Want to ask a GP?
Email a GP. Reply in 72 hours. Free.
|This is archive material from the MHF's malehealth.co.uk website which is now part of this site in the section Male Health. This page remains on the site as site traffic suggests visitors find this page useful but it may not be up to date. It was last updated in 2003 and so does not conform to the NHS England Information Standard of which the MHF is a member. Up-to-date information on this topic can be found here: Mid-life crisis FAQs.|
A controversial condition or syndrome which some doctors and psychologists thinks affects many men in their 30s, 40s and 50s. Some believe it has mainly psychological causes while others argue that it's related to hormonal changes. Other health professionals argue that there's no such condition, however, and that the symptoms often associated with mid-life crisis have other causes.
From Reggie Perrin to American Beauty, we're all familiar with the stereotype of the man who reaches 50 and trades his wife in for a younger model or chucks in his job to go off and travel the world. The term "mid-life crisis" conjures up images of a dissatisfied man in middle age who suddenly goes through a series of sudden and violent changes of behaviour.
Those doctors and psychologists who believe the mid-life crisis is a genuine condition have identified a wide range of symptoms. Frequently reported problems include:
Some men may also be affected by:
Several of these symptoms, occurring together, might understandably provoke a sense of crisis in a man.
Not only is the existence of the mid-life crisis questionable, those who believe it exists also disagree about the causes. Is it psychological, even sociological, in origin? Or hormonal? Or a bit of both?
While the Reggie Perrin stereotype is richly comic, it isn't difficult to see that in real-life cases such drastic behaviour may be motivated by deeper issues that are all too serious. Many of us are aware of feelings of disillusionment and irritability setting in in middle age, attributable perhaps to a heightened sense of our own mortality and/or feelings of dissatisfaction at the way life has turned out. Very often such gloomy insights are brought on by a specific trigger: a redundancy or divorce, perhaps, or a more trivial event like a milestone birthday.
In a society which puts a particularly high value on youth, and sidelines older people, it's difficult for many people to move smoothly into their middle years. Men reaching mid-life may feel a loss of masculinity and confusion about their future role. Divorce, insecurity at work and the changing role of men add to the uncertainty many feel during this time of transition.
Many men find the changes in sexual function which come with getting older unsettling. Suddenly, you can't do it three times a night any more, it's harder to get an erection. Is this the start of the slippery slope? And where will it end?
By middle age, men may have achieved most of their realistic goals and be unclear about their future direction. Relationships may also change, and are often adversely affected, especially when children leave the parental home.
Men are better educated, healthier and likely to live longer when they enter mid-life than at any time in the past. This can lead to a greater degree of reflection, and often, introspection, on what has happened during the first part of life and what the future holds.
Sleep may be another factor. According to a report in the Journal of the American Medical Association, mid-life crises may be linked with a growing inability to sleep deeply. Men in their 30s and 40s sleep far more patchily and lightly than in younger years — even when they sleep the same number of hours as before. By the age of 45, according to the report, few manage deep sleep at all, leading them to grow fatter and more unfit because they cease to generate growth hormone.
Some doctors argue that the crisis of confidence and the unpleasant mid-life symptoms some men experience are not primarily psychological in origin. While there may be common psychological problems arising as a reaction to life events and the consequences of getting older, they argue for the existence of a "male menopause" involving hormonal changes in the body, analogous to the female menopause.
In fact, it may be possible that some men have to go through both a psychological crisis AND a hormonal one!
The very phrase "male menopause" is misleading, however, since menopause strictly refers to the cessation of menstruation. If there is a male equivalent, the experts have yet to agree on the name: the terms "andropause", "viropause" or "endopause" have all been put forward.
The male menopause has been defined by its proponents as the hormonal, physiological and chemical changes which occur in men between around 40 and 55.
It's argued that the symptoms of the male menopause — the main one being a loss of libido — are caused in middle-aged men by the decreasing level (and effect) of testosterone, the hormone responsible for secondary sexual characteristics such as muscle strength and facial hair, as well as sexual drive and the production of other hormones, such as DHEA (dehydroepiandrosterone).
Testosterone levels gradually decrease from the late 20s, and, by the time a man reaches 80 they will be at pre-puberty levels. However, unlike oestrogen in women, there is no sudden, measurable drop in testosterone in men in middle age, and often the testosterone levels of men complaining of andropausal symptoms can still be measured as normal.
What does appear to happen is that a carrier protein called sex hormone binding globulin (SHBG) increases in mid-life men. This increase is believed to undermine the body's ability to make use of its own testosterone. In addition, the cells in the body also tend to thicken with age, so they are less able to absorb testosterone.
Opponents of the male menopause theory don't deny that testosterone levels fall steadily with age or that SHBG levels may rise. What they do say, however, is that these changes aren't sufficient to produce any noticeable symptoms in the vast majority of men.
If you believe that falling testosterone levels and rising SHBG levels are responsible for a male menopause then there's not much you can do about it.
If you believe in a mid-life crisis that's primarily psychological in origin, then you could take steps to head it off by:
Yes, if need be. Many symptoms linked to the mid-life crisis need to be checked out for underlying physical causes. For example, erectile dysfunction (impotence) can be caused by depression, diabetes or heart disease. If you feel you'd rather talk your problems over with a sympathetic stranger, such as a counsellor, your GP can refer you. (If you can afford to see someone privately, however, you may save yourself a long wait.) Talk it over. Don't be afraid to ask for help.
Advocates of the male menopause believe TRT (testosterone replacement therapy) is the answer.
If the debate on the existence of the male menopause is heated, TRT has caused even more controversy. This treatment involves administering doses of extra testosterone through patches, injections, pills or creams to those suffering male-menopausal symptoms.
According to its proponents, many men who have received TRT have reported almost miraculous results. These include:
So why are some healthcare experts so opposed to it?
Talking about your problems is all very well, but sometimes it isn't possible to talk to your friends or partner. Counselling can help for individuals, and an intermediary can also be effective in dealing with problems in relationships. Contact your GP or Relate. Psychotherapy can help with more deep-seated difficulties, but may not be easily available on the NHS.
A short course of antidepressants or tranquillisers may be prescribed to combat depression in those suffering from a mid-life crisis. Alternatively, you could try a natural remedy such as St John's Wort. Also known as hypericum, the herb — available as a supplement in tincture or capsule form — has been shown to alleviate feelings of anxiety, agitation, disinterest and despair. In a study carried out by the Berlin Depression Self-Help Group, 34 men took extracts of the herb three times a day for six weeks. After just five weeks three out of four showed a marked improvement, and one in three became symptom-free.
Doctors may also be able to treat any specific conditions such as erectile dysfunction (impotence) or skin problems.
Potentially good. Ultimately, the mid-life crisis is about managing change of one kind or another, and as millions of older men can testify, there lies a fresh perspective and new satisfactions on the other side of the transition. Never suffer in silence: always ask for help if you need it, and explore every avenue. And remember: life can begin at any age.
Page created on May 9th, 2003