While the changes that women experience before and after menopause are finally gaining much-needed attention, the hormonal shifts that happen with aging for men may be downplayed, misunderstood, or dismissed entirely—often by men themselves.
This shift, known as andropause, late-onset hypogonadism, or “male menopause,” involves a gradual decline in testosterone as men age, which can lead to a reduced libido, loss of muscle mass and strength, and low mood.
Yet few men are taught what to expect as they age or that the changes they’re experiencing, or are worried about, aren’t inevitable.
Nelson Bennett Jr., MD, professor of urology at Northwestern University Feinberg School of Medicine, says that when men start to notice symptoms related to drops in testosterone, they may think, “I’m getting older, so this is just the way it’s going to be for the rest of my life.”
“But it doesn’t have to be that way,” Bennett emphasizes. “The first step [when you notice changes] is going to the doctor and talking about your concerns.”
A look at andropause
While andropause is a clinical term for these hormonal shifts, Bennett says it may not best capture what’s happening for men as they age.
“With menopause in women, there’s usually a pretty drastic decrease in hormones and a cessation of ovulation,” he says. However, “men don’t really stop making sperm, and our testosterone gradually decreases; this hormone doesn’t precipitously drop unless there’s a disease present.”
Instead, Bennett says it might be better to describe these changes in men as “age-related low testosterone.”
Research shows that, for men, the total testosterone level in the blood begins to gradually decline around age 30 or 40, with larger decreases over time for free testosterone levels. “Free” means the testosterone is unattached to proteins in the blood, allowing the hormone to easily move into cells to do its thing.
This type of hormone shift can lead to symptoms such as:
- low sex drive
- difficulty having an erection
- low sperm count
- sleep problems
- loss of muscle mass or reduced ability to exercise
- bone loss
- increase in body fat
- depression
- trouble concentrating
“In my opinion, testosterone is most important for bone health,” says Bennett. “Men with lower testosterone levels tend to have osteoporosis, which is not great long-term, because if you fall, you can break a hip, and then there are a lot of other health issues that happen related to that.”
Bennett points out that other conditions can also cause some of the symptoms associated with low testosterone. For example, obstructive sleep apnea can lead to difficulty sleeping, and depression unrelated to testosterone levels can cause a drop in sex drive.
Awareness as prevention
Certain conditions can directly affect the production of testosterone, such as testicle injury or cancer; so can problems with the glands in the brain that control hormone production. These may require medical or surgical treatment.
Other factors related to low testosterone are influenced by lifestyle choices, including:
- obesity
- certain sleep problems
- alcohol and marijuana abuse
- use of opioids or anabolic steroids or high doses of glucocorticoids
- illnesses such as diabetes or liver, heart, or lung disease
- extremely poor diet or eating disorders
- excessive exercise
This means men can take many steps to keep their hormone levels healthy as they age. “I tell my patients that what’s good for your heart is good for your penis and testicles,” says Bennett. To reduce the risk of chronic disease and maintain a healthy weight, focus on:
- Eating healthily. One option is the Mediterranean diet, which includes lots of fruits, vegetables, beans, lentils, nuts, and whole grains, as well as healthy fats such as extra-virgin olive oil.
- Getting a good night’s sleep. Most adults need seven to nine hours of sleep a night, ideally in complete darkness with generally consistent waking and bedtimes.
- Exercising regularly. “Cardio is great for maintenance of blood vessels and blood pressure,” says Bennett. “But for boosting testosterone levels, resistance training works a lot better.”
- Managing stress. Chronic stress is linked to cardiovascular disease, stomach and intestinal problems and disrupted immune function and may also lower testosterone levels.
Men’s health supports
Several supplements can help men stay active and healthy as they age:
- Magnesium may lower high blood pressure, improve sleep quality, and, for older men, improve muscle strength.
- Collagen may reduce joint stiffness in people with osteoarthritis and boost muscle mass and strength in older men.
- Polyphenols are found in foods such as red wine, dark chocolate, tea, and berries; these plant compounds may promote a healthy gut microbiome and protect against heart disease and type 2 diabetes.
- Protein powders support muscle growth as well as recovery after exercise.
- Creatine increases muscle strength and performance and may improve short-term memory.
A new model of masculine aging
While men may feel pressure to hold onto the younger version of themselves as they grow older, shifting the focus from denial to acceptance of change and embracing resilience can help improve their mental health.
A 2023 AARP survey of men and women 40 years or older suggests this mindset shift is already happening, with 86 percent of men feeling optimistic about their future. In addition, 60 percent of men surveyed said that they are taking proactive steps to improve their physical stamina, while 72 percent are working toward heart health and 66 percent are trying to improve their sleep.
Bennett also sees this in his practice. “I’ve noticed that a lot of my older male patients want to live longer and enjoy all the wonderful things of life, whether that’s being physically or sexually active,” he says. “They also want to keep their testosterone levels up and have a good quality of life.”
What this looks like varies among men. “There are men in their 70s who still do extreme sports,” says Bennett. “Maybe not at the same intensity as 25-year-olds, but they enjoy pushing themselves.” Even so, staying active as you age doesn’t need to be extreme, he adds. Some men may prefer to take it easy after retirement.
As physicians, “we need to meet men where they are and ask questions about what they expect out of their life in the future when it comes to activity levels, testosterone levels, and so on,” Bennett says.
While developing healthy habits earlier in life is always beneficial, it’s never too late to get started doing good things for your mind and body.
“It’s well known that the acquired damage from type 2 diabetes, hypertension, and poor sleep is cumulative,” says Bennett. “But as soon as you get back on the wagon, some of the damage begins to reverse.”
Testosterone replacement therapy for men
When a man’s testosterone level drops low enough to cause concerning symptoms, testosterone replacement therapy (TRT) may be an option. “It is not a fountain of youth, but elevating testosterone levels can be beneficial for men,” says Nelson Bennett Jr., MD.
This treatment involves administering artificial testosterone through a pill, gel, patch, injection, or implant.
The first step is to talk to your healthcare practitioner, who will likely have your testosterone level checked with a blood test. This test might be repeated two or three times to confirm the level. Your practitioner will also check for other causes of your symptoms, such as diabetes, high blood pressure, or thyroid problems.
Your practitioner will also explain the risks of TRT, which may include:
- infertility
- enlarged prostate
- blood clots
- worsening cardiovascular disease
- sleep problems
- cholesterol problems
The U.S. Food and Drug Administration recently recommended removing a warning about TRT related to an increased risk of cardiovascular disease, while the warning about TRT being linked to a rise in blood pressure remains.
TRT is not recommended for men who are planning on having a baby in the near future or who have certain conditions, including breast or prostate cancer, recent heart attack or stroke, untreated obstructive sleep apnea, or uncontrolled heart failure.
Because of the health risks of TRT, men should carefully weigh those against the expected benefits. They may also want to first consider non-medication options such as exercise, maintaining a healthy weight, and an improved diet.
“I think men prefer [non-TRT options], because no guy really wants to be on a medication for the rest of his life, even if it’s something that really supports them to feel better,” says Bennett. “They’d rather do it naturally.”
With the rise in “anti-aging” clinics, men should be careful in choosing where to receive TRT. Before committing to treatment, ask questions such as:
- What are the benefits, risks, and possible side effects?
- How will testosterone levels be monitored?
- What dosage is recommended?
- What forms of testosterone are available?
- How long will it take to see results?
- Are there alternatives to TRT?
- What happens if I stop treatment?
Boost health, boost testosterone
A 2020 study published in The Aging Male found that out of almost 700 men aged 40 to 70 with low testosterone, 97 percent had other health conditions, such as obesity, type 2 diabetes, high blood pressure, high cholesterol, or chronic obstructive pulmonary disease.
This article was originally published in the June 2026 issue of alive magazine.
