Is there such a thing as male menopause, also known as late-onset hypogonadism (low testosterone levels)?

Is There Such a Thing as "Male Menopause"?

Yes, "male menopause" exists as a legitimate clinical entity, but the term is medically inaccurate—the correct terminology is late-onset hypogonadism (LOH) or age-related low testosterone, which describes a gradual decline in testosterone levels with aging that causes specific symptoms and biochemical deficiency. 1

Why "Male Menopause" Is a Misnomer

• Unlike female menopause, which involves abrupt cessation of ovarian function, men experience a gradual, progressive decline in testosterone production averaging 1.6% per year after the mid-30s 1
• The term "andropause" or "male menopause" is erroneously applied because men do not experience a sudden, universal cessation of reproductive function 2, 3
• More accurate terms include "late-onset hypogonadism," "age-related low testosterone," or "androgen decline in the aging male (ADAM)" 1, 3, 4

Prevalence and Definition

• Approximately 20% of men older than 60,30% of those older than 70, and 50% of those older than 80 years have low testosterone levels 1, 5
• LOH is defined as both symptomatic presentation AND biochemical evidence of testosterone deficiency—not age alone 1, 4
• The European Association of Urology (2025) characterizes male hypogonadism as requiring both symptoms and biochemical evidence of testosterone deficiency 1

Clinical Presentation: What to Look For

Sexual Symptoms (Most Specific)

• Reduced libido (decreased sexual desire) is the most specific symptom 1, 5
• Erectile dysfunction, particularly when PDE5 inhibitors fail 5
• Decreased spontaneous or morning erections are "more specific" for hypogonadism than other symptoms 5
• Decreased volume of ejaculate 1

Physical Symptoms

• Loss of muscle mass and strength 1, 6
• Increased body fat/adiposity 1, 6
• Decreased bone mineral density/osteoporosis 1, 6
• Loss of body and facial hair 1, 5
• Difficulty with vigorous physical activity, walking >1 km, or bending 5

Psychological Symptoms

• Depressed mood or mood deflection 1, 5
• Fatigue and decreased energy 1, 6
• Decreased motivation and sense of vitality 1, 5

Critical Diagnostic Approach

• Measure morning total testosterone between 8 AM and 10 AM on at least two separate days 1, 5
• Free testosterone by equilibrium dialysis and sex hormone-binding globulin (SHBG) should also be measured, especially in obese men 5
• If testosterone is subnormal, repeat measurement and obtain serum LH and FSH to distinguish primary (testicular failure with elevated LH/FSH) from secondary hypogonadism (pituitary/hypothalamic dysfunction with normal/low LH/FSH) 1, 5
• Total testosterone <200 ng/dL indicates hypogonadism; levels between 200-400 ng/dL require repeat testing with free testosterone determination 7

Important Caveats

• Do not screen asymptomatic older men for testosterone deficiency based solely on age 5
• The FDA explicitly states that safety and efficacy of testosterone therapy in men with "age-related hypogonadism" have not been established 8
• Functional hypogonadism (low testosterone due to comorbidities like obesity, diabetes, chronic illness) should be addressed by treating underlying conditions first 1
• The American College of Physicians recommends against initiating testosterone treatment solely to improve energy, vitality, physical function, or cognition without sexual symptoms 1, 5

Classification of LOH

• LOH represents a combined primary and secondary hypogonadism, as both testicular endocrine capacity and pituitary function decline with age 4
• This differs from classical hypogonadism with identifiable organic causes (Klinefelter syndrome, testicular trauma, pituitary tumors, etc.) 1, 8
• The 2018 US Endocrine Society guidelines now include advanced age as a cause of organic hypogonadism in men >65 years with consistently low morning testosterone and suggestive symptoms 4

When to Consider the Diagnosis

Prioritize testing in men presenting with sexual symptoms (decreased libido, erectile dysfunction, reduced spontaneous erections) combined with objective physical findings (reduced bone mass, fractures, testicular atrophy) over nonspecific symptoms like fatigue or depression alone 5