Andropause: Testosterone Decline and Effective Management

When we talk about “menopause,” most people instinctively associate it with the cessation of menstruation in women. However, men also face hormonal decline as they age—commonly referred to as “male menopause.” Conversely, unlike the abrupt hormonal shifts in women, this process happens gradually, as testosterone levels decrease year by year, impacting physical functions, emotions, and overall quality of life.

Many men mistakenly attribute fatigue, reduced libido, or low mood to work stress, overlooking the possibility of hormonal imbalance. By recognising the symptoms of male menopause and adopting proper management strategies, you can maintain your health and vitality as you age.

What Is Andropause?

Male menopause, medically termed andropause, is also known as Late-Onset Hypogonadism (LOH), Testosterone Deficiency Syndrome (TDS), or Partial Androgen Deficiency in the Ageing Male (PADAM). It describes the gradual decline of testosterone levels as men age, leading to physical and psychological changes.

Testosterone is one of the most crucial hormones in males. It is responsible for maintaining muscle mass, bone health, regulating reproductive functions, and supporting red blood cell production. When testosterone levels drop, these vital functions can be affected.

Male Andropause vs Female Menopause: Key Differences

While female menopause signifies the end of menstruation and fertility, accompanied by a sharp hormonal drop, male menopause involves a slower, more gradual decline in testosterone levels.

Age of Andropause

Though andropause typically manifests between the late 40s and early 50s, testosterone levels begin to decrease as early as the mid-30s, at a rate of 1–2% annually.

Why Does Testosterone Decline?

There are two primary causes:

1. Primary Testicular Failure

Mechanism: The testes fail to produce sufficient testosterone due to impaired steroid synthesis.
Indicators: Persistently low serum testosterone levels, paired with elevated luteinizing hormone (LH) levels.

2. Secondary Hypogonadism

Mechanism: The chemical signals from the pituitary gland (via LH) or the hypothalamus (via gonadotropin-releasing hormone, GnRH) fail to adequately stimulate Leydig cells (in the testes) to produce sufficient testosterone.
Indicators: Low serum testosterone with normal or reduced LH levels. This is often linked to obesity, diabetes, or chronic illnesses.

How Is Andropause Medically Defined?

The European Male Ageing Study (EMAS), a large-scale prospective study conducted across eight European countries with over 3,300 men aged 40–79 being followed up for 4 years, provides the diagnostic standards for Late-Onset Hypogonadism (LOH):

Total testosterone <11 nmol/L and free testosterone <220 pmol/L, AND
Accompanied by at least three sexual symptoms, such as erectile dysfunction, reduced libido, or fewer morning erections

It is important to note that abnormal blood test results alone, without accompanying symptoms, do not constitute a diagnosis of andropause. Additionally, diagnosis requires at least two morning fasting blood tests to measure testosterone levels, ensuring accurate results.

Symptoms of andropause

The symptoms of andropause vary widely but may include:

Reduced libido
Low mood or irritability
Poor sleep quality
Fatigue
Cognitive changes
Decreased physical strength
Loss of muscle mass
Bone density loss

Suspect you’re experiencing andropause? Take a quick self-assessment (Only available in Chinese) by answering 10 targeted questions to evaluate your symptoms.

Effective Ways to Manage Andropause

1. Address Underlying Conditions: The First-Line Approach

Andropause often coincides with other health issues such as hypertension, diabetes, and high cholesterol, all of which can exacerbate symptoms. Treating these comorbidities through personalised care is critical for improving overall health and symptom relief.

2. Lifestyle Adjustments: Equally Important

For most men, lifestyle changes are the first step, often recommended before turning to medication. These adjustments are safe, effective, and beneficial for overall health:

Prioritise Sleep: Aim for 7–8 hours of quality sleep nightly, as sleep deprivation can further disrupt hormone levels.
Maintain a Healthy Weight: Excess body fat and high cholesterol can lower testosterone levels and increase the risk for early andropause.
Exercise Regularly: Strength training and High-Intensity Interval Training (HIIT) are particularly effective.
- Weight training: particularly compound exercises that engage multiple large muscle groups (e.g., squats and deadlifts), can temporarily boost testosterone levels
- High-Intensity Interval Training (HIIT): avoid overtraining and ensure adequate rest days are included in your routine
Manage Stress: High cortisol (stress hormone) levels can suppress testosterone.
Adopt a Healthy Diet
- Make sure sufficient intake of protein
- Eat zinc, vitamin D, magnesium, healthy fats, and antioxidant-rich foods. Adding onions and garlic to your meals can help increase testosterone levels and support protection against cellular damage.
- Limit sugar, saturated fats, trans fats, and processed foods.
Consider DHEA Supplements: Dehydroepiandrosterone supplementation may help boost testosterone.
Reduce Alcohol Intake
Quit smoking

3. Medication: A Secondary Option

Testosterone Replacement Therapy (TRT)

For men with confirmed low testosterone levels and significant symptoms, TRT may be considered. Common forms include:

Topical Gel: Applied daily to the shoulders, arms, or inner thighs. Side effects may include skin irritation or tingling.
Intramuscular Injections: Administered every 3 weeks or 3 months. Side effects may include injection pain or needle phobia.

Every medical treatment comes with its benefits and risks, and testosterone replacement therapy (TRT) is no exception.

Benefits: increase libido, improve sexual function, alleviate anaemia, stabilise mood, and boost physical energy.
Side Effects: testicular shrinkage, reduced sperm count, acne, fluid retention, abnormal lipid levels, and sleep apnoea.

Recent studies have also linked TRT to potential risks, such as pulmonary embolism, fractures, atrial fibrillation, lower urinary tract symptoms (LUTS), or prostate cancer. Before starting treatment, your doctor will assess your prostate health and any LUTS conditions. If you have a history of venous thromboembolism, preventive anticoagulation therapy may be considered.

It is important to note that TRT is not a cure for testosterone deficiency. Theoretically, men need to continue TRT long-term to maintain its benefits. Stopping treatment can lead to a rapid drop in testosterone levels, temporarily affecting natural sperm production. Therefore, it is advised to have a detailed discussion with your doctor about the potential risks and how your body might respond before starting or discontinuing therapy.

Conclusion

Andropause is a natural biological process caused by the gradual decline of testosterone with age. While not every man will experience noticeable symptoms, understanding andropause can help identify and manage these changes early. If you notice persistent fatigue, reduced sexual function, or other related symptoms, do not hesitate to seek medical advice. With the right combination of lifestyle adjustments and medical treatment, symptoms of andropause can be effectively managed. Take care of yourself and embrace every stage of life with confidence.

If you have any questions about andropause, feel free to consult our family doctors.

References

Centre for Health Protection, (2017) Men's Health Line – Andropause. Retrieved 22 October 2025 from https://www.chp.gov.hk/en/static/80026.html
Cleveland Clinic, (2022) Testosterone. Retrieved 22 October 2025 from https://my.clevelandclinic.org/health/articles/24101-testosterone
Havard Health Publishing, (2025) Navigating "male menopause". Retrieved 22 October 2025 from https://www.health.harvard.edu/mens-health/navigating-male-menopause
Sizar O, Leslie SW, Schwartz J. Male Hypogonadism. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532933/
Dimopoulou, C., Iuliana Ceausu, Depypere, H., Lambrinoudaki, I., Mueck, A.O., Pérez-López, F.R., Rees, M., Yvonne, Senturk, L.M., Tommaso Simonsini, Stevenson, J.C., Stute, P. and Goulis, D.G. (2016). EMAS position statement: Testosterone replacement therapy in the aging male. 84, pp.94–99. doi:https://doi.org/10.1016/j.maturitas.2015.11.003.
Cleveland Clinic, (2022) Testosterone Replacement Therapy (TRT). Retrieved 22 October 2025 from https://my.clevelandclinic.org/health/treatments/testosterone-replacement-therapy-trt
Mayo Clinic, (2025) Male menopause: Myth or reality? Retrieved 22 October 2025 from https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056