Andropause Is a Gradual Testosterone Decline in Aging Men
Medically reviewed by Dr. Michael Teplitsky, MD Last reviewed 2026-10-21
How testosterone falls with age in men and which tests confirm a real deficiency.
Andropause, often called male menopause, is the slow age-related fall in testosterone. Only symptoms plus two low fasting morning testosterone tests confirm a real deficiency, and treatment is aimed at that confirmed deficiency.
The clearest signs of andropause are low sex drive and weaker or fewer erections. At The Metabolic Journal, the guides we publish on men's hormones follow the Endocrine Society rule that a diagnosis needs both symptoms and repeated low morning blood tests.
Fatigue, low mood and lost muscle often come with those sexual changes. Testosterone drifts down by about 1% a year from around age 30 to 40, so there is no sudden stop like the final period in women. Many men with these symptoms do not have a hormone deficiency, and the tests below sort out which men do.
Is this andropause, or something else?
The symptoms men get told to accept after 40 — energy, mood, libido, body composition — are testable. Opt Health runs the panel and treats what it finds.
Read Opt Health on andropause →Signs of Andropause
The signs of andropause that track testosterone most closely are sexual: low desire, poor morning erections and erectile dysfunction. In the European Male Ageing Study (EMAS), which tested 3,369 men aged 40 to 79, only those three symptoms rose together as testosterone fell.
The NHS lists a wider set of symptoms that often appear in the late 40s to early 50s.
- Sexual: low sex drive and erectile dysfunction.
- Body: muscle loss, less exercise capacity, and fat moving to the belly or chest (gynaecomastia).
- Energy and sleep: low energy, more tiredness and trouble sleeping.
- Mood and thinking: depression, mood swings, irritability, poor concentration and short-term memory problems.
Fatigue and low mood alone are weak signals, because stress, poor sleep, heavy drinking and inactivity cause the same complaints. The full symptom-by-symptom breakdown is on our low testosterone guide. Hot flashes are not on the NHS or EMAS lists, so if you have them, read hot flashes in men for the causes that do produce them.
What Age Andropause Starts
Andropause has no single starting age, because testosterone begins a slow decline around 30 to 40 and symptoms usually surface in the late 40s or 50s. The Massachusetts Male Aging Study followed 1,156 men for 7 to 10 years and measured total testosterone falling 1.6% a year within each man.
Bioavailable testosterone, the share not tightly bound to sex hormone-binding globulin (SHBG), fell faster at 2% to 3% a year. Compounded over 20 years, a 1.6% yearly drop leaves a man at about 72% of where he started.
The Baltimore Longitudinal Study of Aging found testosterone in the hypogonadal range in about 20% of men over 60, 30% over 70 and 50% over 80. Low numbers on paper are common late in life, which is why a blood level without symptoms does not settle the question. Our testosterone by age chart shows typical ranges decade by decade.
Andropause Versus Late-Onset Hypogonadism
Andropause is real as a gradual hormone decline, while a true testosterone deficiency in older men is less common and has a medical name. The NHS calls "male menopause" an unhelpful term, since symptoms do not come from a sudden midlife drop. It reserves the diagnosis of late-onset hypogonadism for men whose testes make little or no testosterone.
Late-onset hypogonadism is more likely in men with obesity or type 2 diabetes, and the NHS describes it as uncommon and not a normal part of ageing. In the Massachusetts study, good health added 10% to 15% to several androgen levels, and new illness seemed to speed the decline.
That makes weight, blood sugar, sleep and alcohol the first things to check, before any hormone treatment. If you have obesity or type 2 diabetes, ask your doctor to treat those conditions alongside any testosterone workup.
How Andropause Differs From Menopause
Andropause differs from menopause in speed, reach and treatment: a slow, partial decline in some men compared with a sharp fall in estrogen in every woman. Women's life-stage changes have their own hubs on menopause and perimenopause.
| Feature | Andropause | Menopause |
|---|---|---|
| Hormone change | Testosterone drifts down, about 1% to 2% a year | Estrogen falls sharply around the final period |
| Onset | Gradual from around age 30 to 40 | Marked by the final menstrual period |
| Who it affects | Some men, with about 20% over 60 low by blood test alone | All women who live past midlife |
| Hot flashes | Not a listed andropause symptom | Frequent hot flashes last a median 7.4 years |
| First-line hormone treatment | Testosterone only if deficiency is confirmed | Hormone therapy for bothersome hot flashes |
| Verdict | Milder and optional to treat | Universal, with a clearer case for treatment |
The hot-flash duration comes from the Study of Women's Health Across the Nation (SWAN). The treatment row follows The Menopause Society, whose 2022 hormone therapy statement calls hormone therapy the most effective treatment for hot flashes.
What to Test for Andropause
Testing for andropause starts with a fasting morning total testosterone, repeated on a second morning to confirm a low result. The 2018 Endocrine Society guideline asks for an accurate assay and both readings to be unequivocally low before anyone calls it deficiency.
- Total testosterone, fasting and in the morning, done twice on separate days.
- Free testosterone when total testosterone sits near the lower limit or SHBG is likely abnormal, measured by equilibrium dialysis or an accurate formula.
- LH and FSH (luteinizing and follicle-stimulating hormone) to tell a testicular cause from a pituitary or brain cause.
The Endocrine Society's guideline page advises against routine screening of men without symptoms. EMAS defined late-onset hypogonadism as three sexual symptoms plus total testosterone under 11 nmol/L (about 320 ng/dL) and free testosterone under 220 pmol/L. See our pages on free testosterone and hormone testing for how to order and read each test.
Andropause Treatment Options
Andropause treatment depends on the test results: lifestyle and mental-health care for most men, and testosterone only for confirmed deficiency. For mood symptoms, the NHS points to talking therapy such as cognitive behavioral therapy (CBT), medication when needed, and exercise.
Testosterone helps sex drive more than energy. In the Testosterone Trials, 790 men aged 65 and older with low levels and symptoms used gel or placebo for a year. Testosterone improved sexual activity, desire and erections, slightly improved mood, and did nothing for vitality or walking distance.
On heart safety, the TRAVERSE trial of 5,246 men at high cardiovascular risk found major heart events in 7.0% on testosterone and 7.3% on placebo. The testosterone group did have more atrial fibrillation, acute kidney injury and pulmonary embolism.
The Endocrine Society advises against testosterone for men planning a pregnancy soon, men with breast or prostate cancer, and men with untreated severe sleep apnea, among other conditions. It also suggests against routinely prescribing it to every man over 65 with a low level. Our testosterone replacement therapy (TRT) guide covers forms, dosing and monitoring, and enclomiphene vs TRT covers the fertility question.
Testosterone is a poor bet if your only symptoms are tiredness and low mood with normal sexual function. Our view would change if a large trial showed testosterone improving energy in older men, which the Testosterone Trials did not.
Where to Go Next on Andropause
Pick the guide that matches your andropause question.
- Matching symptoms to testosterone: low testosterone.
- Checking your number against your age: testosterone by age and free testosterone.
- Ordering labs: hormone testing.
- Weighing treatment: testosterone replacement therapy and enclomiphene vs TRT.
- Seeing every hormone topic: the hormone optimization hub.
Book a fasting morning total testosterone test and repeat it on a second morning. Then take both results and your symptom list to a doctor to judge whether andropause explains them.
How to test testosterone at home
You don't need a lab appointment to check your own testosterone — a few at-home kits mail you a collection kit and return physician-reviewed results online within days:
Prefer to order direct? The Everlywell Testosterone Test uses a CLIA-certified lab, physician-reviewed results, and prepaid return shipping.
Frequently Asked Questions
What is the age range for andropause?
Testosterone starts falling slowly around age 30 to 40, and andropause symptoms usually show up in the late 40s to early 50s. The decline continues with age, so low levels become more common in the 60s, 70s and 80s.
What is the treatment for andropause?
Treatment starts with the cause: weight, blood sugar, sleep, alcohol, stress and depression. Testosterone therapy is an option only when symptoms come with two low fasting morning testosterone results, and it mainly helps sex drive and erections.
Is andropause as bad as menopause?
For most men, no. Andropause is a slow, partial decline that the NHS says is unlikely to cause problems on its own, while menopause brings a sharp fall in estrogen for every woman and years of hot flashes for many.
What percentage of men get andropause?
About 20% of men over 60, 30% over 70 and 50% over 80 had testosterone in the low range in the Baltimore Longitudinal Study of Aging. A true deficiency with symptoms is rarer, because EMAS required three sexual symptoms on top of low levels.
Why do men get grumpy as they get older?
Irritability and mood swings are on the NHS list of midlife symptoms in men. The NHS also names stress, poor sleep, money or work worries and depression as common causes. A doctor can check mood and testosterone together.
Does andropause cause hot flashes?
Hot flashes are not a standard andropause symptom on the NHS or EMAS lists. If you get them, the hot flashes in men guide walks through the causes.
Does andropause end?
No. Testosterone keeps drifting down with age, so andropause has no end point the way perimenopause ends at menopause. Symptoms can improve when weight, sleep or mood problems are treated.
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