’re wrong and you can do something about it, and the solution is having your hormones balanced and taking care of yourself?’
That view is heresy to mainstream medics.
And yet things do seem to be changing. The latest figures for NHS prescriptions dispensed in England showed there were over 201,000 issued for testosterone in 2015, up more than 200 per cent from the 65,000 ten years earlier.
So it seems some men are being helped.
But this increasing use of hormone therapy has been condemned as ‘an epidemic of testosterone prescribing’ in a paper co-authored by Richard Quinton and published in the journal Clinical Endocrinology in 2013.
‘Many men in the UK might be receiving testosterone replacement therapy with neither clearly established indications, nor robustly diagnosed hypogonadism,’ it said. In other words, some men receiving the treatment should not be.
They laid the blame primarily at the door of an increase in online advertising by U.S. pharmaceutical companies designed to create the impression that testosterone deficiency is common in older men.
It would not, Dr Quinton told Good Health, be unreasonable for a man with symptoms suggestive of testosterone deficiency to ask his GP for a blood test.
But he insists: ‘Only 2 per cent of older men actually have something that is similar to a menopause, where their testes begin to function less efficiently and they produce less testosterone and less sperm.
I say “similar to” because in the menopause the ovaries just shut down completely and produce no hormones, whereas in these men the testes begin to function less efficiently.’
With medical opinion so widely divided, men could be forgiven for being confused about what to do for the best.
Two years ago, reseachers at 12 centres across the U.S, funded by the National Institutes of Health, set out to settle the question once and for all, with a series of seven studies on testosterone treatment in older men, known as the Testosterone Trials.
The study published last month looking at the 65-year-olds’ libido was one of the seven.