As often as not the middle-aged male is a good subject for jokes, but there is a serious problem behind the onset of old age - and that is the male menopause.

But mid-life crises and the male menopause, otherwise known as the andropause, have been confused for years, says Dr Malcolm Carruthers, author of The Male Menopause. "It has prevented the proper treatment of both," says Dr Carruthers. "A mid-life crisis is an emotional, psychological condition that occurs between the ages of 35 to 45.

"It is much more like Basil Fawlty rushing around Fawlty Towers, questioning whether he wants to spend the rest of his life married to this awful woman?

"That is separate and distinct from the male menopause, which tends to be later - at the same time as women - from the age of 45 to 55. "It can occur over a wider age range because it has a number of contributory factors, such as stress, alcohol and infections such as orchitis - caused by mumps - and a vasectomy, which many of my patients seem to have had 10 to 15 years previously."

Fatigue, depression, irritability, reduced libido, aching and stiff joints, increased sweating and above all, a reduced ability to achieve an erection, are all warning signs.

The symptoms are a result of a lessening of testosterone in the body. Total testosterone reduces slightly with age, but that is not the whole story. Blood analyses show that levels of free active testosterone (FAT) de- crease in the body because of high levels of the carrier protein sex hormone binding globulin (SHBG).

Dr Carruthers says: "An average man - a dynamic, high-testosterone guy, one that I call a mover and shaker - would start off with a total testosterone count of 30 units and a SHBG count at about a similar level.

"In his 50s, particularly if he works under a lot of stress and has a little too much alcohol along the way, the testosterone level will be at 15 units and the SHBG at 60. He will therefore be working at 25 per cent rather than 100 per cent."

Dr Carruthers says that there are problems associated with the male menopause, the first of which is usually that men are not keen on coming forward to talk about their problems. But he has seen more than 1,000 patients in his private clinic in London - and confirms that a previously sceptical medical establishment is now more interested and convinced by his ideas.

Three years ago, on a trip to Australia to promote his book, he set up STAG - the Supplementary Testicular Action Group - to help men suffering from the male menopause. Despite the Crocodile Dundee view of masculinity Down Under, he says that thanks to his radio and TV coverage, 16,000 Australian men contacted the organisation.

According to Dr Carruthers, the idea is not new - the male menopause was recognised 60 years ago. In 1944, what we now call the menopause was discussed by two American doctors, Carl Heller and Gordon Myers, who tested the effectiveness of testosterone treatment. Despite the discovery, the condition has largely been ignored by the medical profession. Dr Carruthers says: "It's a form of sex discrimination against men.

"Women go to a surgery with menopausal complaints and receive sympathy, but if a man goes along with complaints of an erection problem he is told to pull himself together.

"But there are signs that is changing. Women are saying, 'I have been treated and I feel better', and because men are beginning to demand it." The male menopause is treated with "pills, pellets and potions", he says. Testosterone replacement therapy, or TRT, consists of tablets and an implant in the buttocks that slowly releases testosterone over time.

But TRT is still a controversial subject for many in the medical profession who are unhappy about testosterone's drawbacks. They are worried that it could lead to prostate tumours as well as heart and liver problems.

And of course, there is a public perception of the hormone's responsibility for hypersexuality and aggression.

But research shows that cardiologists think that testosterone could improve the coronary arterial blood flow - making it an important protective agent.

Testosterone has had a bad press, admits Dr Carruthers. "In fact, it lessens aggression and makes men sweeter and lighter. Nor are they oversexed, but restored to their normal, previous levels. There are many myths surrounding it and my work is concerned with dispelling them."

Story date: Saturday 05 February

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