Misdiagnosing male menopause blog post
The recent announcement that an ambulance trust in Northern England was going to allow male staff with symptoms of testosterone deficiency to take up to 18 months off for treatment was greeted in the press with some derision. 
I have two views on it: I’m very pleased that recognition has been given to what can be a debilitating condition, but saddened that it should take potentially so long diagnose and manage. 
A man in his late 30s came to see me recently. He was very overweight and suffering from symptoms of chronic fatigue, lack of motivation, depression, erectile dysfunction and loss of libido. He had tried for some years to diet and exercise, without improvement. He was not diabetic and his thyroid function was normal. He had persuaded his GP to check his testosterone levels, which were extremely low. He was referred to an endocrinologist on the NHS who, after an 18 month wait, advised him that the reason his testosterone level was so low was because he was very overweight; and was told to go away and diet and exercise…. 
This illustrates the difficulty in having treatment for testosterone deficiency on the NHS: there seems to be an inbuilt resistance to recognizing and managing it, either in primary or secondary care. Men with testosterone deficiency are at significant risk of future cardiovascular disease, diabetes/metabolic syndrome, and osteoporosis from thin bones or osteoarthritis from being overweight. 
“Menopause” means cessation of periods. Men don’t have periods, so the phrase “male menopause” is incorrect. “Manopause” is a rather unsatisfactory neologism/portmanteau. “Male hypogonadism” is probably best, until someone conjures up something more satisfactory. 
Interpreting testosterone levels is also an issue, and I have covered this, and the need to also measure sex hormone binding globulin (SHBG), in previous blogs. Suffice to say that I see many patients who have been advised their levels are normal, when they are anything but. 
And the final obstacle is the endocrine team who decide whether or not treatment should be given (I should emphasize this is an issue in both the NHS and the private sector). My patient in the second paragraph is but an extreme example of other cases I have seen where it was blatantly obvious that testosterone deficiency was the cause of the symptoms; symptoms which improved when testosterone replacement was commenced. 
So, well done the ambulance trust, and good luck to those with the symptoms. I would offer to help, but I’m a bit far south… 
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