Andropause

Why the term is misleading

The word suggests a male version of menopause, but the two are quite different. Menopause is a defined event: the ovaries stop releasing eggs, estrogen falls sharply, and periods end. In men there's no equivalent shutdown. Testosterone tends to drift downward slowly over decades, sperm production usually continues, and many men keep testosterone levels in the normal range well into old age.

Clinicians tend to prefer terms such as testosterone deficiency, late-onset hypogonadism or age-related low testosterone, which describe something that can be measured.

What can come with lower testosterone

When testosterone does fall below the normal range, men may notice:

• Lower sex drive and fewer spontaneous or morning erections.
• Erectile difficulties.
• Fatigue, low motivation or low mood.
• Loss of muscle and strength, with more body fat.
• Reduced bone density over time.

Many other things cause the same symptoms

None of these symptoms is specific to testosterone. Poor sleep and sleep apnea, depression, heavy drinking, weight gain, diabetes, thyroid problems, some medicines (including opioids) and simple overwork can all produce the same picture. Excess weight and poor metabolic health are common contributors to low testosterone in midlife, and levels can improve when those are addressed.

How low testosterone is diagnosed

Professional guidelines from the Endocrine Society and the American Urological Association agree on the basics. A diagnosis requires both symptoms or signs and consistently low lab results. Testosterone should be measured in the early morning on at least two separate days. The AUA uses a total testosterone below 300 ng/dL as a reasonable cutoff. Follow-up tests, such as LH and prolactin, help find out why the level is low.

The Endocrine Society recommends against routinely treating all men over 65 who simply have low levels. For men with symptoms and confirmed low testosterone, treatment can be offered after a careful discussion of benefits and risks.

If treatment is considered

Testosterone therapy needs monitoring. It can raise hematocrit (the proportion of red blood cells), it suppresses sperm production and can cause infertility, and PSA should be checked in men over 40 before starting and during treatment. Men who want to have children have other options to discuss, such as medicines that stimulate the body's own production. At HealifyMD, TRT is offered after an online assessment, lab work and a visit with a licensed clinician who reviews these trade-offs with you.