Manopause: How Men Experience Hormone Decline

As we get older, it’s natural for our hormone levels to decline. For women, there is a sharp drop in hormone production during menopause and the symptoms are often obvious — like irregular periods, hot flashes, and night sweats. Reduction in hormone levels is much more gradual in men. The symptoms of “manopause” or andropause are generally subtle and they can go unnoticed.

Andropause symptoms may be confused with normal signs of aging, side effects of medication, or other health conditions. It’s important for men to understand what andropause is, how it may impact their life, and when they should seek help in dealing with it.

What is Andropause?

Testosterone is a hormone produced primarily in the testicles that helps men maintain sex drive, muscle mass, strength, facial and body hair, bone density, and red blood cell production. Testosterone is also essential for sperm production.

Andropause is when a man’s testosterone levels begin to decrease. It typically starts when a man is in his 40s or early 50s but can begin as early as age 30. During andropause, testosterone levels usually drop by about 1% each year. Andropause usually happens so slowly that most men aren’t aware of it.

However, the rate of testosterone decline can be greater in some men, depending on factors like genetics, lifestyle choices, and overall health. It’s estimated that about 30% of men between ages 40 and 79 have low testosterone levels. They may feel a more substantial impact from andropause.

A disease called hypogonadism can reduce testosterone production, because of problems in either the testicles or the hypothalamus and pituitary gland (the parts of the brain that tell the testicles to produce testosterone). Hypogonadism can make the symptoms of andropause more pronounced.

Symptoms of Andropause

The most common symptoms of andropause include:

• Reduced sex drive
• Erectile dysfunction
• Loss of muscle mass
• Increased body fat
• Loss of body hair
• Decreased bone density
• Fatigue and low energy
• Mood swings and irritability
• Depression
• Poor memory and difficulty concentrating
• Insomnia

Swollen or tender breasts, hot flashes, and night sweats are less common symptoms of andropause.

It’s normal for men to experience some symptoms of andropause. At what point should you seek help? If your symptoms are persistent and significantly affecting your life, it’s time to talk with a health care provider.

How is Low Testosterone Detected?

Visiting your primary care provider is a good place to start if you’re concerned about andropause symptoms. Your primary care provider can:

• Assess your symptoms
• Review your medical history for conditions that may be contributing to your symptoms
• Do a physical exam
• Run blood tests to measure your testosterone levels

If your testosterone levels are low, the provider may do other tests to determine the cause, such as hypogonadism.

Depending on initial results, your primary care provider may refer you to a specialist, such as a urologist or an endocrinologist (a doctor that treats hormone imbalances), for further evaluation and treatment.

Low Testosterone Treatments

If your testosterone levels are low, your health care provider may recommend testosterone replacement therapy (TRT) to relieve your symptoms. TRT is available in several different forms, including:

• Gels applied to the skin
• Injections into a muscle or under the skin
• Patches placed on the skin
• Pellets implanted under the skin
• Tablets applied to the gums
• Nasal gel
• Oral pills

Before making a decision about TRT, be sure to talk with your provider about possible side effects. They can include:

• Acne or oily skin
• Fluid retention
• Prostate problems such as difficulty urinating
• Breast enlargement or tenderness
• Skin irritation
• Worsening of sleep apnea
• Overstimulation of red blood cell production, which can increase risk of blood clots

Some men may not be eligible for TRT, including those that have a history of prostate or breast cancer, uncontrolled heart failure, untreated obstructive sleep apnea, a recent heart attack or stroke, or a history of blood clots in the legs or lungs.

Is TRT The Fountain of Youth?

Testosterone replacement therapy is becoming more popular, with the number of prescriptions in the U.S. increasing from 7.3 million in 2019 to more than 11 million in 2024.

TRT is being touted by some as a way to regain youthful vigor. However, health experts say TRT is not a fountain of youth. While it can help alleviate some of the symptoms of andropause, it cannot reverse the effects of aging.

Some health experts are cautious about using TRT to treat normal symptoms of aging. They point to the possible side effects and risks of using it long-term. In fact, the U.S. Food and Drug Administration (FDA) recently updated its labeling requirements for testosterone products to include a warning that they may increase blood pressure.

Testosterone replacement products are only approved by the FDA for men who have low testosterone levels because of a specific medical condition, like hypogonadism. The FDA continues to urge caution for using testosterone products for treating low testosterone due to aging.

Over-the-counter supplements containing herbs, vitamins, and minerals may make claims that they can boost testosterone, but these products are not regulated by the FDA and their claims are unproven. If you want to increase your testosterone, it’s important to see a licensed health care provider first.

Other Strategies for Treating Andropause

Testosterone replacement products are not the only way to combat the symptoms of andropause. Lifestyle changes can also be effective, including:

• Maintain a healthy body weight. Obesity is strongly linked with lower testosterone levels, studies have found. Fat cells can convert testosterone into estrogen, another hormone, which reduces overall testosterone levels in the body. Lowering your Body Mass Index can increase testosterone. Calculate your BMI.
• Eat a balanced diet. Meals that feature lean proteins, healthy fats, whole grains, and fruits and vegetables can help you maintain healthy body weight. Foods that may help increase testosterone include onions, fatty fish (containing omega-3 fats), and extra virgin olive oil. Nutritional counseling can help you adopt healthy eating habits.
• Exercise regularly. A workout routine that includes both aerobic exercise to increase the heart rate and resistance training to build strength has been shown to increase testosterone production.
• Improve the quality of sleep. Sleeping better can help boost testosterone production, as most testosterone is made when a person is in the rapid eye movement stage of sleep. Check out our blog on tips for successful sleep.
• Avoid tobacco products. Some studies indicate that smokers have a faster age-related decline in testosterone than non-smokers.
• Don’t drink too much. Excessive consumption of alcohol (more than two drinks a day) can interfere with production of hormones, including testosterone.
• Avoid opioid medications. Pain medications like morphine and other opiates can decrease testosterone levels. Do not stop or change pain medications without talking with the health care provider who prescribed the medication.
• Manage your stress. When we’re stressed, our bodies release the hormone cortisol, which can suppress testosterone production. Learn how to recognize and manage stress.

Talk to Your Provider About Options

The decline in testosterone production associated with aging is often gradual enough that most older men will still have testosterone levels in the normal range and their andropause symptoms will be mild. However, a significant percentage of men experience symptoms that are bothersome enough to disrupt their lives. If you are one of these men, talk with your health care provider about options for treating andropause. Your provider can help develop a treatment plan that’s best for you.