Are you a tired older man who's a bit depressed and has a low sex drive?

Your symptoms may just be old age – or they could be part of the so-called 'male menopause'.

More than 700,000 British men aged between 50 and 79 are thought to suffer from symptoms associated with the 'male menopause'. This is also known as 'andropause', and more correctly as testosterone deficiency syndrome (TDS), or hypogonadism.

Testosterone is a hormone produced in the testes which stimulates sperm production and sex drive, and supports the development of muscle and bone. TDS occurs when testosterone drops to an unusually low level, or stops being produced altogether.

Not inevitable

However, a crucial difference between the menopause in women and TDS in men is that TDS, unlike the menopause, is not an inevitable result of ageing. It occurs in about 8% of men aged between 50 and 79 years old, and its prevalence increases with age.

Unlike women, middle-aged men don't experience a complete and permanent physiological shutdown of the reproductive system as a normal event, but instead experience a steady decline in testosterone levels with age. TDS is diagnosed when a man's symptoms and blood tests indicate an unusually low level of testosterone, rather than simply the normal decrease with age.

Risk factors include chronic illness such as diabetes mellitus, chronic obstructive lung disease and inflammatory arthritic, renal and HIV-related diseases, as well as obesity and excessive alcohol consumption.

Underdiagnosed

New research has found that TDS is underdiagnosed and undertreated, mainly because of lack of awareness of the condition.

A study conducted by Besins Healthcare UK surveyed more than 100 men aged 40 or over who'd been diagnosed with low testosterone. They found that two thirds of them had experienced symptoms for up to two years before seeking advice.

The main reasons for this delay were:

- Wrongly believing it wasn't a serious problem (49%)
- Thinking it was part of life (46%), or a normal consequence of ageing (44%)

Symptoms of male menopause

Symptoms are often subtle, and can be mistaken as part of ageing. They include:
• Low libido
• Erectile dysfunction
• Ejaculatory dysfunction
• Reduced muscle mass and weakness
• Fatigue
• Reduced well-being
• Depression
• Loss of concentration
• Hot flushes and sweats
• Reduced body hair
• Irritability

Treatment for male menopause

Treatment options include changes to diet and lifestyle, such as losing weight or drinking less, and testosterone replacement therapy (TRT) in the form of gels applied to the skin, injections and oral formulations.

However, nearly a quarter of men aged over 40, and 40% of those aged over 60, never receive any TDS treatment.

[Related story: Did you know 20% of men die before retirement age?]

What the expert says about the male menopause

One of the survey’s authors, Dr David Edwards, GP and immediate past president of the British Society of Sexual Medicine, says: “It's tragic that so many men aren't receiving treatment for their low testosterone following a correct diagnosis. This clearly highlights the need for improved awareness and management of this condition.

“Testosterone is required by all men for a healthy life, physically and psychologically, so it’s really important that low testosterone is treated.”

He says the number of men who suffer from TDS is likely to be higher than figures suggest, and points out: “Unfortunately, because testosterone deficiency syndrome is a sensitive issue, men can be reluctant to seek medical advice.

“I urge men, and their partners, not to brush the symptoms under the carpet as being a normal part of ageing.”

Have you got 'male menopause' symptoms? Tell us in the Comments section below.