By Dr Richard Antbring
As we embrace Movember, the global movement dedicated to raising awareness for men’s health, it’s the perfect time to shed some light on critical topics that impact men’s well-being.
While the iconic moustaches are a fun and visible symbol, the real goal is to start essential conversations about mental health, prostate cancer, testicular cancer, and conditions like late-onset hypogonadism. At London Bridge Sports Medicine, we are committed to helping men lead healthier lives through education, prevention, and specialised care.
Understanding the “Male Menopause”: Fact or Fiction?
The term “male menopause,” sometimes referred to as andropause, is often misleading. Unlike the female menopause, which involves a significant hormonal shift, testosterone in men declines gradually, by about 1% per year after the age of 30-40.
While this slow decrease is usually not enough to cause symptoms on its own, some men experience significant changes as they approach their late 40s to early 50s. These changes may include:
- Mood swings and irritability
- Reduced sex drive and erectile dysfunction
- Loss of muscle mass
- Poor energy levels
- Weight gain or redistribution (e.g., increased abdominal fat)
- Sleep disturbances and poor concentration
Lifestyle and Psychological Factors
Many of these symptoms can be attributed not only to hormonal changes but also to personal and lifestyle factors, such as:
- High stress levels
- Anxiety and depression
- Sleep deprivation
- Poor diet and lack of exercise
- Excessive alcohol consumption and smoking
Workplace pressures, relationship issues, and financial concerns can also contribute to symptoms commonly associated with the so-called “male menopause.” Addressing these areas through strategies like stress management and improved lifestyle choices can significantly enhance well-being.
Late-Onset Male Hypogonadism: A Closer Look
For a subset of men, these symptoms described above may be linked to late-onset hypogonadism, a condition where the testes produce insufficient testosterone.
It is not a typical part of aging and can often be seen more prevalently in men who are overweight or have type 2 diabetes. A proper diagnosis involves clinical assessment and blood tests to measure testosterone levels.
In adult males, hypogonadism can alter certain masculine physical characteristics and impair normal reproductive function. Early signs and symptoms might include:
- Decreased sex drive
- Decreased energy
- Depression
Over time, men with hypogonadism can develop:
- Erectile dysfunction
- Infertility
- Decrease in hair growth on the face and body
- Decrease in muscle mass
- Development of breast tissue (gynecomastia)
- Loss of bone mass (osteoporosis)
Severe hypogonadism can also cause mental and emotional changes. As testosterone decreases, some men have symptoms similar to those of menopause in women.
The Role of Testosterone Replacement Therapy (TRT)
When someone presents with a number of the symptoms described and low testosterone levels are confirmed from a blood test, Testosterone Replacement Therapy (TRT) may be considered.
TRT aims to restore testosterone to normal levels, alleviating symptoms like fatigue, low libido, and depression.
Forms of Testosterone Therapy
- Topical Gels: Easy to apply, with daily use ensuring stable hormone levels.
Common products include Testogel® and Tostran®, which are applied to the skin once daily. Men typically start with a 5g dose of Testogel® or 3g of Tostran®, which can be adjusted based on response.
- Injections: Options like Sustanon® and Nebido® provide a less frequent, longer lasting dosing schedule.
Injections are given intramuscularly, usually in the thigh or buttock. Some patients may learn to self-administer, while others visit a clinic for injections.
- Oral Capsules: While available, oral testosterone (e.g., Restandol® Testocaps) is less commonly prescribed due to the risk of liver-related side effects and reduced effectiveness. When used, patients start with 120-160mg daily for the first few weeks, later reducing the dose based on their response.
In some cases, testosterone therapy is also prescribed for postmenopausal women to manage specific menopausal symptoms, though this is an unlicensed use and should only be done under a specialist’s guidance. Women use much lower doses, usually a small amount applied a few times a week.
Safety and Monitoring
While TRT can improve quality of life, it’s essential to undergo regular monitoring to manage potential side effects. These include mild effects such as:
- Skin reactions (for gel users) such as redness or irritation.
- Acne and hair growth
- Mood fluctuations – irritability or aggression and sometimes depression.
- Weigh gain
In rare cases, more serious side effects can occur:
- Breast Enlargement (Gynaecomastia) – This can happen due to hormone imbalances during treatment.
- Sleep Apnoea: Testosterone may worsen sleep apnoea, a condition that affects breathing during sleep.
- Polycythaemia – An elevated red blood cell count increases the risk of blood clots.
- Prostate health concerns
Regular blood tests, prostate exams, and check-ups are crucial for safe and effective treatment.
Prostate Cancer Risk
An important consideration with testosterone therapy is its potential to increase the risk of prostate cancer or accelerate the growth of existing cancer cells. However, the treatment is aimed at normalizing testosterone levels, and regular prostate checks help manage this risk.
Regular monitoring may include:
- PSA Test – A blood test measuring prostate-specific antigen (PSA) levels. Higher PSA levels may indicate a problem, though they are not definitive for prostate cancer.
- Digital Rectal Exam (DRE) – If there are symptoms of a prostate-related issue, the doctor will examine the prostate through the rectum to check for enlargement or abnormalities.
Blood Counts
TRT can cause an increase in red blood cell count, which can lead to polycythaemia, a condition that increases the risk of blood clots. A full blood count (FBC) should be monitored annually to ensure levels stay within a safe range.
Liver and Kidney Function
Liver and renal function tests are conducted regularly to watch for any signs of strain caused by the therapy.
Conclusion
Testosterone replacement therapy can significantly improve the quality of life for those with low testosterone levels, helping alleviate symptoms like fatigue, low libido, and mood changes. However, it’s a long-term commitment that requires careful monitoring to ensure it remains safe and effective. Patients should adhere to their prescribed regimen, attend regular follow-up appointments, and communicate any concerns with their healthcare provider.
Seeking Help
If you’re experiencing symptoms related to low testosterone or other men’s health issues, seeking help is vital.
At London Bridge Sports Medicine, we encourage men to prioritise their well-being not just during Movember, but year-round.
Talking to one of our medical professionals will ensure you receive targeted treatment and lifestyle adjustments that foster better health.
This Movember, let’s not only grow moustaches but also grow awareness, support each other, and take actionable steps towards better health. If you have any questions or wish to schedule a consultation, our specialists are here to help.
