Andropause is the popular name for the slow drop in testosterone that comes with age in men. Doctors usually call it late-onset hypogonadism or age-related low testosterone, and Mayo Clinic says men’s testosterone levels generally fall about 1% a year after age 40. That pace is the whole story. Menopause in women happens over a fairly short stretch of time, while the male version runs across decades, so there is no birthday when andropause switches on.
Quick answer: Male menopause is real in one sense: testosterone does fall with age. It is gradual, though, with no sudden shutdown like menopause in women. The decline starts somewhere between the mid-30s and 40s at roughly 1% to 1.6% a year. Only a minority of men end up with low levels plus symptoms, and that is confirmed with repeat morning blood tests.
Is male menopause real?
The hormone change is real. The name is the problem.
Mayo Clinic’s article on the subject is titled “Male menopause: Myth or reality?” and it answers by separating the two processes. In women, ovulation ends and hormone production falls over a fairly short period. In men, testosterone and other hormones go down over many years. The word menopause suggests an event with a start and a finish, and the male decline has neither.
The American Heart Association made the same point in a June 2024 article, quoting Dr. Robert H. Eckel, who described andropause as “a gradual fall” in testosterone without a defined endpoint, compared with menopause, which usually arrives around age 50 and involves periods and estrogen production stopping over a finite stretch.
You will see several labels for the same thing. Andropause, male menopause, manopause, testosterone deficiency, late-onset hypogonadism and androgen decline in the aging male all point at one pattern. Manopause is the slang version. Clinicians and guidelines use hypogonadism or testosterone deficiency, and that is the language you will see on a lab order.
Here is the position this page takes: asking whether male menopause is real is less useful than asking whether your own testosterone is low and whether it explains how you feel, because age by itself answers neither question.
Myth: Every man goes through male menopause around 50.
Fact: Testosterone falls slowly over years. Mayo Clinic notes that most older men keep levels in the normal range, and only about 10% to 25% have levels thought to be low.
Myth: Andropause ends at some point, the way menopause in women does.
Fact: The American Heart Association article describes andropause as a gradual fall with no defined endpoint.
Myth: Feeling tired and flat at 50 means low testosterone.
Fact: In a European study of 3,369 men aged 40 to 79, only about 2% met a strict definition of late-onset hypogonadism, and even the most specific symptoms were common in men with normal levels.
What age does andropause start?
Sources do not agree on a single number. The American Heart Association says the decline begins in the mid-30s and averages about 1.6% a year. Cleveland Clinic says levels can drop 1% a year starting in the late 30s. Mayo Clinic puts it at about 1% a year after 40. Those are different studies and different ways of measuring, and nobody has settled on one start date.
What they share is the shape. A long, shallow slope.
The best long-term data comes from the Baltimore Longitudinal Study of Aging, which followed 890 men over years and was published by Harman and colleagues in 2001. The share of men with total testosterone in the hypogonadal range rose to about 20% of men over 60, 30% over 70 and 50% over 80. So the andropause age question has two answers. The decline starts in the 30s or 40s for most men, and low levels become common from the 60s onward.
| Age | What the research shows | Source |
|---|---|---|
| Mid-30s | Testosterone begins to decline, averaging about 1.6% a year | American Heart Association |
| Late 30s | Levels can drop about 1% a year | Cleveland Clinic |
| 40 and up | Levels generally fall about 1% a year | Mayo Clinic |
| Over 45 | Low testosterone becomes more likely | Cleveland Clinic |
| Over 60 | About 20% of men had total testosterone in the hypogonadal range | Harman et al., 2001 |
| Over 70 | About 30% of men | Harman et al., 2001 |
| Age 75 | Men have typically lost about 30% of the testosterone they had at 25 | American Heart Association |
| Over 80 | About 50% of men | Harman et al., 2001 |
These are population averages. They say nothing about which curve one particular man is on, and none of the sources above explain well why one 55-year-old holds steady while his brother drops early. If you want to see how the numbers look on a lab report decade by decade, read our guide to normal testosterone levels by age.
Andropause symptoms: the short version
Mayo Clinic lists the signs that can point to low testosterone: less sexual desire and function, erectile dysfunction, lower energy and motivation, depression, trouble focusing, sleep problems, less muscle, more body fat, and hot flashes or sweats. Some of those are vague. Plenty of 50-year-olds sleep badly for reasons that have nothing to do with hormones.
The sharpest data on which male menopause symptoms track testosterone comes from the European Male Ageing Study (Wu et al., New England Journal of Medicine, 2010). The researchers checked 32 candidate symptoms in 3,369 men aged 40 to 79 across eight European centers and found only nine linked to low testosterone. Three sexual symptoms stood out: fewer morning erections, less frequent sexual thoughts and erectile dysfunction.
Their definition of late-onset hypogonadism was strict. A man needed all three sexual symptoms plus a total testosterone below 11 nmol/L (about 320 ng/dL) and a free testosterone below 220 pmol/L. About 2% of the men met it.
Two percent.
That number is the reason this page takes a firmer line than most: fatigue and low mood on their own are weak evidence of andropause, and the sexual symptoms are the ones worth paying attention to, while even those showed up often in men whose testosterone was normal. A full list of andropause symptoms is on our main testosterone page, linked below.
How andropause is evaluated
No single test diagnoses andropause. Low testosterone is confirmed with blood work and symptoms together, and both major U.S. guidelines say one reading is not enough.
The Endocrine Society guideline (Bhasin et al., 2018) calls for a diagnosis only in men who have symptoms and signs of testosterone deficiency plus “unequivocally and consistently low” total testosterone, measured fasting in the morning and confirmed with a repeat test. It also recommends against routine screening of men who have no symptoms.
The American Urological Association guideline uses a total testosterone below 300 ng/dL as a reasonable cut-off and says the diagnosis should be made only after two measurements taken on separate occasions, both early in the morning, in a man who also has symptoms or signs.
What a workup usually includes
- A symptom and medical history, including medicines such as opioid pain relievers, which Mayo Clinic lists as a cause of low testosterone
- A fasting, early-morning total testosterone test, repeated on a second morning
- Luteinizing hormone (LH) once low testosterone is confirmed, per the AUA guideline
- Prolactin if LH comes back low or low-normal
- A look for other causes, such as obstructive sleep apnea
Timing matters because testosterone moves around. Cleveland Clinic notes that morning is when levels should be highest and that being sick can lower them for a while, so a test taken during a cold is a poor test. In the American Heart Association piece, Dr. Nannan Thirumavalavan put it plainly: “We never want to just treat a number.”
Who should get checked for andropause
The guidelines point one way. Get tested because of symptoms, not because of a birthday.
A man in his 40s or 50s with fewer morning erections, low desire or erectile dysfunction has a reason to ask for labs. So does a man whose energy and mood have slid for months with no other explanation, as long as he knows those signs are less specific. A man who feels fine does not need a screening test just because he turned 50, and Dr. Eckel told the American Heart Association that low testosterone without symptoms “is not a cause for concern.”
Testosterone is also one item on a longer list. Heart disease, prostate changes and diabetes sit on the same list of health issues men face after 50, and a checkup for one is a good time to raise the others.
At Proactive Choice, Dr. Drew Collins follows the Endocrine Society approach: a fasting, early-morning total testosterone test repeated on a second morning, with treatment considered only when results are consistently low and symptoms line up. He has seen patients from age 22 to 80, and the clinic’s view is that your labs and how you feel day to day matter more than your age. If you want to know whether your symptoms are worth testing, book a free 10-minute call about male hormone replacement in Bend at +1 (858) 333-5196.
Frequently asked questions
Is male menopause real?
The hormone change is real, but the name is misleading. Men’s testosterone falls slowly over many years, about 1% a year after 40 according to Mayo Clinic, instead of dropping over a short period the way hormones do at menopause in women. Doctors call the clinical version late-onset hypogonadism or age-related low testosterone, and it affects a minority of older men.
What age does andropause start?
The decline usually starts between the mid-30s and 40s. The American Heart Association says it begins in the mid-30s at about 1.6% a year, and Mayo Clinic says about 1% a year after 40. Low levels become common later: in the Baltimore Longitudinal Study of Aging, about 20% of men over 60 and 30% over 70 had levels in the hypogonadal range.
How long does andropause last?
Andropause has no set end. Menopause in women finishes once periods and estrogen production stop, but the male decline is a gradual fall that keeps going through later life. The American Heart Association describes it as having no defined endpoint, which is why men are evaluated on current symptoms and labs instead of a stage or a timeline.
What is manopause?
Manopause is a slang word for andropause, the age-related drop in testosterone in men. It means the same thing as male menopause. Clinicians use terms like late-onset hypogonadism or testosterone deficiency instead, and those are the words you will see in guidelines and on lab paperwork. The slang suggests a sudden change, while the real decline is slow.
Can a blood test confirm andropause?
A blood test is part of it, but one result is not enough. The Endocrine Society and the American Urological Association both call for fasting, early-morning total testosterone measured on two separate days, plus symptoms or signs of low testosterone. The AUA uses 300 ng/dL as a reasonable cut-off and recommends checking LH once low testosterone is confirmed.
Sources
- Mayo Clinic. Male menopause: Myth or reality?
- American Heart Association News. Is andropause the same as “male menopause,” and should men worry? (June 21, 2024)
- Harman SM, et al. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001
- Wu FCW, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010
- ScienceDaily. Report on the European Male Ageing Study findings (June 2010)
- Bhasin S, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. 2018
- American Urological Association. Evaluation and management of testosterone deficiency
- Scripps Health. Is male menopause real?
- Cleveland Clinic. Low testosterone (male hypogonadism)
Medically reviewed content from Proactive Choice. This article is for education and is not a diagnosis. Talk with a licensed clinician about your own labs and symptoms.
Want to talk this through for your own health? Book a visit with Dr. Drew Collins, ND at 601 NW Harmon Blvd in Bend, or call (858) 333-5196.
