Male menopause (andropause): is it real?

Is the male menopause real?

The short answer is no – at least not as a male version of the menopause. In women, the ovaries stop releasing eggs and oestrogen falls sharply over a few years. Men have no equivalent event. Testosterone declines gradually, and most men keep producing sperm and testosterone into old age.

The NHS describes “male menopause” – also called andropause – as an unhelpful and misleading term, because it suggests a sudden drop in testosterone in middle age. What is real is that some men develop symptoms in their late 40s and early 50s, and those symptoms deserve a proper look.

What happens to testosterone as men get older?

From around the age of 30 to 40, testosterone falls by about 1% a year. At the same time, levels of SHBG – the protein that carries testosterone in the blood – tend to rise, so slightly less of it is freely available. This slow change is unlikely to cause problems on its own.

Research on European men aged 40 to 79 found that obesity was linked with a much bigger drop in testosterone than age itself, and that poor general health also played a part. In other words, much of the fall seen in older men is linked to weight and health rather than to the passing years. For more on normal levels, see Testosterone in men.

What are the symptoms of andropause?

The symptoms usually grouped under “male menopause” include:

• Low sex drive and erection problems
• Mood swings, irritability and low mood
• Tiredness and lack of motivation
• Loss of muscle and more fat around the middle
• Breast swelling (gynaecomastia)
• Poor sleep
• Poor concentration and short-term memory

These are real and can have a big impact on your life, work and relationships. But they are not specific to hormones.

What else could be causing these symptoms?

In many men, midlife symptoms have causes other than testosterone. Common ones include:

• Stress, anxiety and depression – often linked to work, money, relationships, caring for others or what is sometimes called a midlife crisis. These can cause low sex drive, erection problems and mood swings on their own.
• Lifestyle – poor sleep, little exercise, an unbalanced diet, heavy drinking and smoking.
• Weight gain – particularly around the waist, which also lowers testosterone.
• Physical health problems – heart disease, high blood pressure and type 2 diabetes can all cause erection problems and tiredness.

Several of these can be changed, and they often improve symptoms whatever your testosterone level. For practical steps with real evidence behind them, read How to increase testosterone naturally.

What is late-onset hypogonadism?

In a small number of men, the testes produce too little testosterone later in life. This is called late-onset hypogonadism. It is uncommon – in the European Male Ageing Study, about 2% of men aged 40 to 79 met the criteria – and it is not a normal part of ageing. It is more likely in men who are obese or have type 2 diabetes.

It is diagnosed from a combination of symptoms – especially sexual symptoms such as low sex drive, fewer morning erections and erection problems – and testosterone blood tests. Read more in Low testosterone: symptoms, tests and treatment.

Should I get my testosterone checked?

If you have symptoms that are affecting your daily life, see your GP. They will ask about your work and personal life, mood, sleep and alcohol, to look for a mental health or lifestyle cause, and may arrange a testosterone blood test.

• The blood test should be taken in the morning, when testosterone is highest, and repeated on another day if the first result is low.
• A total testosterone above about 12 nmol/L makes low testosterone unlikely; below about 8 nmol/L is low; in between is a grey zone where a repeat test and free testosterone help decide.
• If a deficiency is suggested, you may be referred to an endocrinologist.

Home testosterone test kits are widely sold, but a single result, often taken at the wrong time of day, can be misleading. It is better to have the test arranged and interpreted alongside your symptoms.

What helps with male menopause symptoms?

Treatment depends on the cause. For stress, anxiety or depression, your GP may suggest talking therapies such as cognitive behavioural therapy (CBT), medicine or both. Regular exercise and relaxation help many men. Losing excess weight, improving sleep and cutting back on alcohol can ease tiredness and other symptoms, and in men whose testosterone is lowered by excess weight, losing weight can help it recover.

If repeat blood tests confirm a testosterone deficiency, a doctor may offer testosterone replacement, given as a gel or injections. It is prescription-only, needs regular monitoring and is not suitable for men who want to father children, because it stops sperm production.