In recent years, increasing awareness has grown around what is known as the “male menopause” or “manopause”. More accurately termed andropause or late-onset hypogonadism, it refers to the gradual decline in testosterone levels in men, typically starting from the mid-30s and progressing at about 1% per year. A significant number of men suffer from its symptoms, often without realising there is a medical reason behind their low energy, mood changes, or reduced sex drive.
This blog has been written with information taken from the Wealth of Health podcast episode ‘Manopause: The Change That Affects EVERY Man’
What Is the ‘Manopause’?
Unlike the female menopause, which occurs over a relatively short period and involves a sharp drop in hormone levels, the male equivalent is more subtle and gradual. From about age 30-35, men’s testosterone levels begin to decline slowly. This decline can lead to a range of physical and emotional symptoms, including:
- Increased irritability and mood swings
- Decreased libido and erectile dysfunction
- Low energy and motivation
- Reduced muscle mass and strength
- Difficulty sleeping
- Lack of enthusiasm for activities
- Mild depression or anxiety
- Weight gain and fatigue
Many men attribute these symptoms simply to “getting older,” often dismissing them or struggling silently. However, these changes can significantly impact relationships, productivity, and overall quality of life.
Can You Discuss This With Your NHS GP?
If you are experiencing these symptoms and over 40, you are entirely within your rights to bring this up with your NHS GP. A simple blood test, done in the morning when testosterone levels are highest, can check whether you have low or borderline-low levels of testosterone.
The NHS may prescribe Testosterone Replacement Therapy (TRT) if your testosterone levels are clearly below the normal range. If your levels are “low normal” meaning they’re still within the lower end of the acceptable spectrum, it becomes a grey area. Some GPs may hesitate to prescribe TRT in these cases.
However, some doctors advocate for a pragmatic approach. If a patient has clear symptoms and low-normal levels, they may still benefit from a trial of TRT, especially since it’s the only definitive way to determine if testosterone deficiency is the cause of their symptoms.
Does TRT Always Work?
TRT can be transformative for many men, restoring their energy, libido, mood, and overall zest for life. Some patients return after just two or three months and report remarkable improvements.
But for others, it may have no noticeable effect, especially if testosterone wasn’t the root cause of their symptoms. In these cases, it’s important not to continue with TRT unnecessarily. Testosterone therapy isn’t a magic bullet for all midlife concerns.
Is TRT Safe?
There are legitimate concerns about safety, especially surrounding testosterone’s relationship with cancers or heart disease. But when used responsibly, meaning within physiological, not pharmacological doses, TRT is generally safe.
It is crucial to distinguish between medical TRT and abusive steroid use, such as the high-dose regimens used by some bodybuilders. Medical TRT aims only to bring testosterone levels to the upper part of the normal range, not to superhuman levels.
That said, TRT isn’t for everyone. It may be contraindicated if you:
- Have active prostate cancer (though the guidelines here are evolving)
- Have polycythaemia (a condition where your blood becomes too thick)
- Suffer from severe obstructive sleep apnoea
- Have very high red blood cell counts
TRT does not cause prostate cancer, but if cancer is already present, it can cause it to grow faster. A strong family history of prostate cancer isn’t a strict barrier to TRT, but in such cases, regular PSA screening and medical oversight are essential.
How Common Is Low Testosterone in the UK?
While precise figures vary, it’s estimated that around 10-15% of men over 40 in the UK have low testosterone. This number likely underrepresents the true scale, as many men go undiagnosed due to stigma, misinformation, or simple lack of awareness.
Interestingly, 50% of men diagnosed with type 2 diabetes in their 50s are found to have low testosterone. This correlation highlights the need for routine testosterone screening in such groups. Moreover, TRT has been shown to improve insulin sensitivity, helping manage or even reduce the risk of type 2 diabetes in men with both conditions.
Treatment Options for TRT
If you and your doctor decide that TRT is appropriate, you’ll have several options:
1. Gels
- Applied daily, usually in the morning after a shower
- Absorbed through the skin (chest, arms, shoulders)
- Easy to dose and adjust
- Quick onset of effect
- Popular starting option
2. Short-Acting Injections
- Given every 1–2 weeks
- Require self-injection or a visit to the clinic
- Less convenient for some, but preferred by others
3. Long-Acting Injections
- Administered every 10–12 weeks
- Suitable for patients stabilised on TRT
- Needs to be given by a professional due to needle size and volume
4. Other Options (Rarely Used Now)
- Buccal tablets (placed in the gum)
- Oral tablets (mostly discontinued due to liver toxicity risk)
Tablets are now avoided because they undergo first-pass metabolism through the liver, which raises the risk of liver damage or cancer.
Caution: Unregulated Clinics and Gym Culture
TRT is becoming more widely discussed, and many men are turning to private clinics. While some of these offer legitimate services, others operate without proper oversight. There’s also a subculture of gym-based testosterone use, where steroids are often obtained and injected without medical supervision.
Men must ensure they seek care from qualified medical professionals, not just because of legality, but because monitoring is essential. TRT requires regular blood tests to track hormone levels, blood thickness (haematocrit), and PSA levels (for prostate monitoring).
Lifestyle Changes and Synergy
One powerful insight shared by clinicians is the synergistic effect of TRT with lifestyle changes. When testosterone is restored to normal levels, men often:
- Feel more energised
- Are more inclined to exercise
- Sleep better
- Make healthier choices
- Regain self-confidence
This creates a positive feedback loop. As they feel better, they do more. As they do more, such as exercise or eat better, they feel even better.
TRT isn’t a substitute for a healthy lifestyle, but it can unlock a man’s potential to re-engage with healthy habits.
So Why Aren’t More Men Doing This?
More men are seeking help, but many are still unaware. Some hesitate because of stigma; others don’t know TRT exists or feel awkward raising the issue. Doctors are increasingly recognising the importance of screening for low testosterone in men with symptoms. Still, awareness campaigns and better GP training could make a major difference.
If you’re a man over 40 or 45 and you’ve noticed changes in your mood, energy, libido, or motivation, don’t simply write it off as “getting older.” It could be a sign of low testosterone, a highly treatable condition. Talk to your GP. Get tested. If appropriate, consider a trial of TRT under professional guidance.
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Further Reading
https://www.nhs.uk/conditions/male-menopause/
https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056
