“Male menopause” sounds like a meme or a midlife excuse—until you look at the data. Men don’t have a sudden, all‑or‑nothing shutdown of fertility like women do, but there is a real, age‑related testosterone decline, and for a sizeable chunk of men it comes with a cluster of symptoms that can wreck mood, libido, muscle mass, sleep, and long‑term health. Clinically, this is called late‑onset hypogonadism (LOH), androgen deficiency in the aging male, or just andropause.
The catch: not every tired 50‑year‑old has andropause—and not everyone with a lowish lab value needs a testosterone prescription. The science‑backed reality sits in the messy middle: real, diagnosable hormone deficiency in some men; normal aging, lifestyle, and other illnesses in others; and a growing evidence base on when testosterone therapy helps, when it doesn’t, and how to navigate the whole thing without getting scammed.
Here’s how to make sense of it.
Is “Male Menopause” Real? The Andropause / LOH Basics
Women’s menopause is defined by a clear event (last period) and a rapid fall in estrogen. Men’s version is slower, more variable, and not universal.
What actually happens with testosterone and age
On average, male testosterone:
- Peaks in late teens / early 20s.
- Begins a slow decline from around age 30–40.
- Drops by roughly 1–3% per year after 40 in many men.
By age 60–70, a significant minority have levels low enough to be considered hypogonadal, especially if they carry extra visceral fat, have chronic disease, or live a sedentary, high‑stress lifestyle.
A review on late‑onset hypogonadism notes that LOH is “a common disorder which increases in prevalence with advancing age,” and estimates that about 10% of men over 50 and up to 20% over 60 meet criteria when symptoms and low levels are both present.
How LOH / andropause is defined
Professional groups don’t diagnose andropause just because a lab panel says “borderline.” The European Male Ageing Study (about 3,000 men) proposed evidence‑based criteria:
- At least three sexual symptoms:
- Reduced libido (sex drive)
- Reduced spontaneous/morning erections
- Erectile dysfunction
- And low testosterone:
- Total testosterone < 11 nmol/L (≈3.2 ng/mL)
- Free testosterone < 220 pmol/L (≈64 pg/mL)
Other typical symptoms include:
- Fatigue, low vitality
- Decreased muscle mass and strength
- Increased body fat and central obesity
- Low mood, irritability, reduced motivation
- Decreased bone mineral density / osteoporosis
- Reduced shaving frequency or body hair
Crucially, none of these symptoms are specific to low T—they overlap with depression, poor sleep, hypothyroidism, anemia, and simple burnout. That’s why guidelines insist on both symptoms and consistently low morning testosterone on repeat testing.
How Low Testosterone Impacts Health and Quality of Life
When testosterone really is low and not just “ish,” the effects show up across multiple systems.
Sexual function and relationships
Low T is most strongly linked with:
- Lower libido (less interest in sex).
- Fewer morning/spontaneous erections.
- More difficulty achieving or maintaining erections (often alongside vascular issues).
These changes can strain relationships, dent confidence, and feed into anxiety or depression—especially if no one has named what’s happening.
Body composition, strength, and bones
Testosterone supports:
- Muscle protein synthesis – maintaining muscle mass and strength.
- Fat distribution – keeping visceral (belly) fat in check.
- Bone turnover – preserving bone mineral density.
LOH is associated with:
- Decreased lean mass and grip strength.
- Increased fat mass, especially abdominal.
- Higher risk of osteoporosis and fractures in older men.
That’s not just cosmetic—it’s about fall risk, independence, and metabolic health.
Mood, cognition, and energy
Men with LOH frequently report:
- Persistent fatigue and “tired all the time.”
- Low mood, emotional flatness, or irritability.
- Reduced motivation and drive.
- Brain fog and subtle cognitive decline.
Aging, stress, and sleep issues can do this too, but studies find that very low testosterone is associated with worse quality of life and higher rates of depression, even after adjusting for other factors.
Cardiometabolic health and mortality
The old fear was that testosterone = heart attack fuel. Newer data are more nuanced:
- Observational studies show that low endogenous testosterone in older men is associated with:
- Higher blood pressure
- Worse cholesterol (higher total and LDL, lower HDL)
- More insulin resistance and visceral fat
- More atherosclerosis and thrombotic risk
- Increased total and cardiovascular mortality
- A prospective study in men aged 70–96 found low testosterone levels were associated with higher all‑cause mortality, independent of other risk factors.
A 2016 review in European Heart Journal summarised it this way: decreasing testosterone with age (“low T,” “manopause”) is linked to a high cardio‑metabolic risk profile and modest increases in total and CV mortality.
Low T doesn’t cause every problem, but it’s clearly entangled with the cardiometabolic spiral: weight gain → lower T → more visceral fat → worse insulin resistance → more vascular issues.
Testosterone Therapy: Hype, Help, and Real Risks
Once you realise how wide‑ranging low T’s impact can be, it’s easy to think, “Just give everyone testosterone.” That’s exactly what happened in the 2000s—and then the backlash arrived. Now the picture is more balanced.
Potential benefits of testosterone replacement therapy (TRT)
In men with confirmed LOH (symptoms + low levels), TRT has been shown to:
- Improve sexual function – higher libido, more frequent erections, better sexual satisfaction.
- Increase muscle mass and strength, reduce fat mass modestly.
- Enhance bone mineral density, lowering osteoporosis risk.
- Improve mood, vitality, and sense of well‑being in many (though not all) men.
- Improve insulin sensitivity, waist circumference, and some lipid parameters in metabolic syndrome and type 2 diabetes.
A 2025 review on TRT in men ≥50 with confirmed hypogonadism concluded that therapy “provides consistent and clinically meaningful benefits across sexual, musculoskeletal, metabolic, cardiovascular, and neuropsychological domains” when prescribed according to guidelines.
The risk side: what you need to take seriously
TRT isn’t a multivitamin; it’s a hormone drug with real risks if used wrongly. Reviews list potential adverse effects:
- Erythrocytosis (high hematocrit) – thicker blood, raising clot risk if not monitored.
- Prostate – can worsen urinary symptoms from benign prostatic hyperplasia (BPH); requires PSA monitoring and prostate exams.
- Infertility and testicular atrophy – exogenous testosterone suppresses the hypothalamic–pituitary–testicular (HPT) axis, reducing sperm production; not appropriate if you want to father children.
- Gynecomastia – breast tissue growth via aromatisation to estrogen.
- Sleep apnea – can worsen untreated obstructive sleep apnea.
- Fluid retention / heart failure – caution in severe, uncontrolled CHF.
- Skin issues – acne, oily skin, injection‑site reactions.
Older reviews worried a lot about prostate cancer, but more recent data and expert panels note that when men are screened properly, TRT does not appear to increase major adverse cardiovascular events or prostate cancer risk, though monitoring remains essential.
A 2025 expert statement summarised the current consensus: when TRT is prescribed to appropriately selected patients and monitored regularly, its cardiovascular safety is acceptable and “the potential benefits outweigh the risks” in true hypogonadism.
Who should not be on TRT
Most guidelines advise against TRT in men who:
- Have normal testosterone and nonspecific symptoms (fatigue, low mood) without a clear hormonal cause.
- Have untreated prostate or breast cancer.
- Have severe untreated sleep apnea.
- Want to father children soon (TRT suppresses sperm).
- Have very high baseline hematocrit or uncontrolled severe heart failure.
The key message: TRT is for documented, symptomatic hypogonadism – not for “feeling older than I’d like” when your labs are normal.
How to Navigate Andropause As an Adult
If you’re in your 40s–60s, feeling “off,” and wondering if andropause is to blame, here’s a sane, science‑aligned way to approach it.
1. Start with symptoms and context
Common LOH symptoms (libido changes, energy, mood, muscle loss) overlap heavily with modern life: stress, poor sleep, too much alcohol, ultra‑processed food, lack of exercise.
Ask yourself:
- Has my sex drive changed markedly vs 5–10 years ago?
- Are morning erections less frequent or absent?
- Is erectile function worse, even with arousal?
- Have I lost muscle and strength despite similar activity?
- Is my waistline growing faster than expected?
- Is my mood flatter or more irritable with no clear trigger?
If the sexual symptoms are front‑and‑centre, that raises the probability of LOH vs purely lifestyle or psychological causes.
2. Get properly tested (not just one random T number)
If symptoms seem plausible, ask your doctor for:s
- Morning total testosterone, drawn between ~7–10 a.m.
- Ideally, at least two separate measurements on different days.
- Sometimes free testosterone or SHBG if total T is borderline but symptoms are strong.
Good practice is to rule out other issues as well (thyroid, anemia, depression, sleep apnea, medication side‑effects) because these are common and treatable.
3. Fix lifestyle and weight – they directly influence testosterone
Many men with “low‑normal” T can move into a healthier range by fixing fundamentals. Excess visceral fat and poor metabolic health suppress the hypothalamic–pituitary–testicular axis.
Evidence‑backed levers:
- Lose excess fat, especially around the waist – even 5–10% body‑weight loss can raise T.
- Lift weights 2–3 times per week – resistance training improves T, muscle, and insulin sensitivity.
- Prioritise sleep – chronic sleep restriction lowers testosterone and increases cortisol.
- Dial back alcohol – heavy drinking is toxic to Leydig cells (testosterone‑producing cells).
- Clean up diet – Mediterranean‑style patterns support vascular and hormonal health.
Sometimes, once these are addressed, symptoms and T levels improve enough that TRT becomes unnecessary—or safer to consider.
4. If you genuinely have LOH, discuss TRT realistically
If repeat labs show consistently low T and your symptom picture fits LOH, it’s reasonable to talk TRT with a clinician who understands both benefits and risks.
Key points to cover:
- Goals: Libido? Mood? Muscle? Bone? Metabolic health?
- Formulation: Gels, injections, long‑acting formulations each have pros/cons.
- Monitoring plan:
- Testosterone levels (to avoid supra‑physiologic dosing).
- Hematocrit (to catch erythrocytosis).
- PSA and prostate exams.
- Symptom check‑ins and side‑effect monitoring.
The 2025 TRT review emphasises individualised therapy with structured monitoring, noting that safety looks favourable when guidelines are followed, but erythrocytosis is common and needs management.
5. Avoid the “low T clinic” trap
Be wary of:
- Clinics that promise to treat “low T” based on symptoms alone or a single borderline lab.
- Protocols that push men into supraphysiologic ranges (way above normal).
- Aggressive, one‑size‑fits‑all sales pitches, especially bundled with lots of supplements.
Excess testosterone (especially via injections abused like steroids) can increase cardiovascular risk, worsen sleep apnea, and cause liver and lipid issues. The goal is physiologic replacement, not pharmacologic blasting.
The Bottom Line: Andropause Is Real, But Not Inevitable Disaster
“Male menopause” is a clumsy term, but it points at a real clinical entity:
- Late‑onset hypogonadism / andropause is a combination of specific symptoms (especially sexual) and consistently low testosterone, increasingly common in aging men.
- Low T is linked to worse quality of life, body composition, bone and muscle health, mood, and a more adverse cardiometabolic profile with higher mortality risk.
- In men with documented deficiency, testosterone therapy can meaningfully improve sexual function, physical capacity, metabolic markers, and well‑being, with an acceptable safety profile under modern guidelines and monitoring.
At the same time:
- Not every midlife slump is andropause. Modern stress, poor sleep, excess weight, and inactivity can mimic or worsen it—and are often easier and safer to fix first.
- TRT is not a fountain‑of‑youth hack for men with normal levels; used inappropriately, it carries real risks.
Navigating this chapter well means dropping the shame and denial, skipping the quick‑fix marketing, and approaching your hormones the way you’d approach any other major health decision: with proper testing, honest lifestyle work, and, when needed, targeted therapy backed by real evidence, not just vibes.
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC4046605 https://en.wikipedia.org/wiki/Late-onset_hypogonadism https://pmc.ncbi.nlm.nih.gov/articles/PMC12535424/ https://academic.oup.com/eurheartj/article/37/48/3569/2901164 https://pmc.ncbi.nlm.nih.gov/articles/PMC12535424/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4046605/
