It would be grossly unfair to suggest that opera singers spend their free time lounging on chaises longues being spoonfed foie gras. When there are no witnesses, many of them probably run marathons or something. Still, Ian Storey must be more active than most; as a young man, he played badminton and squash at county level and above. Now aged 52, he relaxes by laying bricks or swinging a sledgehammer. Having built a home for his family in the Herefordshire countryside, he's planning to bulldoze it and start over. "I normally have a building project on the go," he says.
Yet a couple of years ago, he found this energy draining away. He'd taken on one of opera's most demanding roles – the lovestruck hero of Wagner's Tristan und Isolde – and breezed through the 10-hour rehearsals and the first shows in Milan. But in early 2008, he recalls, "I just started to feel tired. I thought, 'Oh, well, maybe it's just everything catching up with me.' So I plodded on. But I wasn't my usual self."
Fatigue turned to exhaustion, joined by headaches and hot flushes. Away from the stage, Storey could barely bring himself to pick up a drill. By the summer of 2009, he says, "I was getting to the end of a performance and I'd just want to curl up under the table and go to sleep. The next day I felt like I'd been run over by a tram. Performing takes it out of you, but not to that extent." In the end his wife insisted he take himself to the doctor.
It took six months of blood tests and MRIs, but Storey finally got a diagnosis. The good news? He didn't have heart disease, diabetes or a brain tumour. On the other hand, he did have extremely low levels of the sex hormone testosterone. He was going through the andropause.
"I hadn't even heard the term before," Storey says. A lot of people haven't. It's sometimes called the male menopause, or even the "manopause". But the snappy terms are misleading, implying something that is as inevitable for men as the menopause is for women. As with the female menopause, some drugs manufacturers are keen to offer solutions for this frightening idea. Schering-Plough's website Andropause.com, for instance, which makes a big deal of a testosterone preparation called Andriol, claims that "starting at about age 30, testosterone levels drop by about 10% every decade" and estimating that "30% of men in their 50s will have testosterone levels low enough to be causing symptoms or putting them at risk". So if you are male and middle-aged, should you worry?
Not according to the experts, who say a diagnosis such as Storey's is actually quite rare. "We get a lot of referrals from men who believe that their sort of midlife symptoms are due to low testosterone," says Frederick Wu, professor of medicine and endocrinology at Manchester Royal Infirmary. "More often than not there are other explanations."
Storey's diagnosis – what Wu prefers to call late onset hypogonadism "is not inevitable or universal like the female menopause," he insists. "The age-related decline in testosterone starts at about 35 or 40 but it's very slow. And it's very much influenced by health and body weight." His recent study of more than 3,000 European men, published in the New England Journal of Medicine, found that 2% had "symptomatic testosterone deficiency". The older you are, the more likely you are to be affected: among over-70s, only 7% will have a problem; at 40, the figure is less than 1%. And since testosterone deficiency is often the result of other health problems rather than the cause of them, obese men, for example, often find that once they lose weight, hormone levels bounce back.
"People do have pathologies that affect the testes [where men produce almost all their testosterone] or the pituitary gland [which controls its release]," Wu says, "but that can happen at any age. The low testosterone that is supposed to be purely related to old age – that is pretty rare."
Those, such as Storey, who do need attention are prescribed some form of hormone replacement, although this is not without risk. "Putting older people on testosterone for many years could have quite dangerous consequences," says Wu. "Another paper in the same issue of the New England Journal of Medicine showed that older men given testosterone have an increased incidence of serious cardiovascular events."
Gels and injections are the commonest means of application; a single jab can last three months. Storey has patches, which he changes daily, choosing a different location each time to prevent soreness. The patches made him nauseous at first, but that was the only side-effect. His testosterone and energy levels are back to normal. Now he says, he still sometimes feels tired after a performance, but is no longer "destroyed". "It's been superb to find that this could be treated so easily."
