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The menopause is a well-known event for women, even celebrated, though this has been late in coming to the understanding of men -- and male doctors in particular. What is much less known is that men have to endure a similar biological and emotional experience. It is obscured by the usual male inability to come to terms with personal issues and the fact that it is perceived as less than masculine to even admit to such feelings.

Matters are made more complicated by the fact that there are really two phenomena rolled into one and these easily become confused. It is vital that women appreciate what is happening to their loved one and that doctors get to grips with this important aspect of growing older. Although men like to believe they are tough and immune from care, the truth is they are often desperately insecure and failing to understand what is happening to one’s self can be a major cause of anxiety and suffering.

There is a male hormonal shut-down, akin to the menopause, which is therefore named the “andropause”. But this is quite distinct from the mid-life crisis, as we shall see in detail. The trouble is that both happen at a similar time, though the crucial difference is that the mid-life crisis tends to occur somewhat earlier. How can we tell these two apart?

Let us consider first the true andropause.


It starts, usually, in the fifth decade. It is unrelated to life events (though it may happen at the same time as an unrelated disaster). There are true biological changes, which can be measured in the laboratory. Testosterone levels fall. The resulting symptoms are not unlike those experienced by a woman at the menopause:

  • fatigue
  • depression
  • aches and pains
  • sweating and flushes
  • reduced libido

To which may be added: loss of erectile function. The latter is particularly disturbing to a man and difficulty in talking about this problem is one of the reasons why the male menopause has been little attended to.


This often falls earlier than the andropause, maybe in the fourth decade. Typically, it occurs in response to some outside challenge in a man’s life: a breakdown of the marriage, career failure, bankruptcy, death of a peer or loved parent, redundancy and so on. Essentially, it is an emotional crisis and not a hormonal one. Deep introspection often results in the feeling that life is passing by and precious years have been wasted with so little achieved. Dreams that were once so important seem to have faded or gone forever beyond reach. It can be a time of great anguish, despair, inadequacy and feelings of guilt or futility.

Whereas anyone, sooner or later, will experience a shut down of hormones, the man who suffers the mid-life crisis is typically one who has been challenged and cannot come to terms with his life. There has been a shock which brings him face to face with self and he doesn’t like what he sees. In trying to rationalize the unhappy feelings he may begin to see his life partner in negative terms or blame his bosses and work dissatisfaction. Therefore he seeks change: a new partner (times of infidelity and experiment), a new career, new home territory and so on.

Unfortunately, alcohol and drugs are often seen as the answer. They shut out the pain temporarily but of course solve nothing. This may be the start of a slippery slope to abuse, addiction and early demise.

Far from the libido shut down characteristic of the andropause, a man in a mid-life crisis wants to boast of sexual prowess and seeks new thrills and adventure. This is the man likely to start buying younger generation fashion clothes and run off with a tart or have an affair with his secretary in her twenties. But it is a kind of denial, an admission that things are not as they were, underscored by a great desire to prove everything is OK, “No problem!”

The andropause man lacks any energy or drive and cannot be bothered with sex or adventure. For him, it already is too late (he thinks).


One can gain a deeper insight by looking far beyond the moment of crisis.

The mid-life crisis is a kind of rite of passage. It comes to an end eventually and good may come of it. A marriage may not always be wrecked but may be strengthened and renewed by surviving the threat. A great deal depends on the response of the life partner in this time of upheaval and change.

A man may be renewed through suffering, discover a vision for the future and come home once again to feelings of family and love. He can learn something of great value, about himself, about others, about the deeper nature of life. If the trigger was a financial collapse, he may recover the determination to work hard and rebuild his empire. In this way, some men will go forward and meet the challenge.

Sadly, many do not do so but give in to what they see as an overwhelming tide of misfortune. Alcohol or drug addiction takes a lasting grip. These individuals rapidly advance into the inertia of age and decrepitude. For them, the mid-life crisis was a disaster from which they do not recover.


And yes, the mid-life crisis can occur for women. Almost all of what is said here applies equally. Even the search for new loves, thrills and adventure can lead to women too becoming unfaithful or seeking divorce. Obviously it needs to be distinguished from the onset of the menopause.


The most important first step is to have blood tests to check up on the man’s hormones, as described in the section HORMONES FOR MEN and PROSTATE. If this reveals there is a problem, testosterone supplements are needed and will work a satisfying and sometimes dramatic change. The fatigue and depression will lift, life becomes worthwhile, energy levels and zest return to former levels, potency problems recede. What is more, testosterone improves circulation, protects against heart disease, aids weight loss, improves skin condition, increases muscle strength and works in a host of healthy ways to rejuvenate the man. It is a tragedy that early experiments (with artifical methyl testosterone) bungled by the greed of drug companies have led to testosterone supplements having bad press.

Testosterone supplementation does need some care and is discussed elsewhere. Generally, though, one can say that the dangers of NOT supplementing testosterone well into old age are far greater than any theoretical risks to prescribing it. Be clear about it: testosterone saves lives and saves hearts and minds!

On the other hand, what if the tests show that testosterone deficiency is not significant? Clearly supplements will not help. This is an emotional or life-events crisis and needs handling as such, at whatever age it befalls.

The first sensible step towards surviving the mid-life crisis is having the problem identified and understood, as above. Kindness, tact and sympathy are required, despite outrageous and often destructive behaviour by the affected individual, because it is still a medical condition. Any crisis is a time of great stress and stress, we know, is a killer. It shortens lives. If the individual is already abusing drugs and drink as a solution, then the danger to health and longevity is even greater. Bitter acrimony and rejection from relatives, even though badly affected in turn, are counter productive and simply make everyone suffer more. At all costs keep the communication flowing; it’s the only hope for a sane future and rebuilding friendships.

The man concerned has to be brought to confronting his situation. The pretense that there is nothing wrong and everyone else is to blame does not help. Dr Malcolm Carruthers, a male hormone and lifestyle specialist and author of THE TESTOSTERONE REVOLUTION makes the point that the kind of man likely to suffer a mid-life crisis is one with an unhappy childhood, maybe abusive or with cold and unloving parents. Such early formative experiences often engender a feeling of unworthiness which emerges later in life, at a time of crisis. This is fruitful ground for counselling or other therapy.

Even without a therapist, a man can sit down with pen and paper and start to write down what matters. Nothing changes the meaning of life more than working out what one’s values truly are. Often we aspire to false goals, imposed by others, which have little meaning to ourselves. Society at large, and the media in particular, often impose ridiculous standards of goodness and value. There is a cult of greed, materialism and celebrity worship in vogue which is very dangerous and tends to create envy, desire, inadequacy and misery in those who do not have all the trappings of a luxurious film-star lifestyle.

The irony is, you only have to look at the stories in that same press to realize that the people we are supposed to envy have disastrous, miserable and often very short sick lives.

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