In short
Andropause is the gradual fall of testosterone in ageing men, not a male equivalent of the menopause. Total testosterone falls about 0.4 percent per year between 40 and 79, and free testosterone falls further. Genuine deficiency is uncommon: 2.1 percent of men aged 40 to 79 had low testosterone with three sexual symptoms. In the Testosterone Trials, treating men over 65 with confirmed low testosterone improved sexual desire, mood, anaemia and bone density modestly, but not energy or memory.
Condition Overview
Is andropause real?
Andropause is real as a slow and partial fall in testosterone with age, but it has no defined event like the menopause. Ovarian oestrogen production stops in almost every woman within a short time. Testosterone in men declines gradually over decades, many men stay in the normal range into old age, and only a minority develop symptoms. The US Food and Drug Administration (FDA) does not approve testosterone for men whose level is low for no reason other than age.
How much does testosterone fall with age?
Testosterone falls by about 0.4 percent per year in total testosterone, with a larger fall in free testosterone, according to the European Male Ageing Study. The table lists the four measurable changes.
| Measure | Change with age |
|---|---|
| Total testosterone | Falls about 0.4 percent per year in men aged 40 to 79 |
| Free testosterone | Falls further; men aged 75 to 79 have about 30 percent less than men aged 40 to 44 |
| Sex hormone-binding globulin (SHBG) | Rises slowly, so less testosterone is free and active |
| Daily rhythm | The morning peak flattens |
The normal range shifts with age. In the harmonised reference ranges, the lower limit for healthy men of normal weight drops with age: 264 ng/dL at age 19 to 39, and 219 ng/dL over 60. A pooled analysis of more than 21,000 men found total testosterone broadly stable until about age 70. Sperm production changes little with age.
How common is testosterone deficiency in older men?
Testosterone deficiency in older men is uncommon: only about 2 in 100 men aged 40 to 79 had a testosterone below 317 ng/dL together with three sexual symptoms (2.1 percent of 2,966 men) in the European Male Ageing Study. Severe deficiency below 230 ng/dL affected 0.9 percent. These men had lower haemoglobin, bone density and muscle mass, and severe deficiency was associated with insulin resistance and the metabolic syndrome.
Why does weight matter more than age?
Excess weight lowers testosterone more often than age does, and the effect reverses with weight loss. Obesity lowers SHBG, which lowers total testosterone, and in men with comorbid illness or severe obesity also lowers the pituitary signal. A low total testosterone in a heavy man therefore leads to free testosterone and weight management first. Medical weight loss often corrects the reading.
What else causes the same symptoms as andropause?
The symptoms of andropause are more often caused by sleep problems, weight, low mood, thyroid disease, alcohol or medicines than by testosterone. The common look-alikes are:
- Sleep: obstructive sleep apnoea and chronic short sleep.
- Mood: depression and chronic stress.
- Blood and hormones: thyroid disease, iron deficiency and poorly controlled diabetes.
- Substances: alcohol, long-term opioids and high-dose steroids.
How each cause is separated is explained under male hormonal fatigue.
What did the Testosterone Trials show in older men?
The Testosterone Trials showed that testosterone gel for one year in 788 men over 65 with confirmed low testosterone improved sexual desire, mood, anaemia and bone density modestly, but not energy or memory. Testosterone rose from a median of 232 ng/dL into the middle of the young adult range. More than 51,000 men were screened to find the 790 who qualified, 1.5 percent of those screened.
| Outcome | Result |
|---|---|
| Sexual desire and activity | Moderate improvement |
| Erectile function | Smaller improvement than desire |
| Mood and depressive symptoms | Better than placebo |
| Walking distance | No difference in the dedicated trial, small gain across all men |
| Energy (vitality) | No difference in the dedicated trial |
| Memory and thinking | No improvement |
| Unexplained anaemia (anaemia trial) | Haemoglobin rose by 1 g/dL or more in 54 percent, against 15 percent on placebo |
| Spine bone density (bone trial) | Up 7.5 percent, against 0.8 percent on placebo |
Benefit is more likely the lower the testosterone, especially below 200 ng/dL. Clinical guidance therefore considers treatment in an older man only with symptoms and a testosterone below normal on at least two mornings, preferably below 200 ng/dL.
What are the risks of testosterone in older men?
The risks of testosterone in older men are more atrial fibrillation, pulmonary embolism and fractures, without more heart attacks or strokes, according to the TRAVERSE trial of 5,204 men with a median age of 63. Fractures rose from 2.46 to 3.50 percent, mostly ankle, wrist and rib (fracture analysis). In a substudy of 170 men from the Testosterone Trials, one year of testosterone increased non-calcified coronary plaque on CT. Men at high risk of fracture receive osteoporosis treatment alongside testosterone.
For men over 50 considering treatment, the approach with Dr. Felix is described on the TRT for men over 50 page.
Andropause in Dubai and the UAE
Why do many men in the UAE have a low reading without a deficiency?
Many men in the UAE have a low total testosterone without a deficiency because excess weight lowers SHBG and total testosterone while free testosterone often stays normal. The UAE Ministry of Health and Prevention National Health and Nutrition Survey 2024-2025 found obesity in about 22 percent of adults. For a man in Dubai with a low total testosterone and a high BMI, the next step is free testosterone by equilibrium dialysis and weight management, not a prescription.
How Dr Felix treats andropause symptoms, the cause first and testosterone only for a confirmed deficiency: andropause treatment in Dubai.
When to See a Doctor
- Libido and morning erections have declined steadily over several years.
- Strength has fallen and waist size has risen despite similar training and eating.
- Mood, drive and stress tolerance have changed in a way the family also notices.
- Heavy snoring, unrefreshing sleep or daytime sleepiness are present.
- Persistent headaches, changes in side vision or breast discharge: pituitary assessment is needed quickly.
- Unexplained weight loss, night sweats, bone pain or urinary obstruction: investigation comes before any attribution to age.
- Persistent low mood, hopelessness or thoughts of self-harm: urgent care is needed rather than a hormone appointment.
How Dr. Felix Assesses This
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1
Symptom timeline
Dr. Felix maps the order and speed of change in libido, erections, energy, mood, concentration, strength and sleep, because a slow decline and a sudden change point in different directions.
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2
Risk and medication review
Chronic illness, cardiovascular risk, alcohol, opioids, steroids, antidepressants and any previous testosterone or anabolic steroid use are documented.
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3
Examination and blood tests
Blood pressure, waist, testes and breast tissue are examined, with prostate assessment where age-appropriate. Morning fasting testosterone is taken on two days, with thyroid, prolactin, blood count, ferritin, HbA1c and lipids.
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4
Diagnosis and order of treatment
Sleep apnoea, weight, alcohol or medicines are often treated first. Testosterone is considered only when deficiency is confirmed.
Treatment Options
TRT Consultation
The diagnosis comes first because testosterone treatment suppresses the body’s own production, and the symptoms that bring men in usually…
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Testosterone Replacement Therapy
Testosterone replacement therapy (TRT) is a prescription treatment that raises a low testosterone level into the normal range for adult…
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Testosterone Gel
Testosterone gel is a daily skin gel and the usual first choice for testosterone replacement therapy, because it gives normal…
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Long-Acting Testosterone Injection
A long-acting testosterone injection is testosterone undecanoate injected deep into the muscle every 10 to 14 weeks after a loading…
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Why Early Treatment Can Matter
Early assessment of andropause symptoms finds treatable causes such as sleep apnoea, thyroid disease, iron deficiency and early diabetes before they shape health for years.
Muscle and bone density are easier to maintain than to rebuild, and blood pressure, lipids and glucose respond well while the values are still modest.
Why Early Treatment Can Matter
Early assessment of andropause symptoms finds treatable causes such as sleep apnoea, thyroid disease, iron deficiency and early diabetes before they shape health for years.
Muscle and bone density are easier to maintain than to rebuild, and blood pressure, lipids and glucose respond well while the values are still modest.
Treatable causes found
Sleep apnoea, thyroid disease and iron deficiency respond well once identified.
Muscle, bone and metabolism
Strength and bone density are easier to preserve than to recover later.
One assessment, one answer
A structured review replaces years of guessing at the cause.
Cost & Consultation Investment
The cost of an andropause assessment covers consultation time with Dr. Felix, the examination, interpretation of the morning blood tests and the written plan. Laboratory tests, any sleep study and any prescription are separate. Dr. Felix explains the full cost before anything is arranged.
Frequently Asked Questions
Andropause is real as a gradual fall in testosterone of about 0.4 percent per year in total testosterone, with a larger fall in free testosterone. Most men with the decline have no symptoms from it.
No, andropause is not the same as menopause. Menopause ends ovarian oestrogen production in almost every woman, while testosterone in men falls slowly, partially and very differently from man to man.
Testosterone deficiency after 40 is uncommon: 2.1 percent of men aged 40 to 79 had low testosterone with three sexual symptoms, and 0.9 percent had severe deficiency, in the European Male Ageing Study.
Testosterone did not improve energy in the Testosterone Trials vitality study, and memory did not improve. Sexual desire, mood, anaemia and bone density improved modestly.
Testosterone treatment helps older men more the lower the level, especially below 200 ng/dL. Men in the borderline range gain less while carrying the same risks.
Excess weight lowers SHBG and therefore total testosterone, and severe obesity also suppresses the pituitary signal. Unlike age, both effects reverse with weight loss.
Sperm production changes little with age. Studies comparing older and younger men found similar semen results, although sperm motility is somewhat better in younger men.
The cost of an andropause assessment in Dubai depends on the blood tests and repeat samples needed. Dr. Felix explains the full cost before anything is arranged.
Evidence
Where this information comes from
Every figure on this page is taken from the sources below. All of them are free to read, so you can check them yourself.
- Identification of late-onset hypogonadism in middle-aged and elderly men (European Male Ageing Study)
- Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe
- Effects of Testosterone Treatment in Older Men (The Testosterone Trials)
- Association of Testosterone Levels With Anemia in Older Men: A Controlled Clinical Trial
- Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone
- Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE)
- Testosterone Treatment and Fractures in Men with Hypogonadism
- MoHAP releases National Health and Nutrition Survey 2024-2025
This page is general medical information and does not replace a personal consultation. Trial results are averages across large groups, not a prediction for any one person.