Middle-age dread

The ‘manopause’, or testosterone syndrome, is real but often responded to with flat denial and shame, says Dave Kenny.

ROBBIE Williams has it all: money, a beautiful wife, adoring female fans. He has fast cars, hair, biceps. He is on the precipice of 40 and looks 25. He is a sex symbol who has defied ageing.

But Robbie has one thing shared by a tiny group of middle-aged men. He has the sex drive of a 100-year-old. The former Take That singer — who plays Dublin tonight — has no testosterone. The 39-year-old began injecting the male sex hormone two years ago, after being diagnosed with early onset male ‘menopause’ or testosterone-deficiency syndrome (TDS). His revelation fuelled the debate over whether ‘manopause’ exists or not.

Since its first diagnosis, in the US in the 1940s, the term ‘manopause’ has been ridiculed as an excuse for men to behave stupidly in middle age; to hang around bars in their aviators and Jeremy Clarkson jeans, chatting up ‘chicks’; to wear biker jackets and cowboy boots.

When a man’s masculinity is slipping, why does he reach for leather? The caveman proves he’s still got it by clubbing a buffalo and poncing around in its skin. Modern man buys a leather jacket and goes clubbing.

The media calls this behaviour ‘manopause’. The medical world calls it andropausal syndrome (AS), androgen deficiency in the ageing male (ADAM), hypogonadism, or TDS. The rest of us call it ‘behaving like a fool’.

The andropause/TDS is triggered by a decline in testosterone (T) levels. Symptoms include exhaustion, loss of facial hair, changes in the testes, weight gain, depression, confusion, memory loss, libido problems, erectile dysfunction and sleep disturbance. Many experts say reduced ‘T’ levels can be attributed to stress, boozing, overeating, and lack of exercise.

The portmanteau ‘manopause’ is misleading. It implies that the andropause/TDS is as inevitable for men as the menopause is for women. It’s not. Not all men are affected. TDS may strike 20% of men over 60, 30% over 70, and 50% over 80. It affects millions, but just 1% are diagnosed.

Most Irishmen are reluctant to speak about it. According to a survey by drug firm, Shering AG, 64% said they did not believe their menopausal symptoms warranted a GP visit. The ‘manopause’ is not just about depletion of testosterone. It’s about the loss of maleness. Gail Sheehy, author of Passages and Menopause: The Silent Passage, says, “If menopause is the silent passage, ‘male menopause’ is the unspeakable passage. It is fraught with secrecy, shame, and denial. It is much more fundamental than the ending of the fertile period of a woman’s life, because it strikes at the core of what it is to be a man.”

As a mid-40s male, I can identify. My libido is as strong as ever. My ‘manopause’ is the melancholy when I do a stock-take of my life. Where is my rock band? My editorship? My mega-bestseller? The ‘manopause’ is about self-esteem. Men are raised to be taciturn ‘providers’. We aim high in our testosterone-fuelled youth and hit middle-age slightly deflated.

We become obsessed with breathing life into terminally ill, youthful dreams. We ask ‘is that all there is?’ as we realise we will never be Springsteen or O’Driscoll.

We become obsessed with how we look. We look in the mirror and see hair that should be growing on our head sprouting out of our ears. We don’t recognise ourselves. If I had the money, I would have a hair transplant. Now.

One man who has weathered this emotional storm is documentary editor and director, Will Harris (47). He has embraced middle age. “It was a struggle but, eventually, I just had to accept it. Last year, I noticed my energy levels went down and my gym visits dropped off. Physically, I started to look like one of those men I swore I would never become. I could have kept pushing myself, but, instead, I deepened my commitment to myself through yoga and pursuing a love of dance.”

Will, who is single, spent his teenage years as a radio DJ. “Last year, I dusted off my records, got a set of turntables and have been spending hours lost in vinyl. With a hobby like DJing, some weekends are spent surrounded by younger, ‘buzzed-up’ people. I don’t drink or do drugs, so those ‘stimulants’ were out. Instead, I’ve got a healthy lifestyle on my side.

“Dancing may seem odd for a middle-aged man, but it’s an amazing form of expression, of letting go. It releases my ‘inner youth’. At the end of the party, I’m often the freshest-faced of them all.

“In my 30s and early 40s, life appeared to go on forever, the end wasn’t in sight — then, a switch seemed to go off and I felt like I had crossed an invisible line. On one side was my youth — suddenly, I was standing in the second-half. I started to question everything. Life, love, career.

“Now, with age, I’ve become more secure in the narrative of my own life story. I’m wiser.”

For others, the ‘change’ can be traumatic, especially in the bedroom, according to the bestselling Manopause: Your Guide To Surviving His Changing Life. “The pressure on men to keep performing in bed can lead to depression and esteem issues. As a man ages and he begins to doubt himself, his partner may feel she needs to be more assertive about what she wants sexually. This change may be hard for him to accept, because, in his mind, the implications are vast.”

So what can a man do to deal with the onset of TDS/manopause? Increasing numbers of doctors are prescribing testosterone replacement therapy: shots and patches containing the hormone.

The belief that TRT is linked to prostate cancer was dispelled by clinicians in 2011. However, London-based specialist, Dr Sean Cummings, says TRT must still be prescribed with caution.

“In some cases, because testosterone is being provided by the drugs, the testicles switch off. This leads to testicular shrinkage, cardiac enlargement, leading to heart failure, kidney and liver damage, and the development of breasts,” he said in a recent interview.

Kildare GP and sexual medicine expert, Dr Andrew Rynne, is a long-time advocate of the therapy. “Mention of TRT to your average doctor is likely to elicit vague objections to do with increased cancer risks, and other generally negative and ill-defined resistance to the suggestion.”

Are things changing? “I hope that they are. To summarily dismiss TRT as unnecessary, unnatural or even dangerous, might be to deny some older men a chance for a better quality of life,” he says.

Through his practice and his website (www.testosterone.ie), Dr Rynne has seen a slow increase in the amount of younger men, in their 30s, presenting for therapy.

“They have complaints, such as loss of libido and depression. Naturally, you have to be careful giving them testosterone. Does it work? Well, most patients stay on it. That tells you something,” he says.

Jim (52) says TRT has helped him. He’s a builder and plays drums in a pub rock band. Five years ago, he started to feel inexplicably tired. He was making excuses to miss gigs.

“I thought ‘just keep going, you’ll be grand’. I wasn’t. The slower I got, the more depressed I became. Tiredness turned into exhaustion. I even had hot flushes.

“After gigs, I just wanted to curl up in the van and sleep. The following day, I would be in bits — far worse than I should have been.”

Eventually, he was diagnosed with ‘late onset hypogonadism’ and prescribed patches. They made him feel sick, at first, but then his testosterone and energy levels returned to normal. “I felt brilliant. It didn’t help my drumming though,” he says.

With or without TRT, hitting the ‘manopause’ is like standing on the banks of a psychological rubicon. If you cross it, you’re in the land of slippers, comb-overs and evenings talking about power tools at the golf club. Fight it and you look like a sad tosspot.

Like everything else in life, though, you eventually get over it. You have to.

That said, I’m not getting over my impending baldness. If anybody wants to sponsor my hair transplant, drop by my office for a chat.

It’s Finnegan’s of Dalkey and I’m the man in the aviators, leather jacket and cowboy boots, sipping the frozen Margherita.