Don’t be a grumpy old man

Every week patients walk through my door telling me the same story that they’re falling asleep during the day, they don’t feel as if they are performing well at work, they lack energy, have lost interest in sex and have problems getting an erection.

The impact on their self-esteem is huge. Many say that after decades of feeling “like a man”, they suddenly find they can’t help their wife lift the shopping from the car or even kick a football around with their children.

For years, they have brushed these feelings aside and told themselves they are simply becoming grumpy old men. They feel embarrassed and alone, which all feeds into their sense of low self-worth. It is no wonder that for those who do seek help from their GP, the diagnosis often delves no deeper than depression.

But when taken together, these signs can be significant and indicate a clinical problem with hormones. A simple blood test can reveal if the real cause is testosterone deficiency syndrome or TDS.

TDS is not unusual. More than half a million men suffer with it in the UK and around one in seven men with erectile dysfunction (ED) will actually be suffering from low testosterone, which can trigger ED.

I believe it is now more important than ever that we start to talk about sexual problems more openly and spot those suffering with TDS sooner

When these men turn up in my clinic, you can see their immediate relief when I tell them they’re not simply grumpy, they’re suffering from low testosterone levels and this can be easily treated. Testosterone replacement therapy can be given to diagnosed men in order to bring their testosterone levels back into the normal range and relieve symptoms such as low libido, tiredness and apathy, and loss of enjoyment in daily life.

It has also been shown in some studies to have secondary benefits in reducing obesity and improving diabetes control – both risk factors for cardiovascular disease (CVD).

I sometimes apologise to them for the years it has taken for their condition to be diagnosed, when a simple symptom check and blood test could have spotted it long ago. While many doctors will carry out simple thyroid tests in men, for fear of litigation, few carry out the checks for TDS, a problem which is much more common.

We don’t yet fully understand why some men suffer from TDS while others do not. But there is mounting evidence that it may not be the simple by-product of ageing we once thought it was.

There are now a number of studies that show low testosterone levels are a key biomarker of a man’s risk of CVD – the third biggest killer in this country.

And for this reason I believe it is now more important than ever that we start to talk about sexual problems more openly and spot those suffering with TDS sooner.

Studies show that testosterone appears to be closely linked to two of the biggest risk factors for suffering CVD – obesity and diabetes.

For example, an obese man is four times more likely to have TDS than a man with a “normal” BMI (body mass index) of 25. Research in the journal Obesity this year showed that three in four obese men with TDS, who were given testosterone therapy for four years, saw a 10 per cent reduction in their weight. Other studies have shown that some TDS patients, who were given treatment, also saw their diabetes control improve, reduced rates of depression and even lower total cholesterol – all of which improve heart health.

And treatments for this condition are all relatively simple. Along with changes to diet and exercise, men can try testosterone gels, solutions or an injection that lasts three weeks. Alternatively, they can have a long-acting testosterone injection which provides three months of treatment. These treatments may not be the magic bullet for everyone, but your doctor can talk this through with you.

The most important thing is not to suffer for years in silence. TDS can be simple to diagnose and easy to treat. Like so many conditions, the biggest hurdle is simply mentioning it to the doctor in the first place.


Paul Bearley, 60, was diagnosed with testosterone deficiency syndrome four years ago.

The former PE teacher says that, despite being extremely fit, he’d found his energy levels had suddenly slumped and he felt he couldn’t do any sport at all.

The typically unemotional Paul found he was unable to go back to school in case he burst into tears if a pupil confronted him. At home, he says he became so emotional he “even cried at X Factor”.

But the biggest toll was on his happy marriage to wife of 38 years, Susan. The father of three had become snappy and withdrawn, lost interest in sex and Susan even feared he might be having an affair. His weight also ballooned from 12 to 16 stone.

“The worst thing was not knowing what was happening to my mind and body,” Paul says. “Everything was destroyed and I didn’t know what was wrong.” At one stage, things got so bad that he was considered suicidal.

After a particularly bleak period, Susan urged him to go to the doctor. During the appointment, the GP decided to refer him to a consultant in sexual medicine.

Paul was quickly given the blood tests that proved he had TDS and started treatment immediately. Slowly, over time, he began to feel normal again. He has lost all the weight and plays tennis regularly with his grandson. “It’s like a new lease of life,” Paul says.

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