Dr Cherry Armstrong is assessing whether I need hormone replacement therapy (HRT).
In the chic consulting room of a private medical clinic, she asks whether I am tired all the time, lacking in concentration, focus and get-up-and-go and suffering from ‘increased central obesity’, which, I think, is the medical term for ‘beer belly’ or ‘spare tyre’.
Being a middle-class, 52-year-old man with a stressful, but mostly sedentary, life, I answer ‘yes’ to all the above.
As she takes a blood sample, Dr Armstrong tells me that most men do not notice the ‘andropause’ — the gradual, natural decline in their testosterone levels as they get older — and put their decreased libido, depression or diminished tolerance for exercise down to other factors.
Nick Curtis visited Dr Cherry Armstrong at the Light Touch Clinic to assess whether he needs hormone replacement therapy
‘After the age of 30, there is a 10 per cent reduction in production,’ says Dr Armstrong. ‘Symptoms of a testosterone deficiency are gradual and insidious. Many men just regard some of these symptoms as “part of growing old” and accept them.’ But now, more and more men are looking for a medical top-up of testosterone, even though potential side-effects — which, Dr Armstrong says, she can mostly protect against — include ‘growing breasts, mood swings, hot flushes’, shrinkage of the testicles and infertility.
Increasingly, health and diet-conscious, particularly in recent years, men are encroaching on what has been the largely female preserve of hormone replacement. It seems the andropause is the new menopause and TRT is the new HRT for men.
We’re not talking about ageing millionaires trying to stave off the passage of time and keep up with their younger trophy wives, either. Dr Armstrong’s consulting room is not in Switzerland, but in comfortable commuter belt Weybridge in Surrey.
A GP who works for half the week in an NHS hospital and whose specialist interest is dermatology, in 2009 she set up the Light Touch Clinic, offering a range of medical and cosmetic treatments and procedures, including Bioidentical Hormone Replacement Therapy, to a predominantly female clientele.
Then, in 2017, she introduced the Men’s Wellness Clinic within Light Touch. It took a holistic approach to health, offering a medical check-up and advice on diet, exercise, sleep and stress reduction with registered nutritional health therapist and functional medicine practitioner Helen Williams. And, where necessary, Testosterone Replacement Therapy (TRT).
Dr Armstrong says that most men do not notice the ‘andropause’, which is the gradual, natural decline in their testosterone levels as they get older
‘The clinic has been providing this service for more than a year — and it is becoming increasingly popular,’ says Dr Armstrong. ‘The ratio of women [having bioidenticals, which can include progesterone, oestrogen and testosterone] to men [having testosterone] is 70:30. But the number of men consulting us on TRT has increased by 25 per cent in the past six months.’
Men who attend Light Touch will immediately feel a little lighter — mostly in the wallet area. The initial consultation with Dr Armstrong and a blood test cost £300 apiece and then there’s the treatment, which starts at £300 a month. It’s £250 for the first consultation with Helen Williams and £125 per 30-minute session after that.
But, then again, as Dr Armstrong puts it, ‘we are in an affluent area’.
Most of her male clients are ‘middle to upper-class, from a whole range of professions’ and aged between 40 and 65. A lot ask for HRT on arrival, having researched it beforehand.
Men who, in the past, wouldn’t have shared anything more intimate than a joke at the golf club and who bought a new Jaguar when their libidos needed boosting, are now discussing diets and the state of their prostates with each other.
‘Men are much more informed than they were ten years ago, through the media, advice at the gym, talking more openly with each other and also from their wives, who read magazines regarding their husband’s health,’ says Dr Armstrong.
Particularly in recent years, men are encroaching on what had previously been the largely female industry of hormone replacement
Indeed, wifely nagging still plays a part: ‘We also have female patients on bioidenticals at the clinic who suggest that their husband should have a check-up for a testosterone deficiency.’
Testosterone replacement therapy has been around in the U.S. for more than ten years and there are conferences all over the world focused on the latest research and development in the field, adds Dr Armstrong.
In the UK, it was initially used for specific medical problems such as hypogonadism (the inability of the body to synthesise sex hormones) but, ‘over the past few years, the medical community in the UK is embracing the concept of TRT for healthy men with andropause symptoms’.
Various forms of testosterone are available, but the bioidentical version used at Light Touch is mostly plant-based and chemically similar to those naturally produced in the body, which minimises side-effects.
The testosterone is administered through weekly injections at the clinic, although creams, which are applied to the upper or inner arms, buttocks, upper or inner thigh, can be offered as an alternative.
Not that Dr Armstrong hands out courses of testosterone treatment like sweets. ‘You should not treat people whose levels are within the normal range,’ she says.
She works in Weybridge, Surrey and says: ‘After the age of 30, there is a 10 per cent reduction in production’
‘If you give someone testosterone, your body believes it is producing enough, so stops producing it naturally in the testes. So you have shrinkage of the testes and a reduction in sperm production that can make you infertile.’ Gulp. Um, OK.
She stresses again that most of the side-effects — notably the risk of growing breasts or of becoming infertile — can be countered with other drugs, called ‘inhibitors’, and that the testosterone dose can be ‘tweaked’ if other symptoms such as mood swings, acne or hair problems develop. So that’s all right, then.
While it sounds daunting, some men clearly swear by it. John Walker*, a 41-year-old driver from Guildford, Surrey, started taking TRT four months ago.
‘I was fed up with my total lack of energy. I’d gained weight and struggled to lose it again and I wasn’t particularly interested in sex — even though I had girlfriends,’ he says.
Dr Armstrong put him on a weekly course of TRT injections and ‘almost immediately, I felt more awake. Interestingly, I had more confidence, too, and the fat began to melt away.’
Despite testosterone replacement therapy being around in the US for more than ten years, it has only recently started becoming popular in the UK (file photo)
He was prescribed anti-oestrogen pills because, paradoxically, TRT can increase oestrogen levels in men, leading to those feminising side-effects such as ‘man boobs’.
‘Stereotypically, you think of a man taking testosterone supplements as very macho, extra competitive — but I’ve not felt like that at all,’ adds John. ‘Just happy because I’m not constantly tired.’
John admits it’s not a topic he brings up voluntarily at the pub, but says he has told friends about it.
‘Despite the eye-watering cost, I can honestly say that TRT has made a really positive change to my life — especially my self-esteem. And yes, I’ve ditched the Viagra!’
Dr Armstrong is keen to point out that testosterone is not a ‘magic bullet’ that can cure all ills and she will only prescribe TRT as part of a holistic approach to a client’s ‘wellness’. Rather than merely treating symptoms, this involves looking at all aspects of diet, exercise, mental wellbeing and lifestyle, to look at the root cause of their health problems.
And yes, I’ve ditched the Viagra!
A report in 2017 estimated that the global wellness market was worth $3.7 trillion and, like with exercise, grooming and diet before it, the share of the market dedicated to men is increasing. It’s not such a leap for men already investing in expensive moisturiser, pricey cycling gear or triathlon training sessions to fork out on a wellness check-up.
My own consultation with Dr Armstrong and then Helen Williams was comprehensive. Before she took my blood, Dr Armstrong asked me how much I exercise (quite a lot), how much I drink (also, sadly, quite a lot) and how well I eat (quite well a lot of the time, quite badly when I’m busy and have to grab a sandwich or fast food).
She listened to my chest and lungs and measured my height (5 ft 11 in) and weight (14 st 8 lb). She examined my prostate, too — another thing you wearyingly get used to as a man in his 50s — and told me it was fine.
Her colleague Helen’s analysis of my lifestyle revealed both good and bad news. On the plus side, I do between four and ten hours of exercise a week — a mix of gym, swimming, cycling, yoga and Pilates — which is good for both mental and physical wellbeing.
This not only provides a structure and a reason to get out of the house during my working week as a freelance journalist, but also means I am stronger and calmer than I was in my 40s.
When we’re home together, my wife and I usually make our own food from scratch — mostly chicken or fish with vegetables and, very rarely, red meat. We also take supplements and vitamins to ward off dementia and arthritis.
Nick Curtis says that more and more men are looking after themselves better and its natural for them to then spend money on a wellness check-up (file photo)
Although I am sometimes tired, I have quite a lot of energy and engage heartily with life, trying to get as much from each day as I can. I still have a reasonably healthy libido.
Now the bad news. I feel depressed every Monday morning. I’m around a stone overweight. My work involves a lot of evenings out, which means I often grab food on the go and get to bed late.
Even in middle-age, I find it hard to persuade myself to go to bed early, convinced I will miss something. Often, I am looking at my iPad or phone in the hours immediately before sleeping.
I drink pretty much every day and at least double the recommended weekly allowance, although my wife and I do give up alcohol every February.
Meanwhile, my job, which mostly involves meeting strangers and asking them very personal questions, can be stressful.
As Helen explains, stress causes the body to generate the fight-or-flight hormone cortisol, flooding the body with energy. And, since we’re not using that energy for its primal purpose, it gets ‘packed away’ as glucose and fat.
She advises me to introduce meditation into my day, through smartphone apps such as Calm or Headspace, or by doing breathing exercises. ‘Go to bed earlier,’ she adds. I should also not look at a phone or iPad screen for two hours before bed, because the blue light they produce adversely affects levels of melatonin, which aids restful sleep.
If this proves impossible, then I should invest in some blue light-blocking glasses (available on amazon.co.uk, from £19). ‘Really attractive!’ says Helen.
But do I need testosterone? Dr Armstrong has the results of my blood test. They show that my liver function, kidneys, calcium and vitamin D levels are all fine and that I am not at any imminent risk of diabetes or prostate, bowel or pancreatic cancer.
‘Your testosterone is in the lower limits of normal,’ she says. ‘However, since you don’t have symptoms, I won’t treat you.’
My tiredness and occasional lack of focus and low mood are just part of the wear and tear of everyday life and my extra weight a result of my lifestyle, rather than a testosterone deficiency. Dr Armstrong advises me to cut down on alcohol (I think I’m finally getting the message here) and follow Helen’s advice on diet and optimising energy levels.
And maybe if I do, I won’t find myself rubbing testosterone cream on my buttocks and wondering if my testicles are about to start shrinking.
As Helen says, the sort of stuff she suggests men factor into their lives is not rocket science, just good advice, which I’d better start following. It’s time I opened my heart and my mind to wellness. Resistance is futile.
lighttouchclinic.co.uk
*Name has been changed.