Hormones

The Andropause: What is it & How to Treat it

Andropause is real, it is common, and reversible. Read about what happens to your hormones as you age and what you can do about it.

Testosterone declines approximately 1–2% per year from midlife. This can produce noticeable physical, sexual, and behavioural symptoms.
The andropause can be reversed. Weight loss, resistance training, good sleep, and diet can restore testosterone without medication.
Maintaining a healthy bodyweight is the single most effective thing you can do — excess body fat converts testosterone to oestrogen.

The ‘andropause’, also called the ‘male menopause ’, is the gradual decrease in testosterone that some men experience as they age. In this article, we’ll go through what it is, its symptoms, diagnosis, treatment and how it affects your body and quality of life.

Unlike female menopause, where estrogen decline is largely irreversible, much of what drives declining testosterone in men is linked to things you can change: your body weight, lifestyle, diseases and how you sleep. There are many things you can do. It can be delayed, prevented or even reversed.

What exactly is andropause?

It is a set of symptoms plus a decline in testosterone, which occurs as you get older. It is medically referred to as ‘late-onset hypogonadism’, which is when your (previously fully functioning) testicles don’t produce enough testosterone to meet your body’s needs.

Andropause refers to the cluster of symptoms and hormonal changes associated with declining testosterone levels in ageing men. It is formally known as late-onset hypogonadism ("LOH") in the medical literature — a condition where the testes produce insufficient testosterone to meet the body's needs, in men who previously had normal testicular function.^[1]

Whereas female menopause is a (relatively) quick and almost complete loss of their estrogen-producing capacity, andropause is slower and less dramatic. Testosterone is said to decrease in some men by 1-2% a year from their mid-30s onwards. So by the time a man reaches his 50s or 60s, levels may have dropped enough to cause noticeable changes.^[2]

In addition to ageing, andropause can be driven by obesity, poor health, diseases, and many other lifestyle decisions, which means it can be (partially) delayed, prevented or reversed.

In fact, many men (who generally maintain a healthy body weight and good health) can maintain their testosterone levels throughout their life and won’t experience andropause. Twenty percent of men who are over 70 years old have low testosterone levels. But more thorough assessments have suggested that 2% of men over 40 are andropausal.

Symptoms of andropause

Symptoms tend to develop gradually, which is why they often go unrecognised for years. Many men attribute the changes to stress, poor sleep, or simply "getting older." The most common symptoms include:

Physical symptoms

Loss of muscle mass and strength, even with regular exercise
Increased body fat, particularly around the abdomen
Reduced energy and persistent fatigue
Decreased bone density (raising long-term fracture risk)
Reduced body and facial hair
Hot flushes and sweating (less common, but reported in some men)
Enlarged or tender breast tissue (‘gynaecomastia’)

Sexual and reproductive Symptoms

Reduced libido (or sex drive)
Erectile dysfunction or difficulty maintaining erections
Reduced semen volume
Decreased testicular size
Reduced fertility (though complete infertility is uncommon)

Psychological and cognitive symptoms

Low mood, irritability, and increased anxiety
Difficulty concentrating and mental fogginess
Reduced motivation and drive
Poor sleep quality and insomnia
Loss of confidence and sense of well-being

How is andropause diagnosed?

No single symptom is a diagnosis on its own. The pattern and combination of many of these symptoms, alongside blood testosterone test results, is what confirms the diagnosis. There is no single “gold-standard” test at the moment. A single low total testosterone reading doesn’t necessarily indicate that you’re going through andropause.

Clinicians will administer a few tests and examine several markers in conjunction with total testosterone (e.g., free testosterone, sex hormone-binding globulin, luteinizing hormone, follicle-stimulating hormone, prolactin, thyroid function, and blood glucose). These are taken to confirm you have low T and help deduce the cause of it.^[3]

Andropause isn’t the easiest condition to diagnose, as there are a lot of (common) conditions that have similar symptoms. Fatigue, low mood and reduced libido are also seen in men with depression, thyroid problems, sleep apnoea and anaemia. This is why clinical assessment is needed for proper diagnosis.

Effects of andropause on the body

Physical health

Low testosterone in men is associated with increased cardiovascular disease risk, type 2 diabetes, obesity, osteoporosis, low muscle mass (‘sarcopenia’), fragility, frailty and fractures.^[4]

Mental health and brain health

Men with low testosterone have an increased risk of depression, anxiety, and reduced quality of life. Many men anecdotally report that they have low drive (to do things), enthusiasm for life or “flatness” without having depression.^[2]

Fertility

Testosterone is needed to produce sperm. So, men with low testosterone tend to have low sperm volume and quality, although they are generally not completely infertile.^[3]

Treatment of the Andropause

For men whose andropause is caused by poor lifestyle habits (e.g., diet, activity, body weight), they can restore their testosterone levels and improve their symptoms and quality of life, usually without any medication.