Testosterone deficiency (TD), often called the 'manopause,' is a largely overlooked hormone problem affecting millions of men, yet fewer than half are diagnosed, according to NHS GP and men's health specialist Dr Jeff Foster. He argues that the condition needs a public awareness breakthrough similar to the female menopause.
What is Testosterone Deficiency?
Testosterone deficiency is a slow, insidious decline in the male hormone that typically creeps up on men in their forties and fifties. Symptoms include persistent tiredness, loss of muscle strength, unexplained weight gain, irritability, and a fading libido. Dr Foster describes it as a mid-life 'flatness' that many men dismiss as normal aging. 'For most men it's slow and insidious,' he says, adding that a man often realizes he has felt 'really rubbish' for two or three years without knowing why.
The Scale of the Problem
At least two million men in the UK have testosterone deficiency, yet fewer than a million have been diagnosed. The condition often goes untreated because men do not recognize it as a medical issue. 'If you don't test it, you don't know,' Foster warns. More than 40 percent of men with low testosterone experience depressive symptoms, according to Foster.
Stigma and Bravado Hold Men Back
Dr Foster compares the current state of testosterone deficiency to the menopause before it was widely discussed. 'Back when I trained as a doctor, medicine still waved it away as something natural women go through,' he says. It took years of advocacy, with Davina McCall among the loudest voices, to bring menopause into the open and win support for HRT. Men, Foster suggests, are now roughly where women were before that shift.
Stigma is a major barrier. To admit low testosterone is to risk feeling 'I'm not so much of a man anymore,' Foster says. When a fortysomething man loses interest in sex, the assumption is often marital problems rather than a hormonal issue. 'Could you imagine a low testosterone or erectile dysfunction café?' Foster jokes, highlighting the lack of open discussion among men.
Misinformation and the Longevity Fallacy
While many men ignore real symptoms, others are misled by influencers on Instagram, TikTok, and YouTube who promote testosterone replacement therapy (TRT) as a performance enhancer. Foster is scathing about young men who boast of being on TRT since age 16 when they are actually taking steroids. 'That's not the same thing,' he says. Loading testosterone into a healthy young body is 'catastrophically bad for you' and can cause infertility, breast tissue growth, and shortened lifespan.
Similarly, the longevity craze often sells testosterone as an anti-aging hack. Foster is cautious: 'There's very little evidence for anything in longevity.' However, for genuinely deficient men, treatment can improve longevity. 'If you've got low testosterone and you treat it, it really does improve longevity. You will live longer,' he says.
What Men Should Do
Dr Foster advises men not to turn to supplements, as 'almost all testosterone boosters do nothing.' Instead, he recommends starting with lifestyle basics: proper nutrition, regular exercise, and adequate sleep. If symptoms persist, men should get their testosterone levels tested through a GP or reputable private provider. A mentor once told Foster that 'testosterone is the best single indicator of a man's current health.'
'It might be that your wife doesn't hate you, it might be that your testosterone was low, and you can do something about it,' Foster says. His book, Optimal: Understanding Testosterone for Strength, Health and Wellness, is now available.
