Andropause: Why We Need To Be Talking About It

Article written by James Davis, Initiative Member, from The Midlife Mentors, UK

We’ve (finally) started talking about menopause at home and at work. Good. But there’s a parallel conversation for men that still gets whispered or laughed off: andropause. I’ll come to what that is and how we define it shortly, but first, let me paint the picture….

You’re a 47 year old man. Up at 3:11 a.m. –  mind racing. You drift back off at five and wake up  groggy, already behind. The gym that used to be your anchor now feels like another chore and, when you do work out, it’s like wading through treacle; the numbers on the bar haven’t moved in months, but the number on the waistband has – in the wrong direction.

You’re on your third coffee by ten, still staring through the screen. The fuse is shorter than it used to be, you can feel it with the team, and you hate that. You struggle to focus, you’re forgetful, you’re second guessing yourself, less confident in your decisions, and that low level anxiety is nibbling away at you daily. By evening you’re wired, tired, and not particularly present. Sleep is patchy. Rinse and repeat.

Back at home, the unspoken bits start to bite. Libido isn’t what it was, or it’s up and down and you can’t predict it. You’re more self-conscious in front of the mirror. A few injuries linger. You’re doing everything you used to do, but it isn’t working anymore and that messes with your head. Men are fixers; when we can’t “fix” ourselves quickly, we withdraw. That’s when silence becomes its own problem.

At the same time your stress levels are elevated as you obsess about your job security, your finances, the state of the world. Yet because you’ve never been taught how to express emotion, how to vocalize what you’re feeling (and you may not even be sure what you’re feeling), you start to bottle it up. Maybe you withdraw more, you go out less, you tune out with the help of a device or video game, you pull back from your friends, your partner…

Does that sound familiar? This is not just an anecdote. Large scale surveys have provided evidence indicating that many aspects of our wellbeing hit a nadir in midlife (Blanchflower and Oswald, 2008). Midlife is multifactorial: our social roles, support networks, and cultural expectations can buffer or amplify stress during this life phase (Ryff et al., Psychological Well-Being in Midlife, 2018).

Furthermore, our social factors, like loneliness, in middle age can manifest as inflammation in our bodies (Nersesian et al. Social Science and Medicine, 2018), and large UK and US cohort studies have found that work strain, relationship quality, financial pressure, and lifestyle habits often interact with hormonal and health changes to influence our wellbeing and later-life outcomes (Kuh et al., MRC National Survey of Health and Development, 2016; Marmot et al., Whitehall II Study, 2009).

Recognising that men’s midlife experience is woven from biological, psychological, and sociocultural threads helps us see why support has to extend beyond hormones alone. Research shows that hormonal change is only one strand of a wider web: midlife men are often balancing heavy career demands, financial pressure, family responsibilities and shifting social roles all of which can interact with declining testosterone and affect wellbeing (EMAS, 2010).

What we’re not stating here is a need to play “male menopause” tit-for-tat. The biology is quite different, as we’ll explain below. But the impact on energy, mood, focus, relationships and work performance is real, and dismissing it as “just getting older” helps no one.

We also need to set this against a stark backdrop. Suicide remains one of the top 10 killers of men globally (M. Naghavi et al. BMJ, 2019), with rates around 4 times higher than those for women of all ages (ONS, 2024; AFSP, 2023). When we leave men to “just get on with it,” we risk missing the warning signs of distress. Acknowledging the biological and social load that midlife places on men is the first step toward helping them stay healthy, productive and connected.

The reality is many men struggle significantly at this point in their lives and we should be leaning it to how we better support them.

So What Is “Andropause”?

One way we can characterize the midlife phenomonen of andropause is biologically, and one biological marker is the age-related decline in testosterone. And, while that’s useful, it really only tells one part of the story. Let’s look at that testosterone though and how it can impact men. Unlike menopause where estrogen and progesterone are fluctuating whilst declining in a relatively narrow window of lifecycle, for men testosterone declines at a steady rate of between 1% to 3% a year from it’s peak in our 20s.

Now, that might not sound a lot, but compound it, and by the time we’re in our 50s our T levels could be 30 to 50% lower than that peak. Some men barely notice. Others notice a lot: lower drive and stamina, more belly fat, sleep and mood all over the place, brain fog, libido changes. The kicker is, it comes on gradually, so it’s often dismissed as ageing, fatigue, stress, or a combination of those things. Clinically, when hormones, specifically Testosterone, are the driver, we call it late-onset hypogonadism (LOH): the right symptoms plus consistently low testosterone on morning blood tests.

So that’s the clinical definition, but should we be “declassing” andropause to refer to a possible host of emotional, psychological, physical, and cognitive symptoms that men may notice as they age? Would that be more helpful rather than focusing purely on Testosterone levels?

Well, looking at Testosterone gives us a measure, and a possible medical solution, but I feel it’s more helpful to look across the range of symptoms and see low T as just one possible driver for how men can be affected at this stage of life.

If we stick with a purely clinical definition fixed around low T levels, then current research suggest the number of men affected is relatively low (though there are issues with this as we’ll see), but if we broaden the definition with the aim of providing a useful shorthand to describe a suite of symptoms, then we have the potential to positively impact and even save more lives, because as we’ll see, clearly many men are currently being adversely affected.

So how common is it?

Depends what you count.

• With strict clinical criteria (symptoms and low T), only a small but important minority of midlife men meet the diagnosis. The European Male Ageing Study found ~2.1% of men aged 40–79 meet the definition of LOH. Small, but important if you’re in it. New England Journal of Medicine
• Biochemical low T alone (threshold-based, community samples): varies with the cut-off you pick. EMAS data suggest ~4% of men had total T <8 nmol/L, and roughly ~17% fell below ~11 nmol/L depending on criteria. Generally below 12nmol/L would make a man eligible for Testosterone Replacement Therapy, so you can see that already we are up at around 17%.
• Still low, however, remember, men are not routinely having their testosterone levels checked, so it’s like the number of men over 40 with low T levels is even higher, we simply just don’t have the data as men don’t know what to look for and it’s not being tested for.
• If you count symptoms that overlap with low T, things like fatigue, low mood, brain fog, libido changes, then you’re definitely into the “many men” category, because stress, poor sleep, weight, alcohol and meds can mimic or magnify the same picture. A recent UK survey found that 82% of men over 45 reported at least one symptom.

So where do headlines like “a quarter of men” come from? Often from symptom counts or lab cut-offs without the full clinical picture. Plenty of men have overlapping symptoms driven by lifestyle and stress. That doesn’t make the symptoms less real, it means we should assess properly before labelling or treating. (The NHS also notes obesity and type 2 diabetes are linked with LOH, which is another nudge toward lifestyle first.)

What does this mean? A minority need medical treatment; a much larger group need smart lifestyle support and permission to talk about it.

This isn’t vanity. Fatigue, poor sleep, low drive and brain fog bleed into everything, your patience with your kids, the quality of your work, your confidence in high-stakes moments. Add relationship strain if intimacy’s changed, and you’ve got a feedback loop that can drag even resilient men down. Midlife is also when many men hit their toughest external pressures: career, ageing parents, teens at home, finances. Silence makes it heavier. Isolation can be fatal.

What Good Support Looks Like

For men (start here)

• See your GP – ask for morning bloods. Diagnosis needs symptoms + consistently low testosterone on repeat morning tests. No guesswork, no one-off number.
• Embrace the change rather than fearing it. Focus on what’s on the other side of it and what you can achieve going forward. While midlife is challenging, recent research has found that this period of our lives is also a time of great change and opportunity (Infurna et al. 2020; Lachman, et al. 2014)
• Lift, move, sleep. Prioritise resistance training, regular cardio and 7–9 hours’ These shift mood, metabolism and hormones.
• Sort the basics. Bring weight, alcohol and stress under control; they’re heavy hitters for symptoms and
• TRT is for the right case only. If you’re diagnosed with hypogonadism, testosterone therapy can help, with proper monitoring and shared decisions. It’s not a cure-all for “feeling tired.”
• With your partner, mates, a coach or counsellor and where appropriate, your manager. Shame shrinks in daylight.

For organisations (where culture changes)

• Name it. Add andropause to your health conversation, without forcing equivalence with menopause.
• Short, plain-English sessions: what it is, what it isn’t, how to get checked, where to get support.
• Design work that helps. Reasonable flexibility, sane workloads, sleep-respecting norms (let’s stop celebrating 2 a.m. emails).
• Back the basics. Access to strength options, activity challenges, sleep resources, mental-health pathways.
• Measure what matters. Engagement, absence, retention. If men feel safe to seek help, you’ll see the shift.

Quick Myth-Busting

• “Every tired midlife man needs TRT.” Treat only when the symptoms line up with consistently low morning T, as confirmed by a licensed physician.
• “If the bloods are ‘normal’, it’s just ageing.” Not necessarily. Training, sleep, nutrition managing stress, and optimizing work all move the needle, often a lot.
• ‘If my libido is fine, my T is fine.” Nope: you could have a healthy libido and sexual function but still have low T.
• “Andropause is just PR spin.” The label is imperfect; the lived experience isn’ A minority need clinical care; many more need practical support.

Selected Sources

• G. Blanchflower, A. J. Oswald. ”Is well-being U-shaped over the life cycle?” Social Science & Medicine. Volume 66, Issue 8, 2008. Pages 1733-1749, ISSN 0277-9536, Available at: https://doi.org/10.1016/j.socscimed.2008.01.030
• V. Nersesian, H. Han, G. Yenokyan, R. S. Blumenthal, M. T. Nolan, M. D. Hladek, S. L. Szanton. ”Loneliness in middle age and biomarkers of systemic inflammation: Findings from Midlife in the United States.” Social Science & Medicine. Volume 209, 2018. Pages 174-181. ISSN 0277-9536. Available at: https://doi.org/10.1016/j.socscimed.2018.04.007
• NHS “The ‘male menopause’” (last reviewed 13 Oct 2022). Plain-English overview: why the term is misleading, the ~1% per year age-related testosterone decline, lifestyle contributors (stress, sleep, alcohol, weight), and when late-onset hypogonadism (LOH) should be considered and tested. uk
• Endocrine Society Clinical Practice Guideline (2018). Gold-standard diagnostic criteria and care: diagnose only with symptoms + unequivocally and consistently low morning testosterone; repeat testing; check the cause; who should/shouldn’t get TRT; and how to monitor safely. Endocrine Society
• EMAS NEJM (2010): identification of LOH. Landmark population study defining LOH by three sexual symptoms alongside low total/free T, establishing the clinical framework used widely today. New England Journal of Medicine
• EMAS JCEM (2012): prevalence and health impact. Using those strict criteria, ~2.1% of men 40–79 met LOH; affected men tended to be older and more obese and showed lower muscle mass and poorer general health. PubMed
• American Foundation for Suicide Prevention (2023): Suicide statistics. Available at: https://afsp.org/suicide-statistics/
• Araujo et al., JCEM (2007): U.S. population prevalence. Broader definition (symptoms consistent with androgen deficiency plus low T) estimated ~5.6% prevalence in men 30–79, rising with age. Helps explain why figures vary by definition. PubMed
• Kuh D, et al. (2016). A Life Course Approach to Healthy Ageing. MRC National Survey of Health and Development. London: UCL.
• Marmot M, et al. (2009). Health, Wealth and Lifestyles of the Older Population in England: The 2002 English Longitudinal Study of Ageing (ELSA). London: Institute for Fiscal Studies.
• Naghavi et al. ”Global, regional, and national burden of suicide mortality 1990 to 2016: systematic analysis for the Global Burden of Disease Study 2016.” BMJ (2019), 364:l94 Available at: http://dx.doi.org/10.1136/bmj.l94
• Office for National Statistics (2024 release; 2023 registrations). Male suicide 4 per 100,000 vs females 5.7; highest male rate 25.5 in ages 45–49—context for why midlife men’s health needs daylight, not stigma. Office for National Statistics
• Ryff CD, et al. (2018). “Psychological well-being in midlife: The role of family, work and community.” Annual Review of Gerontology & Geriatrics, 38, 23-43.
• Society for Endocrinology (UK) factsheet (2018). Concise clinician summary noting LOH is uncommon on strict criteria and heavily influenced by comorbidities (notably obesity)—reinforcing the “lifestyle first” endocrinology.org
• Infurna, F. J., Gerstorf, D., & Lachman, M. E. (2020). “Midlife in the 2020s: Opportunities and challenges.”American Psychologist, 75(4), 470–485. https://doi.org/10.1037/amp0000591
• Lachman, M. E., Teshale, S., & Agrigoroaei, S. (2014). “Midlife as a pivotal period in the life course: Balancing growth and decline at the crossroads of youth and old age.” International Journal of Behavioral Development, 39(1), 20-31. Available at: https://doi.org/10.1177/0165025414533223