He changes from being a positive, bullish person who is good to be around to a negative, pessimistic, depressed bear with a sore head and it is increasingly difficult to live or work with him.

At work he is seen to have ‘gone off the boil’ and no amount of encouragement or urging will improve his performance. At home, family relations tend to become increasingly strained and social life and activities are close to nothing.

His sexual life is usually a disaster area too. He experiences a loss of libido and intermittently fails to achieve an erection, leading to performance anxiety and eventually complete impotence. This creates a downward spiral of failing function both in bedroom and boardroom.

There seems to be no doubt about the existence of two separate challenges that can occur in men (but may not do so) between the ages of about 40 (occasionally earlier) and 55. These are the midlife crisis and the male menopause, also called the andropause or viropause.

They are not concepts that have found universal acceptance. But various health professionals and psychologists have heard from men who have gone through what can be profound and agonising crises. Many midlife crises go unnoticed and are passed off as the effects of a change of job, a change of house or a change of spouse.

Only occasionally does the drama turn into a full-blown existential crisis in which the man may feel he is stuck in a career which under- or over-extends him, producing the prospect of burn-out; or in a dead marriage or relationship which gives him the choice of separation and its consequent traumas, financial ruin and starting over again.

The male midlife crisis is essentially emotional in nature; the andropause has a basis in falling hormone levels, and in that sense at least is physical, although the consequences of changes in hormone levels are not just physical. The two are not independent of each other.

A significant number of men experience a range of ill-defined symptoms such as fatigue, loss of concentration, forgetfulness and sleep disturbances that are commonly suffered by menopausal women. Many medical experts believe that male symptoms are not hormonally driven but caused by stress and psychological factors.

Certainly, middle age can be a time of change and is often a period when people start to come to terms with their own mortality, sometimes coupled with the feeling that their best years now lie behind them.

Many middle-aged men notice a reduction in their libido or experience minor problems

relating to sexual performance that may contribute to their symptoms. However, some experimental studies have shown that, given testosterone replacement therapy, a number of men have noticed an improvement

in their symptoms.

Some doctors therefore believe that although there is no reduction in testosterone levels, the hormone works less effectively in middle-aged men and this is the factor responsible for male menopausal symptoms.

Testosterone replacement therapy is currently a very controversial treatment because there are concerns that giving additional testosterone to essentially healthy men may have detrimental effects, particularly an increased risk of cancer of the prostate gland.

Of course, as a man you may have some inhibition against speaking in an intimate way with other men; and this could present a challenge to dealing with the issues you face. If this seems too big a challenge, you might want to buy relevant books and gain a sense of not being alone in what you are experiencing.

A man suffering from such symptoms should visit his doctor for a health check up.

The doctor may recommend measures to deal with stress.

The importance of therapy should not be underestimated. The problem, of course, is finding a therapist who is good, mature or wise enough to help in the transition from one side of the crisis to the other.

But they are out there, and they can ease the pain and provide support.

It might follow that you would want to see a male therapist since this issue at least is one that a male might be better qualified to understand.

With or without therapy, there is no doubt that for men who have a crisis, it can be no laughing matter, for it often seems to be based on unsolved issues from the past that cause self-doubt about the present and fear of what the future holds.

It may be difficult for an

individual to regain a positive outlook on life but, given a

little effort or with professional help, this may be achieved with time.