What andropause is and when it starts
Unlike menopause, andropause does not happen to every man, and it has no clear starting point. Testosterone production begins a slow decline from the early 30s, but the pace and the impact vary widely from one man to the next. Many men reach 70 with normal levels; others develop symptoms well before 50.
So there is no particular age at which anyone should start "treating andropause." What does exist is a medical condition, hypogonadism, which is confirmed by symptoms together with lab results, at any age.
Symptoms of andropause and low testosterone
The symptoms are nonspecific: each one can have several causes, and none of them on its own is enough for a diagnosis.
- Low libido
- Erectile dysfunction
- Persistent fatigue that does not improve with rest
- Loss of muscle mass and strength
- More body fat, especially around the abdomen
- Mood changes, irritability, trouble concentrating
- Loss of bone density
- Less body hair
One caveat: poor sleep, depression, obesity, certain medications and chronic diseases can produce exactly this picture while testosterone is normal. In those cases, hormone treatment does not solve the problem. It only delays finding out what the problem really is.
How it is diagnosed
A diagnosis requires two things at the same time: compatible symptoms, and low total testosterone confirmed on at least two blood tests drawn in the morning, when levels are highest. As a reference, international guidelines use cutoffs between 300 and 350 ng/dL (the American and European guidelines, respectively), always interpreted in light of the clinical picture.
A single measurement is not enough. Nor is a value at the low end of normal, in a man without symptoms, a reason to treat.
The workup continues with FSH, LH and prolactin, which show whether the problem lies in the testicles or in the signals from the pituitary gland, along with a complete blood count, PSA and a metabolic panel. It also looks for reversible causes before any testosterone is prescribed: sleep apnea, obesity, opioid or corticosteroid use, and other associated conditions, assessed case by case.
Before treatment: the fertility conversation
Testosterone given as medication shuts down the body's own production, and sperm production along with it. In men of reproductive age, testosterone replacement can significantly reduce fertility, and in some cases this suppression is not fully reversible after treatment stops.
If you plan to have children
This needs to be discussed before you start any testosterone replacement. There are alternative treatments that raise testosterone without suppressing sperm production, covered on the male infertility page. This is one of the most important points on this page, and one of those most often left unsaid.
Treatment options and follow-up
Testosterone is available as injections with different dosing intervals and in transdermal forms. The choice takes into account the hormone level profile, convenience and your preference.
Whichever form is used, it requires the same thing: follow-up. Testosterone replacement is not something you prescribe and then review a year later. It means monitoring hormone levels, hematocrit, PSA and clinical response at regular intervals, every two to three months early in treatment. This monitoring is part of the treatment, not an add-on.
What testosterone replacement treats, and what it is not
When it is correctly indicated, it brings consistent improvement in libido, energy, muscle mass, bone density and mood. Its effect on bone health in aging men is a topic I have published on. One finding was that testosterone is only one part of a larger picture that also involves body composition, physical activity and metabolic health.
What testosterone replacement is not: it is not a weight-loss treatment, a sports performance aid, a longevity protocol, or a fix for fatigue that has not been investigated. Used this way, it not only lacks a medical indication but also carries risk. And it is precisely this kind of use, outside a medical context, that has given the treatment a bad name among the men who actually need it.
Evaluation and follow-up by telemedicine
The initial evaluation, review of your test results and ongoing follow-up can all be done by telemedicine, which makes the frequent check-ins this treatment needs much easier.
If you have not been evaluated yet, the usual starting point is a routine men's health check-up.
Frequently asked questions
Does testosterone replacement cause prostate cancer?
There is no evidence that testosterone replacement in men with hypogonadism causes prostate cancer. That link came from older studies and has been reassessed in the medical literature over recent decades. What still holds is the need for a prostate evaluation before starting and for monitoring throughout treatment.
Can testosterone replacement make me infertile?
It can significantly reduce sperm production, and in some cases recovery after stopping is incomplete. That is why men who plan to have children should discuss alternatives before starting.
Are hormone implants sold as "beauty chips" a form of hormone replacement?
No. The implants sold for this purpose usually contain hormones in doses and combinations with no established medical indication and without proper monitoring, and they are often placed without any diagnosis of deficiency. That is not treatment for hypogonadism.
What is andropause?
"Andropause" is the popular name for androgen deficiency of the aging male: the gradual decline in testosterone that can occur with age. Unlike menopause, it does not happen to every man and has no clear starting point. Treatment is indicated only when there are symptoms and laboratory confirmation.
At what age does andropause start?
There is no fixed age. Testosterone production declines slowly from the early 30s, but the pace varies widely. Some men have symptoms before 50; others reach 70 with normal levels. What defines the condition is not age but the combination of symptoms and an abnormal test result.
What is a normal testosterone level?
International guidelines use cutoffs between 300 and 350 ng/dL as a reference for total testosterone, but a number on its own does not make a diagnosis. It needs to be confirmed by a second morning test and interpreted together with your symptoms and the rest of the workup.
Will I need to take it for the rest of my life?
It depends on the cause. When there is a reversible factor, such as sleep apnea, obesity or a medication, treating it can bring levels back to normal. In established primary hypogonadism, treatment is usually ongoing, with regular follow-up.
My testosterone is borderline. Should I treat it?
A borderline level in a man without symptoms is not a reason to treat. If you do have symptoms, the workup looks for other causes and repeats the test before any decision is made.
