Psychotherapist Noel McDermott examines the lifestyle, psychological, and social factors behind male menopause and the life transitions that take place during male middle age. Older men in their late 40s and early 50s are usually affected, with many men developing depression, loss of sex drive, erectile dysfunction, and other physical and emotional symptoms usually linked to declining testosterone levels and ageing.

Male menopause is unlike female menopause, and debate rages about whether it’s a useful term. Both relate to changes in reproductive health and reproductive status, but male menopause does not have the same level of biological transition.

Most accounts of female menopause refer to the peri-menopause stage when women go through most physical changes with the body, reducing the production of oestrogen and what happens when that drops. Men have no equivalent hormonal process as testosterone levels don’t drop similarly. 

Psychotherapist Noel McDermott comments: ‘With men, there is neither the defined medical changes nor the specific time and age that defines the female menopause. Nevertheless, andropause or male menopause is a useful concept to aggregate several important life transitions during middle age for men.’

Erectile dysfunction (ED) and diminished sexual function

Some of the midlife changes men go through are linked to reproductive health, and many can experience issues around erectile dysfunction, which can also be affected by lifestyle. This can lead to a significant amount of psychological distress. Many men don’t get help from their doctors due to issues in general about avoiding help and the psychological distress it can cause.

The UK recently removed the medication for ED from prescription to over-the-counter, mostly to stop the risky buying of the medications online. There are also related lifestyle issues, and psychological therapy can help with ED and lower libido, as can stopping smoking, cutting down on drinking, losing weight etc.

Midlife changes in men 

The other issues men often report during midlife onwards.

• mood swings
• muscle loss
• reduced ability to exercise
• changes in body shape, fat redistribution such as pot belly and man boobs
• concentration and memory issues

Some of these developments may be due to mood disorders such as anxiety or depression or a result of stress and therefore have little to do with age. In terms of body shape changes and loss of muscle mass, while this is true of older age, it’s not necessarily the case for middle-aged men.

It’s highly recommended that middle-aged and older men engage in load-bearing exercise using weight or calisthenic-based activities such as yoga. Strength-based exercise in later life is a positive way to reduce problems with bones and joints.

Many men may lose interest in weights if they don’t see commensurate muscle growth leading to a vicious cycle of reduced resistance work. Developing greater insight into how these workouts contribute more widely to health and well-being can help bridge the motivation gap. 

The menoporsche

We have a culture that elevates youth and denigrates age. Men often report great sadness at getting older and becoming less attractive and less virile. Loss of fitness, strength and agility can compound all this, leading to acting out in buying adult toys such as motorbikes or trying to regain youth by having relationships with younger women, for example.

In general, we can see that our culture seems to have lost many of the rites of passage celebrations and rituals that have throughout history helped us navigate major life transitions such as from child to adult or from adult to middle age. We need to recapture our ability to celebrate ageing through ritual and encapsulate the loss of change and celebrate more the development of skills that getting older gives.

Men and psychological support 

Men have traditionally taken an all your eggs in one basket approach to psychological support men have shied away from any hint or suggestion that the activities that provide support (spending time with your mates at work or play) is psychological or supportive.

As men go through these life transitions, it is important that they make time to normalise feelings and emotions and reach out to friends and loved ones for support. 

The best therapy in life is the company and support of other humans we care about. The herd is where we feel safe and get the most boosts regarding our health and well-being.

Simply being in the company of folk we like when we are troubled will reduce our stress responses to our troubles. For men, this is often the best approach; activity-based support often works better for men, and often, guys will open up to each other during these contacts normalising the changes they are going through.

Noel McDermott is a psychotherapist with over 25 years of experience in health, social care, and education.