How Testosterone Changes Affect Men’s Health as You Age

Most people recognize “menopause” as the time in a woman’s life when menstrual periods stop and hormone levels—especially estrogen—drop, bringing on hot flashes, mood changes, and sleep disturbances.

But did you know that men can experience a similar change? It’s sometimes called “male menopause” or andropause. Unlike women, men don’t stop producing testosterone completely, but their levels can slowly decline with age. This gradual drop can lead to both physical and emotional changes that may impact energy, mood, and sexual health.

“These changes are normal, common, and manageable, but you need to take proactive steps to address them. Don't accept diminished quality of life as inevitable,” says Stephen A. Ferrara, DNP, who has spent decades treating patients in men's health and primary care. “I've seen countless men dramatically improve their well-being by addressing these issues directly. This is an opportunity to invest in your health for the decades ahead.”

Ferrara explains what happens during andropause and shares strategies for maintaining health and confidence.

What is andropause, and how does it compare with menopause in women?

Men don't have an "off switch" for hormones like women experience with menopause, so I don’t love the term “manopause.” Andropause represents the gradual decline in testosterone levels that occurs in men as they age. The key difference from female menopause is that it's a slower process. While women experience a relatively sudden drop in estrogen and complete end to reproductive function during menopause, men experience approximately a 1-2 percent decline in testosterone per year. Not all men will experience symptoms; it really depends on individual baseline levels and overall health.

At what age do men typically begin to experience a drop in testosterone?

Most men begin experiencing testosterone decline around age 40, though it can vary considerably based on individual factors. By the age of 50-55, many men observe more noticeable symptoms. However, it's important to understand that not every symptom men experience in midlife is due to low testosterone. We need to rule out other conditions, such as thyroid disorders, diabetes, depression, and sleep apnea, before attributing everything to hormonal changes. That's why proper evaluation by a health care provider is essential rather than self-diagnosing.

What are the most common physical symptoms men notice during andropause?

The most frequently reported physical symptoms include decreased energy and stamina, reduced muscle mass and strength, increased abdominal fat, and changes in sexual function, particularly erectile dysfunction and decreased libido.

Men also report changes in sleep patterns, sometimes accompanied by night sweats, and a reduction in bone density over time. Some men notice changes in body hair or skin. What's challenging is that these symptoms develop gradually, so men often attribute them to "just getting older" rather than recognizing them as potentially treatable hormonal changes.

Could you describe the changes in energy, sleep, and weight gain that men experience?

Absolutely. These are among the most common complaints I hear in practice. Men describe profound fatigue that doesn't improve with rest, difficulty falling or staying asleep, and a frustrating tendency to gain weight, particularly around the midsection, despite maintaining their usual diet and activity level. The decreased energy can create a vicious cycle: Men feel too tired to exercise, which leads to further muscle loss and weight gain, ultimately decreasing testosterone levels. Breaking this cycle often requires a multifaceted approach addressing sleep hygiene, physical activity, and nutrition simultaneously.

How can men tell if their symptoms are due to normal aging or low testosterone?

This is where professional evaluation is crucial. You can't reliably distinguish between normal aging and a significant drop in testosterone without proper testing and a systemic approach. We need to check morning testosterone levels, more than once, since levels can fluctuate daily, along with other hormones and metabolic markers.

But lab values alone don't tell the whole story. A man might have testosterone in the "normal range" but still be symptomatic if that level is significantly lower than his baseline. Conversely, symptoms might be due to other medical conditions, medications, lifestyle factors, or psychological stressors. A comprehensive evaluation considers the whole person, not just a number on a lab report.

Can fitness trackers and wearables help?

Yes, to a point. Devices that monitor heart rate variability, sleep quality, VO2 max, and stress levels can provide useful objective data and help you see progress over time. They can be particularly motivating when you're making lifestyle changes. However, don't become overly reliant on them or let the data create additional anxiety. These devices aren't always perfectly accurate, and they can't capture everything that matters about your health. Use them as one tool among many, not as a substitute for how you actually feel or for proper medical evaluation. The goal is health, not perfect metrics.

TRT can be appropriate for men with documented low testosterone and bothersome symptoms who haven't responded adequately to lifestyle interventions. Testosterone is available in various forms: injections, gels, patches, and pellets. When properly monitored, it can be safe and effective.

However, testosterone replacement is not right for everyone. Men with prostate cancer, severe sleep apnea, uncontrolled heart failure, or elevated red blood cell counts typically shouldn't receive testosterone therapy. Regular monitoring of blood counts, prostate health, and cardiovascular risk factors is essential. The decision should be individualized based on symptoms, lab values, overall health status, and patient preferences, and it requires ongoing medical supervision; this isn't something to self-prescribe from online sources.

TRT is also not recommended for men who wish to stay fertile, because it can lower or stop sperm production. Alternative treatments are available and generally safe, but some are used "off label," meaning they are not officially approved for this purpose but are supported by medical studies and guidelines. This is why it is so important to speak with your clinician about your specific situation and goals.

How can partners support men going through andropause?

Partner support is invaluable and often underappreciated. First, partners can recognize that these changes are real and not just "in his head" or signs of weakness. Encourage open, non-judgmental communication about physical and emotional symptoms. Partners can also participate in lifestyle changes by exercising together, preparing healthy meals, and establishing good sleep routines. Be patient with mood changes and decreased libido, understanding these are symptoms, not character flaws. Encourage seeking professional help rather than suffering in silence.

Sometimes partners notice changes before the man himself recognizes them, so gentle observation and concern can prompt important conversations. Remember that this is a couple's issue, not just an individual problem, and addressing it together can actually strengthen the relationship.

What message do you want men to take away about this stage of life?

Take charge of your health by maintaining healthy lifestyle habits, staying connected with others, finding meaning and purpose, and seeking help when you need it. There's no shame in experiencing these changes or in getting professional support. Remember that aging doesn't mean declining; with the right approach, men can remain vital, engaged, and healthy throughout this transition and beyond. Your health matters, and it's worth the effort.