The Marion Gluck Clinic

Male menopause: Does your husband need HRT?

I’ll come clean: I do not want a fat, lethargic, moody husband. Who does? When Andrew, my 59-year-old spouse, developed a hefty tummy that he couldn’t shift, seemed to spiral easily into emotional collapse and kept telling me that he was exhausted, I decided that buying a sports car to ‘fix him’ wasn’t an option for us. While many wives endure grumpy, tired and tubby hubbies in long-suffering silence, convinced that this is normative in a flagging middle-aged marriage, I persuaded my husband to shell out over 5,000 euros (£3,500) and accompany me to Europe’s top anti-ageing clinic, Palace Merano, in Italy. Why? A) It would be cheaper than a divorce; and B) I was convinced that his moodiness and sluggishness were the result of hormonal imbalance. I thought that he was suffering from the male menopause. He thought I was my usual, deranged self. The ‘andropause’ – as the male menopause is commonly known – is controversial because most men (doctors included) do not acknowledge its existence. However, just like women, when men start ageing their hormone levels decline. This is an accepted fact among the medical community – although the rate of decline is much slower than in women. The male menopause is a minefield, completely polarising opinion. While some of the medical community argue that one third of all men over the age of 45 experience a reduction in testosterone, others dismiss this figure as too high. However, for some men, loss of libido, fatigue, depression, sleeplessness and weight gain from their early 40s onwards could all be symptoms of falling testosterone.

Two years ago, aged 46, I, too, felt unusually low. I was constantly crying and exhausted. Initially I put it down to the sudden death of my mother, but the feeling of dragging myself through life every joyless day didn’t abate. I feared that I might be perimenopausal but didn’t feel comfortable going on HRT, given the scare stories in the press about increased risk of cancer, so I went to see leading bioidentical hormone expert and GP Dr Marion Gluck on the recommendation of a friend. (Bioidentical hormones have the same chemical structure as our own hormones, and are gentler on the system than conventional synthetic hormones.) I sobbed through our first assessment. It was such a relief when a blood test showed that I had low levels of progesterone. She said that it was no wonder that I was feeling so emotionally fragile and told me that within two months, I would feel energetic and robust. I was sceptical, but I rubbed in my prescription bio-identical hormone cream each day. Dr Gluck was right. After six weeks, I felt a noticeable difference in my emotional and physical self. My energy levels returned, as did my sense of humour and passion for life. I felt as if I had got myself back. And a year later, I wanted my warm, wisecracking, wonderful husband back too.Talking to my female friends, I was not alone. Two of them told me how their successful, affluent, 50-something husbands were taking antidepressants because they were low, shut-down and comfort-eating. Their sex lives were dwindling and they felt alienated from their partners, partly due to side-effects of the antidepressants. As I listened, I wondered if their husbands would benefit from hormones instead.

In the UK, short shrift is given to the andropause. The NHS does not recognise it and rarely prescribes testosterone unless men have a disorder called hypogonadism, where the testicles do not produce the hormone as a result of disease or damage. Many doctors argue instead that the male symptoms are a result of unhealthy ageing (poor diet, lack of sleep and exercise). I spoke to three NHS GPs who were all vigorously opposed to the idea of the male menopause and saw bio-identical hormone replacement as a ‘quack money-making exercise’. Ashley Grossman, professor of endocrinology at Oxford University, does not believe the male menopause exists. ‘In later life, testosterone does fall very slightly, but the great majority of men in their 50s, 60s and 70s have good levels,’ he says. ‘Imperial College did a big trial on men over 60 who were feeling tired and depleted and where some had low testosterone, replacing the hormone did not improve their levels of energy and other symptoms. It did, however, improve sexual function and libido. The upshot was that a very small number of men who have low libido and erectile dysfunction would benefit from taking testosterone.’ What makes the andropause controversial isn’t just that much of the established medical community dismisses it, but that on a social level it is taboo.

Men are typically reluctant to admit to any psychological or sexual failings, and few high-profile figures have discussed the issue, concerned, presumably, about the effect on their image.Robbie Williams is a rare case – he believes that a lack of testosterone had a profound effect on him. For years, he battled weight gain, moodiness and mild depression. When he was living in LA, he had a blood test and was told, ‘You have the testosterone of a 100-year-old man.’ Hormone replacements, he says, revolutionised his life. Eventually, I cajoled Andrew into a trip to the prestigious Italian clinic. I’d been previously, and was impressed by the battery of diagnostic tests they undertake to determine the body’s performance. They see hormone rebalancing as one of their biggest growth areas: over the past five years, there has been a 46 per cent rise in men attending the clinic for hormone testing. When I meet the clinic’s founder, Dr Henri Chenot, a French pioneer in anti-ageing, he tells me he has been taking bioidentical hormones since he was 50 and, aged 72, he ‘still has sexual relations’ with his wife. Palace Merano’s German doctor, Max Mayrhofer, firmly disagrees with those who deny the existence of the male menopause. ‘Every man suffers a psychological and physiological process in ageing, but to different degrees. Some men lose memory, muscle mass and libido fast, and others so slowly that it is hardly noticeable,’ he says.‘Having your hormones rebalanced resolves a lot of problems,’ adds Merano’s general manager Maximillian Newiger. ‘It can ease family problems, tensions and boredom between couples.

Men do not easily seek help; women are the persuaders. When women who come here return home and their husbands see the results of their weight loss and revitalised selves, then they become curious. Sixty-five per cent of our women clientele return with their husbands for our anti-ageing programme.’During our stay at Palace Merano, Andrew had blood tests and I was almost euphoric to discover that I was right: he had low levels of dehydroepiandrosterone (DHEA). Known as the ‘mother of all hormones’, low levels of DHEA can lead to depression, weight gain and low libido. He was instantly prescribed a 30-day treatment of 25mg a day. Another reason that the andropause is controversial is because treating it is such a finely calibrated process. ‘Everyone needs a different prescription,’ says Dr Mayrhofer. ‘Ideally, you need a blood test every six months to see the hormonal fluctuations.’ As with women and HRT, controversy exists around the side-effects: many doctors maintain that too much DHEA, for instance, can raise the risk of prostate cancer, while others argue DHEA actually inhibits the growth of prostate cancer.

Professor Grossman is positive about DHEA. ‘There is solid scientific evidence that it can do some good,’ he says. ‘I sometimes prescribe it and I certainly do not think that it causes prostate cancer.’And indeed, after a month of taking DHEA, Andrew has lost a stone, goes to the gym five times a week, is far more energised and our marriage (and sex life) has never been stronger. I’m delighted to report that I no longer have a fat, lethargic, moody husband. His transformation, according to Dr Gluck, is not unusual. ‘I only have to look at my male patients to know that there are real physiological, psychological and emotional symptoms that can be alleviated with the right hormones,’ she says. ‘They sleep better, have more energy, more enthusiasm and a restored sex drive. They get back their zest for life and their wives get back the men they fell in love with. ‘Amen to that.

Stella Magazine, The Sunday Telegraph, 6th December 2015
Writer: Anna Pasternak

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