'Honey, I shrunk my testosterone levels'
It's the news that no male wants to hear: your levels of testosterone - the hormone that makes a man a man - are lower than a dachshund's belly. Here's an anonymous account of how it happened.
'Interestingly, your testosterone levels are outside the normal range,' said the doctor with the sort of smile that suggested it made a bit of a change from low blood sugar.
'Really?' I mumbled, sounding bored. It was Valentine's day and I was thinking about flowers. As far as I was concerned these were routine tests and I wasn't expecting much. Although the news perked me up a little, outside normal range was no great surprise. I've been bald since my early 20s — a condition which, as every slaphead will tell you, is partly caused by testosterone.
'Yes, several points below, in fact.'
Below? I sat up sharply in my chair. Hadn't moved so fast for years.
So that was it. The poor concentration. The sluggish grump I'd been in all day. The fact that I'd just been sitting in a room full of uniformed nurses and not fancied any of them. The flowers. They all suddenly made sense. The male menopause.
The existence or otherwise of this condition has divided the medical profession for years. In 2000, it was honoured with a 'for' and 'against' debate in the British Medical Journal. In the 'for' camp are doctors like Malcolm Carruthers who runs a private clinic in Harley Street called Androscreen. He estimates that by the age of 50, 50% of men will be experiencing the symptoms of what he prefers to call the andropause. To him the solution is simple: hormone replacement therapy — the replacement of the male hormone testosterone in andropausal men just as the female hormone oestrogen is replaced in menopausal women. On the other side are the more cautious doctors who, while recognising that the classic 'mid-life crisis' symptoms such as lethargy, depression, reduced concentration, poor erections, hot flushes and a wilting libido are very worrying for the men concerned, believe they are far more likely to be psychological than hormonal in origin. Basically, my doctor is one of the latter. Thanks, doc.
'Look, testosterone levels rise and fall throughout the day with your circadian rhythms. That's one explanation,' he said .
'And the other?'
I looked blank. Hypogonadic sounded like a character in Asterix.
'Are your secondary sexual characteristics abnormal?'
'Do you have small balls?'
This was going from bad to worse. Within minutes I was lying on the couch with my testicles in the good doctor's chilly hands consoling myself with the thought that 'there might be an article in this'.
I didn't have hypogonadism which is caused by a major testosterone deficiency but with a month to wait for the next test results I still couldn't stop thinking about the milder version, the andropause.
Testosterone, after all, is what makes men men - literally so inside the womb where it turns the default female foetus into a baby boy. Later on it is responsible for your sex drive and - Dr Carruthers would argue - for your more general drive: your ambition, your lust for life. Male testosterone levels begin to fall around the age of 40 and by the age of 80 there is often, for practical purposes, only half as much of the hormone in a man's blood as when he was 20. Physically, low testosterone levels can lead to loss of muscle tone, a tendency to put on weight and increased risk of bone fracture, diabetes and possibly heart disease. However, the fall is gradual and the testicles continue to produce some testosterone in all men and in some men, there is very little fall in testosterone at all.
I tried to play it down to myself. It was true that I'd had a lot of the symptoms of the andropause but then who hasn't? Tired all the time is not so much a symptom as a lifestyle these days. But I gave Dr Carruthers a call anyway - just for the sake of the article. I put it to him that my low levels were probably a blip. 'I mean you've never treated anyone as young as me, have you?'
'I've had patients of 35.'
'Oh, my God,' I said, much as Janice used to say it in Friends.
Janice, you will recall, was a girl.
Over 15 years, Carruthers has treated over 1500 patients with testosterone replacement therapy. He measures both total testosterone and, more importantly, free - or active - testosterone. The latter can be low even when the former shows normal. 'I generally prescribe oral testosterone,' he says. 'If that is ineffective - as it is about a third of cases - I try pellet implants in the buttocks. They put a tiger in the tank for six months at a time.'
Life events can also make a difference to testosterone levels, he tells me - the loss of a partner or job, even a tennis match. 'Men get a burst of testosterone when they're successful and a slump when they fail,' he says. 'Research has shown that supporters of the winning team even get a surge after a football match.'
This, with apologies to the three blokes on the planet that I can beat at tennis, seemed to be getting to the heart of the problem. First, I support Spurs - no testosterone surges there since Paul Gascoigne was a lad - and second I've never won anything in my life. The thing is that if plummeting testosterone is related to failure, it's no wonder it appears to be on the increase. Our sense of success has been skewed by serving after sickly serving of shallow celebrity and soulless style. When there's no respect, job security or pension prospects for the honest plodder, you can be doing your best and still feel like you've failed.
Bernard Collen, now 56, was 40, the age I'll be next birthday, when he turned into an irritable, miserable road-rager. 'I was awful to live with and very unhappy,' he says, 'but I just thought it was the stress of my job. I was like that for years until my wife read about Malcolm Carruthers and suggested I call him. I was suspicious of Harley Street and thought it was a scam. She called him instead and between them they persuaded me to go along. I had the blood tests and he told me my active testosterone was reduced. He prescribed some tablets and within two weeks everything had turned round. I'd been losing it at work. I couldn't make decisions and now I could. Every aspect of life - mental agility, memory, libido, they were all better.' Twelve years later he is still on the treatment.
This new, calmer man is no surprise to Carruthers. 'Contrary to popular belief, testosterone doesn't make you aggressive,' he says. 'Quite the opposite. Animals get aggressive as testosterone levels drop after the rutting season.' He stresses it's not just about taking the tablets. 'Cutting down alcohol will help testosterone levels. So will getting fitter, having a healthy sex life and wearing boxer shorts rather than briefs.' None of this is too surprising but then he says: 'you should also have a reasonably meaty diet - particularly a little red meat - since 90% of testosterone is manufactured from cholesterol.'
I didn't know that. Is that why I've been craving a steak ever since mad cow disease took it off the menu?
I started off as a sceptic but now I'm not so sure - the sort of indecisiveness that Bernard Collen would know all about.
I was still dithering when a letter from my doctor arrived and put me out of my misery. In the repeat test, my testosterone levels were back to normal. This cheered me up enormously. I was strutting round the flat like a horse out to stud. I did a few hamstring stretches. I gave my girlfriend a passionate kiss.
'You're in a good mood considering your football team lost 4-0 last night,' she said.
That made three 4-0 defeats in a row. She assumed I knew but I'd been deliberately avoiding the football results and it was amazing how physical and sudden the sense of deflation was.
I don't know. Maybe implants in the buttocks would help. I'm not thinking of me, I'm thinking of the Spurs first-team for next season. Half of them are pushing 40 too.
Page created on June 1st, 2002
Page updated on January 14th, 2010