By a certain age, a lot of men know the feeling, even if they’ve never put a name to it. The constant tiredness, the lack of gains in the gym, the weight you can’t shift, an irritability you can’t explain. And sex, somewhere along the way, has stopped feeling worth the effort. It’s a particular kind of mid-life “flatness”, as Dr Jeff Foster explains it — and he should know, he hears about it from patients almost daily.
“If [sex] is offered, great,” he says of the way many describe their fading libido. “But otherwise I’ll just watch TV, I’m not bothered.” If that feels a little too familiar, you may be exactly the man he is trying to reach.
Foster, an NHS GP and men’s health specialist, has spent more than a decade treating what he calls one of medicine’s blind spots: testosterone deficiency (TD), the slow fall in the male hormone that creeps up on men through their forties and fifties. The trouble, he says, is just how quietly it arrives.
“For most men it’s slow and insidious.” A man simply reaches a stage where he realises he has felt “really rubbish” for two or three years, and puts it down to nothing more than age.
Part of the reason TD flies under the radar is that we barely understand what testosterone is and why it’s so important. “For most, it’s just about getting stacked in the gym, taking steroids, or losing your sex drive, and that’s it,” says Foster. But the doctor argues the hormone has “been hijacked a bit” in recent years — tied so tightly to muscle and masculinity that “people don’t often think of it as a real medical thing”.
More than 40 per cent of men with low testosterone have depressive symptoms
The symptoms are far more ordinary than many realise. Not only is there the drop in energy and drive, there are physical shifts, too — such as fat that won’t budge and strength that quietly drains away. Finally, there are subtle changes in mood, with short temper being common. “Mentally they’re more irritable, they’re ratty,” Foster says before dropping the more worrying stat: “And more than 40 per cent of men with low testosterone have depressive symptoms.”
Stigma and bravado
A comparison Foster keeps coming back to is the menopause, and not by accident. Back when he trained as a doctor, he says, medicine still waved it away as “something natural women go through… nature’s way”. It took years of advocacy and myth-busting, with Davina McCall among the loudest voices, to force it into the open and win the argument for HRT. Men, Foster suggests, are now roughly where women were before that shift.
What’s holding them back is stigma. To admit low testosterone, he says, is to risk feeling “I’m not so much of a man anymore”. When a fortysomething goes off sex, the assumption is that something’s gone stale at home, that he’s unhappy, or, as Foster jokes, that “his wife hates him”. The idea that it might be hormonal, rather than marital, rarely gets a look in.
The female menopause, by contrast, now has its books, its specialist clinics, even its cafés. Foster can’t picture the male version. “Could you imagine a low testosterone or erectile dysfunction café?” he laughs. It’s funny because it’s true: men, as a rule, don’t gather to compare failing bodies or mental health, and the familiar stiff-upper-lip thing, only now starting to shift, is what keeps a condition like this in the dark.
And while one half of the story is men ignoring a real problem, the other is men inventing one. Foster is scathing about the influencers all over Instagram, TikTok and YouTube egging on young men to push their levels ever higher, and the young men boasting that they’ve been on testosterone replacement therapy since they were 16 when really they’ve been taking steroids. “That’s not the same thing,” he says. Loading testosterone into a healthy young body is, in his words, “catastrophically bad for you” — effectively an overdose that can shorten a life and bring side effects like infertility and breast tissue growth. It also makes his job harder, because every steroid-fuelled influencer makes it that bit harder for him to be taken seriously when he treats the men who genuinely need help.
The longevity fallacy
It’s the same story with the longevity craze, where testosterone gets sold as an anti-ageing hack. Here Foster is far more cautious. “There’s very little evidence for anything in longevity,” he says. For genuinely deficient men, though, it’s a different story. “If you’ve got low testosterone and you treat it, it really does improve longevity,” he says. “You will live longer.”
So where does that leave the man who recognises himself in all this? The first thing, Foster says, is to resist the temptation of supplements. “Almost all testosterone boosters do nothing,” he says, “and even the ones that do are marginal.” Instead, he wants men to start by taking an honest look at the basics. Are you eating properly? Exercising enough? Sleeping well? Sort the basics out, he says, and you’ve either fixed how you feel or narrowed it down to something that needs a proper look.
If the fog still hasn’t lifted, get your testosterone levels tested, through a GP or a reputable private provider. And if that sounds like overkill for a bit of tiredness, Foster points to a line from a mentor that’s stuck with him, that “testosterone is the best single indicator of a man’s current health”. The trouble is that most men never get that far. At least two million men in the UK have the condition, Foster notes, yet fewer than a million have been diagnosed.
“If you don’t test it, you don’t know,” he says. “It might be that your wife doesn’t hate you, it might be that your testosterone was low, and you can do something about it”.
