Male Menopause Is Real: Causes, Warning Signs And When To Get Tested

While the term "menopause" is conventionally associated with women, many men enter a phase of hormonal and physiological transition often referred to as "male menopause". In India, where changes in lifestyle, diet, stress and chronic diseases are rising, it is important for men and their families to understand this phenomenon. Unlike the abrupt cessation of menstrual periods in women, the changes in men are gradual, subtle, and often ignored. Hormone levels, particularly testosterone, decline slowly over years, and when combined with other risk factors they may lead to pronounced symptoms.

Awareness around male menopause remains limited in India, but recognising the causes and risk factors early can help in management and better health outcomes.

What Is Male Menopause?

Male menopause, clinically referred to as andropause or late-onset hypogonadism, describes the phase in a man's life when androgen (especially testosterone) levels decline, accompanied by symptoms of sexual, physical and psychological change. 

In a recent Indian review, specialists from Karnataka described it as a "prevalent occurrence that more men experience as they age". It is important to note that while women go through menopause at a more defined point, men's hormonal decline is not sudden and does not mean complete cessation of function. In fact, many men do not experience significant symptoms.

Signs Of Male Menopause

Unlike the sudden hormonal shift women experience during menopause, male menopause or andropause develops gradually, often between the ages of 40 and 60. The symptoms may be subtle at first and can easily be mistaken for signs of stress or ageing. Here are some of the most common signs and symptoms doctors associate with declining testosterone levels:

• Fatigue and low energy: Persistent tiredness even after adequate rest.
• Mood changes: Increased irritability, anxiety, or mild depression.
• Reduced libido: Noticeable decrease in sexual desire and performance.
• Erectile difficulties: Trouble achieving or maintaining erections.
• Loss of muscle mass and strength: Gradual decline in muscle tone and endurance.
• Increased body fat: Especially around the abdomen and chest.
• Sleep disturbances: Insomnia or disrupted sleep patterns.
• Memory and focus issues: Trouble concentrating or increased forgetfulness.
• Hot flashes and sweating: Though less common, some men report temperature fluctuations.
• Hair thinning: Subtle or noticeable hair loss due to hormonal imbalance.

A 2023 review published in the Journal of Clinical Endocrinology & Metabolism found that testosterone levels typically decline by about 1% per year after age 30, and symptoms may become more pronounced when the drop affects energy, libido, or mood.

Note: If several of these symptoms occur together and persist for months, experts advise seeking medical evaluation rather than self-diagnosing.

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Causes And Risk Factors For Male Menopause

• Hormonal ageing and testicular changes: From around age 30-40 onwards, testosterone levels in men begin to drop, and some studies suggest a decline of about 1% annually. Age-related changes in the testes (Leydig cell mass reduction), increased sex hormone-binding globulin (SHBG) which lowers free testosterone, and aromatisation of testosterone in visceral fat are mechanisms described as being related.
• Lifestyle, chronic disease and metabolic risk: In India, with rising rates of obesity, type 2 diabetes, hypertension and sedentary lifestyle, men are at higher risk of earlier or more severe androgen deficiency symptoms. For instance, hypertension, heart disease and sleep apnoea are linked to lower testosterone levels. Alcohol, smoking, poor diet, high stress, inadequate sleep and inactivity further accelerate decline.
• Psychological, social and occupational stressors: Studies show that men under high occupational stress or with poor social well-being report more andropause symptoms. A 2024 study among retired male nurses found that age, marital status and spouse's menopause status predicted severity of symptoms. As per studies, in the Indian context, awareness of andropause is low, which may delay recognition and management. 
• Other risk factors: Late-onset hypogonadism may be more likely in men with testicular disease, pituitary/hypothalamic disorders, or exposure to chemotherapy/radiation. Central obesity and increased visceral fat raise the conversion of testosterone to oestrogen, reducing available androgen. Poor diet (e.g., very low-fat diets) may reduce testosterone levels (a meta-analysis found low-fat diets led to lower testosterone).

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Why Male Menopause Matters: Risks Of Ignoring It

Men experiencing undiagnosed andropause or low testosterone may face:

• Declining libido, erectile dysfunction, fewer morning erections.
• Loss of muscle mass, increased fat, fatigue, mood changes like irritability or depression.
• Beyond symptoms, larger-scale health risks such as reduced bone density (osteoporosis), increased risk of cardiovascular disease, insulin resistance and type 2 diabetes.

Therefore, in India where cardiovascular and metabolic disease burdens are high, recognising androgen decline is doubly important.

What Indian Men Can Do

• Lifestyle first: Healthy diet, regular exercise (especially resistance training), good sleep and stress management help maintain testosterone and mitigate decline.
• Medical check-up: If you're over 40 and have symptoms (low libido, erectile issues, fatigue, mood changes), get evaluated by a doctor (urologist/endocrinologist). Blood tests in morning, repeated for accuracy, are needed.
• Address underlying conditions: Managing hypertension, diabetes, obesity, sleep apnoea and other comorbidities can improve hormonal health and reduce risk.
• Be cautious about hormone therapy: Testosterone replacement therapy (TRT) is not for every man and comes with risks/benefits. Guidelines emphasise individualised discussion.
• Raise awareness: In Indian context especially, talk openly about symptoms, reduce stigma around men's hormonal health, and encourage family support and early intervention.

Male menopause may not mirror female menopause in its abruptness, but the gradual decline in testosterone and its health consequences deserve attention, especially in India's changing lifestyle and disease landscape. Recognising the causes and risk factors early, adopting a healthy lifestyle and seeking medical guidance when symptoms appear can make a significant difference. If you're a man over 40 experiencing changes in sexual drive, energy levels or mood, don't dismiss them as "just ageing". A proactive approach can safeguard your long-term health and quality of life.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.