Midlife crisis was all down to my hormones

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LOW testosterone puts men at greater risk of developing deadly illnesses yet many remain unaware of it.


The-TDS-treatment-gave-Rick-Dale-here-with-partner-Sandra-Facer-a-new-lease-of-lifeThe TDS treatment gave Rick Dale, here with partner Sandra Facer, a new lease of life

RICK DALE, 49, had always been the life and soul of  the party. He regularly worked out and never lacked motivation in his  job as an orthopaedic practitioner, setting broken bones at his local NHS hospital.

Yet five years ago he found himself turning into a recluse.

“I felt stressed and depressed, I lacked concentration, my libido dropped dramatically and I became increasingly irritable,” recalls Rick, who lives in Birmingham.

“My self-confidence decreased beyond recognition and I felt lower and lower as each day passed.”

So sudden was the onset that he attributed it to his divorce and the death of his dog.

“I’d get in the car to go to the gym but would wind up taking a nap in the driver’s seat instead and while I’d always cooked, I would come home from the supermarket with a trolley full of junk food. I put on three stone,” he says.

Realising this was abnormal behaviour for him, Rick went to see his GP.

“I felt there must be a reason. Maybe I had a thyroid problem or diabetes,” he says.

What was diagnosed was Testosterone Deficiency Syndrome (TDS). The condition affects one in every 200 men but as it remains largely undiagnosed many experts estimate the real figure is far higher.

Now on hormone replacement therapy with an injection every 12 weeks Rick feels better than ever.

“Testosterone peaks at the age of 30 and then begins to fall at a rate of around one per cent a year,” explains Dr Geoff Hackett, a consultant urologist at the Good Hope Hospital in Sutton Coldfield.

“But some men’s testosterone falls by two or more per cent and it’s those men who are likely to suffer from TDS, the symptoms of which include lethargy and fatigue, hot flushes or sweating, sleep disturbance, decreased cognitive function and diminished sexual desire and erectile dysfunction.”

“Obesity can cause TDS but TDS can also cause obesity. Indeed testosterone’s most important action is the conversion between muscle and fat. That is why an athlete who takes excessive testosterone builds more muscle and has less fat. Likewise if you lose testosterone at a fast rate you become weaker and form more fat.”

Visceral or intra-abdominal fat can metabolise and turn to oestrogen in men with TDS which can lead to the development of breasts and shrinking testicles and penis, adds Dr Hackett. Another symptom is depression.

“In fact it’s the depression that often gets men to go to the doctor, who doesn’t look at the wider picture and puts them straight on to anti-depressants. However anti-depressants can actually make TDS worse,” he warns.

Dr Malcolm Carruthers, medical director of the Centre for Men’s Health in London’s Harley Street has treated more than 2,000 men with TDS, also known as andropause. The average age of the men he sees is 55.

“Most have been bouncing between GPs and specialists for some years before they reach me so I’d say the usual age of onset is nearer 50,” says Dr Carruthers.

Others are in their 40s or younger. Some sufferers are still in their 20s. The cause of TDS is not always clear although contributory factors include mumps in childhood, alcohol, obesity and ageing.

TDS can be fatal, according to Dr Hackett. “At least 10 studies show that if you have low testosterone you die earlier than if you don’t. In particular, low testosterone is associated with coronary heart disease and Type 2 diabetes. If you are obese it strains the body’s insulin production. It’s no wonder so many more men have diabetes than women.”

TDS is easy to treat.

“Over the past 10 years there have been huge developments and we now have treatments including a gel that can be applied to the skin daily or an injection every three months,” says Dr Hackett.

“These are very effective with studies coming out all the time showing that if you restore testosterone levels back to normal the patient loses weight, their libido improves, they become less depressed and more energetic.”

Rick can’t believe the change to his life since having his injections.

“It’s ridiculous how good I feel,” he says. “I am more confident, I’m sleeping like a baby at night and feel more awake in the day. I’m training five days a week and things are good with my partner Sandra.”

Most men with TDS don’t know they have it, says Dr Hackett.

“There are many reasons it doesn’t get picked up,” he says. “Men are far less likely than women to go to the GP when something’s wrong and when they do, the GP is unlikely to ask about morning erections, a lack of which is a clue.

“Men come in to be treated for depression or obesity alone so they get treated for that instead.”

Dr David Edwards, a GP and specialist in sexual dysfunction, adds: “Hormone levels don’t just change by the day but by the hour. I measure between 8am and 10am because levels are highest at 9am.”

Some experts, however, are sceptical and claim pharmaceutical companies are cashing in on symptoms of ageing and that some doctors are over-prescribing testosterone replacement therapy for financial gain.

Others including Dr Fred Wu, a researcher at the University of Manchester, adds the treatment may aggravate prostate problems and sleep apnoea and lead to a raised blood-cell count which may increase the risk of a stroke.

Rick Dale isn’t worried. “I’ve had no side effects whatsoever,” he says.

“I am regularly monitored for any potential health problems and there is no doubt that I’m far healthier than I was.”


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