Male Menopause: Overview and More

Some Men Experience Symptoms of Low Testosterone Later in Life

Updated on March 12, 2023

Medically reviewed by Lindsay Cook, PharmD

When men age, there’s a natural decline in the body’s production of the hormone testosterone (androgen), which is responsible for regulation of sex characteristics in those assigned male at birth. Later on in life, testosterone is vital to a man's physical and mental wellness. A drop in testosterone can cause what’s commonly referred to as hypogonadism ("male menopause" or "age-related low testosterone"). The decline in testosterone in men usually arises around the same time as menopause in women: in their late 40s or early 50s.

There has been controversy about the causes of male menopause and even the replacement of testosterone in men that have symptoms. There is also some discrepancy in how many men actually meet criteria for low testosterone.

Verywell / Julie Bang

It is estimated that hypogonadism affects an estimated 5 million men in the United States, and although it may occur in men at any age, low levels are more common in older men. This can lead to symptoms like erectile dysfunction, loss of energy and muscle mass, and changes in mood. Treatment for this condition primarily involves testosterone replacement therapy (TRT), alongside careful monitoring.

These symptoms can have a significant impact on quality of life while making other health issues more difficult to manage.

Male Menopause Symptoms

In contrast to female menopause, wherein women become unable to ovulate, male menopause doesn’t interfere with sperm production. But it does develop more slowly, with symptoms and signs often subtle. This leads to:

Irritability and unstable mood
Loss of libido or sexual drive
Loss of muscle mass and weakness
Low energy or fatigue
Reduced hair growth
Concentration and/or short-term memory problems
Reduced bone density

Some men with the condition also experience symptoms associated with female menopause such as hot flashes and sweating. Notably, too, some men with low testosterone display no signs.

Causes

Whereas menopause in women sets on relatively quickly as production of the hormones estrogen and progesterone stops, there’s a more gradual shift in men. Starting in the mid-30s, men lose about 1.6% of their testosterone a year, which is usually a natural, unproblematic process. However, symptoms can arise if you don’t have enough.

Some experience late-onset hypogonadism (LOH), which is characterized by very low levels of testosterone in older men arising with natural declines in that hormone.

Testosterone Levels and Male Menopause

There’s no agreed-upon testosterone level threshold for male menopause. In fact, there’s still some medical debate about whether the absence of this hormone is directly at fault. What is known is that healthy levels fluctuate as you age; what’s OK for a 50-year-old may not be for a 30-year-old.

In many cases, however, the symptoms of male menopause can be attributed to other factors and are not necessarily due to reductions in testosterone levels. This is at the root of controversies surrounding the condition.

Lifestyle Factors

Activities and habits you partake in can be at the root of some symptoms such as loss of sexual drive, decreased motivation, unstable mood, and others. Significant among these lifestyle factors are:

Insufficient sleep or insomnia
Unhealthy diet
Not getting enough exercise
Smoking tobacco

Psychological Factors

Emotional or psychological issues can also be at the root of some male menopause issues, and they can be worsened by this condition. Cases have been linked with:

Depression: Even in the absence of low hormone levels, depression is often associated with loss of libido, low energy levels, and shifts in mood.
Anxiety: Levels of anxiety can rise in middle age, and they’re closely related to depression. Changes in life status, such as divorce, loss of job, or financial problems, can all contribute to these issues.
Stress: Elevated stress, due to the above factors, can affect sexual function, libido, and mood. This can also contribute to anxiety and depression problems.

Medical Conditions

A number of other medical conditions have also been linked with severe reductions in testosterone levels as the body’s ability to synthesize this hormone is impacted. This can happen with:

In addition, low testosterone can occur when the testes—where this hormone is manufactured—become damaged or are lost. Accidents, testicular cancer, genetic conditions (especially Klinefelter syndrome), HIV/AIDs, some autoimmune disorders, and infections can also influence levels of this hormone.

Medications

Taking some medications causes low testosterone, leading to male menopause. This is the case for a range of drugs:

Opioids for pain, such as Vicodin, or as in illicit drugs like heroin can cause reductions in testosterone if used long-term.
Corticosteroids (glucocorticoids) are prescribed for arthritis, chronic obstructive pulmonary disease (COPD), and multiple sclerosis, among other conditions.
Other tranquilizers, such as benzodiazepines (Xanax) and barbiturates (Luminal and Nembutal), may also affect testosterone levels.
Chemotherapy and radiation therapy for cancer have also been known to cause drastic reductions in testosterone.

Diagnosis

If you’re experiencing symptoms of male menopause, it’s important to seek out medical attention. Diagnosis begins with a careful evaluation of your health status, as well as a physical evaluation; a mental health evaluation may also be called for.

This may involve:

Assessment of medications you’re taking or treatments you’re undergoing
Tests for signs of metabolic syndrome (cholesterol, blood pressure, and blood sugar)
Physical examination of testicles, hair growth, or any gynecomastia
Asking about any family history of low testosterone
Checking weight status and body mass index (BMI)

Blood Tests

Blood tests can help determine if you have low levels of testosterone and assess for any other conditions that may be causing the issue. Common tests include:

Testosterone level tests: In the bloodstream, some of the testosterone ("attached testosterone") attaches to proteins; the rest ("free testosterone") remains unattached. Clinical testing measures total levels, which are usually sufficient, though panels of free testosterone are helpful to detect some other conditions.
Luteinizing protein: Levels of this protein, which is a precursor to testosterone, help doctors get a better sense of the causes of the low levels. Problems with the pituitary gland can affect how much is in the blood.
Prolactin tests: A test administered when low testosterone levels are found, high amounts of the protein prolactin can indicate pituitary problems or tumor growth in that gland called a "prolactinoma."
Blood hemoglobin (Hgb): Hemoglobin is a protein in the blood essential for transporting oxygen to the rest of the body. If doctors detect low testosterone, the Hgb tests will help doctors determine the presence of blood disorders or other problems.

Additional assessments may be necessary to assess complications of male menopause or further investigate the cause of low testosterone. These include:

Treatment

The primary means of managing men with symptoms from male menopause is testosterone replacement therapy. This is usually called for by a primary care doctor, urologist, or endocrinologist. Replacement therapy has been shown to help improve libido, memory, muscle mass, and bone strength.

That said, TRT can also cause infertility and lead to a range of other side effects such as blood clots. This is why it's important to have replacement therapy done under the care of an expert medical professional.

TRT is delivered in several different ways:

Transdermal, using a gel, cream, or patch
Injection of both long- and short-acting doses
Oral daily medications, such as Kyzatrex, Jatenzo, and Tlando (testosterone undecanoate)
Transmucosal, using a nasal inhaler several times a day or a patch placed above the incisors in the mouth
Pellets of three to six months’ worth of testosterone implanted in the buttocks or hip

Throughout the course of treatment, your progress will be regularly monitored. Follow-up appointments are necessary every six to 12 months.

Prognosis

While male menopause on its own is not fatal, if untreated, the symptoms can significantly affect your quality of life. Low testosterone levels have been found to increase the risk of death due to heart conditions. This condition is also linked with a number of other conditions, which can also have a severe impact. These include:

That said, if the condition is monitored and managed, and alongside other positive changes in lifestyle, you can lead a full, productive life with male menopause.

Coping

As noted, the symptoms of male menopause can lead to significant psychological issues, especially when sexual function is impacted. It’s important to remember that these issues can be sorted through, and there are means to help you cope:

Counseling: Individualized counseling with a therapist can help unpack some of the difficult emotions associated with the condition. Couples therapy can also help restore intimacy in relationships.
Family and friends: It may help to talk to trusted family and friends about your condition. Members of your trusted circle can be an invaluable source of support.
Support groups: There may be support groups in your area for men with low testosterone. It’s also worth looking into social media groups and pages. These can be an excellent way to share experiences and trade information.
Advocacy organizations: Advocacy organizations, such as the Hormone Health Network, are dedicated to raising awareness of the condition. This organization helps connect patients and caregivers while being a source of reliable information.

A Word From Verywell

Though there’s medical debate about male menopause, there’s no doubt that older men can be severely impacted by low testosterone levels. Life with this condition can be particularly challenging as the symptoms are subtle, and it can severely affect emotional health.

If you’re concerned about reduced levels of this hormone, be sure to seek out medical help. As with many conditions, early detection and timely intervention can drastically improve outcomes. It’s important to be careful when considering TRT for this condition, too. This needs to be a decision made along with your doctor.

With an aging population, the number of men living with symptoms of male menopause will continue to grow. In kind, endocrinologists and researchers will continue to learn more and more about the health effects of low testosterone levels, and management of this condition will get even better.

Why Is Testosterone Important?

9 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.