Is Your Husband Still the Man You Married?

Sometimes the people closest to us notice the change before we do.

As doctors, we pride ourselves on delivering patient-centred care. But there is another side to Testosterone Deficiency that deserves more attention: its potential impact on the people around the patient.

Partners. Children. Friends. Work colleagues.

Over the years, I have met many men who come to see me because somebody else has noticed that they are no longer quite themselves.

Often, it is their wife or partner.

The change is rarely dramatic. There may not be a particular day when everything suddenly became different. Instead, it can be an insidious decline over months or even years.

He is more tired. Less motivated. Perhaps increasingly irritable or withdrawn. He doesn’t want to socialise as much. His enthusiasm for things he once enjoyed has faded. His confidence has changed. He may struggle to concentrate or find himself lacking the drive he once took for granted.

And then there is the relationship itself.

Perhaps affection has diminished. Sex has become infrequent or disappeared altogether. Are you finding that you’re always the one initiating intimacy? Perhaps he’s also experiencing erectile difficulties. What was initially attributed to stress, work, getting older or simply being together for many years gradually becomes the new normal.

But accepted does not necessarily mean normal.

“You’re not the man I married.”

One of the privileges of caring for patients over many years is hearing not only about their own experiences, but also those of the people closest to them, who are very much part of that journey.

I’ll always remember standing at reception when a patient and his wife walked into the clinic. His wife bounded over to me, threw her arms around me and gave me a hug. She then looked at me and said, “Thank you. You’ve given me my husband back.”

It was an incredibly humbling moment and one that has stayed with me ever since. It was also a powerful reminder that the impact of our work extends far beyond the individual patient. Health affects relationships, families and the people closest to us.

This isn’t about suggesting that every struggling relationship has a hormonal explanation. However, there is an interesting overlap between the age at which women typically experience perimenopause and the stage of life when men may begin experiencing symptoms associated with Testosterone Deficiency. Both can affect physical and psychological wellbeing, sexual intimacy and relationship dynamics.

Changes in mood, energy, motivation, sexual function and general wellbeing have numerous possible causes. Stress, poor sleep, depression, relationship difficulties, medication, alcohol, obesity, metabolic disease and other medical conditions may all contribute.

Testosterone Deficiency is simply one possibility that should not be overlooked.

Why those closest to us often notice the changes first.

When something changes very gradually, we adapt to it.

A man may not recognise that his energy has progressively declined because there was never a dramatic change. He may attribute falling asleep on the sofa every evening to getting older, reduced libido to being busy, or increasing irritability to pressure at work.

The person living alongside him has a different perspective.

She remembers the man who used to suggest going out at the weekend. The man who couldn’t keep his hands off her. The dad who had the energy to play with his children. The person who was ambitious, engaged and interested in the world around him.

And there can be another complication. When we’re struggling, we’re not always the best judge of how much we’ve changed.

A partner saying, “You don’t seem yourself lately” may be trying to help, but it can easily be heard as criticism. If someone is already feeling tired, irritable, low in mood or unlike themselves, concern from the person closest to them can sometimes provoke defensiveness rather than reflection.

That can create a difficult dynamic. One person is saying, “I’m worried about you”, while the other hears, “There’s something wrong with you.” Our physiology can influence our perspective, sometimes making genuine concern feel like criticism.

Sometimes it is worth stepping back and asking a different question: Is my partner trying to criticise me, or have they noticed something in me that I haven’t yet recognised myself?

This doesn’t mean a partner can diagnose Testosterone Deficiency. Irritability, low mood, fatigue and changes in behaviour can have many possible causes and need to be considered in their proper clinical context.

But the observations of the people who know us best can be valuable.

Sometimes they see the gradual change before we do.

Thanks for helping me unwind the years and giving me a full tank of fuel to enjoy every day. My wife is enjoying having ‘the old you’ back. She says I’m no longer as tired or grumpy. – Rupert, 42

What are the symptoms of Testosterone Deficiency?

Testosterone plays an important role in male physical and psychological health. Symptoms associated with Testosterone Deficiency can include:

• fatigue or reduced energy
• low mood
• irritability or changes in mood
• reduced motivation
• difficulty concentrating or “brain fog”
• reduced libido
• erectile dysfunction
• loss of muscle mass and strength
• changes in body composition
• reduced general sense of wellbeing.

No individual symptom proves that a man has Testosterone Deficiency.

That distinction is extremely important.

Testosterone Deficiency is a clinical and biochemical diagnosis. Symptoms need to be considered alongside appropriately performed blood tests and a wider assessment of the man’s health.

What should you do if you’re concerned?

If several of these changes sound familiar, the first step isn’t to assume low testosterone. It is to investigate properly.

A validated symptom questionnaire such as the ADAM questionnaire can help identify symptoms associated with androgen deficiency and provide a useful starting point.

However, a questionnaire cannot diagnose Testosterone Deficiency.

At The Men’s Health Clinic, diagnosis requires a comprehensive assessment together with appropriately timed blood testing. Testosterone levels naturally fluctuate, which is why a diagnosis should not be based on one isolated result.

We require two separate morning testosterone measurements, taken between 7am and 11am and several weeks apart. A comprehensive initial blood panel is also important because simply finding a low testosterone result doesn’t explain why it is low.

The underlying cause matters.

Sleep, weight, stress, medication, alcohol, nutrition, metabolic health and other medical conditions can all influence testosterone and wellbeing. Where reversible factors exist, addressing them may be more appropriate than immediately considering medical treatment.

Open the lines of communication, not confrontation.

If you recognise your husband or partner in this article, you don’t need to suggest that he has low testosterone. Start by sharing what you’ve noticed.

Men have traditionally been less inclined to communicate openly about their health, particularly when it comes to emotional wellbeing and sexual function. He may not have recognised the gradual changes himself, may have dismissed them as an inevitable part of ageing, or may know something isn’t quite right but struggle to articulate it.

For many men, acknowledging that something is wrong requires a degree of vulnerability. But vulnerability is not weakness. Recognising when something isn’t right and being willing to talk about it is a strength, not a failing.

Approaching the subject with understanding rather than perceived criticism can open the lines of communication and encourage him to take his health seriously.

If Testosterone Deficiency is suspected, it deserves proper investigation.

Because the objective shouldn’t simply be to improve a number on a blood test. It should be to understand what has changed, establish why, and help that individual achieve the best possible physical and psychological health.

Sometimes the person who recognises that change first isn’t the patient.

It’s the person who knows him best.

Dr Robert Stevens MBChB MRCGP Dip.FIPT
Medical Director, The Men’s Health Clinic