Why every man like me needs a midlife MOT

The epiphany occurred at Vue Cinema in Portsmouth, in the middle of The Super Mario Bros Movie. I was there with my 21-year-old daughter and 16-year-old son (there was nothing else on, OK), and it dawned on me that Mario was a metaphor for middle-aged males like myself. There he is, clunking through a rigged system, dodging hazards, on a quest for what? Just when he thinks he’s triumphed, victory is snatched away, and the whole game begins again.

This is where I am. Fifty-plus years in, much luckier than some, but still plugging away. The barrels and fireballs I dodged in the video games of my youth are now to be found in a real-life “sniper alley” – financial instability, obesity, hair loss, and the nagging worry that the movie is in its closing scenes and the plot hasn’t worked out quite as I hoped.

This low-level existential malaise is not uncommon among my peers – we are more likely than women to struggle with our health, to suffer from loneliness, and to attempt suicide. A 2018 study by the National Institute for Health and Care Research concluded that by 2035, two-thirds of us aged over 65 will be living with multiple health conditions, such as type 2 diabetes, cancer and heart disease.

Men don’t need or expect pity, but we may need to start addressing problems sooner rather than later. Earlier this summer, the government launched an online midlife MOT for everyone between the ages of 45-65, which covers work, health and money. It’s a good idea – but it doesn’t touch the sides when it comes to what’s really going on, so I have decided to do one of my own.

Physical fitness

Middle-aged men are sold several myths about their bodies. One is that our metabolism slows down because of ageing. It doesn’t – it plateaus between the ages of 20 and 60. The other is that we go through a male menopause, caused by a drop in testosterone and typified by weight gain, lack of focus, a drop in libido, and fatigue.

In truth, clinical male menopause, or andropause, is very rare, and it’s nothing compared to the very real symptoms women go through. While testosterone levels do drop by around one per cent a year from the age of 40, this is usually due to lifestyle factors such as obesity, stress and inactivity, rather than any natural process. Comparing midlife male lethargy with the hot flushes, mood swings, anxiety and sleep disturbances that women endure does women a disservice. If a healthy lifestyle is maintained, studies show that testosterone levels remain stable throughout middle and old age, so the majority of men just need to start moving a bit more.

Keeping fit is the most effective way of warding off a health crisis, and maintaining muscle mass is key. One of the most useful things a man past 40 can do is to have a body composition scan to check his levels of fat and muscle.

Which is why I find myself squeezing into a rubber suit dotted with electrodes, with personal trainer Fraser Smith passing an electrical current through my body while I perform a range of functional strength exercises. This electrical muscle stimulation, or EMS, is one of the most effective methods for maintaining muscle mass. In just 20 minutes at Fraser’s Vive Fitness studio in London, I get a targeted, intense workout that would take hours at the gym to achieve.

“Men lose muscle as they age not because of ageing but because they tend to become less active,” Fraser explains. “Ratios tend to tip with age towards an increase in fat mass, which often isn’t realised as your overall body weight can remain the same: muscle mass down and fat mass up.”

The only truly accurate way to detect fat composition is with imaging technology such as MRI, CT, and X-ray scans, with the gold standard being a dual-energy X-ray absorptiometry scan, or Dexa. A scan like this gives a detailed full-body X-ray showing where in the body fat and muscle are located and analysing the ratio and volume of fat mass and muscle mass. Mine shows a healthy distribution, which suggests I don’t need to worry too much.

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“If you train regularly, independently of your testosterone level, you are going to be fitter and healthier with improved aerobic capacity, stronger muscles, and better functional movement, which begs the question: do testosterone levels matter as much as is being made out?” asks Fraser.

The key to staying in shape is not rocket science. It’s good nutrition and regular exertion, which should be a mix of cardiovascular exercise, such as running or cycling, and strength training.

The World Health Organization recommends that adults should do at least 150–300 minutes of moderate-intensity aerobic physical activity a week (vigorous walking, cycling on a flat or anything that raises your heart rate), or at least 75–150 minutes of vigorous-intensity aerobic physical activity (running, cross-trainer, cycling up hills). While this should be a baseline, if you are aiming to lose weight, add more.

Fraser explains that it’s also important not to overlook functional movements that engage a range of muscle groups, which include squats, lunges, mountain climbers, and burpees. A good target for a middle-aged man with an average fitness level like mine would be four 40-minute sessions a week, with two concentrating on cardio and one combining 20 minutes of cardio and 20 minutes of resistance training with weights.

Your ability to balance on one leg is important too, as poor standing balance has been associated with memory loss and faster decline in mental function. Typically, a person in their 50s should be able to hold their balance for around 40 seconds, and practising doing this can be incorporated into daily routines such as boiling the kettle or brushing your teeth. “There’s not one rule,” says Fraser. “You need a holistic approach.”

Nutrition

Around 15 years ago, I changed my diet profoundly. I cut out almost all meat, bread, and beer and concentrated on a mainly pescatarian diet full of fresh fish, fruit, and vegetables. I lost two stone in six months and went from a 34-inch waist to a 30-inch waist.

But in the last five years, that weight has slowly started to creep back up as I find it harder to resist biscuits and a pint. While I can still fit comfortably into my jeans, my shirts are starting to strain.

Which is why I called Rhiannon Lambert, a nutritionist and founder of Harley Street clinic Rhitrition, who recommended that I try mindful eating. The idea is to slow down and appreciate the taste, texture, and smell of whatever you are eating and cut your portion in half. I tried it with biscuits, which I would normally mindlessly shovel in half a packet at a time. By mindfully eating, I kept it to just two biscuits. It’s a neat trick.

Biscuits are one vice. Beer is another, and I often go over the recommended 14-unit weekly limit. According to the NHS, the recommended daily calorie intake is 2,500 for men; the average chocolate Hobnob is nearly 100, so if you factor in a couple of pints after work on top of three or four biscuits with a cup of tea, and you are adding around 650 calories each day. As a guide, it takes me a gruelling 45-minute high-intensity interval training session to burn through that amount of energy.

The result? Middle-aged spread and beer bellies. The key to avoiding this is to “prioritise eating in a better way”, which means consuming fibre, whole grains, and healthy fats such as oily fish, olive oil, and avocado. In essence, a Mediterranean diet.

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“Keep saturated fat to a minimum, avoid processed meat and add more pulses and beans,” recommends Rhiannon. She also advises Omega 3 and vitamin D supplements at any adult age. Omega 3 being good for brain development and cognition, eyesight, and reducing inflammation, while vitamin D helps the body absorb and retain calcium and phosphorus, which are both critical for building bone.

One of the common mistakes middle-aged men make is loading up with protein in an effort to gain or maintain muscle mass. “Protein seems to be a health halo food group for men, but it is not calorie-free and will be turned to fat if it’s not used.” Much better, she says, to eat some form of protein three times a day, aiming for just over 1 gram of protein per kilogram of body weight.

Sex and relationships

I’ve been married to my wife, Stephanie, for seven years. We got together 12 years ago, and the fireworks have now settled into a smouldering bonfire that occasionally relights. Five years of unsuccessful IVF did little to help our sex life, which became mechanical and functional for a while.

However, I’m lucky that my libido is still intact, and I still desire my partner, which isn’t always the case for many middle-aged couples. According to a recent survey conducted by The British Medical Journal, 34 per cent of women and 15 per cent of men said that they lost interest in sex after being in a committed relationship... for just three months.

Sexologist and associate professor at California State University, Fullerton, Dr Tara Suwinyattichaiporn, says that boredom is a common problem. “I coach many middle-aged men, and a lot are experiencing boredom in the bedroom or a lack of desire to initiate sex,” she explains.

She differentiates between low libido, which involves bodily function, and low sexual desire or passion. It is common, she says, for relationships to hit these barriers at around the 10-year mark. Which could all be a bit depressing if it were not for Dr Tara’s “radical sexual intervention” techniques, which start with a difficult conversation.

“One person usually hits the wall first and realises that things can’t go on as they are. The conversation about how they feel needs to be open and honest,” she says. “Then you need to work on compromise. Try different sexual activities together that are not just penetration to make sexual intimacy more interesting again.”

Another technique is “sex fasting” followed by “sex feasting”.

“Commit to no touching for seven days to reset the body and the familiarity of touch. Hopefully, it creates longing and craving for each other,” she explains. “Then try sex feasting where you both commit to having sex every day for seven days.”

Ultimately, she says, it all boils down to this: “Everyone wants to feel desired, turned on, and loved.” All of which resonates. I realise I’m guilty of plodding along and taking my relationship for granted, and I need to make a bigger effort to foster more intimacy in my marriage.

Mental health

Recently, I was asked to go to an awards ceremony on behalf of a friend who couldn’t attend. My wife was busy and in years gone by, I could have called any number of mates who would have been happy to avail themselves of the free food and drink. In the event, the handful of friends I have weren’t interested, and the thought of spending several hours with strangers making small talk terrified me. It struck me; I don’t have the confidence I did, nor the friendship circle.

Social anxiety creeps up on you as you get older, and so does loneliness. Simon Gunning is the kind of person that every middle-aged man should have as a friend. He’s funny, smart, and caring. A mental health professional, Simon is CEO of the Campaign Against Living Miserably (CALM), he describes the middle-aged male human condition perfectly.

“When you are middle-aged, it feels like things are stopping. Depending on your circumstances, the hope starts to fade that the future can be as good as the past or present.”

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Calls to CALM’s helpline predominantly fall into two categories: financial worries and loneliness, and the latter affects how resilient you are when it comes to other problems. Simon explains: “The friendship networks built when we were younger are not present for many middle-aged men. Your opportunities for meeting like-minded people diminish year on year. Men often end up being friends of the husbands of their wife’s friends, but when your kids get older, those friendship groups can go too. A lot of men end up with nothing on their plate.”

When you’re lonely, studies have found that white blood cells change their behaviour, leading to more inflammation and a weakened immune response, and this has been linked to heart disease, obesity, and cognitive decline. According to the British Psychological Society: “Friendship is the single most important thing affecting our psychological wellbeing, as well as our physical health. Spending time with our friends releases endorphins in the brain and makes us happy.”

Simon provides valuable advice. “Go to that thing,” he says. “Whatever that is – a football match, a concert – do it, because it’s easy not to as you get older.”

For me, “that thing” was the awards ceremony. I went on my own and for 30 minutes felt awkward and out of place, as I was the only person there not in a couple or a group. But then I met a few interesting people and, ultimately, I left on a high, taking full benefit of the endorphin hit that comes with increased social activity.

My conclusion? If you’re looking for health, happiness and purpose, a mid-life MOT could also be what helps you get there.