Andropause

Written By Jennifer Kowalyk

Andropause refers to the age-associated, gradual decline in male sex hormones — especially testosterone — over decades. Unlike menopause in women, andropause is not a sudden shutdown; hormone levels slowly decrease (often ~1% per year after age 30) and clinical symptoms may or may not appear depending on individual physiology. 

Because the decline happens gradually, many clinicians prefer to call it “late-onset hypogonadism” or “age-related testosterone deficiency.” 

Common symptoms

In men experiencing significant testosterone decline, possible symptoms include:

  • Low libido, decreased sexual desire or performance, erectile dysfunction 

  • Decreased energy, fatigue, reduced muscle mass and strength, increased body fat, altered body composition 

  • Mood changes: low mood, irritability, reduced motivation or vitality 

  • Cognitive changes: memory, concentration, mental clarity (in some) 

  • Reduced bone density and increased risk of osteoporosis or fractures (over time) 

  • Decreased general well-being, vitality, possibly mild anemia due to decreased blood cell production

However, many men with declining testosterone never develop symptoms; the condition is variable and multifactorial (age, lifestyle, comorbidity, receptor sensitivity). 

Common hormone therapy prescriptions / interventions

When clinically indicated (i.e. low testosterone confirmed + convincing symptoms), testosterone replacement therapy (TRT) may be considered. Options include: 

  • Testosterone gels, creams, patches

  • Injectable testosterone formulations, with regular dosing to maintain steady levels

Therapy decisions consider age, cardiovascular health, prostate health, fertility intentions, baseline labs, and risk-benefit balance.

How hormone therapy may improve symptoms

Properly dosed and monitored TRT may provide benefits such as:

  • Improved libido, sexual function, and erectile quality 

  • Increased muscle mass and strength; improved body composition (less fat, more lean mass) 

  • Enhanced mood, energy, motivation, mental clarity in some men 

  • Potential benefit to bone density over time, reducing fracture risk in men with significant androgen deficiency 

Important caveats & monitoring

  • Not all men with declining testosterone will benefit — symptoms should guide decision, not just lab numbers. Many men with low levels have no symptoms. 

  • Because TRT may have risks (cardiovascular, prostate, hematocrit increase), careful baseline evaluation and periodic monitoring is required: testosterone levels, hematocrit/Hb, prostate-specific antigen (PSA) (if indicated), lipids, and overall health. 

  • Lifestyle modifications (weight management, exercise, sleep, stress reduction) remain foundational; hormones should not be viewed as a “magic bullet.”

Jennifer Kowalyk
Previous

Menopause