Most people have heard of menopause and the hormonal rollercoaster it puts women through. Far fewer know that men go through their own version of it. It’s slower, subtler, and often mistaken for “just getting older”, but it’s real, and it has a name: andropause.
If you’ve noticed unexplained fatigue, a dip in your sex drive, stubborn belly fat, or mood swings creeping in after 40, andropause could be the reason. Here’s what’s actually happening in your body, and what you can do about it.
What Is Andropause?
Andropause, sometimes called “male menopause,” refers to the gradual decline in testosterone that happens as men age. Unlike female menopause, which involves a relatively sharp drop in hormone production over a short window, testosterone in men declines slowly, at a rate of about 1% per year after age 40.
Medically, doctors don’t use the term “andropause” the way they use “menopause.” The more accurate clinical term is late-onset hypogonadism, or age-related low testosterone. As Mayo Clinic explains, not everyone with age-related low testosterone experiences symptoms, and the long-term effects of this decline aren’t always clear-cut. Still, for the men who do feel it, the impact on daily life is very real, which is why the term “male menopause” has stuck around in everyday conversation.
If you’re already familiar with how women experience hormonal decline, our guide to perimenopause symptoms breaks down the female side of this process, the two conditions share some surprising overlaps, from mood changes to sleep disruption, even though the underlying biology is different.
What Causes Andropause?
Andropause comes down to one core mechanism: declining testosterone production. Testosterone is made in the testicles, and its output is regulated by a signaling loop involving the brain (hypothalamus and pituitary gland) and the testes.
A few things drive this decline:
- Natural aging – Testosterone declines by approximately 1% a year starting between ages 30 and 40, with men in their 70s having roughly 65% of the testosterone levels they had in their youth, on average.
- Reduced signaling hormones – As men age, the hormones that tell the testes to produce testosterone also decline, compounding the drop.
- Hormone conversion – A portion of testosterone gets converted into estrogen and other hormones as men get older, further reducing the “usable” testosterone in circulation.
- Underlying health conditions – Obesity, type 2 diabetes, chronic stress, poor sleep, and certain medications can accelerate testosterone decline independent of age.
It’s worth noting that low testosterone alone isn’t always the sole cause of andropause symptoms, sometimes the decline follows a completely normal pattern but still produces noticeable problems, while other times testosterone production drops off faster or more dramatically than expected.
Andropause Symptoms
Symptoms vary from man to man, but they generally fall into three categories: physical, sexual, and psychological.
Physical symptoms:
- Persistent fatigue and low energy
- Loss of muscle mass and strength
- Increased body fat, especially around the abdomen
- Reduced bone density
- Hot flashes or night sweats (less common, but reported)
Sexual symptoms:
- Reduced libido (sex drive)
- Erectile dysfunction
- Fewer spontaneous erections
Psychological symptoms:
- Low mood or depression
- Irritability and mood swings
- Difficulty concentrating or “brain fog”
- Sleep disturbances
According to Cleveland Clinic, symptoms of low testosterone can vary significantly depending on a man’s age and how severe the deficiency is. That’s why two men with similar testosterone levels can report very different experiences.
Who Gets Andropause, and When?
There’s no fixed age when andropause “starts.” It doesn’t affect all men, and about 30% of men are affected by it by the time they reach their 50s. Symptoms most commonly emerge between the ages of 40 and 60, though the timeline varies widely based on genetics, lifestyle, and overall health.
How Is Andropause Diagnosed?
There’s no single test for “andropause” itself, since it isn’t an official medical diagnosis. Instead, doctors diagnose the underlying issue: low testosterone (hypogonadism). This typically involves:
- A symptom review – Your doctor will ask about energy levels, libido, mood, and physical changes.
- A physical exam – Including a prostate check, since prostate health can influence treatment decisions.
- Blood tests – Healthcare providers generally consider testosterone levels below 300 nanograms per deciliter (ng/dL) as low in adults, and diagnose male hypogonadism when low levels appear alongside symptoms. Tests are usually done in the morning, when testosterone levels peak.
Treatment Options for Andropause
The right treatment depends on how low your testosterone is, what’s causing the drop, and how much your symptoms are affecting your life.
1. Lifestyle Changes (First Line of Treatment)
For many men, small changes can meaningfully improve symptoms:
- Exercise regularly, especially resistance training, which naturally supports testosterone production
- Improve sleep quality, poor sleep is directly linked to lower testosterone
- Manage weight, since excess body fat increases the conversion of testosterone into estrogen
- Reduce alcohol intake and quit smoking
- Lower chronic stress, which elevates cortisol and suppresses testosterone
2. Testosterone Replacement Therapy (TRT)
If lifestyle changes aren’t enough and blood tests confirm clinically low testosterone, a doctor may recommend TRT. Testosterone replacement therapy is an option for men with low testosterone levels due to male hypogonadism, and it can improve many symptoms, though it also comes with side effects and certain risks that should be discussed with a physician.
TRT is available in several forms:
- Gels or patches applied to the skin
- Injections
- Oral or buccal tablets
- Implantable pellets
Recent large-scale research has helped clarify TRT’s safety profile. A Cleveland Clinic-led trial (TRAVERSE) found that testosterone replacement therapy did not result in a higher incidence of major adverse cardiac events in middle-aged and older men with hypogonadism who also had existing or high risk of cardiovascular disease, though researchers still recommend caution and ongoing monitoring when considering treatment.
3. Treating Underlying Conditions
Sometimes low testosterone is a symptom of something else, sleep apnea, diabetes, obesity, or thyroid issues. Addressing the root condition can restore hormone levels without needing TRT at all.
Andropause vs. Menopause: What’s the Difference?
It’s a fair comparison, but the two conditions aren’t medically identical. In women, ovulation ends and hormone production drops sharply over a relatively short period of time, that’s menopause. In men, testosterone and other hormones decline gradually over many years, which is why andropause feels more like a slow fade than a sudden shift.
Frequently Asked Questions
Is andropause a real medical condition?
Andropause isn’t an official diagnosis the way menopause is. The clinically recognized term is late-onset hypogonadism, or age-related low testosterone. That said, the symptoms associated with declining testosterone are well documented and treatable.
At what age does andropause start?
There’s no fixed starting age. Testosterone begins declining gradually from a man’s 30s onward, but noticeable symptoms most commonly appear between ages 40 and 60.
Can andropause be reversed?
Symptoms can often be significantly improved through lifestyle changes, and testosterone replacement therapy can restore hormone levels in men with clinically low testosterone. However, the natural aging process behind the decline can’t be fully reversed.
What’s the difference between andropause and low testosterone?
Low testosterone (hypogonadism) is the clinical, measurable condition. “Andropause” is the informal term used to describe the cluster of symptoms, physical, sexual, and psychological, that can result from it.
Does testosterone replacement therapy have risks?
Yes. While recent research suggests TRT doesn’t significantly increase cardiovascular risk in most men, it can still cause side effects and requires monitoring by a physician. It’s not a decision to make without medical guidance.
Can diet and exercise really improve andropause symptoms?
Yes. Regular resistance training, quality sleep, weight management, and reduced alcohol intake are consistently linked to healthier testosterone levels and can meaningfully ease symptoms in many men.