Andropause, or ‘male menopause‘, is a real thing. Men’s testosterone levels decline with age, which can impact energy, mood, and overall well-being. Dr Sanjay Prakash J, consultant microsurgical andrologist and urologist, Asian Institute of Nephrology and Urology, Chennai, in an interview with HT Lifestyle, said it’s a gradual process, often intertwined with lifestyle factors and chronic illnesses. Also read | Twinkle Khanna on struggling with menopause at 51: I am tired, overheated while my husband sleeps through demolitions
Male menopause: myth or reality?
He said, “When we hear the word menopause, it instantly brings to mind the physical and emotional changes that women experience in mid-life. Yes, men too, undergo their own version of hormonal transition known as andropause, late-onset hypogonadism, or age-related testosterone decline. However, it is not as sudden or dramatic as in women, yet its impact on health, energy, mood, and sexuality is very real.”
Dr Prakash added, “In men, testosterone — the primary male hormone — declines slowly, starting from the mid-30s at a rate of 0.4 percent per year (as per European ageing male study). This lowers energy, reduces libido, and can alter physical and mental well-being. Unlike women’s menopause, which is a biological milestone, men’s hormonal changes often intertwine with lifestyle factors and chronic illnesses. Obesity, diabetes, chronic stress, and the use of certain medications can further suppress testosterone beyond what is expected from ageing alone. While ageing is the primary driver, these accompanying factors often make the experience more pronounced in some men.”
Key signs to watch out for
Andropause can manifest in several ways, according to Dr Prakash: “Persistent fatigue and low energy, even after rest, mood changes, such as irritability, depression, or increased anxiety, decreased libido and performance issues, including erectile dysfunction, loss of muscle mass, increased body fat, especially around the abdomen, and even hot flashes or sweating in some cases and sleep disturbances. Notably, these shifts arise gradually, often between ages 40 and 60, and are frequently mistaken for normal aging or occupational stress.”
Awareness is key
As per the doctor, there is often confusion around ‘male menopause,’ as its symptoms overlap significantly with general ageing and chronic health conditions. “Diagnosis typically involves a clinical evaluation, blood tests to assess testosterone levels, examination of other contributing factors, and careful exclusion of alternative explanations for the symptoms,” Dr Prakash said.
Addressing so-called male menopause requires a comprehensive approach, he added. “Starting with lifestyle optimisation like maintaining a healthy weight, regular physical activity, reducing alcohol, and managing stress are paramount. Treating underlying health problems – obesity, sleep apnea, diabetes, and chronic illnesses, which can reduce the worsening of hormone levels. Psychological support for mood disturbances with counselling or therapy can greatly improve the quality of life. In select men with proven testosterone deficiency and significant symptoms, testosterone replacement therapy (TRT) can be considered, but only under medical supervision due to potential risks,” Dr Prakash said.
According to Dr Prakash, different forms of TRT are available – injections, gels, implants, intranasal spray and oral preparations (less preferred):“TRT is contraindicated in locally advanced or metastatic prostate cancer, male breast cancer, poorly controlled congestive heart failure, men desiring to have a child, packed cell volume >54 percent and family history of venous thromboembolism.”
He concluded, “Men do not go through menopause in the same way as women, but they can experience a gradual hormonal decline with ageing called andropause or late-onset hypogonadism. As a clinician, I find that awareness is the biggest barrier. Just as society encourages women to understand and manage menopause, we must encourage men to acknowledge and address andropause without stigma. Regular health check-ups, hormonal screening after 40, and proactive dialogue with a qualified uro-andrologist can make ageing a more confident, energetic, and sexually fulfilling phase of life. Ageing is inevitable, but feeling old doesn’t have to be.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
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