The change of life

A middle-aged male who spruces up his wardrobe and buys a convertible may blame hormonal changes on his so-called mid-life crisis.


But while a slow decline in testosterone happens to all men as they age, it can’t really be blamed for sudden changes in behaviour or wellbeing, say health experts.

While women generally experience a 90% decline in estrogen over 12 months at menopause, men’s testosterone levels decline about 1% a year as they age, says endocrinologist and clinical research fellow Dr Carolyn Allan, Medical Adviser for Andrology Australia.

She says ‘male menopause’ is a bit of a myth, although about 1 in 200 men under 60 years of age do have a medical condition that causes the testes to make less than normal amounts of testosterone.

The most common is Klinefelter syndrome, a genetic disorder in which the testes don't function adequately. Damage to the testes (for example, through infection, trauma, medications or chemo/radiotherapy), undescended testes, or – rarely – a lack of hormones produced by the brain, can also affect testosterone production1. “We know, as a group, these men are under-recognised,” says Dr Allan.

Symptoms of testosterone deficiency may include low energy, poor concentration or memory, mood changes, reduced muscle strength, sweats and even a low sex drive. 

Blood tests are used to check hormone levels and, if a deficiency is found, treatment in the form of injections, implants, tablets, patches or gels is often recommended.

For men who feel they may be a bit low on testosterone but who don’t have a medical condition, the long-term benefits and risks of supplementing testosterone are uncertain, warns Dr Allan.

Despite this, statistics show that testosterone replacement treatments are a booming business. Professor David Handelsman, Professor of Reproductive Endocrinology & Andrology at the University of Sydney and founding director of the ANZAC Research Institute (the country’s leading clinical research centre in the clinical pharmacology of androgens), has found that, from 1992 to 2010, total annual expenditure on testosterone products increased ninefold to $12.7 million2.

He says the introduction of two new testosterone products – an injection and a gel – marketed by Bayer in Australia, has seen a sharp increase in prescribing trends.

“By definition, only doctors can write prescriptions [for these drugs],” says Professor Handelsman. “And not just anti-ageing clinics but also many individual doctors – including GPs and specialists who believe they are treating a condition called ‘andropause’ [more or less the same as male menopause] – are prescribing them.”

Apart from medical conditions, our increasingly unhealthy Australian lifestyle may be playing a part in the number of men seeking testosterone therapy from doctors or anti-ageing clinics. For instance, says Dr Allan, obesity can negatively affect testosterone levels. 

She says a healthy lifestyle – fresh fruit and vegetables, lean proteins, plenty of fresh air and regular exercise – is one way to help ensure hormones function adequately.

If you are an overworked, under-exercised middle-aged male, you might want to talk to your doctor – not about testosterone supplementation but about changing your lifestyle.

Manning up about health

According to Andrology Australia, 1 in 3 men have a problem below the belt.

And every year, about 700 men are diagnosed with testicular cancer, says Cancer Council Australia. Unfortunately, the fact that men don’t tend to talk about their reproductive health and are less likely to visit the doctor means they are putting their lives at risk1.

So what can you do?

Have regular check-ups to ensure you’re in good health and talk to your GP if you have a concern.

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References: 1 2 Handelsman, DJ., ‘Pharmacoepidemiology of testosterone prescribing in Australia, 1992–2010’, Medical Journal of Australia, June 4: 196 (10) 642–5,