Exactly how is the andropause affecting men professionally and what can be done to help destigmatise the issue, raise awareness and create a climate where men feel increasingly comfortable opening up about it at work?
The more we understand about the andropause (sometimes referred to as the male menopause), the more we know that it can significantly affect men’s physical, psychological and emotional well-being. Many men may feel uncomfortable or embarrassed talking about how it is affecting their health or work or they might be completely unaware that the symptoms they are experiencing are hormonally related. It is also made harder by the fact that many experts still dispute that the male menopause is real. This is why greater awareness around the andropause (a collection of symptoms linked to declining testosterone typically experienced by men in their late 40s to mid 50s) is needed and the issue of testosterone decline and deficiency deserves more attention and open dialogue to explore how it can affect men on a professional level. No one should be put in a position where they have to suffer in silence and we need to work to help de-stigmatise the subject, shatter the wall of silence and create a climate at work where men feel comfortable raising the subject of their hormonal health.
Whilst not an illness or a disease, the reality is that testosterone levels start to decline naturally by around 1-2% a year from the ages of 30 to 401 and this drop can be exacerbated by lifestyle factors (such as lack of sleep, prolonged stress and heavy drinking). There is also research to show a global generational decline in levels of testosterone. Testosterone depletion can then lead to life-affecting symptoms including lethargy, difficulty concentrating and finding motivation, sleep problems, lack of libido, low self-esteem, anxiety, depression, weight gain, hot flushes and finding it increasingly harder to cope with stress2- and these side effects can potentially last years.
Work Matters
There are currently millions of men of andropause age in the workplace and many will be navigating their way through this transitional time coping with changes which are impacting on crucial aspects of their life and work. Men still tend to derive much of their self-worth and sense of identity from their work and the impact of the andropause for some men is concerning.
Research suggests 31% of men ages 40 plus have anxiety about going to work. 29% find it difficult to focus at work. 15% are more short tempered with co-workers, and 15% actually quite their job during this period.
Unfairly this means, many men in their 40s and 50s, who may be at the top of their game professionally, are finding that the effects of hormonal imbalance and decline are affecting their ability to do their job and many may be prematurely leaving the workforce and/or a job and career they have previously enjoyed or thrived in.
Midlife Crises
Recent studies also show that people in midlife (and this is a global trend) start to feel a significant dip in their well-being and life satisfaction3 This increases the risk of depression and suicide (men aged 40-49 have the highest suicide rates in the UK and less well-off men are even more at risk)4 with further research showing that job loss and unemployment can have a greater impact on men than women.5 Uncoincidentally perhaps, divorce rates in the UK are highest among the 45-55 age group. It’s also highly likely you have other age-related concerns at the same time - such as caring for ill or dying parents, your children leaving home, fears about your financial security, possibly feeling less fulfilled in your relationship, coping with your own health worries or just wondering what you have achieved at this ‘half-way’ stage in your life.
It is one of the ironies of midlife, however, that at a time when you are likely to have more, and new, stresses your body becomes less efficient at coping with them. Not least because stress triggers production of the stress hormone cortisol and being exposed to cortisol for a prolonged period is known to cause health concerns including digestive problems, headaches, sleep problems, anxiety, depression and memory and concentration issues. Chronic stress has also been found to cause actual structural changes in the brain which can have an adverse effect on memory, concentration and learning.6 Significantly too, stress has also been found to lower testosterone7 and if your testosterone levels are already low due to the andropause this can make you feel increasingly exhausted, stressed and prone to anxiety and depressive symptoms. Invariably all this can make work – and life – a severe struggle.
Working with the Andropause
The progress that has been made in the UK over the last couple of decades in terms of destigmatising and acknowledging how the menopause affects women in the workplace has been hugely significant. It is a mark of success that around one in four employers now has a formal menopause policy in place.8 9 As these discussions continue and more guidance is put in place for women, we can capitalise on these gains by inviting men into the conversation and ensure they find ways to navigate their way through work and the andropause. Encouragingly, policies to help men cope with ‘androgen-related issues’ are already being put in place in some workplaces, for example 1 in 10 NHS trusts now have an andropause policy in place10 11 Educating and raising awareness around the issue can also foster greater understanding and empathy in all of us – not just for the men going through the andropause but also their colleagues, bosses, spouses (and interestingly, more and more experts are highlighting how the andropause and the menopause can be an issue for couples to navigate together) and family. It should also make us aware of the need to be sensitive and respectful and take into account how highly vulnerable a man can feel around this midlife phase.
Whether your workplace has a formal andropause guidance policy or not, your employer is still legally obliged to make reasonable adjustments and modifications for you. Whilst there is no specific law that covers the andropause, your employer has a duty to ensure your health, safety and welfare under the 1974 Health & Safety at Work Act (HSWA). The Equality Act of 2010 also protects anyone from discrimination in the workplace and that includes being discriminated against on the basis of age, gender or having health problems12 but even with this legal obligation in place we still need to create a climate where male employees actively feel comfortable opening up about their hormonal health and the andropause.
Professional Help
It should be pointed out that each man's experience of andropause is unique and as such there is no universal approach to managing its effects.13 For many it can be managed effectively by making lifestyle changes such as exercising more, dietary changes, reducing stress and getting more sleep but you should also see your GP for medical advice. Your doctor may prescribe medication, possibly talking therapies or even testosterone replacement therapy (TRT) if a blood test shows a testosterone deficiency. Nobody should ever feel pressurised into talking about their hormonal health but for those who do want to reach out and discuss how it is impacting them at work you might want to confide in a trusted colleague. Alternatively, and all organisations have different ways of doing things, book a time to speak to your Line Manager, someone in HR or Occupational Health. The key is to find someone who will actively listen, keep the details of your conversation confidential and respect how you want to proceed. Depending on how severely your symptoms are affecting you your employer should try to make it easier for you to work more flexible hours, say, or relax its policies around uniform if applicable. They should also understand you might need to take time off for medical assessments or appointments and be aware that treatment can take time. If you are formally diagnosed with testosterone deficiency and prescribed TRT, for example, it can take 3-6 months for the treatment to kick in and stabilise. It then may take the same time again if you are then changed to a different dose or mode of delivery so there is not necessarily any quick fix solution.
The bottom line is that we urgently need to acknowledge the reality of the andropause and promote open dialogue around its existence at work. It shouldn’t need to be said that employers need to value their employees’ mental and physical health but for this to happen we must initiate inclusive conversations around men’s hormonal health and create more andropause-friendly environments in which they can do it.
Further resources:
The European Menopause & Andropause Society (EMAS) - https://emas-online.org/
The British Association of Urological Surgeons (BAUS) - https://www.baus.org.uk/
British Society of Sexual Medicine (BSSM) - https://bssm.org.uk/
References:
- https://www.nhs.uk/conditions/male-menopause/
- https://www.baus.org.uk/patients/conditions/7/male_menopause_androgen_deficiency_in_the_ageing_male/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8525618/
- https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/men-and-mental-health
- https://psychiatryonline.org/doi/full/10.1176/appi.ajp.2013.13101375
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/
- https://pubmed.ncbi.nlm.nih.gov/37014073/
- https://www.gov.uk/government/news/government-appoints-first-menopause-employment-champion-to-improve-workplace-support
- https://www.cipd.org/uk/knowledge/reports/menopause-workplace-experiences/
- https://www.ucl.ac.uk/news/headlines/2023/oct/male-menopause-debated-nhs-trust-considers-giving-men-time-symptoms
- https://www.thetimes.com/uk/healthcare/article/one-nhs-trust-in-ten-has-a-male-menopause-policy-b073h0fg6
- https://www.local.gov.uk/our-support/workforce-and-hr-support/wellbeing/menopause/menopause-and-perimenopause-legal#:~:text=Where%20an%20employee's%20experience%20of,not%20discriminate%20against%20the%20worker.
- https://bssm.org.uk/wp-content/uploads/2023/08/Trends-Urol-Men-s-Health-2023-Hackett-A-practical-guide-to-the-assessment-and-management-of-testosterone-deficiency-1.pdf