Andropause: Why the Term “Male Menopause” Gets It Wrong

For two decades, my patients were the people running the City of London: bankers, traders, senior executives at firms used to performing under enormous pressure and used to solving problems by working harder. So when a man in his late forties told me he was training as hard as ever, doing everything right, and still felt like a duller version of himself, tired, flat, carrying weight around his middle he could not shift, I paid attention. I saw this pattern often enough, across enough capable, high-performing men, to know it was not a willpower problem.

What he was describing has a name, and it is not the male menopause.

Is andropause the same as menopause?

No, and the difference matters more than it sounds. In women, menopause is a relatively abrupt hormonal shift, typically unfolding over a few years. In men, the decline in testosterone is gradual. It generally begins around the mid-thirties and continues at roughly 1% a year. There is no single date it starts and no single moment it becomes noticeable.

Borrowing the word menopause for men suggests a cliff edge. What most men actually experience is a slope, gentle enough to blame on ageing, stress, or simply getting older, and gentle is exactly what makes it easy to underplay. A slow decline can still add up to something worth taking seriously.

What does that slope actually feel like?

No man experiences all of this, and the mix varies widely from one patient to the next, but the pattern tends to cluster in a few areas.

• Energy and mood: persistent tiredness, low mood, irritability, and difficulty concentrating or holding a thought as easily as before.
• Body composition: loss of muscle mass, fat redistribution around the middle, and a harder time getting the results from training that used to come easily.
• Sexual health: reduced libido, fewer spontaneous erections, and erectile difficulty.
• Sleep and long-term health: insomnia or poor-quality sleep, and over time, decreased bone density.

Is it always the hormones?

Most conversations about men’s hormones jump straight to testosterone. The more useful question a specialist asks first is what else could be producing the same picture. Poor sleep, a poor diet, inactivity, drinking more than intended, and psychological load from work, relationships, ageing parents or the pressure of midlife itself can all produce a symptom picture that looks almost identical to a genuine hormonal decline.

Untangling which of these is actually driving a patient’s symptoms, rather than assuming testosterone is the whole story, is the job of a proper assessment. It is also why treating a number on a blood test in isolation, without looking at the person attached to it, so often fails to help.

Andropause and hypogonadism are not the same thing

Andropause is a natural, gradual part of ageing. Hypogonadism is a distinct medical condition in which the body fails to produce enough testosterone on its own. It can be present from birth, or it can develop later in life, particularly alongside conditions such as obesity or type 2 diabetes, in which case it is often called late-onset hypogonadism.

The distinction is not academic. Andropause is something every man will experience to some degree. Hypogonadism is a specific, diagnosable condition that needs its own evaluation, and getting that distinction right is the difference between a sensible conversation about ageing and a missed diagnosis.

What does a proper assessment actually involve?

A meaningful work-up looks beyond a single testosterone reading. It typically includes blood tests for both testosterone and DHEA, since hormone decline rarely happens on one axis alone, a careful prostate assessment before any hormone therapy is considered, and an honest look at the lifestyle and psychological factors described above, addressed alongside any hormonal findings rather than after them. Referral to a urologist follows when the findings call for it, not as a default first step.

Where does hormone therapy fit in?

For men with a confirmed hormone deficiency, bio-identical hormone replacement therapy (BHRT) uses hormones with the same molecular structure as those the body produces naturally, delivered by injection, gel, implant, patch or tablet depending on the patient. Long-term data in men with diagnosed hypogonadism specifically, not men with general age-related decline, has shown sustained improvements in sexual function, mood, lean and fat mass, and bone density.

Testosterone therapy’s effect on cardiovascular and metabolic risk is still a genuinely active area of research, not a settled protective benefit, and I would rather say that plainly than overstate it. What is settled is this: the right treatment starts with the right diagnosis, not with a prescription.

What this means at The Schoeman Clinic

This is why we assess testosterone alongside the wider hormonal and metabolic picture, not as a single number in isolation. If you have been putting your energy, your mood or your changing body down to simply getting older, it may be worth finding out what a fuller assessment would actually show.

If this resonates, get in touch to find out whether a full hormonal and metabolic assessment could explain what you have been feeling.

References

• Wang C, Cunningham G, Dobs A, et al. Long-term testosterone gel treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. Journal of Clinical Endocrinology & Metabolism, 2004.
• Darby E, Anawalt BD. Male hypogonadism: an update on diagnosis and treatment. Treatments in Endocrinology, 2005.
• Watt PJ, Hughes RB, et al. A holistic programmatic approach to natural hormone replacement. Family & Community Health, 2003.