Originally written by ZRT Laboratory author. Reproduced with permission. Last reviewed: May 2026.
Andropause — often referred to as male menopause — describes the gradual decline in testosterone and other key hormones that affects many men from their forties onwards. Unlike the relatively abrupt hormonal transition of female menopause, andropause develops slowly and insidiously, making its symptoms easy to attribute to stress, overwork, or simply “getting older.”
Yet the hormonal changes involved are real, measurable, and clinically significant. By mid-life, testosterone levels in men can decline by up to 40% from their peak. When this decline is compounded by cortisol dysregulation, thyroid dysfunction, rising oestrogen, and metabolic changes, the cumulative impact on energy, mood, body composition, sexual health, and cognitive function can be substantial.
Understanding what is driving these changes — and testing to confirm it — is the first step towards addressing them effectively.
What Is Andropause?
Andropause is the clinical term for the age-related decline in male sex hormones, primarily testosterone, that occurs gradually from the late thirties or forties onwards. Unlike female menopause, which involves a relatively rapid and complete cessation of ovarian hormone production, andropause is a slow, progressive process. Testosterone levels typically decline at approximately 1–2% per year from the age of 30, with the cumulative effect becoming clinically apparent in many men by their mid-forties to fifties.
The condition is also known as late-onset hypogonadism (LOH) in clinical literature, and its prevalence increases significantly with age. Lifestyle factors — including chronic stress, excess body weight, physical inactivity, poor sleep, alcohol consumption, and environmental toxin exposure — can accelerate the rate of hormonal decline and worsen its clinical impact.
Common Symptoms of Andropause
Andropause symptoms develop gradually and are frequently dismissed as normal ageing. However, they are often driven by identifiable and addressable hormonal imbalances. Common symptoms include:
- Persistent fatigue and low energy — despite adequate sleep, many men with andropause feel chronically tired and lacking in drive
- Reduced libido and sexual function — declining testosterone directly reduces sexual desire and can contribute to erectile dysfunction
- Loss of muscle mass and strength — testosterone is essential for muscle protein synthesis; its decline leads to progressive sarcopenia
- Increased body fat, particularly abdominal — hormonal changes shift fat distribution towards the abdomen and visceral compartment
- Mood changes — including low motivation, irritability, anxiety, and depression
- Poor sleep quality — testosterone and cortisol both regulate sleep architecture; their imbalance disrupts sleep
- Brain fog and reduced cognitive function — difficulty concentrating, memory lapses, and reduced mental sharpness
- Reduced bone density — testosterone supports bone mineralisation; its decline increases fracture risk over time
- Hair thinning or loss — related to changes in DHT and androgen receptor sensitivity
These symptoms are not always caused by testosterone alone. Multiple hormone systems are typically involved, which is why comprehensive testing provides more actionable information than measuring testosterone in isolation.
The Key Hormones Involved in Andropause
Testosterone
Testosterone is the primary male sex hormone, responsible for energy, muscle mass, bone density, libido, mood, and cognitive function. Its decline is the central feature of andropause. Both total testosterone and free (bioavailable) testosterone are clinically relevant — a man can have normal total testosterone but low free testosterone if sex hormone-binding globulin (SHBG) is elevated, which is common with ageing.
DHEA and DHEA-S
Dehydroepiandrosterone (DHEA) is an adrenal hormone that serves as a precursor to both testosterone and oestrogen. DHEA levels peak in the mid-twenties and decline steadily thereafter — by age 70, levels may be 80% lower than at their peak. DHEA supports energy, immune function, bone density, muscle maintenance, and mood. Its decline compounds the effects of falling testosterone and is often overlooked in standard assessments.
Oestrogen (Oestradiol) in Men
Men produce oestrogen through the conversion of testosterone by the enzyme aromatase, found primarily in fat tissue. As men gain weight with age — a common consequence of declining testosterone — aromatase activity increases, converting more testosterone to oestradiol. Elevated oestrogen in men contributes to weight gain (particularly in the chest and abdomen), fluid retention, reduced libido, mood disturbance, and cardiovascular risk. The testosterone-to-oestradiol ratio is therefore as important as the absolute level of either hormone.
Cortisol
Cortisol — the body’s primary stress hormone — has a directly antagonistic relationship with testosterone. Chronic stress and chronically elevated cortisol suppress testosterone production, accelerate muscle breakdown, promote abdominal fat accumulation, disrupt sleep, and impair immune function. Conversely, low cortisol — associated with adrenal exhaustion from prolonged stress — causes chronic fatigue, low resilience, and poor recovery. Assessing the full diurnal cortisol pattern is essential for understanding how stress is affecting male hormone health.
Thyroid Hormones
Thyroid dysfunction is frequently overlooked in men presenting with andropause-like symptoms. An underactive thyroid (hypothyroidism) produces symptoms that closely mirror those of low testosterone — including fatigue, weight gain, low mood, brain fog, and reduced libido. Because thyroid hormones regulate metabolic rate, cardiovascular function, and muscle performance, thyroid dysfunction compounds the effects of testosterone decline and must be assessed as part of any comprehensive male hormone evaluation.
DHT (Dihydrotestosterone)
DHT is a potent metabolite of testosterone, produced by the action of the enzyme 5-alpha reductase. Elevated DHT is associated with scalp hair loss, benign prostatic hyperplasia (BPH), and urinary symptoms in men. Assessing DHT alongside testosterone provides a more complete picture of androgen metabolism and its effects on target tissues.
SHBG (Sex Hormone-Binding Globulin)
SHBG binds testosterone in the bloodstream, rendering it biologically inactive. SHBG levels increase with age, meaning that even when total testosterone appears normal, the amount of free, bioavailable testosterone available to tissues may be significantly reduced. Measuring SHBG alongside total testosterone is essential for accurately assessing functional testosterone status.
Cardiometabolic Factors
Insulin resistance, elevated blood glucose, dyslipidaemia, and high blood pressure are both consequences and drivers of hormonal decline in men. Insulin resistance reduces testosterone production; low testosterone worsens insulin sensitivity — creating a self-reinforcing cycle of metabolic and hormonal deterioration. Assessing cardiometabolic markers alongside hormones provides the most complete picture of a man’s health risk and treatment priorities.
Our Complete Hormone & CardioMetabolic Test Kit combines a full hormone panel with key cardiovascular and metabolic markers — providing a comprehensive at-home assessment of the hormonal and cardiometabolic factors driving andropause symptoms.
Why Comprehensive Hormone Testing Matters
Because andropause symptoms overlap significantly with those of thyroid dysfunction, adrenal imbalance, depression, sleep disorders, and metabolic syndrome, testing is essential for accurate diagnosis and targeted treatment. Measuring testosterone alone — as is common in standard GP assessments — frequently misses the broader hormonal picture.
Saliva testing measures bioavailable (free, active) hormone levels — the fraction that actually reaches tissue receptors and drives biological effects. This makes it particularly valuable for assessing testosterone, DHEA, cortisol, and oestradiol in men, as it reflects the hormones that are functionally active rather than those bound to carrier proteins.
Our LCMS 10-Hormone Saliva Test for Men measures ten key hormones using LCMS-validated saliva analysis — including testosterone, DHEA, oestradiol, cortisol, and progesterone — providing a detailed, clinically meaningful picture of male hormone status that standard blood tests frequently miss.
What You Can Do About Andropause
Lifestyle Optimisation
Several lifestyle factors have a direct and meaningful impact on testosterone and overall hormonal health in men:
- Resistance training — the most effective exercise modality for stimulating testosterone production and preserving muscle mass
- Adequate sleep — the majority of daily testosterone production occurs during sleep; poor sleep directly suppresses testosterone
- Stress management — reducing chronic cortisol elevation through mindfulness, adequate rest, and workload management protects testosterone
- Healthy body weight — reducing excess body fat decreases aromatase activity and the conversion of testosterone to oestrogen
- Dietary optimisation — adequate protein, healthy fats (including cholesterol, the precursor to all steroid hormones), zinc, magnesium, and vitamin D all support testosterone production
- Limiting alcohol — alcohol directly suppresses testosterone production and increases aromatase activity
Nutritional Support
Key nutrients that support male hormone health include zinc (essential for testosterone synthesis and LH signalling), magnesium (supports free testosterone by competing with SHBG), vitamin D (acts as a steroid hormone precursor and supports testosterone production), omega-3 fatty acids (reduce inflammation and support cardiovascular health), and ashwagandha (an adaptogen with evidence for reducing cortisol and supporting testosterone in stressed men).
Hormone Replacement Therapy
For men with confirmed testosterone deficiency, testosterone replacement therapy (TRT) can significantly improve energy, mood, body composition, sexual function, and quality of life. TRT is available in several forms including topical gels, injections, and patches. It requires careful monitoring of haematocrit, prostate-specific antigen (PSA), oestradiol, and cardiovascular markers. The decision to initiate TRT should be made in partnership with a knowledgeable clinician following comprehensive hormone testing.
Our Advanced Male Wellness Test provides a comprehensive blood spot assessment of testosterone, DHEA, cortisol, thyroid markers, and toxic elements — with a specialist doctor’s report included — giving you and your healthcare provider the detailed baseline data needed to make informed decisions about treatment.
Frequently Asked Questions
What age does andropause start?
Testosterone levels begin to decline gradually from around age 30, at approximately 1–2% per year. The cumulative effects of this decline typically become clinically apparent in the mid-forties to fifties, though some men notice symptoms earlier — particularly if lifestyle factors such as chronic stress, excess weight, or poor sleep are accelerating hormonal decline.
Is andropause the same as male menopause?
The term “male menopause” is commonly used but is somewhat misleading. Unlike female menopause, which involves a relatively rapid and complete cessation of ovarian hormone production, andropause is a slow, gradual process that does not result in complete testosterone cessation. The clinical term late-onset hypogonadism (LOH) is more precise. However, the hormonal changes and their health consequences are real and clinically significant.
How is andropause diagnosed?
Andropause is diagnosed through a combination of symptoms and hormone testing. Standard GP assessments typically measure total serum testosterone, but this alone is insufficient — free testosterone, SHBG, DHEA, oestradiol, cortisol, thyroid hormones, and cardiometabolic markers all contribute to the full clinical picture. Comprehensive at-home hormone testing provides a more complete assessment than standard blood tests alone.
Can andropause be treated without testosterone replacement?
Yes. For many men, particularly those with mild-to-moderate symptoms, lifestyle optimisation — including resistance training, improved sleep, stress management, dietary changes, and targeted nutritional supplementation — can meaningfully improve testosterone levels and reduce andropause symptoms. Hormone testing helps identify which specific imbalances are present and guides the most appropriate intervention strategy.
Does andropause affect mental health?
Yes, significantly. Testosterone plays an important role in mood regulation, motivation, and cognitive function. Low testosterone is associated with increased rates of depression, anxiety, irritability, and reduced quality of life in men. Cortisol dysregulation — which commonly accompanies andropause — further compounds these psychological effects. Addressing the underlying hormonal imbalances often produces meaningful improvements in mental health and wellbeing.
How does andropause affect cardiovascular health?
Low testosterone is an independent risk factor for cardiovascular disease. It is associated with increased visceral fat, insulin resistance, dyslipidaemia, elevated inflammatory markers, and endothelial dysfunction. The relationship between testosterone, oestradiol, cortisol, and cardiometabolic health is complex and bidirectional — making comprehensive assessment of both hormonal and cardiometabolic markers essential for men concerned about long-term cardiovascular risk.
Originally written by ZRT Laboratory author. Reproduced with permission. Last reviewed: May 2026.