How the ‘male menopause’ impacts men’s testosterone levels

Medical

Over the past few, there has been a much-needed societal push to increase awareness and tackle the stigma surrounding menopause.

However, as the conversation develops, we understand that it’s not just women that can be affected by fluctuating hormones. There is also a change in hormone levels that sees some men’s mental, physical and sexual health affected. Is it time to raise awareness of low testosterone? 

GP at LloydsPharmacy Online Doctor, Dr Sabah Salman, explains the common signs of low testosterone and how it differs from menopause.

When do testosterone levels drop in men?

When some men reach their 40s or 50s, they experience mental and physical symptoms such as depression, loss of sex drive and erectile dysfunction. There is some overlap between symptoms of menopause and low testosterone – mood swings, difficulty sleeping and changes in body shape.

The NHS discourage the use of the term male menopause. They say the term is unhelpful and misleading because it falsely suggests symptoms are the result of a sudden drop in testosterone in middle age.

In reality, men experience a steady decline in testosterone. From around the age of 30 to 40, men’s testosterone levels reduce by about 1% each year.

What are the common signs of low testosterone?

Low testosterone doesn’t always result in symptoms. However, there are a range of signs associated with low testosterone.

  • Mood swings and irritability
  • Depression
  • Loss of muscle mass and reduced ability to exercise
  • Fat redistribution, such as developing a large belly or man boobs (gynaecomastia)
  • A general lack of enthusiasm or energy
  • Difficulty sleeping (insomnia) or increased tiredness
  • Poor concentration and short-term memory
  • Loss of sex drive
  • Erectile dysfunction

What are the symptoms of (female) menopause?

Menopause affects women and people who menstruate, occurring when a sudden drop in hormone levels causes menstrual periods to stop. It usually affects women between 45 and 55 but can happen earlier.

There are over 30 recognised symptoms of menopause. Those impacting mental health can include anxiety, mood swings, and difficulty concentrating. Hot flushes, difficulty sleeping and changes in body shape are common physical symptoms.

For women, symptoms of menopause can last for months or years, and some symptoms, such as joint pain, can continue after your periods have stopped.

Why is there little understanding about low testosterone?

Public knowledge of male menopause, or low testosterone, and its symptoms is lacking. According to a survey conducted by LloydsPharmacy Online Doctor, while 95% of UK adults had heard of the term ‘menopause’, almost half (49%) had heard of ‘male menopause’ and related terms. 

Similarly, while 84% said they could define menopause, less than half said the same of male menopause. And while 92% were aware of some of the symptoms of menopause, just 60% could not name any male menopause symptoms. 

What factors contribute to low testosterone?

Here are some other factors that contribute to low testosterone.

Hypogonadism 

Hypogonadism is the medical term for testosterone deficiency which can impact men of any age. Low testosterone can be caused either by an issue in the testes themselves (where testosterone is produced) or the part of the brain that controls the function of the testes.

Type 2 diabetes

Health data suggests that there is a link between type 2 diabetes and low testosterone. NHS statistics indicate that around 16% of males with type 2 diabetes have lower-than-normal testosterone levels.

Obesity 

Studies have demonstrated a link between obesity and low testosterone levels. In fact, it’s estimated that a one-point increase in BMI can lead to a 2% decrease in testosterone. Similarly, a four-inch increase in waist circumference is approximated to raise a man’s odds of having low testosterone by 75%.  

Why is low testosterone so hard to diagnose?

Low testosterone can be hard to diagnose because low testosterone levels in men often go undiagnosed. Although testosterone levels can be easily checked by a blood test, tests aren’t routinely carried out. 

Plus the symptoms of low testosterone aren’t specific to the condition. Erectile dysfunction, low libido and mood swings, for example, may be the result of stress, anxiety or depression.

But as these symptoms can interfere with everyday life and happiness, it is important to find the underlying cause and assess what can be done to resolve them. 

How can you treat and manage low testosterone?

If your own body does not make enough testosterone, testosterone replacement therapy (TRT) may be recommended. This can come in the form of injections or topical gels.

NHS data indicates a growth in demand for TRT. Prescriptions for TRT increased 22% in 2023. In 2024, the NHS spent over £13.5 million on Testosterone. 

It’s worth noting that TRT isn’t just prescribed to men experiencing symptoms of low testosterone, it can also be recommended as a treatment for women who have a low sex drive during menopause, and trans men as part of their transition. 

Like most medications, TRT carries some risks. Side effects may include increased appetite, weight gain, acne, excessive sweating and mood changes.

Taking testosterone can also thicken your blood, increasing your risk of heart attack, stroke and blood clots. It can also cause an enlarged prostate or other prostate disorders.

TRT can also affect sperm production which could impact your fertility. If you are considering having children in the future, you should discuss this with your endocrinologist before starting treatment.

What’s the problem with non-prescription testosterone?

Due to risks associated with TRT, it’s important you only take testosterone prescribed by a doctor. Anabolic steroids or testosterone boosters are manufactured drugs that copy the effects of testosterone. 

There is a trend among gym-goers for taking this addictive, synthetic form of testosterone, believing they can increase muscle mass and decrease fat. But taking anabolic steroids carries serious health risks.

It is illegal to sell testosterone without a prescription in the UK – and for good reason. The potentially life-threatening risks associated with taking testosterone mean it should only be prescribed by a doctor after careful consideration. Regular monitoring including blood testing is required to screen for adverse side effects.