At Dr. Aamer Khan's Men's Midlife Clinic, the focus is on managing male menopause (andropause) and other midlife health concerns. This condition, marked by a natural decline in testosterone levels, leads to symptoms like low energy, depression, increased body fat, and erectile dysfunction. These issues are addressed through comprehensive testing, hormone replacement therapy, and lifestyle changes.

The clinic takes a personalised approach to health, including genetic testing, gut health, and mental well-being. By adopting healthier habits and managing stress, men can maintain vitality and well-being during midlife and beyond in a supportive environment.

I think I have low testosterone because I feel low and depressed for no reason. I have a great family and job. I'm 41 and have a good diet. I don't smoke or drink. How can I find out if this might be the case?

For more than 20 years researchers have been studying happiness as a curve, and have found that men in their 40s are at their lowest. In fact, the highest incidence of depression in men is at the age of 47.2 years.

In general, the age period between 40 and 60 years is defined as ‘mid, or middle age’ and this in itself may have a psychological impact on how we perceive ourselves.

Testosterone levels in men drop by about 1% per year from their 30s, and is unlikely, by itself to be the cause of these symptoms, unless you have developed a medical condition known as ‘late onset hypogonadism’. This can be primary, where no cause can be found, or secondary, where there is an underlying condition. These conditions may include a high visceral and central fat distribution, metabolic syndrome-X, pre-diabetes, diabetes, hypertension, heart disease and other physical conditions. Certain drugs can also cause secondary ‘late onset hypogonadism’.

If you suffer from depression and other psychological issues, this may lead to similar symptoms. Depression, loss of sex drive, erectile dysfunction, and other physical and emotional symptoms can affect some men when they reach their late 40s to early 50s.

These symptoms interfere with everyday life and happiness, so it's important to find the underlying cause and work out what can be done to resolve it. We can help by performing tests to determine if your testosterone levels are potentially affecting your moods and work to address both your symptoms and the underlying cause at the clinic. 

I used to take testosterone to increase muscle mass when I was 25. I'm now 36 and I struggle getting an erection during sex. Could this be the cause and if so, can I take testosterone again to bring my levels back up?

Taking testosterone can cause your own testosterone production to stop. This is known as ‘secondary iatrogenic hypogonadism’. If this is the case, then it is important to get assessed by a medical practitioner and get a proper diagnosis, and other conditions are excluded or managed.

You may require TRT, but this will need supervision and monitoring so you get the right dose for you.

I feel as if I want sex all day long. I'm 52 and have had these feelings for the past 6 months. Is there such a thing as too much testosterone? If so, should I take something to reduce it? The feeling has started to consume me (and my poor wife).

This is known as ‘hyper-sexuality disorder’, as it was not your normal state prior to 6 months ago.

The causes of hyper-sexuality disorder are not fully understood, however possible causes of hyper-sexuality in humans are: 

-       Biological factors

Hyper-sexuality disorder may be caused by imbalances in brain chemistry, alterations in brain structure or hormonal fluctuations that affect sexual behaviour. Some studies have suggested that imbalances in neurotransmitters, such as dopamine and serotonin, may be involved in the development of compulsive sexual behaviour. Hormonal imbalances, such as an overproduction of testosterone, may also play a role in the development of hyper-sexuality in some.

-       Psychological factors

Psychological trauma, such as abuse or neglect, may increase the risk of developing hyper-sexuality in some. Additionally, mental health conditions, such as anxiety disorder, depression or bipolar disorder may also contribute to the development of compulsive sexual behaviour.

-       Social and cultural factors

Societal attitudes towards sex and relationships may influence the development of hyper-sexuality. For example: Individuals exposed to sexual content at a young age or who grow up in an environment where open discussions about sex are not encouraged may be more likely to develop compulsive sexual behaviour as a result.

-       Physical trauma and head injury 

Head injury can cause an imbalance of neurotransmitters that can lead to hyper-sexuality and other behavioural disorders.

To get a proper diagnosis it is important to get a medical assessment.

My wife and I have been trying to conceive for 2 years to no avail. We've not done any tests but her doctor says she has a healthy egg count. I'm only 32. Is it possible I already have declining testosterone levels? I feel too ashamed to get tested.

Around 1 in 7 couples may have difficulty conceiving.

More than 8 out of 10 couples, where the woman is under 40, will conceive naturally within a year if they have regular unprotected sex (every 2 or 3 days).

For couples who have been trying to conceive for more than 3 years without success, the likelihood of getting pregnant naturally within the next year is 1 in 4, or less.

There are many possible causes of infertility, and fertility problems can affect either partner. But in a quarter of cases it is not possible to identify the cause.

Poor quality semen could potentially be the cause, as well as factors like obesity, smoking, stress or alcohol consumption. 

It is important to get a referral to a fertility specialist via your GP to assess what may be causing your difficulties.

I have recently started developing moobs. I train regularly and eat really well and always had great pecs. What can the cause be and is there a cure that's not surgical?

The development of moobs in later life may be a genetic predisposition, and may have nothing to do with your hormonal levels.

It is important to have a hormonal and physical assessment.

Usually surgery is the only solution for this, which we can look at for you.