Andropause (“Male Menopause”): Symptoms, Causes, and Treatment Options

Andropause, often called “male menopause,” is a gradual fall in testosterone with age, not a sudden life stage like menopause. Symptoms can include fatigue, low libido, erectile dysfunction, mood changes, and muscle loss, but diagnosis requires symptoms plus repeat morning blood tests and a clinician’s review.

What is andropause, and is “male menopause” a real condition?

Andropause is a common name for symptoms that may occur when testosterone falls with age. The more medical term is late-onset hypogonadism, which means low testosterone with symptoms starting later in life 3.

Testosterone is the main androgen hormone in men. It helps regulate sex drive, erections, sperm production, red blood cell production, muscle, bone, mood, and energy 3.

The tricky part is that many andropause symptoms overlap with sleep apnea, depression, thyroid disease, medication side effects, alcohol use, stress, obesity, and normal aging 3. That is why a symptom checklist alone is not enough.

How is andropause different from menopause in women?

Male menopause is not the same as menopause. Menopause is defined after 12 months without a menstrual period and reflects a major ovarian hormone change; andropause is usually slow, variable, and does not end fertility 2.

In the European Male Ageing Study, strict late-onset hypogonadism was uncommon when researchers required both symptoms and low testosterone, showing why repeat testing and clinical context matter 4.

What are the symptoms of andropause?

Andropause symptoms can be physical, sexual, emotional, or cognitive. The most useful clue is a pattern: symptoms that are new, persistent, and paired with low morning testosterone on more than one test 3.

Physical symptoms

• Lower energy or fatigue
• Reduced muscle mass or strength
• More body fat, especially around the waist
• Lower bone density or fracture risk in some men
• Sleep problems or worse recovery after exercise

Low testosterone has been linked with lower lean mass and bone density, but these symptoms are not specific to testosterone alone 5. Sleep apnea, low activity, under-eating protein, alcohol, and certain medications can look similar 3.

Sexual symptoms

• Lower sex drive
• Fewer morning erections
• Erectile dysfunction
• Lower sexual activity or satisfaction
• Infertility concerns

Sexual symptoms are more closely tied to low testosterone than many general symptoms, but erectile dysfunction can also come from blood vessel disease, diabetes, medications, stress, or nerve problems 4.

Emotional and cognitive symptoms

Some men notice irritability, lower motivation, low mood, or “personality changes” after 50. These changes can happen with low testosterone, but depression, grief, sleep loss, alcohol, chronic pain, and job or relationship stress are also common causes 3.

If mood changes include thoughts of self-harm, feeling unsafe, or major behavior changes, seek urgent medical support. Hormone testing can be part of the workup, but safety comes first.

What causes low testosterone as men age?

Testosterone changes with age because the testes, pituitary gland, body weight, sleep, illness, and medications all affect the hormone signal. A large aging study found that total testosterone fell with age while SHBG rose, which can lower free testosterone 1.

Normal age-related decline

The hypothalamus and pituitary gland send signals to the testes through luteinizing hormone (LH) and follicle-stimulating hormone (FSH). With age, this system can become less responsive, and testosterone output may fall 3.

Late-onset hypogonadism

Late-onset hypogonadism is not just “getting older.” It means symptoms plus consistently low testosterone, with labs that may point to testicular causes, pituitary causes, or mixed causes 3.

LH and FSH can help clinicians sort this out. High LH with low testosterone can suggest the testes are not responding well; low or normal LH with low testosterone can suggest pituitary, hypothalamic, medication, obesity-related, or illness-related causes 3.

Lifestyle and medical contributors

• Poor sleep or untreated sleep apnea
• Higher body fat or metabolic syndrome
• Type 2 diabetes
• Heavy alcohol use
• Opioids, glucocorticoids, some psychiatric medications, and other drugs
• Chronic illness, under-fueling, or overtraining

These contributors matter because some are treatable without TRT. Guidelines recommend looking for reversible causes before starting testosterone therapy 3.

How is andropause diagnosed?

Diagnosis starts with symptoms, but it does not stop there. The Endocrine Society recommends diagnosing hypogonadism only in men with symptoms and signs plus clearly and consistently low serum testosterone 3.

Symptom review

A clinician will ask about libido, erections, energy, mood, sleep, exercise, medications, fertility goals, prostate history, heart history, and alcohol or substance use. This review helps avoid missing a non-hormone cause 3.

Blood tests and timing

Testosterone has a daily rhythm, so guidelines recommend morning testing, with confirmation on a separate morning if the first result is low 3. Many clinicians also check SHBG when total testosterone and symptoms do not match, because SHBG affects free testosterone.

Depending on the situation, the workup may include LH, FSH, prolactin, thyroid tests, blood count, metabolic labs, and prostate-specific antigen (PSA) before TRT is considered 3.

Ruling out other causes

This step is important because treating a lab number alone can miss the real problem. For example, fatigue from sleep apnea or depression may not improve with testosterone and may need a different plan 3.

How do you treat andropause?

Treatment depends on whether a man has confirmed hypogonadism, what symptoms matter most, and whether fertility is a goal. Lifestyle care is often first-line for general vitality, while TRT is reserved for selected men after a proper workup 3.

Lifestyle changes and natural options

Exercise, sleep, weight management, alcohol reduction, and treatment of sleep apnea can support testosterone biology and improve symptoms that overlap with andropause. Weight loss in men with obesity is associated with increases in testosterone in clinical studies, though individual results vary 6.

• Strength train 2–4 days per week if your clinician says it is safe.
• Aim for steady sleep timing and screen for sleep apnea if you snore or wake unrefreshed.
• Eat enough protein and fiber, and avoid crash dieting.
• Review medications with a clinician instead of stopping them on your own.
• Treat diabetes, high blood pressure, and high cholesterol as part of the same health plan.

Testosterone replacement therapy (TRT)

TRT can be given as gels, injections, patches, pellets, or other forms prescribed by a clinician. In the Testosterone Trials, older men with low testosterone received testosterone gel adjusted to target a normal range, and sexual function improved more than vitality; individual results varied 5.

TRT is not a general anti-aging treatment. The Endocrine Society recommends against routine testosterone therapy for all older men with low testosterone unless they have symptoms and consistently low levels after evaluation 3.

Risks and side effects of TRT

TRT can cause acne, oily skin, breast tenderness, fluid retention, higher red blood cell counts, lower sperm production, and reduced fertility 3. It also requires monitoring for prostate symptoms, PSA changes, hematocrit, and response to therapy.

Cardiovascular safety has been studied closely. In the TRAVERSE trial, men with hypogonadism and high cardiovascular risk received testosterone gel or placebo; testosterone was noninferior for major adverse cardiac events, but the trial also reported higher rates of atrial fibrillation, acute kidney injury, and pulmonary embolism in the testosterone group 7.

Supporting healthy aging beyond testosterone: where longevity peptides fit

Longevity peptides and related compounds are not TRT and should not be used to skip a low-testosterone workup. They may fit a broader healthy-aging plan for selected patients, especially when the goal is sleep, recovery, body composition support, or oxidative stress support rather than replacing testosterone.

Sermorelin

Sermorelin is a growth hormone-releasing hormone analog, meaning it signals the pituitary gland to release growth hormone in a more upstream way than taking growth hormone itself. In a clinical study of older adults, growth hormone-releasing hormone increased growth hormone and insulin-like growth factor 1 activity, but benefits were modest and side effects can include injection-site reactions, fluid retention, tingling, or changes in glucose biology 8.

At Chia, sermorelin is available as injection, nasal spray, and tablets when prescribed after online evaluation. Plans for sermorelin injection currently start at $199/month.

NAD+

NAD+ is a coenzyme involved in cellular energy metabolism and redox reactions. Human trials of NAD+ precursors show that raising NAD-related metabolites is possible, but symptom benefits are still being studied; side effects depend on the form and can include flushing, nausea, headache, or injection-site discomfort 9.

At Chia, NAD+ is available as injection and nasal spray. Plans currently start at $199/month for injection and $129/month for nasal spray.

Glutathione

Glutathione is a major antioxidant made by the body. In a randomized human study, oral glutathione changed body glutathione stores over time, but it is not a testosterone treatment; side effects can include gastrointestinal upset, headache, or reactions depending on route 10.

At Chia, glutathione is available as injection and nasal spray. Glutathione injection plans currently start at $199/month.

How does Chia support men navigating age-related hormone and vitality changes?

Chia supports the healthy-aging side of the conversation, not TRT prescribing. If your symptoms suggest low testosterone, we encourage a proper hormone workup with a licensed clinician such as a primary care doctor, urologist, or endocrinologist.

For patients focused on adjacent goals, our care path is 100% online: a short health questionnaire, review by a licensed US provider, provider-guided dosing when prescribed, portal messaging, US 503A pharmacy compounding, and home delivery. A prescription is never guaranteed.

For men who want one clinician-reviewed longevity plan, our Foundation Longevity protocol combines sermorelin injection, NAD+ injection, and glutathione injection. It is designed to sit alongside routine medical care, not replace evaluation for low testosterone, depression, sleep apnea, diabetes, or heart disease.

When should you see a clinician?

See a clinician if low libido, erectile dysfunction, fatigue, mood changes, or muscle loss are persistent, new, or affecting your life. You should also seek care if symptoms come with chest pain, severe depression, sleep apnea signs, testicular changes, infertility concerns, or major behavior changes.

A good visit should connect symptoms, labs, medical history, medications, sleep, fertility goals, and cardiovascular risk. That complete picture is what helps a clinician decide whether the issue is late-onset hypogonadism, another condition, or more than one factor at the same time 3.

Frequently asked questions

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