MAX PEMBERTON: Is your man grumpy? He may just need hormone replacement therapy (yes, really!)

What is it about the male psyche that means men often become curmudgeons as they age?

We all know a once perfectly pleasant man whose inner Victor Meldrew emerged as soon as he hit 50. The grumpy old man isn’t a well-recognised trope for nothing.

But could something else be going on? Could it actually be that they have a medical problem?

For years we’ve assumed that misanthropic old men were just a fact of life. We put their moods down to missing their purpose in life or thinking the world is moving on too fast for their liking. But increasingly there’s a view that they could be suffering from an hormonal imbalance called the andropause.

This controversial condition - also known as the ‘manopause’ - is a result of low testosterone, and has inevitably attracted a lot of sniggering debate. Some even say it’s a condition made up by men trying to muscle in on all the attention women are getting over the menopause.

Yet it’s also been estimated by scientists that as many as one in five males over the age of 65 could be experiencing symptoms. And, yes, these are similar to the female menopause, including low libido, irritability, tiredness, sweating and generalised aches and pains. One study put the figure at 840,000 men in the UK currently in the grip of symptomatic andropause, with only 19,000 currently receiving treatment in the shape of testosterone replacement therapy - most commonly a gel applied daily to the skin.

Indeed, the ‘manopause’ is increasingly gaining traction as a legitimate condition. Last week it was revealed that NHS bosses are offering middle-aged male workers special uniforms, bespoke desk space, and up to a year’s paid leave from work to help them cope with it.

So is it a real thing?

In women the menopause is triggered by the sudden fall in sex hormones - oestrogen and progesterone - which occurs when the ovaries shut down. In males, however, there is no similar, dramatic decline in testosterone, but rather a natural, gradual reduction with age - a fall of about 0.5 per cent a year.

Advocates of testosterone replacement therapy (TRT) say the fact it offers men a new lease of life, eradicating symptoms while improving mood and libido, is proof that the manopause exists.

Yet many doctors are sceptical. While acknowledging that a genuine change occurs as men age, experts argue it has a psychological, rather than hormonal, basis. Marriage problems, changes in social status, job dissatisfaction, lack of exercise and the long-term effects of alcohol and smoking can all result in similar symptoms to those attributed to the andropause.

They also suggest that some of the symptoms may be the result of other, underlying medical conditions such as thyroid problems, anaemia or depression.

Professor John McKinlay, of the New England Research Institute, has argued that there is ‘no empirical research to support the syndrome’ and advises those with lower testosterone levels to increase physical activity and go on a diet, since obesity itself reduces levels of testosterone.

‘We are medicalising lifestyle problems and the natural process of ageing,’ he says.

And the fact is testosterone treatment is not without risks. Side-effects include possible breast growth, acne, sleep problems and enlargement of the prostate. Some studies have even linked testosterone therapy with prostate cancer.

Critics also point to the fact that men may complain of symptoms while their blood tests show normal levels of testosterone. Conversely, men whose blood tests show low levels don’t necessarily experience problems.

My view is that a version of the menopause does exist in men - but very far from all. Over the years I’ve undoubtedly seen ‘grumpy old men’ whose lives have been transformed by TRT. Men who have been diagnosed as ‘depressed’ have suddenly seen their mood lift and they no longer need antidepressants.

It’s happened enough that I now test the testosterone levels of middle-aged patients who come to me with changes to their mood but no past history of depression and no clear explanation for the deterioration in their personal lives. Their wives often say that something isn’t quite right; that their husbands have lost their va-va-voom, and appear a miserable, moody version of their old selves, and - ta da - when their testosterone is checked, it is indeed too low.

I can’t help but feel this is similar to how many menopausal women have had their low mood misdiagnosed as ‘depression’, only for it to improve when they start HRT.

Whether men really need major adjustments to their working environment is another thing. But certainly the resistance to the idea that men would benefit from hormone treatment does seem to smack of the resistance that women faced for years with regard to HRT.

© Daily Mail