text: Everyone knows the menopause affects women, both mentally and physically. It creeps up on us after decades of dealing with PMT, childbirth and whatever else ovaries throw at the female species. But what about men? Is there a scientific excuse behind the need for Netflix binges, moody man syndrome and grey days? We’re pleased to announce there actually is!
  Gents, here’s your excuse for everything you don’t do quite right…
  "As we all get older, both men and women, we start to develop features of old age, which change how we look, how we move and how we feel,” says Dr. Aamer Khan, MB ChB, co-founder of Harley Street Skin Clinic.
  We’re discussing the concept of the "manopause" and how men experience physical and mental changes as they age. It’s important to understand the hormonal and metabolic changes that occur in men, he says, as he offers Loaded an insight into his medical findings. The results also highlight the need for increased awareness and support for men's mental and physical health.
  Dr. Khan explains that as men age, they experience changes in their hormone levels, similar to women during menopause. These changes in hormone status, particularly a decrease in testosterone levels, can lead to various symptoms such as erectile dysfunction and mood swings.
  “All the things that the menopause brings for women, the same sort of things come for men because of the changes in their hormone status,” he says. “It's an epigenetic change and historically it used to happen later on in life. As we age, our growth hormone diminishes. Everybody's does because it's not needed. If we had high levels of growth hormone in our late twenties to early thirties onwards, then we would carry on stimulating growth of bone. As a result, our joints would fuse and our hearts would get too big and become unhealthy. And of course if we developed any cancer it would stimulate that as well. So growth hormones starts to diminish to try and protect us. Other hormones such as insulin, thyroid hormone, and the other sex hormones like testosterone take over and support our health, wellbeing and musculature. But what happens as we get older is that we develop a metabolic disturbance. It's one of the hallmarks of ageing. In turn, we start to develop insulin resistance and depletion of insulin production, which means we start to put belly fat on and that belly fat and particularly visceral fat around the organs in our abdomen increases our cardiovascular risk. From a hormonal perspective, it breaks down, it starts to metabolise testosterone and produces estrogenic hormones. So what happens is that our testosterone levels start to go down.
  "At the age of 30, one in four (or 25%) of all men will have a degree of testosterone deficiency. But not only that, they will also be experiencing erectile dysfunction as a primary sign of the male menopause starting earlier. I believe this is because of lifestyle, the poor quality highly processed foods we eat, and the relative lack of exercise. We’re sitting a lot and it really doesn't help. We need to be moving.”
  If you feel as if you’re in full depletion mode, the lure of shooting some human growth hormone as sported on the medical card of many a hunky celeb could seem like the answer to age reversal. Not according to Dr Khan though…
  “Human growth hormone can help to slow the visible signs of ageing if it is given in very small doses, but it needs to be monitored very carefully,” he says. “It’s not something I’d recommend and the adverse effects possibly outweigh the benefits. The indication for human growth hormone is in people who have issues with growth hormone itself because the pituitary produced growth hormone naturally diminishes soon after adolescence. At this age, our bodies have already developed and we've grown to what we should be. If we override our own growth hormone production by injecting it, number one, it will stop working. And the second thing is that it will stimulate areas we don't want stimulating. We don't particularly want an overly large heart.
  “If anybody is taking growth hormone and they want to continue, it's their personal choice, but it’s not something that I would particularly recommend. There are more natural ways of stimulating your tissue based growth hormones. But if somebody is taking it, I would recommend that they're monitored very carefully by a metabolic specialist who understands hormones.”
  So lads, you’re pretty much fucked from the age of 30. The “manopause”, it would seem, takes hold at an earlier age than the menopause does for women. Brilliant.
  “As men get older, they may develop a metabolic disturbance, leading to insulin resistance and a depletion of insulin production,” says Dr Khan. “This can result in the accumulation of belly and visceral fat, which increases the risk of chronic inflammation and cardiovascular problems.”
  Dr. Khan attributes the early onset of the "manopause" to lifestyle factors such as poor diet, lack of exercise, and sedentary behaviour. He suggests that making healthier choices and staying physically active can help mitigate the effects of ageing.
  “As I said, we’re noticing changes in men earlier than in women,” he says. “They used to happen later than in women, but diet is the main cause due to the impact of processed foods on the male metabolic state. The “manopause” is not not solely due to testosterone and oestrogen changes. It's related to our metabolism and we're seeing metabolic syndrome X earlier and earlier in men. With women however, we can correct the metabolism and alleviate the effects of the menopause quite significantly.
  “There are countries in Europe where we see metabolic decline before we see the menopause. On the flip side, there are genetic populations, for example in Japan, where they didn't recognise the menopause for a long time, because their lifestyle and genetics mean they often don’t suffer the same menopausal symptoms as we do. Both the menopause and the ‘manopause’ are a complex interplay between what's happening within our bodies and the hallmarks of ageing. Those hallmarks are deterioration and changes in our hormones and our hormonal balances, which are what we call epigenetic and environmental changes. These are also related to that metabolic change that happens as a result of ageing. And if our cellular ageing is accelerating, it's happening earlier because of poor choices with our lifestyles and diets.”
  Changes in mood affect men too. Women complain of pre-menstrual tension. What about ‘pre-manopause’ tension for the lads!? It’s a thing. A real thing.
  “Men have difficulty with mental health because of this toxic masculinity where men are expected to perform and to be quiet and to get on with it,” says Dr Khan. “Talking about how they're feeling isn't something that men do generally. They tend to hold everything in and if something goes wrong, then it makes it a lot worse. But it's becoming a lot better now. More and more men are now opening up and speaking.
  “In men we see hormonal changes that cause brain fog and their concentration is affected, which will always worsen any preexisting mental situation that's there. We've got to start thinking about the human being- not a being whereby mental health and physical health are separated. They are one, and mental health will affect physicality and physical processes happening in the body and metabolic processes and vice versa.
  “Physical health and physical deterioration, metabolic deterioration will affect mental health. They're very closely interlinked. And what we tend to forget is that with the changes in our diet and our environment and how we live, there's a huge change happening in the gut. The gut biome plays a huge part in how we feel mentally and it's not talked about enough. I think gut health is something that we should be including in our assessments of people as they age, so we can help them to reestablish a healthy gut flora and they can have a healthier life.
  “If we look at the hallmarks of ageing, most of the decline is due to chronic inflammation that sets up in our bodies as we get older, because our bodies are not dealing with it well. One of the ways of reducing that inflammation is consuming anti-inflammatory foods. We need good proteins, we need good fats. A rainbow of colour is so important because vegetables contain micronutrients which are represented in their colour. These micronutrients are essential for hormonal balances and balances of your cytokines, which are the messengers that communicate between cells and the macronutrients, which are the building blocks. I'd rather eat smaller portions of higher quality food than have large portions of poor quality food because the body will try and pick out what it can. The easier we make it for our bodies, the better. We should always look at where our nutrition is coming from. In my family we grow our own food and it's all organic. We don't use pesticides or artificial fertilisers. Try to eat things that are organic. They may cost more, but you need to eat less of them. What these organic plants do is they stimulate our cells to regenerate, just as they have to do to survive and regrow. So we're creating a regenerative environment in our bodies.”
  Dr Khan is world renowned for helping men cope better with the “manopause” and related changes. He advocates for a personalised approach to men's health, including genetic testing and understanding individual blueprints. He also emphasises that environmental factors and lifestyle choices have a significant impact on health outcomes and that positive changes can be made to reduce risks.
  “We run clinics and retreats and we also do the basic testing one month prior to arrival, because it's important to know who you are and what your blueprint is,” he says. “Doing a whole genome test gives us so much information from which we can start to change things. Our DNA and your predictive problems are only 20% of the outcome. 80% is what we do, our environment and how we live. So the good news is, we can change things and help to reduce those risks right now. But also if we pick up something that's significant like a potential cancer, we can start screening for it early. Having that knowledge is important. Some people don't want to know if they’re likely to develop cancer and we don't need to tell them that, but if we know, then we are on the lookout for it. It's a mental, physical, psychological and spiritual reset because all those pillars of wellbeing are important. If there's an imbalance, then people are not going to get the best out of what we do or out of their lives.”
  Dr Khan explains why it’s so important to him to raise awareness for mental and physical health (complete health), in men.
  “Women are well supported because the National Health Service is centred around women giving birth and supports them throughout,” he says. “The vaccination programmes are aimed at protecting women because they might get pregnant and they don't want to get measles, for example, during pregnancy. So there's a vaccination programme, there is a screening program. Cervical screening is there for women. And when they go through pregnancy, there's all that support through pregnancy. And then there's the menopause. Nobody believed the menopause existed for a long time. And when the National Health Service accepted it, there was a huge amount done for that. But getting back to men, the first time they see anybody is at the age of 50 when somebody sticks a finger up their backside and if they're already depressed that’s enough to make them even more depressed.
  “I think we need to increase awareness. Men start to develop erectile problems relatively early in their lives and they don't perform as they did when they were in their twenties, but because they don't talk about it and because they perceive this as being shameful and because everybody else is talking about being a man being able to perform properly, they base a lot of their self-worth around that. And rather than seeking help, they'll keep it quiet and that feeds into their mental health. If we bring these issues out into the open and say, “Hey guys, this is what happens, this is part of the ageing process, but there is something we can do about it,” it would make it so much easier.
  “I've got a mission to get the word out there, not just for men, but for everybody. I think there's going to be a huge change in the way we look at health and wellness and we want to do it properly. What we don't want to do is keep trying these different diets and fads, because they’re not doing anybody any good. What we need is facts. We need information. We need to base things on evidence and research, and there's so much coming out. And if we can present that in a palatable form, we can improve the health, not just of the individual, but of the whole world. And if we improve health, we're going to improve the world itself. Because if people are healthier and living longer, they're going to start thinking about how they want the world to be around them, rather than trying to get everything quickly.”
  Dr Khan emphasises the importance of evidence-based information, research, and a holistic approach to health and wellness. This article is intended to highlight the potential for positive change in the way society views and prioritises health, ultimately leading to a healthier and longer-lived population that can contribute to a better world.