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One statistic defines this subject, so it goes first.
In England in 2024, the suicide rate was 17.1 per 100,000 for men and 5.6 for women — around three-quarters of all suicides were male, with the highest rate in men aged 50 to 54. In Ireland the pattern is the same: 13.9 per 100,000 for men against 3.5 for women, roughly 79% of the total.
Set against that: men are diagnosed with depression less often than women, and are less likely to present for help. Those two facts sitting side by side are the whole reason this article exists, and they point at a recognition problem rather than a resilience problem.
An honest note about our own library first
Before anything else. We have written about perimenopause and brain fog, the menopausal brain, postpartum brain fog, why ADHD is missed in women, and creatine in women's health. Until this article, we had written nothing specifically about men.
That wasn't a decision, which is rather the point — it's the same gap that exists across health content generally, arrived at by not noticing. Correcting it is worth doing properly rather than with a list of supplements.
Why it gets missed: the presentation is often different
Depression is commonly described as presenting differently in men, and the features that get reported are ones that don't read as depression to the person experiencing them or to the people around him:
- Irritability and anger rather than visible sadness
- Risk-taking — with driving, money, alcohol
- Working more, not less
- Physical complaints — fatigue, pain, digestive symptoms, poor sleep — which is often what actually gets taken to a doctor
- Withdrawal framed as being busy
- Alcohol as the management strategy
This is an area where the description is better established than the mechanism, so treat it as a pattern worth recognising rather than a rule. But it has a practical consequence: the screening questions ask about low mood and loss of interest, and a man whose main experience is that he's furious and exhausted can answer those questions honestly and score low.
The useful reframe is the one we use elsewhere: the diagnostic question isn't "how sad are you," it's what has changed, and what is it stopping you doing. The same logic separates ordinary anxiety from an anxiety disorder.
The low testosterone pipeline — and why the order matters
This is the most useful section on this page, and it's where most men's health marketing gets the sequence backwards.
The symptoms sold as low testosterone are: fatigue, low motivation and drive, poor concentration, memory problems, low libido, low mood. There is an entire online industry built on that list, running from a free quiz to a prescription.
Here is the problem. That is also, almost item for item, the symptom list of untreated obstructive sleep apnea. A review of the overlap names exactly this cluster — sexual dysfunction, reduced motivation and vitality, poor concentration, memory problems and fatigue — as shared between the two conditions, and notes that it complicates diagnosis.
And it goes further than resemblance. Sleep apnea measurably lowers testosterone. Meta-analyses find significantly lower serum testosterone in men with obstructive sleep apnea than in controls, and the reduction tracks with severity. The proposed mechanisms are direct inhibition of pituitary function — lowering luteinising hormone — plus the effect of hypoxia, night-time awakenings and fragmented sleep, with a further contribution where obesity and insulin resistance are in the picture.
So a man with untreated sleep apnea can have genuinely low testosterone and the full symptom set, and be one quiz away from treating the hormone instead of the cause.
The part that makes this a safety issue, not just a sequencing one
Testosterone replacement is generally contraindicated by guidelines in the presence of untreated or severe obstructive sleep apnea, and short-term high-dose therapy may worsen it.
That turns "get the apnea checked first" from tidy advice into the actual clinical order of operations. If you are considering testosterone therapy and you snore, wake unrefreshed, or have been told you stop breathing, the sleep question comes first — and the screener takes a minute. Note while you're there that male sex is itself one of the eight STOP-BANG criteria, and men are at higher risk of the condition.
One honest caveat, because the neat version of this story isn't quite true. Treating the apnea does not reliably fix the testosterone: a meta-analysis found CPAP use was not associated with a significant change in total testosterone. So the argument isn't "fix your sleep and your hormones sort themselves out." It's narrower and still important — you cannot interpret a testosterone result, or safely start treatment, while a condition that suppresses testosterone and contraindicates the treatment is sitting there undiagnosed.
And real hypogonadism is real
None of the above means low testosterone is invented. Hypogonadism is a genuine diagnosis with genuine treatment, and men who have it benefit from being treated.
What distinguishes proper assessment from the online funnel: testosterone is measured on a morning sample because levels vary through the day, it is repeated rather than acted on from one reading, LH and FSH are measured alongside to work out where the problem sits, and other causes are excluded first. Treatment then involves ongoing monitoring, including of red cell count.
Two things men are often not told before starting: testosterone therapy suppresses the body's own production, and it suppresses sperm production — which matters a great deal if fertility is or might become relevant. Those are conversations to have before the first prescription, not after.
Testosterone booster supplements
Briefly, because it's our category and we should be clear. The evidence for over-the-counter "testosterone booster" supplements raising testosterone or improving the symptoms attributed to low testosterone is poor. It is one of the most heavily marketed and least supported categories in the entire supplement market.
Proco does not sell one, and this is not a gap we're planning to fill.
The rest of the list, which is less interesting and matters more
Alcohol. Men drink more on average and have higher rates of alcohol-related harm. It is directly neurotoxic at volume, it worsens sleep in the second half of the night, it worsens sleep apnea specifically, and it is the most common self-management strategy for the symptoms in the section above. The "moderate drinking is protective" story has not held up, and the sleep effects are measurable.
Vascular risk, earlier. Men develop cardiovascular disease earlier on average than women, and the same cluster — blood pressure, lipids, blood sugar, smoking, weight, inactivity — drives both stroke risk and dementia risk. Knowing your blood pressure is still the highest-value boring thing available, and it produces no symptoms at all until it has done damage.
Head injury. Traumatic brain injury is one of the fourteen modifiable dementia risk factors, and men have higher rates of it — contact sport, occupational, road. Helmets and not returning to play too early are unglamorous and count.
Hearing. Men have higher rates of occupational noise exposure, and untreated hearing loss is on the same dementia list — though the evidence that treating it reduces risk is more mixed than the headlines suggest.
And late diagnosis isn't only a women's story. The inattentive presentation of ADHD gets missed in quiet boys too, and the diagnostic rules themselves excluded a lot of people until 2013 — the reasons adults were missed are here.
Where we sit
Nothing Proco sells treats depression, low testosterone or sleep apnea. We don't sell a testosterone product and won't.
What we'd say about our own category here is specific: the men's supplement market is unusually good at selling a bottle against the exact symptom list that should send someone for a sleep study and a blood test. That's not a small distortion — it is a pipeline that routes people away from the diagnosis, and it works because buying something is easier than booking something.
The order, if you want one
- Screen for sleep apnea if you snore, wake unrefreshed, or are sleepy rather than tired in the day. One minute.
- Get the blood tests — thyroid, iron including ferritin, B12, vitamin D, plus glucose and lipids. The list to ask for, and thyroid problems produce this whole picture on their own.
- Know your blood pressure. One appointment, covers the largest share of two of the biggest neurological risks there are.
- Be honest about alcohol, at least with yourself, at least once.
- Then ask the testosterone question, properly, with a clinician — morning sample, repeated, LH and FSH alongside.
- And if the honest answer is that something has changed and you feel wrong, say that to a GP in those words. You do not need a tidy description or a diagnosis to start with.
This article is not medical advice and cannot diagnose anything. Nothing here should be used to start, stop or change a prescribed medication or hormone therapy. If low mood or hopelessness is part of the picture, that is a reason to speak to a doctor — and support is available whether or not you feel it's serious enough to warrant it.
Sources: Samaritans — latest suicide data for the UK and Ireland · Obstructive sleep apnoea and male reproductive/hormonal function — Frontiers in Reproductive Health (2023)