Andropause, also known as late-onset hypogonadism, is a recognised medical condition in which testosterone levels gradually decline with age. 

Unlike female menopause, it does not occur suddenly. Instead, it develops slowly over many years and varies widely between individuals. 

Andropause becomes clinically relevant only when persistently low testosterone levels occur alongside characteristic symptoms, rather than based on blood test results alone.

What Happens in Andropause?

Andropause reflects a gradual, age-related hormonal change. 

As men age, the tests produce less testosterone, while hormonal signalling in the brain becomes less effective. 

At the same time, levels of sex hormone-binding globulin (SHBG) increase, reducing the amount of free, biologically active testosterone. 

This means symptoms can occur even when total testosterone levels appear borderline.

Symptoms of Andropause

Symptoms develop slowly and are often mistaken for normal ageing. 

The most reliable symptoms are sexual, including reduced libido, fewer morning erections, and erectile dysfunction. 

Other symptoms may include low energy, low mood, irritability, and reduced concentration, although these are less specific. 

Physical changes can include reduced muscle mass and strength, increased body fat, lower bone density, and anaemia. 

Sleep disturbance and hot flushes are less common but may occur.

Why Is It Often Misdiagnosed?

Andropause is frequently underdiagnosed because testosterone declines gradually rather than abruptly. 

Symptoms are often attributed to ageing, stress, or lifestyle factors. 

Rising SHBG levels can further lower free testosterone, meaning symptoms may be present even when total testosterone appears near normal. 

Sexual symptoms are the most consistent indicators, while fatigue and mood changes are less specific, which can delay diagnosis.

Risk Factors for Early Andropause

Although andropause is part of normal ageing, certain factors can accelerate testosterone decline. 

Obesity and metabolic dysfunction are the strongest contributors, as excess body fat suppresses testosterone production. 

Metabolic syndrome further worsens this effect. 

Other risk factors include…

• Long-term use of opioids or glucocorticoids
• Previous anabolic steroid use
• Pituitary disorders
• Testicular damage
• Infections
• Chemotherapy
• Radiotherapy.

Long-term consequences

Persistently low testosterone affects more than sexual health. 

Long-term consequences include…..

• Reduced muscle strength and frailty
• Lower bone density with increased fracture risk
• Metabolic complications such as insulin resistance and type 2 diabetes. 
  
  

Low testosterone is also associated with higher cardiovascular risk and increased mortality, although much of this evidence is observational. 

It may act both as a marker of poor health and a contributor to disease progression.

Diagnosis

Andropause is diagnosed only when symptoms occur alongside consistently low testosterone levels. 

Sexual symptoms are the most reliable clinical markers. 

Assessment begins with a fasting morning total testosterone blood test, repeated on two separate occasions. 

If SHBG levels are abnormal, free or bioavailable testosterone should be measured. 

Additional hormone tests may be needed to identify whether the cause is testicular or related to reduced brain signalling.

Management strategies

Management focuses on improving symptoms while minimising risk. 

A stepwise approach is recommended, starting with addressing reversible causes such as obesity, poor sleep, and metabolic dysfunction. 

Testosterone replacement therapy is considered only when symptoms persist and testosterone levels remain consistently low, following appropriate assessment and discussion of benefits and risks.

Addressing Stigma in Andropause

Stigma remains a significant barrier to diagnosis and treatment. 

Because andropause is linked to ageing, masculinity, and sexual health, symptoms may feel embarrassing or difficult to discuss. 

Many men delay seeking help, assuming symptoms are inevitable or untreatable.

Why stigma exists

Social expectations around strength and resilience can discourage men from acknowledging symptoms such as,

• Low energy
• Mood changes
• Sexual difficulties. 
  
  

Awareness that these symptoms may reflect a treatable hormonal condition remains limited.

Clinical Implications 

As a result of stigma and under-recognition, many men with symptomatic low testosterone remain undiagnosed or untreated. 

Symptoms are often managed in isolation rather than addressing the underlying hormonal deficiency, which can affect bone health, metabolic risk, and overall quality of life.

Strategies to reduce stigma

Reducing stigma involves normalising conversations about energy, mood, and sexual health. 

Explaining that testosterone can be assessed with a simple morning blood test and presenting andropause as a common, medical, and treatable condition can encourage earlier assessment and appropriate care.

What happens if it is left untreated?

Untreated andropause is a progressive hormonal deficiency that can affect physical, metabolic, and mental health. 

Persistently low testosterone may lead to….

• Worsening sexual symptoms
• Fatigue
• Muscle loss
• Increased body fat, 
• Declining bone density
• Higher metabolic 
• Cardiovascular risk, 
  
  

influenced by underlying health status.

Summary

Andropause, or late-onset hypogonadism, is a recognised medical condition that requires careful, symptom-based assessment. 

It develops gradually, varies between individuals, and is strongly influenced by overall health. 

Clinically significant andropause is defined by characteristic symptoms together with consistently low testosterone levels. 

Best practice focuses on confirming the diagnosis, addressing reversible factors, and using testosterone therapy only when clearly indicated, with appropriate monitoring.