Men experience a gradual decline in testosterone with age — andropause. The symptoms are real, the treatment is effective, but the medical establishment has been slow to recognize and treat this condition.
What Is Andropause?
Andropause (also called late-onset hypogonadism or testosterone deficiency syndrome) is the gradual decline in testosterone levels that occurs in aging men. Unlike female menopause, which is abrupt, andropause is gradual — beginning in the 30s and continuing throughout life.
The symptoms of andropause include:
- Fatigue and reduced energy
- Reduced libido and sexual function
- Erectile dysfunction
- Reduced muscle mass and strength
- Increased body fat, particularly visceral fat
- Mood disturbances, depression, irritability
- Cognitive decline, reduced concentration
- Reduced bone density
- Sleep disturbances
The Prevalence
Andropause is far more common than recognized. Studies find that:
- 20-40% of men over 60 have testosterone levels below the normal range for young men
- 50% of men over 80 are hypogonadal
- Many men with symptoms of andropause have testosterone levels in the "low-normal" range — technically normal but suboptimal
20-40% of men over 60 have testosterone levels below the normal range for young men. Andropause is a real, common, and treatable condition.
Why It Is Underdiagnosed
Andropause is underdiagnosed for several reasons:
- Gradual onset: The symptoms develop slowly and are often attributed to "normal aging"
- Non-specific symptoms: Fatigue, mood changes, and reduced libido have many causes
- Physician reluctance: Many physicians are uncomfortable prescribing testosterone due to
unfounded fears about prostate cancer and cardiovascular risk
The Treatment
Testosterone replacement therapy (TRT) is available in several forms:
- Topical gels/creams: Applied daily; convenient but can transfer to partners
- Injections: Testosterone cypionate or enanthate every 1-2 weeks; most cost-effective
- Pellets: Implanted subcutaneously every 3-6 months; most consistent levels
- Patches: Applied daily; less commonly used
The goal of TRT is to restore testosterone to the mid-normal range for young men (500-800 ng/dL), not to supraphysiological levels.
Monitoring
Men on TRT should be monitored for:
- Testosterone levels (to ensure therapeutic range)
- Hematocrit (TRT increases red blood cell production)
- PSA (prostate-specific antigen, though TRT does not cause prostate cancer)
- Estradiol (TRT can convert to estrogen via aromatase)
