At some point in your late forties you find yourself nodding off in front of the telly before the ten o’clock news. You snap at the dog. The stairs feel steeper than they used to. Then you tell yourself it’s just your age, which is very convenient, because it means you don’t have to do anything about it.
Sometimes age really is the answer. Often it isn’t the whole answer, though. A fair number of the things that make men feel tired, irritable and flat in midlife can be measured, and many of them can be treated. The trick is working out which ones apply to you before you spend £40 a month on a multivitamin with a mountain on the label.
Why am I tired all the time in my 50s?
Start with the boring causes, because they’re the most common. The NHS lists poor sleep, an unhealthy diet, too little exercise, stress and low mood as the usual culprits behind tiredness. None of them comes in a capsule.
Be honest about the basics. Are you getting seven hours or so, or nearer five, with a phone in your hand at midnight? Does a pint or three in the evening wreck the second half of your night? Have you gone from walking to the station to driving to the door? Has work, money or caring for an ageing parent quietly piled up? Any of these can leave you drained and short-tempered. Most of us are dealing with two or three at once.
Then there’s the snoring. If your partner has mentioned that you snore loudly, gasp or seem to stop breathing at night, and you wake up feeling as though you haven’t slept, take it seriously. Those are classic signs of obstructive sleep apnoea, which is common in men in midlife, particularly if you’re carrying extra weight around the neck and middle. It’s treatable, and it’s linked to high blood pressure, so it’s worth a conversation with your GP.
Could a deficiency be making me tired?
Yes, and this is the bit the supplement industry loves. A few shortfalls really can sap your energy. The important word is measured.
Iron deficiency anaemia is the obvious one. The NHS lists tiredness, lack of energy, shortness of breath, palpitations and paler than usual skin among the main symptoms. Here’s the part that matters most for men. Our diets don’t usually leave us short of iron and we don’t have periods, so when a man of your age turns out to be low on iron, doctors want to know why. The cause is often slow bleeding somewhere in the gut, and that needs investigating. It doesn’t need masking with tablets from the supermarket. Self-medicating with iron can hide the very clue your GP needs, and too much iron isn’t harmless either.
Vitamin B12 and folate deficiency can also cause tiredness. Sometimes they come with pins and needles, a sore tongue or problems with memory and concentration. You’re more at risk if you eat little or no animal produce, have had stomach surgery, or take certain long-term medicines. Some diabetes and indigestion drugs come up here. If that sounds like you, ask your GP or pharmacist whether a test makes sense. Don’t stop or change any medicine on your own.
Vitamin D is the one where the evidence for a supplement is clearest. In the UK, the sun isn’t strong enough from roughly October to March for your skin to make enough. The NHS advises that everyone considers taking 10 micrograms a day during autumn and winter, and all year round if you rarely get outdoors. It’s cheap from any chemist. It isn’t a cure for tiredness, but it covers a real gap.
If a deficiency is worth treating, it’s worth testing for first. A blood test costs you a GP appointment. Guessing costs you money, and you might miss something.
What else can make a man feel drained and irritable?
Several medical conditions show up first as plain fatigue, which is why they’re easy to shrug off.
An underactive thyroid can leave you tired, slow, feeling the cold and putting on weight without trying. It’s more common in women, but men get it too, and a simple blood test picks it up. Type 2 diabetes can creep up quietly, with tiredness, thirst, peeing more often and slow-healing cuts. Depression in men often doesn’t look like sadness. It can show up as irritability, anger, drinking more, withdrawing from people and a constant flat exhaustion. If that sounds familiar, the GP is the right place to start, and so is a conversation with someone you trust.
And then there’s testosterone, the subject of a great many podcasts. Testosterone falls only gradually with age, and the NHS is sceptical of the term male menopause. A minority of men do have genuinely low levels, which can bring fatigue, low mood, low libido and loss of muscle. Diagnosis needs proper blood tests, usually taken in the morning, and a doctor to interpret them. A home kit and an online clinic keen to sell you a prescription don’t count. Weight, alcohol, sleep and stress all push testosterone down, so the dull fixes help here too.
Are supplements worth it if I just feel run down?
Mostly, no. Apart from vitamin D in winter, there’s little good evidence that a multivitamin or an energy formula gives more pep to a man who eats a reasonable diet. Topping up a nutrient you’re not short of doesn’t give you bonus energy. Your body either ignores it or, with some vitamins and minerals, stores it in amounts that can do harm. Products promising to fight fatigue are usually selling hope with a side order of B vitamins.
Spend the money on things with better evidence instead. Get regular sleep at consistent times. Drink less, especially in the evening. Walk briskly most days, and do some strength work twice a week. Eat proper meals with protein, vegetables and wholegrains. Give these a month before you judge them. They won’t feel as exciting as a new pill, but they work better.
When to see your GP, and what to ask for
The NHS suggests seeing a GP if you’ve felt tired all the time for several weeks and can’t put it down to an obvious cause. Go sooner if you’ve lost weight without trying, if you’re breathless, if you’ve noticed blood in your poo or very dark poo, or if your mood is dropping badly. If you ever have thoughts of harming yourself, call NHS 111 or, in an emergency, 999.
Before you go, jot down how long it’s been going on, how you’re sleeping, how much you drink, any medicines you take and any other symptoms, however minor. Your GP may suggest blood tests for anaemia, iron, B12, folate, thyroid function and blood sugar, depending on what you describe.
If you live in England and you’re aged 40 to 74 with no existing heart disease, diabetes or kidney disease, you should be invited for a free NHS Health Check every five years. It looks at blood pressure, cholesterol and your risk of heart disease, stroke and diabetes. It isn’t a fatigue clinic, but it’s a useful MOT. Scotland, Wales and Northern Ireland don’t run the same programme, so if you live there, ask your GP practice what checks are available to you.
In short
Feeling tired, irritable and low on energy in midlife is common, but it isn’t always just ageing. Poor sleep, alcohol, inactivity and stress are the usual causes, while anaemia, low B12, thyroid problems, diabetes, sleep apnoea, depression and, less often, low testosterone can all play a part. Apart from vitamin D in autumn and winter, don’t guess with supplements. If the tiredness has lasted several weeks, see your GP and get tested.
Sources
Midcent Health
Adrian Irving writes about health for men 45 and over who would rather do something than worry. Training, weight loss, sleep, cholesterol and blood tests, heart health, testosterone, the prostate, mental health and your sex life – what the evidence says, what's worth trying, and when it's time to see your GP.
One of Midcent's writers. Spotted something? Write to adrian@midcent.uk.
