Much is said about menopause; little about its male counterpart. Yet from their forties onward, many men notice a slow erosion: less energy, declining libido, weaker erections, loss of muscle, growing belly fat, poorer sleep and a flattening of drive and mood. The usual explanation is stress or ageing, and often that is correct. But in a meaningful minority, the cause is genuinely low testosterone, a condition doctors call late-onset hypogonadism or andropause. Testosterone clinics now market treatment aggressively, which makes clear, hype-free information essential: when is low testosterone real, when should men get tested, and when does treatment truly help?

What testosterone does and how it changes

Testosterone, produced mainly in the testes, drives male sexual development, maintains libido and erectile function, builds and preserves muscle and bone, supports red blood cell production, and influences mood, energy and cognition. Levels peak in young adulthood and decline gradually, roughly 1 per cent per year after 40, a slow drift, not the cliff of female menopause. Most ageing men stay within the normal range and their symptoms come from elsewhere. True hypogonadism means consistently low levels plus symptoms, and it has specific causes: testicular injury or infection, pituitary disorders, certain medications (especially opioids and steroids), chronic illness, obesity and, rarely, genetic conditions. Obesity deserves emphasis: excess fat converts testosterone to oestrogen and suppresses production, making weight the commonest reversible cause.

Symptoms: what suggests low testosterone?

The most specific symptoms are sexual: reduced libido, fewer morning erections and erectile difficulty. Beyond these, low energy, loss of motivation, depressed mood, poor concentration, reduced muscle mass and strength, increased body fat, breast tenderness or enlargement, and loss of body hair can feature. But every one of these also occurs in depression, sleep apnoea, thyroid disease, diabetes and plain overwork, which is why symptoms alone never diagnose. Red flags strengthening the case include testicular shrinkage, infertility, and a history of pituitary or testicular disease. A useful rule: the more sexual the symptoms and the more risk factors present, the more testing is warranted; vague fatigue alone rarely justifies it.

When and how to get tested

Testing is simple but has rules. Total testosterone should be measured in the morning, between 7 and 11 am, when levels peak, after a normal night’s sleep. A single low reading means little; guidelines require two separate low morning measurements plus symptoms. Labs should be reliable, since assays vary, and results interpreted against reference ranges with clinical sense, not treated as exact cutoffs. If testosterone is low, further tests follow: LH and FSH distinguish testicular from pituitary causes, prolactin screens for pituitary tumours, and morning cortisol may be checked. Men already on testosterone-affecting drugs need medication review first. Testing without symptoms, the increasingly marketed male MOT, mostly generates anxiety and overtreatment.

Treatment: when it helps and when it harms

Testosterone replacement therapy, via gels, injections or patches, genuinely helps men with confirmed hypogonadism: libido, erections, energy, muscle mass and bone density typically improve. But it is not an anti-ageing tonic. In men with normal levels, it offers little and carries real risks: infertility (it suppresses sperm production, ironically), prostate enlargement, elevated red blood cell counts thickening the blood, acne, sleep apnoea worsening, and debated cardiovascular effects. It is contraindicated in prostate or breast cancer and in men seeking fertility. Treatment needs specialist supervision with regular monitoring of levels, blood counts, prostate markers and cardiovascular risk. Lifestyle, weight loss, strength training, sleep apnoea treatment and diabetes control, raises testosterone naturally and should precede or accompany any prescription.

FAQs

Is andropause the same as menopause? No. Menopause is a sharp hormonal stop; andropause is a gradual, variable decline, and most men never develop true hypogonadism.

Can exercise raise testosterone? Yes, modestly. Strength training, weight loss and good sleep raise levels naturally, especially in deficient overweight men.

Are testosterone boosters safe? Over-the-counter boosters have little evidence and occasional harm; prescription therapy is the only proven route, under medical supervision.

Testosterone matters, but it is one instrument in the orchestra of male midlife health, not the whole symphony. Test when symptoms and risk point that way, treat confirmed deficiency properly, and give lifestyle its due: for most men feeling the years, the fix is less hormonal than habitual.

Compiled by the Khabar 24h Editorial Desk from publicly available sources.