Is Andropause Really a Thing?

If you have ever heard someone refer to “andropause”, you may have wondered what exactly they were talking about. The word is often used to describe a collection of changes some men experience as they move through middle age and beyond, particularly changes linked with falling testosterone levels. Reduced energy, lower libido, changes in mood, loss of muscle strength and even problems with concentration can all get bundled under the andropause label.

It sounds rather like the male equivalent of menopause, which makes the idea easy to understand. There is one important difference, though: men do not generally go through a single, clearly defined hormonal event comparable with menopause. Testosterone tends to decline gradually with age, and the experience varies considerably from one man to another. Some men notice very little change, while others may develop symptoms which are significant enough to warrant a medical check.

So what happens to testosterone?

Testosterone is an important hormone for men. It has a role in sexual desire and function, muscle and bone health, red blood cell production and general wellbeing. Testosterone levels tend to fall as men age, although there is considerable variation in both the starting point and the rate of decline.

Age is only part of the story. Weight, sleep, physical activity, alcohol consumption, some medications and various health conditions can influence testosterone levels as well. Consequently, a man who feels more tired or less energetic in his 60s cannot automatically blame testosterone.

This is where the term andropause can become a little misleading. It suggests a single explanation for a broad collection of changes, when the reality is usually more complicated. Feeling tired, gaining weight, sleeping poorly or losing some physical strength can all happen with ageing for reasons which have little to do with testosterone.

What about the symptoms?

Changes in sexual health tend to be among the more recognisable signs associated with low testosterone. A noticeable reduction in sexual desire or changes in erectile function can sometimes be linked with testosterone deficiency. Other possible symptoms include reduced energy, lower mood, difficulty concentrating, reduced muscle mass and strength, and changes in body composition.

The difficulty lies in the fact these symptoms are not exclusive to low testosterone. Poor sleep, prolonged stress, depression, certain medications, being less physically active, carrying more weight than you once did or drinking heavily can all affect general health and may produce remarkably similar results. Even the gradual loss of fitness can leave a man feeling less energetic and capable than he once did. Improving sleep, staying active, moderating alcohol and looking after your general health are sensible steps regardless of whether hormones turn out to be involved.

Other health conditions can produce similar symptoms too. Thyroid problems, diabetes and some chronic illnesses can contribute to fatigue, changes in weight, mood changes or sexual difficulties. It is easy to overlook these possibilities when falling testosterone seems like a convenient explanation for several changes happening at once.

Consider a man who is feeling tired, has gained weight and has noticed a drop in his libido. Perhaps he is sleeping badly because of sleep apnoea, has consequently become less active, gained weight and feels exhausted. Perhaps stress has affected his relationship and libido, or medication is contributing to sexual difficulties. Perhaps there is a genuine testosterone issue. The symptoms alone do not tell you which explanation is correct, which is why persistent or troublesome changes are worth discussing with your GP.

What about testosterone treatment?

Testosterone replacement therapy has received plenty of attention in recent years, accompanied by an equally impressive amount of advertising and online discussion. The idea can sound appealing: if testosterone falls with age, perhaps replacing it could restore energy, strength and vitality.

For men with genuine testosterone deficiency, testosterone treatment can have a place in medical care. It is not, however, simply a general-purpose treatment for ageing. Taking testosterone without an appropriate medical reason is not the same as replacing something your body has inevitably “run out of”, and treatment carries its own considerations.

This is another reason to be cautious about products or programmes promising to “boost testosterone” and reverse the effects of ageing. Feeling older than you once did does not necessarily mean you need more testosterone, so it is better to talk to your GP about persistent or concerning symptoms rather than trying to treat them yourself.

Perhaps the name is the problem

There is something appealing about the word andropause. It gives a name to a stage of life when some men may notice a collection of changes, while offering a reassuringly simple explanation for what is happening. The problem comes when the label makes a complicated situation sound simpler than it really is.

Perhaps the most useful way to think about andropause is not as a male version of menopause, but as a loose term for changes which can occur as testosterone levels gradually decline with age. Some men may experience genuine testosterone deficiency, while others may be dealing with sleep problems, changes in fitness, weight gain, stress, medication or another health issue.

So, is andropause really a thing? The changes people associate with it certainly can be real. The idea of a universal male menopause is rather less so. If something about your energy, mood, sexual health or physical strength has changed noticeably and is bothering you, there is no need to simply put it down to getting older. A conversation with your GP may help establish what is really going on.