Andropause (the 'male menopause')

Andropause, or the male menopause, is the popular name for the idea that men go through a hormonal change in midlife like women do. The guidance is wary of the name.

Women's Health Concern, the patient arm of the British Menopause Society, says the preferred term is androgen deficiency in the ageing male, shortened to ADAM. The NHS website goes further and calls male menopause an unhelpful term, one sometimes used in the media.

The difference is speed. At menopause, a woman's ovaries stop and her estrogen falls over several years. A man's testosterone also falls with age, but the NHS says it falls slowly and steadily from around his thirties or forties, and that this decline on its own is unlikely to cause problems.

There is a real condition behind some cases. The NHS calls it late-onset hypogonadism, when the testes produce little or no hormone. By its account it is uncommon and not a normal part of getting older, and it can affect men who are obese or have type 2 diabetes.

The NHS website lists what men in their late forties and early fifties often describe: low mood, a lower sex drive, erection problems, mood swings and irritability, losing muscle, gaining fat around the middle, low energy, poor sleep and trouble concentrating.

Some of that list will sound familiar. Mood, sleep, energy, desire: it overlaps with what women describe in perimenopause. Two tired people changing at once in one house is hard, and neither of you is imagining it.

The British Association of Urological Surgeons says the common factor behind ADAM symptoms is less active testosterone in the blood as men get older.

The NHS adds the other half. It says the symptoms men get in midlife are often caused by stress, depression or anxiety, or by lifestyle: too little sleep, a poor diet, too little exercise, alcohol and smoking. It also names work or relationship problems, money worries and worrying about ageing parents. In other words, his tiredness may have less to do with hormones than the jokes suggest.

After a GP appointment to talk the symptoms through, the NHS website and the British Association of Urological Surgeons describe:

• blood tests, including testosterone and general checks, which the British Association of Urological Surgeons lists alongside a physical examination
• lifestyle changes first, which the urologists' guidance puts at the top
• talking therapy or medicine, if stress, anxiety or depression is behind it, which the NHS says a GP may suggest
• testosterone replacement, which the NHS says a specialist may offer if they confirm a hormone deficiency

The European Menopause and Andropause Society (EMAS), in its 2023 statement on testosterone for older men, takes the same line. It says men who are overweight should be encouraged to exercise and lose weight, which can raise their own testosterone, and that testosterone treatment should be offered only to men with symptoms and a confirmed low level, once the doubts about its long-term safety have been explained.

Whether any of that applies to him is for his own doctor to decide.

If he has had low mood, low desire or erection problems for a while, the NHS website says a GP is the place to start. The NHS says the GP will ask about his work and personal life, to see whether stress or anxiety could be behind them.

In many homes the husband is the last person a woman tells about her own symptoms. And men are rarely told anything about this stage of life, theirs or yours.

The Pakistan Menopause Society asks doctors to involve husbands and family in counselling, because in a family-centred culture, the support a woman gets at home shapes how she looks after her health (4.2.4.4). It lists what helps at home: honest talk about hormonal changes, respect for sexual health and personal space, healthy habits shared, stress handled together, and asking for professional help without shame (4.2.6). NICE NG23 also asks doctors in England to share information about menopause with family members where that is appropriate (1.2.1).

So it can go both ways. You are allowed to bring him to your appointment. He is allowed to ask his own doctor about his. Knowing the difference between his midlife and yours is a good place to start the conversation.