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13/05/2022 Online

DR MICHAEL MOSLEY: Why being married and working for yourself can help to ward off the manopause (…. that’s the menopause for chaps!

Are you feeling tired and irritable, sleeping badly, with reduced sex drive, breast discomfort and occasional hot flushes or sweats?

These symptoms are typical of women going through the menopause, lipitor package inserts when levels of female hormones fall. But they are also symptoms middle-aged men can experience when their levels of the male hormone, testosterone, begin to drop.

The menopause has quite rightly received a lot of attention recently, not least because of the current shortages of hormone replacement therapy (HRT), which are affecting many women’s lives.

But the male equivalent, the andropause, also known as penopause, Low T, androgen deficiency in the ageing male (ADAM) — or just ‘irritable male syndrome’ — is much less talked about.

That’s partly because, unlike in women, there’s no dramatic period in a man’s life when his testosterone levels fall off the cliff; it’s more like a slow descent.

The male equivalent, the andropause, also known as penopause, Low T, androgen deficiency in the ageing male (ADAM) — or just ‘irritable male syndrome’ — is much less talked about

Because of this, the claim that men go through a ‘menopause’ is controversial.

But there’s no doubt that a lot of men have low testosterone and this is massively underdiagnosed; a 2020 study, by the Yale School of Medicine in the U.S., suggests that up to 40 per cent of men have low testosterone and this has become far more common, particularly among younger men, over the past few decades.

Low testosterone is linked not only to all the symptoms I’ve described above, but also depression, problems with memory, loss of body hair, reduced bone density and a higher risk of type 2 diabetes — essentially because testosterone plays a role in so many bodily functions.

The big debate is when and if Low T should be treated with testosterone replacement therapy. Few men will admit to topping up testosterone, although there are plenty of private clinics that will give you a jab.

But the treatment is quite expensive and unless your testosterone levels are strikingly low, the jabs are unlikely to give you much benefit.

A few years ago I took part in an experiment where, under medical supervision, I injected myself on a regular basis with testosterone to see if it would boost my mood and libido, as advocates promise.

In theory, although my testosterone levels were normal (and I had no symptoms), an extra helping of this hormone should have had a profound impact on my body.

But it didn’t — so within a few months, I gave up.

The NHS advice is that if you’re experiencing the sort of symptoms described above to talk to your GP. You may be offered a blood test, which may then lead to a visit to an endocrinologist (a hormone specialist) who may give you testosterone replacement therapy in the form of tablets, patches, gels or injections.

Not many men go down this route and in fact, your levels need to be really low to get treatment on the NHS.

But the good news is that while big falls in testosterone can happen, they’re not inevitable and there are plenty of things you can do to maintain or boost your levels without medication.

Staying a healthy weight helps. In a study in 2012 involving nearly 1,400 middle-aged men, researchers from the University of Adelaide in Australia found that over a five-year period, testosterone levels fell by an average of 1 per cent a year.

But there were huge variations, with the biggest falls in men who’d put on a lot of weight and in those who’d stayed single. The problem with weight gain is that fat cells contain an enzyme, called aromatase, which converts testosterone into oestrogen. So carrying around lots of fat means less testosterone.

And the reverse is also true: losing some of that fat should boost your testosterone levels.

In a 2011 trial, researchers at Massachusetts General Hospital in Boston found that men with prediabetes who lost 8kg (17lb) in weight reduced their blood sugar levels — and the proportion of the men with low testosterone halved (from 24 per cent to 11 per cent).

There was no change in the men who’d been put on blood sugar medication.

But why would being single affect your testosterone levels? Gary Wittert, a professor of medicine who ran the Australian study, thinks this is probably because married men tend to be healthier and happier. Also, married men tend to have more regular sex; a sure-fire way to increase testosterone levels.

More surprisingly, in another study Professor Wittert found that men who are self-employed tend to have higher testosterone levels than those who work for others or who are unemployed, though it’s not clear why.

I am happily married, reasonably slim and self-employed, so I was not surprised — but certainly relieved — to discover that my testosterone levels are at the higher end of the normal range for my age when I recently had them tested for a TV programme.

But I still take steps to prevent the testosterone slide — doing regular resistance exercises (press-ups and squats), which have been shown to boost testosterone, and trying to get a good night’s sleep (another well-proven testosterone booster). There are also certain foods that may help:

■ Eating oily fish will boost your intake of zinc, a nutrient you need to keep your testosterone levels in the healthy range

■ Leafy green veg, such as spinach and kale, are a good source of magnesium, another nutrient that helps maintain testosterone levels.

■ I also regularly snack on Brazil nuts which are a great way to top up your selenium levels, which tend to be lower in men with low testosterone.

And finally, try to get out in the sun, without burning. A short burst of sunshine will boost levels of vitamin D, which is also linked to libido in men and women.

Yet another friend from medical school, a GP in her early-60s, has announced she’s retiring.

She has had enough — as well as increased bureaucracy, she told me the fear of being accused of malpractice, and rising levels of complaints from frustrated patients, has finally worn her down.

It used to be so different. My GP father-in-law didn’t retire until his mid-60s (other doctors of his generation often kept going into their 70s).

But, as he said, in his day the drug regimens were less complicated, patients less litigious — and doctors felt better supported.

There’s also been the recent fiasco around NHS pension reforms, which meant doctors who wanted to go on working were financially penalised for doing so.

This is all adding to the current manpower crisis in the NHS, with the number of GPs falling just as demand is rising. There’s been a belated attempt to persuade doctors to come out of retirement, but it feels like too little, too late.

Unless more is done to improve GP working conditions, I fear many new graduates will choose either to work part-time, or leave the country once qualified.

Having said all this, when my mother, who’s 93, recently had a fall, a lovely GP made a home visit within a few hours.

There’s still much that’s wonderful about general practice, but the Government really must pull its finger out to sort the current mess.

Fasting can add years to your life

As you will know, I’m a fan of intermittent fasting — cutting your calories for a couple of days a week (the 5:2 diet), or reducing the hours within which you devour them, known as time-restricted eating (TRE).

Studies have suggested that TRE can lead to modest weight loss and improvements in blood pressure and blood sugar levels.

So I was disappointed by recent headlines claiming TRE is a waste of time.

A study in China, where people were asked to eat between 8am and 4pm, found this led to an average weight loss of 8kg (nearly 18lb) after a year; those who simply cut their calories lost 6.3kg (nearly 14lb).

But as the trial was quite small, these differences weren’t considered ‘significant’. However, the volunteers were healthy to begin with, so it wasn’t surprising they didn’t get noticeably healthier.

By contrast a more recent study, in the journal Science, found that combining TRE with calorie restriction extended the lifespans of mice by an impressive 35 per cent. So I won’t be giving up on it!

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