Something happens to men when they reach middle age. It runs deeper than cardigans, slippers, and an intolerance of loud music. The 'mid-life crisis', 'change of life', or 'male menopause' are all names for it, but what is it?

Whether the 'male menopause' is real or not is still controversial. For many years, people have talked about the 'mid-life crisis' that men may go through, where they experience distressing physical and emotional symptoms.

Recently, this has been likened to the female menopause and, called a 'male menopause'. Strictly speaking, since the definition of the menopause is the time at which periods cease, men cannot have a menopause as such. However, it is argued that they can go through a male equivalent, called the 'andropause' that is accompanied by symptoms similar to those experienced by women.

Some argue that this is hormone-related, just like the female menopause. However, the female menopause is triggered by a dramatic fall in the levels of female hormones, whereas the levels of the male hormone testosterone fall very gradually over many years. Moreover, many 70 year-old men have similar testosterone levels to those of a 20 year old.

How are men affected?

Poor sex drive, tiredness and fatigue, acknowledgement of ageing, hair loss, changes in body shape as they become less muscular and more rounded, are common complaints of men as they reach middle age. Other symptoms include irritability, sweating, flushing, generalised aches and pains, and low mood, sometimes depression.

Looking at these symptoms, it's easy to see why a comparison is made with the female menopause. Women may experience any or all of these symptoms during their own 'change of life'.

"Symptoms of andropause "

Poor sex drive Tiredness and fatigue Change in body shape Reduced muscle mass Irritability Sweating Flushing Generalised aches and pains Low mood

What else might be behind it?

Many doctors acknowledge that a change for men occurs, and is real, but believe that it has a psychological basis, rather than a hormonal one. The realisation that they have left youth behind is backed up by the confirmatory signs of wrinkles, receding hairline, and fat. For many, they may have progressed as far as they ever will in their careers and, this may be hard to accept. As their children grow up and leave home, many will question whether they now have a role to play.

"Causes of similar symptoms"

Anaemia Thyroid gland dysfunction Depression Marital disharmony Job dissatisfaction Financial problems Alcohol misuse

Marital disharmony, job dissatisfaction, financial problems, or alcohol misuse, are some of the other reasons that may be behind the way a man is feeling.

If it's accepted that physical changes are a normal part of the ageing process, then this allows the emotional symptoms to support a psychological basis for the male 'change of life'. It's important not to forget that as with women, other physical illness can be responsible for the same group of symptoms and, should be investigated. Anaemia, thyroid gland dysfunction, or depression, may be the underlying cause.

Can men be treated?

Any treatment offered should of course be appropriate to the underlying cause. If the cause is believed to be the andropause, then discussion continues as to whether men at this stage of their life with these symptoms should be offered testosterone as HRT. This is available as skin patches, injections, or as tablets and, many men treated say that they notice an improvement in their symptoms. Whether or not this is because of the HRT or, because of a placebo benefit, is unclear.

Male HRT should not be taken lightly though. It is linked with development of prostate cancer and, if HRT is taken, this needs to be closely monitored.

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