Andropause: Symptoms, Causes, Risk Factors, Terminology, Diagnosis and Treatment

Some men develop depression, loss of sexual desire, erectile dysfunction, and other physical and emotional symptoms when they reach 40 years of age up to 50 years.

Other common symptoms in men of this age are:

  • Mood changes and irritability.
  • Loss of muscle mass and reduced exercise capacity.
  • Redistribution of fat, such as developing a large belly or “male tits” ( gynecomastia).
  • A general lack of enthusiasm or energy.
  • Difficulty sleeping ( insomnia ) or increased fatigue.
  • Lack of concentration and short-term memory.
  • These symptoms can interfere with daily life and happiness, so it is essential to find the underlying cause and determine what can be done to resolve it.


The “male menopause” (sometimes called the “andropause”) is a useless term that is sometimes used in the media to explain the above symptoms.

This label is misleading because it suggests that the symptoms result from a sudden drop in testosterone in middle age, similar to what occurs in female menopause.

This is not true. Although testosterone levels decrease as men age, the decline is constant, less than 2% per year from around 30-40 years, and it is unlikely to cause any problems in itself.

A testosterone deficiency that develops later in life (also known as late-onset hypogonadism ) can sometimes be responsible for these symptoms. Still, the symptoms have nothing to do with hormones in many cases.


Lifestyle factors or psychological problems are often responsible for many of the symptoms described above.

For example, erectile dysfunction, loss of libido, and mood swings can be the result of:


There are also physical causes of erectile dysfunction, such as changes in blood vessels, which can occur along with any psychological reason.

Psychological problems usually occur due to work or relationship issues, divorce, money problems, or concerns about aging parents.

A “midlife crisis” may also be responsible. This can happen when men think they have reached half of life. The anxieties about what they have achieved so far, whether at work or in their personal lives, can lead to a period of depression.

Other possible causes of the above symptoms include:

  • Lack of sleep.
  • Poor diet.
  • Lack of exercise.
  • Drinking too much alcohol.
  • Smoke.
  • Low self-esteem.

Risk factor’s

In some cases, where lifestyle or psychological problems do not seem to be responsible, the symptoms of ” male menopause ” can result from hypogonadism, where the testicles produce little or no hormones.

Hypogonadism is sometimes present from birth, which can cause symptoms such as delayed puberty and small testicles.

Hypogonadism can also occasionally develop later in life, particularly in men who are obese or have type 2 diabetes.

This is known as late-onset hypogonadism and can cause the symptoms of “male menopause” mentioned above. However, this rare and specific medical condition is not a normal part of aging.

Typically, a diagnosis of late-onset hypogonadism can be made based on your symptoms and the results of blood tests used to measure your testosterone levels.

What to do

If you have any of the above symptoms, consult your general practitioner. They will ask you about your work and personal life to see if your symptoms may be caused by a mental health problem, such as stress or anxiety.

If stress or anxiety affects you, you can benefit from medications or talk therapy, such as cognitive-behavioral therapy (CBT). Exercise and relaxation can also help.


Your GP can also order a blood test to measure your testosterone levels. If the results suggest a testosterone deficiency, you may be referred to an endocrinologist (a specialist in hormonal problems).

If the specialist confirms this diagnosis, you may be offered testosterone replacement to correct the hormone deficiency, which should alleviate your symptoms. This treatment can be:

  • Tablets
  • Patches
  • Gels
  • Implants
  • Injections


Three testosterone replacement preparations are commonly available in Singapore, says Dr. Lee Fang Jann, Consultant in the Department of Urology at SGH. These are:

Testosterone gels:

Testosterone gels are easy to use but come with some precautions. They should be applied every morning on the shoulders or upper arms. It would help if you did not bathe or swim for five hours after application to allow time for the gel to be absorbed.

Take these precautions when applying testosterone gels:

Do not let anyone touch the testosterone gel on your skin. If women and children come in contact with the gel, they can experience side effects such as the growth of new body hair in women and more aggressive behavior in children.

Please stay away from an open flame and not smoke while applying testosterone gel because it is flammable.

After each application, wash your hands with soap and water and cover your shoulders or upper arms with a short-sleeved shirt.

Testosterone tablets:

Testosterone pills should be taken two or three times a day, and lightly greasy foods to maximize absorption. Prolonged use of oral testosterone can raise cholesterol levels and increase the risk of heart and liver problems. Therefore, this therapy is only for short-term use.

Testosterone injections:

Testosterone injections are very convenient, but you may experience pain at the injection site. “The latest preparations require only one injection every three months. The absorption rate is very constant, and there is no need for the patient to do anything between injections, “says Dr. Lee.

Testosterone supplementation:

Testosterone supplementation may cause a rash, itching, or irritation at the application site. The long-term side effects are unknown. Supplemental testosterone is not recommended in men with prostate cancer and enlarged prostate because it can accelerate prostate tissue growth.