Male menopause: symptoms, causes, and treatment

The male menopause, also called andropause, is a term used to describe physical and emotional changes that some men experience in midlife. You may also see it called “manopause”, although this is an informal term rather than a medical diagnosis.

Men don’t go through menopause in the same way as women, and symptoms such as tiredness, low mood, reduced sex drive, and weight gain aren’t always caused by low testosterone. Here, we explain what male menopause symptoms can look like, what else may be causing them, and when blood tests or treatment might be appropriate.

Do men go through a male menopause?

No – not in the same way as women.

In men, testosterone is vital to the development and maintenance of male sexual characteristics and function. Normal active testosterone levels help to maintain sex drive and fertility in healthy men. Research is showing it also helps maintain psychological health. It is increasingly being recognised as important to a wide range of health-related areas in men. This includes contributing to maintaining healthy and active energy levels and preventing bone breakdown.

Testosterone levels may decline gradually with age, but this doesn’t automatically cause symptoms or require treatment. When someone has relevant symptoms alongside consistently low testosterone levels, they may be diagnosed with testosterone deficiency or late-onset hypogonadism.

Many men maintain healthy testosterone levels throughout later life. Obesity, type 2 diabetes, medication, poor sleep, and other health conditions can have a greater effect on testosterone than age alone.

The female menopause

During the menopause transition, a woman will experience a significant drop in oestrogen levels. The menopause transition typically starts in a woman’s mid-to-late forties (known as the perimenopause) and the average age for the menopause in the UK is 51. During the perimenopause, oestrogen levels fluctuate wildly and decline significantly (causing many of the symptoms associated with the menopause). After the menopause (postmenopause) they settle down at these lower levels.

At what age can male menopause symptoms start?

Symptoms commonly associated with the male menopause are often reported during the late forties and early fifties, but they can develop earlier or later. There’s no fixed male menopause age because the underlying cause varies from person to person.

What are the symptoms of the male menopause?

Possible male menopause symptoms include:

• Reduced sex drive
• Erectile dysfunction
• Fewer morning erections
• Tiredness or reduced energy
• Low mood, irritability, or mood changes
• Poor concentration or “brain fog”
• Sleep problems
• Reduced muscle mass or strength
• Increased body fat
• Hot flushes or night sweats

Symptoms associated with the male menopause may also be related to stress, anxiety, depression, poor sleep, sleep apnoea, thyroid problems, anaemia, obesity, type 2 diabetes, alcohol, smoking, medication, or another health condition.

Erectile dysfunction can also be linked to cardiovascular disease or diabetes. New or persistent symptoms should therefore be discussed with a clinician rather than assumed to be part of ageing.

How is low testosterone diagnosed?

Low testosterone is diagnosed by considering symptoms, medical history, physical health, and blood test results together.

Current guidance recommends measuring testosterone in the morning, while fasting, on at least two separate occasions. Depending on the results, further tests may be needed to identify the cause and rule out other conditions.

How is the male menopause treated?

Testosterone replacement therapy, or TRT, may be considered when someone has relevant symptoms and low testosterone confirmed through appropriate blood testing. It’s usually given as a gel or long acting injection and requires regular clinical monitoring.

TRT can improve symptoms in appropriately diagnosed men, particularly sexual symptoms, but results vary. It isn’t suitable for everyone and can suppress sperm production, so anyone who wants to maintain their fertility should discuss this with their clinician before treatment.

If you, or your partner, is experiencing possible male menopause symptoms, speak to your GP or clinician. They can investigate low testosterone alongside other possible physical and psychological causes.

Leger Clinic has a low testosterone questionnaire which can help identify whether low testosterone may be an issue.