Sunday 22 April 2018

The 'manopause': Testosterone Replacement Therapy on the rise

Is the boom in testosterone-replacement therapy the latest sign that men have taken to spending their way out of their mid-life crises?

‘Wolverine’ star Hugh Jackman (45) inspires the male generation to keep fit
‘Wolverine’ star Hugh Jackman (45) inspires the male generation to keep fit
The Rock says, Know Your Damn Role

David Thomas

There's a hot new drug called TRT that users take to make them feel more energetic, more alive, more aggressive and sexier, too. As with so many performance-boosters, it is catnip to financial traders. "TRT is extremely popular on Wall Street and increasingly in Canary Wharf, too," says one anonymous insider.

Now, in the surest sign that the drug has gone mainstream, it's on the cover of Time magazine, which claims that the TRT business is now worth $2bn a year in the United States alone.

So what is the actual substance lurking behind those initials? Well, the first 'T' stands for testosterone, and 'RT' for 'replacement therapy'. We're talking about hormone replacement therapy for men.

Testosterone decline sets in from around the age of 30, with one in seven men over 50 estimated to have low 'T' - a phenomenon known as andropause, for which replacement therapy is available on the NHS.

Middle-aged men are scoring testosterone - a class C drug and illegal without a prescription - for exactly the same reasons that their female peers are drawn to HRT. As time goes by and levels of sex hormones drop, the middle-aged can feel their bodies getting flabbier, their libidos are flagging and their get up and go has got up and gone. For women, this is summed up as the menopause. Now, the male of the species has a word for his equivalent. Welcome to the manopause.

The signs of manopausal manhood are all around us. The streets are clogged with middle-aged men in Lycra - or MAMILs - desperately trying to channel their inner Bradley Wiggins as they squeeze into unsuitable, skin-tight clothing and thrash the pedals of their £1,000-plus racing bikes (the opportunity to spend fortunes on exciting new kit is, of course, one of MAMIL-dom's great attractions).

When not on their expensive bikes, the frantically fitness-crazed over-40s are heading to the gym. According to a recent survey, men in their 40s, inspired by their movie star contemporaries such as Hugh Jackman, 45, and The Rock, 42, are the fastest-growing sector of the bodybuilding market.

‘Wolverine’ star Hugh Jackman (45)

Meanwhile, though men still account for just 10pc of plastic surgery procedures in the UK, the number of male patients is growing fast. British stars such as Wayne Rooney and James Nesbitt have made hair transplants socially acceptable; Simon Cowell swears by botox, and a growing number of male celebrities have clearly had, even if they will not admit to, face lifts.

To Mark Simpson, the writer and style-spotter who coined the term 'metrosexual', manopause mania reflects massive changes, both in society's response to growing older and in masculinity itself. Simpson, who is 49 and admits "I go to the gym and worship at the temple of the selfie", points out that "middle-age used to be a time when men could enjoy their accomplishments and their families and maybe coast a bit. But now that security's gone. Today, there are only two ages of man: young man and old man. So you have to stay young."

He agrees when I suggest that the financial independence of women, and the success with which many women are keeping their looks, figures and libidos well into middle-age, has created a pressure for men to keep up. But, he points out: "Of course, most straight men care very much what women think of them, but it's not the case that everything they do is calculated to get women into bed. In the end, it's about how men feel about themselves, and what other men think of them."

The proof of this can be seen in the men's magazine market. The top-selling title in the UK is not a lad's mag, but Men's Health, whose target reader is 35 and whose cover features a six-packed, chiselled male model.

So is this little more than an attack of excessive vanity among a feminised generation that has lost the ability to act like real men? Simpson insists not. "People tend to think of narcissism, especially among men, as an idle, dissipating, poisonous force. But actually, narcissism is self-care as well as self-love, and without it no creature can survive."

Not surprisingly perhaps, Mike Shallcross, the deputy editor of Men's Health, agrees that there is a practical, beneficial side to the manopause. "Men no longer equate settling down with giving up. They're becoming more health-conscious, more aware of their appearance, and more aware of the value of free time.

"Also, there's a shift in working patterns. More men are in jobs where they have to look better groomed, and where youth is equated with vitality and ambition. Men can see this as an additional stress, or they can reflect on the opportunities of a world where women over 40 can look absolutely stunning, and workplaces that don't bring us into contact with asbestos."

As for those much-mocked MAMILs, Shallcross points out that "stuff like cycling is great exercise, and probably makes men look better than they would if they just waddled to the pub and back. It's also fun and a good way to spend time with mates. Maybe just that is enough to feel younger."

But what if getting on your bike and filling in your bald-spot simply isn't enough? What if you want to follow the TRT crowd down the pharmaceutical road to eternal youth?

The same Time article, highlighting the boom in testosterone patches, gels and supplements, admits there has been very little research into its benefits and potential dangers, noting possible side-effects such as heart-attacks, strokes and blood-clots in veins.

The Rock says, Know Your Damn Role

Some doctors, however, do see a role for TRT. Dr Michael Perring is managing director of Optimal Health of Harley Street. Perring does prescribe TRT, with the caveat that "discrimination is needed for who takes it, and in what dose". He believes one reason for its popularity is that you can feel the benefit quickly. "So I may say to a patient: 'We'll do a deal. You will feel more energy from taking testosterone - and then you'll increase your physical activity.'"

And there lies the real key to a successful manopause: in the end, a better, healthier life has nothing to do with a doctor's prescription. Dr Perring sums up the key to surviving middle - and old-age in one word -engagement. "In relationships, purpose, mental challenge and physical activity," he says.

And also, perhaps, acceptance. "I am rather enjoying the sensation of being middle-middle aged," says Nicholas Coleridge, president of Condé Nast magazines. "You feel less anxiety, care less what others think, know what you like and who you like. I am planning to live to precisely 100, so I am 57pc of the way through my life."

And when you look at it like that, the manopause is just one short stop on a man's much longer, happier journey.


- David Thomas is 55. His most recent novel, Ostland, is published by Quercus.

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