While many of us like to think of ourselves as immune to aging, there’s simply no stopping the clock—or the host of physical, mental, and emotional changes that accompany getting older. Currently, there’s a whole lot of discussion happening among women around demystifying menopause, but often overlooked is the male experience. For middle-aged men, the deluge of changes to mind and body is sometimes referred to as “andropause”.
Andropause, also called “male menopause,” is not a universally accepted medical diagnosis, according to board-certified family medicine and regenerative anti-aging medication specialist Gowri Reddy Rocco, M.D., M.S., an expert committed to helping men preserve fertility, sexual function, and hormone health as they age. Rather, “it’s a colloquial term that describes age-related changes in male hormone levels, such as testosterone, and the symptoms that can follow,” she explains.
Read on for more on andropause, including when it occurs and what men can do to quell the symptoms.
- ABOUT OUR EXPERTS: Gowri Reddy Rocco, M.D., M.S., is a board-certified family medicine and regenerative anti-aging medication specialist committed to helping men preserve fertility, sexual function, and hormone health as they age. Jerry Bailey, M.S., D.C., is a functional medicine practitioner, certified nutritionist, and chiropractor with Lakeside Holistic Health in Idaho. Aleece Fosnight, M.S.P.A.S., PA-C, is a board-certified physician assistant specializing in urology and sexual well-being, and medical director at Aeroflow Urology.
Andropause, Explained
Andropause refers to the changes in androgen levels that occur as men age, explains functional medicine practitioner and certified nutritionist Jerry Bailey, M.S., D.C., a health provider and chiropractor with Lakeside Holistic Health in Idaho. Androgens are a group of hormones commonly called “male hormones” because they regulate sexual and reproductive processes in people assigned male at birth. These hormones also spur the development of male (or masculine) secondary sex characteristics, such as a lower voice, facial hair, and body hair. (It’s worth noting that women have androgens too, just at lower levels.)
Testosterone, androstenedione, and dehydroepiandrosterone (DHEA) are the most abundant androgens in the human body, and all three of these hormones gradually decline with age, according to Bailey. However, when people talk about andropause, they are typically referring to a notable fall-off in testosterone production, he says.
Andropause vs. Menopause
In the media, andropause is sometimes described as male menopause. However, the medical community notes that the term “male menopause” is unhelpful. The National Health Service (NHS) goes as far as to call the phrase “misleading” because it suggests that hormonal changes that happen in men in middle age—as well as their accompanying symptoms—are similar to those that occur during female menopause.
During the menopause transition, an individual’s ovaries’ hormone production takes a steep decline before eventually shutting down completely, at which point they make very little to no estrogen, progesterone, or testosterone, explains Aleece Fosnight, M.S.P.A.S., PA-C, a board-certified physician assistant specializing in urology and sexual well-being, and medical director at Aeroflow Urology. Consequently, the term “male menopause” is misleading because the testicles do not suddenly drop testosterone production, nor do they completely cease hormone production, she says. Rather, research has shown that testosterone production slowly declines—at a rate of one to two percent per year—after about the age of 30.
Importantly, if testosterone (and other androgen) levels do nose-dive, it is usually because of an underlying medical condition, such as pituitary disease, type 2 diabetes, or testicular cancer or injury. Medications like chemotherapy and opioids can also cause testosterone to plummet. On the flip side, (female) menopause and the hormonal drop-offs associated with this transition are not symptomatic of an underlying medical condition. Rather, female menopause is a normal and healthy part of the natural aging process in women. So, while female menopause can lead to some unsavory temporary symptoms like night sweats, it isn’t cause for medical concern.
Therefore, “while both sexes experience hormonal shifts, the actual processes and their impacts differ significantly,” says Bailey. “That’s why it’s so important to understand andropause within its unique context,” he says.
The Average Age of Andropause
All this said, the term andropause can help describe the period in life at which men experience significant changes in their health, fitness, and beyond as the result of cumulative testosterone losses. “Age is the most prevalent factor that influences the rate at which testosterone levels decline, as the natural aging processes inherently lead to lower hormone production,” says Bailey.
A one to two percent decrease annually likely doesn’t sound significant—and it isn’t, at least at first, notes Fosnight. However, “the compounded decline over time can lead to noticeable symptoms for men by the time they reach their 40s and 50s,” she says. The NHS agrees, suggesting the average man begins to experience the brunt of andropause in these decades of life.
Getting older isn’t the only factor that impacts androgen and testosterone production. Chronic stress, certain diets, high alcohol consumption, sleep deprivation, opioid usage, and certain chronic health conditions (to name just a few factors) can all cause androgen levels to fall faster or sooner, says Fosnight. This, consequently, can result in the symptoms associated with low testosterone and andropause appearing at a younger age.
On the flip side, “a balanced diet and regular physical activity can help slow hormonal decline and mitigate the effects associated with it,” says Bailey. Indeed, one 2021 study published in Nutrients found that certain vitamins and minerals (like magnesium, zinc, and vitamin D) and macronutrients (mainly, protein and healthy fats) have important roles in testosterone synthesis, and thus avoiding deficiency in these nutrients by eating a colorful, well-balanced diet is essential for maintaining healthy testosterone levels. Meanwhile, research has shown that men who exercise regularly have superior testosterone levels compared to men who are sedentary.
Signs and Symptoms of Andropause
On the physical front, the symptoms associated with andropause include noticeable changes such as changes in body composition and loss of muscle mass, says Fosnight. One 2022 review published in the Archives of Gerontology and Geriatrics found that it is common for men to lose lean mass and put on belly fat as they age. Meanwhile, a study published in the International Journal of Andrology found that obesity is a strong predictor of testosterone deficiency in aging men, suggesting a link between body fat, low testosterone, and getting older.
“The emotional and psychological changes associated with this time include mood swings, irritability, depression, anxiety, fatigue, and difficulty concentrating,” says Fosnight. These mental health symptoms are thought to be a result of the connection between testosterone and serotonin—sometimes known as the happiness hormone—in the body. According to research, testosterone plays a role in serotonin reuptake in the brain, making it an essential ingredient in good mood. As such, when testosterone levels dip, it is common for men to experience worsened mental health.
Read More: 6 Ways You’re Unintentionally Tanking Your Libido
“On the sexual health side of things, men may notice symptoms such as decreases in sexual desire, changes in erectile ability, and decreased orgasm intensity,” says Fosnight. While low testosterone levels don’t always cause sexual dysfunction, they have been shown to interfere with the body’s release of chemicals (like nitric oxide, dopamine, and oxytocin) that support erectile function. The sexual side effects of andropause can also be underpinned by worsened mental health, as research has linked depression with reduced sex drive in men.
What To Do About Andropause Symptoms
Whether physical or mental, emotional or sexual, if you’re experiencing more than two of the aforementioned andropause symptoms, Fosnight suggests talking to a healthcare provider (regardless of whether you are younger or older than the average age of andropause). Bailey also recommends touching base with a provider if you’re experiencing even one of the symptoms of andropause in such a way that it significantly impacts your quality of life.
The reason experts recommend talking to a healthcare provider is two-fold. First, it’s to assess whether low testosterone is the underlying cause of your symptoms. Testosterone levels can be tested through a blood sample, typically taken in the morning when testosterone levels are usually highest. Medically speaking, men’s testosterone levels are said to be normal when they measure in 300 and 1,000 nanograms per deciliter of blood (ng/dL), while anything under 300 ng/dL is considered low, says Bailey.
Read More: 7 Signs You Should Have Your Testosterone Levels Tested
Now, some men experience symptoms associated with andropause when their testosterone levels are not below the medically low range, he says. That’s why it’s important to work with a healthcare provider who regularly works with aging men, as they’ll understand that “normal” testosterone levels can vary widely from one aging man to another, he says.
Another reason it’s important to go to the doctor? An underlying medical condition can cause androgens to decline, says Fosnight. One study published in the American Heart Association Journal found that low testosterone levels are associated with cardiovascular risk and diseases, major adverse cardiac events, and mortality due to cardiovascular events. A second study, published in The American Journal of Medicine, found low testosterone was “strongly associated” with medical conditions like obesity, diabetes, and hypertension. And there’s even some research linking untreated, medically low testosterone levels with all-cause mortality. A doctor can perform certain tests that can rule out these dangerous conditions, says Fosnight.
It’s important to remember that andropause is a colloquial term. Meaning, “there is no medical diagnosis of andropause out there in the medical community,” says Fosnight. So when you see a healthcare provider, the goal isn’t to determine if you are in andropause, but rather to give you a clearer understanding of what is happening in your body physiologically and hormonally, she says. Not to mention, determine adequate treatment and interventions, when needed.
Addressing Andropause and Its Symptoms
There are no generalized treatment plans for andropause, as again, andropause is not a medical diagnosis. In the event your symptoms are caused by reduced testosterone levels, however, treatment typically includes lifestyle or medical interventions, or a combination of both.
On the lifestyle front, increased exercise, a healthier diet, reduced alcohol consumption, and supplements are generally recommended, according to Rocco. “Regular exercise, especially resistance and strength training, are suggested as they can significantly boost testosterone levels and overall well-being,” she says. Research has found that as little as 40 to 60 minutes of walking or jogging one to three times per week can help increase testosterone levels in men who are obese or overweight.
Read More: 5 Ways You Can Boost Your Testosterone Naturally
Meanwhile, “fast food, highly processed foods, and alcohol all severely affect overall hormone health, so opting for whole foods which provide better nutrition and support hormonal balance can be helpful,” says Rocco. Additionally, aiming for seven to nine hours of quality sleep per night and managing stress through techniques like meditation or yoga can also support testosterone production, says Bailey. On the supplement front, you can support healthy T with herbs (including ashwagandha, tongkat ali, saw palmetto, and fadogia agrestis). Other options for hormonal support include multivitamins formulated specifically for aging men and herbs that support healthy stress balance.
On the medical front, when indicated, healthcare providers may prescribe testosterone replacement therapy (TRT), says Bailey. This medication supplements your natural testosterone levels, effectively bringing up the androgen levels, he explains. (If you’re interested in exploring TRT, Whole Health Rx by The Vitamin Shoppe offer access to providers who can evaluate whether you’re a qualified candidate.)
In some cases, your provider may decide that increasing your antidepressant and/or anti-anxiety medication dosage may be helpful. Talk therapy and sex therapy can also be useful for men in andropause, especially when fear and anxiety around aging or sexual performance exacerbate symptoms.
The Bottom Line
For men, a gradual decline in the production of testosterone and other androgens is a normal and natural process of aging. When these declines lead to symptoms such as body composition changes, fatigue, and reduced libido, an individual is colloquially known to be going through andropause. Typically, andropause occurs in a man’s late 40s and early 50s, but it can happen earlier or later than that depending on genetic, health, and lifestyle factors.
Whatever your age, if you think you might be in andropause, it’s important to talk to a healthcare provider, says Bailey. “Intervention through lifestyle adjustments, therapeutic strategies, and possibly hormone replacement therapy can all help manage symptoms effectively and improve quality of life,” he says.