Are you tired all the time, lacking in concentration, focus and get-up-and-go and suffering from “increased central obesity’” also known as the “beer belly” or “spare tyre”?
These are common symptoms for men in their 50s with a stressful, but often sedentary lifestyle. So do you need testosterone replacement therapy (TRT) - the new HRT (hormone replacement therapy) for men?
Dr Cherry Armstrong, a GP in Surrey, the UK, says that most men do not notice the “andropause or gradual, natural decline in their testosterone levels as they get older and put their decreased libido, depression or diminished tolerance for exercise down to other factors”.
“After the age of 30, there is a 10% reduction in production,” said Armstrong. “Symptoms of a testosterone deficiency are gradual and insidious. Many men just regard some of these symptoms as ‘part of growing old’ and accept them.”
But now more men are looking for a medical top-up of testosterone, even though potential side effects include growing breasts, mood swings, hot flushes, shrinkage of the testicles and infertility, says Armstrong.
Increasingly health and diet-conscious, particularly in recent years, men are encroaching on what has been the largely female preserve of hormone replacement.
It seems the andropause is the new menopause and TRT is the new HRT for men.
Armstrong set up her clinic in 2009, offering a range of medical and cosmetic treatments and procedures to a predominantly female clientele.
But in 2017 she decided to also set up a Men’s Wellness Clinic, which took a holistic approach to health, offering a medical check-up and advice on diet, exercise, sleep and stress reduction with a registered nutritional health therapist and medicine practitioner - and, where necessary, TRT.
“The clinic has been providing this service for more than a year and it is becoming increasingly popular,” said Armstrong. “The ratio of women (having bio-identicals, which can include progesterone, oestrogen and testosterone) to men (having testosterone) is 70:30.
“But the number of men consulting us on TRT has increased by 25% in the past six months.”
Most of her male clients are “middle to upper-class, from a whole range of professions” and aged between 40 and 65.
According to Armstrong, a lot of men ask for HRT on arrival, having researched it beforehand.
It appears that men who, in the past, wouldn’t have shared anything more intimate than a joke at the golf club and who bought a new Jaguar when their libidos needed boosting, are now discussing diets and the state of their prostates with each other.
“Men are much more informed than they were 10 years ago, through the media, advice at the gym, talking more openly with each other and also from their wives, who read magazines regarding their husband’s health,” says Armstrong.
Indeed, wifely nagging still plays a part. “We also have female patients on bio-identicals at the clinic who suggest that their husband should have a check-up for a testosterone deficiency.
“Testosterone replacement therapy has been around in the US for more than 10 years and there are conferences all over the world focused on the latest research and development in the field,” adds Armstrong.
In the UK, it was initially used for specific medical problems such as hypogonadism (the inability of the body to synthesise sex hormones), but “over the past few years the medical community in the UK is embracing the concept of TRT for healthy men with andropause symptoms”.
Various forms of testosterone are available, and it is administered through weekly injections at a clinic, although creams, which are applied to the upper or inner arms, buttocks, upper or inner thigh, can be offered as an alternative.
Armstrong, however, warns: “You should not treat people whose levels are within the normal range.
“If you give someone testosterone, the body believes it is producing enough and so stops producing it naturally in the testes.
“So you have shrinkage of the testes and a reduction in sperm production that can make you infertile.”
She stresses that most of the side effects, “notably the risk of growing breasts or of becoming infertile”, can be countered with other drugs, called “inhibitors”, and that the testosterone dose can be “tweaked” if other symptoms such as mood swings, acne or hair problems develop. - Daily Mail