Andropause: Is ‘Male Menopause’ Real? What Testosterone Actually Does After 40

The man in the waiting room is 52, fit enough to run a half marathon, and holding a phone screenshot of a video that told him his tiredness, his softer middle and his flat mood all point to one thing: andropause, the so-called male menopause. He wants a blood test. He half wants a prescription. He is not alone; as of early 2026, searches for andropause are climbing again, pushed by a wave of online testosterone advertising and by a genuine scientific shift. In 2025, US regulators removed the long-standing boxed warning about heart risk from testosterone product labels after a large randomized trial found no excess of major cardiac events in treated men.

That is real news, and it has been stretched into something it is not. A safety finding for men with confirmed deficiency has become a slogan that every man over 40 is running on empty.

Andropause, in plain terms, is the gradual age-related decline in testosterone and the symptoms sometimes blamed on it. Whether that decline deserves a diagnosis, and when it deserves treatment, is where the evidence gets interesting.

Is 'male menopause' real? What andropause actually means

The word itself is a borrowed costume. Menopause describes a biological event in women: the ovaries stop releasing eggs, estrogen falls steeply over a few years, and periods end for good. Nothing equivalent happens to men. The testes keep producing testosterone and sperm into the ninth decade, just less efficiently than they did at 25.

Doctors therefore avoid ‘male menopause’ in clinical writing. The NHS calls it a misleading term, and the condition that actually exists has drier names: late-onset hypogonadism, testosterone deficiency syndrome, or age-related low testosterone. Hypogonadism simply means the testes are producing too little testosterone, whatever the cause. ‘Late-onset’ flags that it appeared in midlife or later rather than at puberty.

Here is the distinction that matters. Falling testosterone with age is nearly universal and, on its own, is not a disease. Late-onset hypogonadism is a specific diagnosis that requires two things at once: consistent symptoms and blood levels that are repeatedly low. In the European Male Ageing Study, which measured hormones in more than 3,000 men aged 40 to 79 across eight countries, only about 2 percent met that combined definition. The figure rose with age and with obesity, but it never approached the ‘half of all men’ numbers that circulate online.

So is andropause real? The hormonal drift is real. The dramatic, menopause-like cliff is not. Keeping those two ideas separate is the single most useful thing a man over 40 can take from this article, because almost every myth about male hormones depends on blurring them.

What changed recently: the TRAVERSE trial and the 2025 label update

For a decade, the loudest question about testosterone therapy was whether it harmed the heart. Observational studies pointed in both directions, and in 2015 US regulators required a boxed warning on testosterone products about possible cardiovascular risk. A boxed warning is the strongest safety alert a prescription label carries.

The answer arrived in June 2023 with the TRAVERSE trial, published in the New England Journal of Medicine. It was a randomized, placebo-controlled study of 5,246 men aged 45 to 80 who had low morning testosterone, at least one symptom, and either existing cardiovascular disease or a high risk of it. Over a median follow-up of nearly three years, major adverse cardiovascular events (a composite of cardiovascular death, heart attack and stroke) occurred in 7.0 percent of men on testosterone and 7.3 percent on placebo. Statistically, the therapy was non-inferior, meaning it did not cause more of these events than placebo.

The same trial reported signals that received far less attention. Atrial fibrillation (an irregular heart rhythm), acute kidney injury and pulmonary embolism (a clot in the lungs) were all somewhat more frequent in the testosterone group. Blood pressure also rose modestly.

In February 2025, regulators responded by removing the class-wide boxed warning about heart attack and stroke, while keeping or strengthening warnings about blood pressure. That is the change behind the current headlines.

What the update does not do is widen who should be treated. TRAVERSE enrolled men with documented deficiency. It says nothing about giving testosterone to men whose levels are normal, and its authors said so plainly.

At what age does a man go through andropause?

There is no single age, because there is no single event. Testosterone peaks in the late teens and twenties, then begins a slow slide. Mayo Clinic summarizes the trajectory as a decline of about 1 percent per year from around age 30 to 40 onward, and MedlinePlus describes the same gradual pattern as a normal part of aging in the male reproductive system.

Put that into numbers. A man whose total testosterone is 600 ng/dL at 35 might, on average, be near 450 ng/dL at 65, still well inside the range most laboratories label normal. Averages hide variation, though. Some men barely move. Others fall faster, and the accelerators are rarely birthdays.

Carrying excess abdominal fat lowers testosterone because fat tissue converts testosterone into estrogen and dampens the brain signals that tell the testes to produce more. Type 2 diabetes, untreated obstructive sleep apnea, heavy alcohol use, opioid painkillers, some antidepressants and chronic illness all push levels down. Severe calorie restriction and overtraining do too.

This is why the question ‘at what age’ is slightly the wrong one. A trim, well-slept 68-year-old can have a higher level than a 42-year-old with sleep apnea and a waist over 40 inches. Age sets the slope; health sets the starting point and the speed.

If you want a practical answer: symptoms that people attribute to andropause most often appear in the late 40s to 60s, and laboratory-confirmed deficiency becomes more common with each decade after 50. Age alone, without symptoms and without low repeated readings, is not a reason to test or treat.

What testosterone actually does after 40

Testosterone is easy to caricature as the hormone of muscle and desire. Its job list is longer and quieter. It maintains muscle protein synthesis, supports bone density by slowing bone breakdown, stimulates the bone marrow to make red blood cells, drives sperm production, sustains libido and contributes to the nerve signaling behind erections. In the brain it influences mood, motivation and spatial memory, though the links are weaker than the marketing suggests.

Most testosterone in the blood is bound to proteins, chiefly sex hormone-binding globulin (SHBG), a carrier protein that holds the hormone in reserve. Only the small ‘free’ fraction, around 2 percent, can enter cells and act. SHBG rises with age, which means free testosterone falls a little faster than total testosterone. That subtlety matters when lab reports are interpreted.

What does a 1 percent annual decline do? Across a decade it is a modest change, and the body adapts. The Testosterone Trials, a set of seven coordinated randomized studies in 790 men over 65 with confirmed low levels, offer a sense of which functions are genuinely hormone-dependent. Restoring normal levels for a year produced a moderate improvement in sexual activity and desire, a small gain in bone density, a small rise in hemoglobin, and little or no measurable change in walking distance, vitality or memory.

Read that list carefully. It tells you that testosterone after 40 still does its structural work in bone and blood and keeps sexual function ticking, but it is not the master switch for energy or sharpness that men hope it is. Sleep, muscle use, body weight and mood disorders explain far more of how a 50-year-old feels on a Tuesday afternoon.

What are the first signs of male menopause?

Ask ten men what low testosterone feels like and most will say tiredness. Yet in the European Male Ageing Study, fatigue turned out to be one of the least specific complaints; it tracked with depression, poor sleep and body weight far more closely than with hormone levels. The symptoms that did correlate with low testosterone were sexual.

The three that held up statistically were fewer morning erections, reduced sexual thoughts and desire, and erectile difficulty. When all three were present alongside a low reading, the diagnosis was likely. Physical changes come next, and more slowly: loss of muscle bulk and strength despite training, an increase in abdominal fat, reduced body hair, and sometimes breast tissue enlargement (gynecomastia). Over years, bone density can fall, which is why unexplained fractures occasionally prompt the first hormone test.

Then there is the psychological cluster that the internet loves: low mood, irritability, poor concentration, loss of drive. These are real experiences. The evidence simply says they are usually caused by something other than testosterone, and treating the hormone without addressing sleep apnea, depression or alcohol rarely fixes them.

Men sometimes describe hot flashes, and these can occur when testosterone is very low, for example after certain prostate cancer treatments. In ordinary aging they are uncommon.

A useful self-check is not a symptom score but a question of pattern. Symptoms that are mainly sexual, persistent for months and accompanied by physical change deserve a conversation and a properly timed blood test. Symptoms that are mainly fatigue and mood, in a man who snores, sleeps six hours and drinks most evenings, deserve a different conversation first.

What is the difference between menopause and andropause?

The two words rhyme and the comparison is tempting, but almost every feature differs. Menopause is universal, relatively abrupt and permanent, and it ends fertility. Andropause, if we use the word at all, is gradual, partial and highly variable, and fertility continues. The table lays the contrasts side by side.

Feature	Menopause (women)	Andropause / late-onset hypogonadism (men)
Who is affected	Essentially all women	Roughly 2 percent of men aged 40 to 79 meet strict criteria; more with obesity or chronic illness
Typical timing	Average age 51; transition over several years	No defined age; gradual decline from the 30s, symptoms more often reported after 50
Hormone pattern	Estrogen falls steeply and stays low	Testosterone falls about 1 percent per year; most men stay in the normal range
Fertility	Ends	Continues, often into old age, with reduced sperm quality
Hallmark symptoms	Hot flashes, night sweats, vaginal dryness, end of periods	Reduced libido, fewer morning erections, erectile difficulty; muscle and bone changes over time
Diagnosis	Clinical, based on age and periods stopping for 12 months	Requires symptoms plus two low morning testosterone readings and exclusion of other causes
Treatment principle	Hormone therapy for symptomatic women when appropriate	Testosterone only for confirmed deficiency, after reversible causes are addressed

The practical consequence is that a menopausal woman can reasonably expect her symptoms to relate to estrogen, whereas a man over 40 with tiredness and low mood cannot assume testosterone is the explanation. His doctor has to look wider, and often the answer is sitting in a sleep study or a depression screen rather than a hormone panel.

How is andropause diagnosed? Why one blood test is not enough

Testosterone follows a daily rhythm, highest in the early morning and lowest in the evening, with a swing that can exceed 20 percent in younger men. It also dips after a bad night, during an acute illness, after a large meal and in the days following heavy drinking. A single afternoon reading can therefore look deficient in a man who is perfectly normal.

Mainstream guidance, echoed by the Cleveland Clinic and the NHS, asks for a total testosterone measured in the morning, usually between about 7 and 10 a.m., and repeated on a separate day if the first result is low. Laboratories and professional guidelines generally set the lower boundary of normal around 300 ng/dL (roughly 10.4 nmol/L), though the exact cutoff varies by lab and assay, which is one more reason a doctor rather than a website should interpret the figure.

Two low results plus symptoms open the next set of questions. Luteinizing hormone, a pituitary signal that tells the testes to make testosterone, helps show whether the problem sits in the testes or in the brain. A prolactin level can reveal a benign pituitary growth. Iron studies, a full blood count, blood sugar and thyroid function screen for mimics. Prostate-specific antigen (PSA) and a prostate assessment are checked before any therapy is considered in older men.

In borderline cases, free testosterone or SHBG may be measured, especially in men with obesity or older age where SHBG distorts the total. None of this is complicated, but it is sequential, and skipping steps is how men end up treated for a deficiency they do not have.

What the evidence actually says: grading the trials

Evidence comes in grades. Randomized controlled trials, where participants are assigned by chance to treatment or placebo, give the most reliable answers about cause and effect. Observational studies follow people without intervening and can show associations but not causation. Expert opinion fills the gaps. On andropause, the picture by grade looks like this.

Strong (randomized) evidence: In men over 65 with confirmed low levels, a year of testosterone modestly improves sexual desire and activity, slightly raises bone density and hemoglobin, and has small or no effects on physical function, vitality and cognition (Testosterone Trials, 2016). In men aged 45 to 80 with deficiency and cardiovascular risk, testosterone does not increase heart attack, stroke or cardiovascular death over about three years, but is associated with more atrial fibrillation, kidney injury and lung clots (TRAVERSE, 2023).

Moderate (observational) evidence: Low testosterone is linked with obesity, type 2 diabetes, metabolic syndrome and earlier death. Whether low hormone causes those conditions or results from them is unresolved; most data suggest a two-way relationship, with weight loss raising testosterone in trials.

Weak or absent evidence: Testosterone for men with normal levels improves anything; herbal ‘boosters’ raise testosterone meaningfully; testosterone treats depression as a primary therapy; long-term safety beyond three years, including prostate cancer risk, is settled.

One honest caveat on the strongest trial: TRAVERSE had a high dropout rate, with most men in both arms stopping their assigned product before the study ended, which weakens confidence in the long-term reassurance. The trial is the best we have, and it still leaves room for caution.

Testosterone replacement therapy: what it can and cannot do

Testosterone replacement therapy (TRT) means prescribing testosterone to bring a deficient man’s blood level back into the normal range. It comes as skin gels, patches, injections, implanted pellets, nasal and oral forms. The choice between them involves convenience, skin transfer risk to partners and children, blood level stability and monitoring burden, and belongs to the prescribing clinician.

What a man with true deficiency can reasonably expect, based on the trials: improved libido within weeks, firmer erections in some but not all (erectile dysfunction has many causes beyond hormones), a gradual increase in lean muscle and a decrease in fat over months, better bone density over a year or more, and in some men a modest lift in mood and energy. Mayo Clinic frames these benefits as possible rather than guaranteed, and the Testosterone Trials found that even sexual gains were moderate and faded for many men over the year.

What TRT cannot be expected to do: restore the body of a 25-year-old, sharpen memory, resolve depression by itself, or lengthen life. The vitality trial inside the Testosterone Trials, the one most men care about, was negative.

Two consequences are often overlooked. External testosterone switches off the brain’s signal to the testes, so sperm production falls, sometimes to zero, and the testes shrink. For a man who may want children, that is a serious trade and must be raised before starting. Secondly, stopping therapy after years of use leaves the testes sluggish for months, which is why the decision to begin is best treated as a long-term commitment made with a doctor, reviewed regularly, and never adjusted or stopped on one’s own.

Risks and side effects of testosterone therapy after 40

The 2025 label change answered one question and left several open. Here is the current balance, drawn from the randomized trials and from the Harvard Health and Cleveland Clinic summaries.

Erythrocytosis, a thickening of the blood from too many red cells, is the most common laboratory side effect and the usual reason therapy is paused. Regular blood counts are part of monitoring. Blood pressure rises modestly on average, enough that regulators now require it on the label. Sleep apnea can worsen, which matters because apnea is itself a cause of low testosterone. Acne, oily skin, fluid retention and breast tenderness or enlargement (gynecomastia) occur in a minority. Fertility suppression and testicular shrinkage are expected effects, not rare ones.

Cardiovascular risk, measured as heart attack and stroke, did not increase in TRAVERSE. Atrial fibrillation did, with about 3.5 percent of treated men versus 2.4 percent on placebo. Pulmonary embolism and acute kidney injury were also more frequent in the testosterone group, in small absolute numbers.

Prostate cancer remains the longest-running uncertainty. Testosterone feeds existing prostate cancer, which is why it is not given to men with active disease and why PSA is checked before and during treatment. Whether it raises the risk of developing a new cancer over decades is unknown; trials to date have been too short to say. TRAVERSE found no difference over three years.

None of this makes TRT dangerous for the right man. It makes it a medicine, with a benefit-risk profile that must be weighed individually, monitored by blood tests, and revisited by the clinician who prescribes it.

Can andropause be treated without hormones? Lifestyle and the conditions that mimic it

Because age-related decline is partly a consequence of health rather than purely of time, the levers that improve general health also raise testosterone, and sometimes by more than a prescription would. Weight loss is the clearest example. In men with obesity, losing a substantial amount of body weight has been shown to raise total testosterone, and the effect scales with the amount lost. Bariatric surgery studies report some of the largest rises, bringing many men back into the normal range without any hormone at all.

Sleep is next. Men restricted to five hours a night in a laboratory study showed drops in daytime testosterone of 10 to 15 percent within a week, a change comparable to 10 to 15 years of aging. Treating obstructive sleep apnea often restores levels and, more importantly, restores the energy men were hoping testosterone would give them.

Resistance training raises testosterone acutely and preserves muscle and bone regardless of hormone level; its benefits do not depend on changing a blood number. Cutting alcohol, reviewing medicines that suppress testosterone (opioids and certain antidepressants in particular, always with the prescriber), and treating depression and diabetes all move the needle.

This is where the honest answer to ‘how do you reverse andropause’ lives. The hormonal slope of aging cannot be stopped. The avoidable part, the deficiency that comes from carrying extra weight, sleeping poorly and drinking heavily, is frequently reversible, and the NHS makes exactly this point in its guidance on the ‘male menopause’: many of the symptoms are explained by lifestyle or psychological causes that have their own, effective treatments.

Common myths about andropause and male menopause

Viral claims about male hormones tend to share a structure: a true fact, stretched past its evidence. Here are the ones currently doing the rounds, with the correction.

Myth: every man goes through andropause the way every woman goes through menopause. Every man experiences some decline; only about 2 percent of men aged 40 to 79 develop symptomatic deficiency by strict criteria. Decline and deficiency are not the same thing.

Myth: the 2025 label change proves testosterone is safe for anyone over 40. The trial behind it enrolled only men with confirmed low levels. It found no excess heart attacks or strokes in that group over three years, alongside more atrial fibrillation and clots. It tested nothing in men with normal levels.

Myth: fatigue and brain fog are the classic signs. Large population data show those symptoms track with sleep, depression and weight more than with testosterone. The symptoms with the tightest hormonal link are sexual.

Myth: a single low test result means you need treatment. Levels vary through the day and with illness. Guidelines require two morning readings and an explanation for why they are low.

Myth: testosterone makes you aggressive or causes prostate cancer. Replacement to normal range has not been shown to cause aggression in trials. It is withheld in active prostate cancer because it can feed existing tumors; whether it causes new ones over decades is unknown, not proven.

Myth: supplements can raise testosterone like a prescription. No over-the-counter product has shown that in well-designed trials; vitamin D and zinc correct deficiencies of those nutrients, nothing more.

The pattern is worth noticing. Each myth sells either reassurance or alarm. The evidence sells neither.

Supplements, boosters and online testosterone: what to know

A search for andropause returns three kinds of product. The first is the herbal ‘testosterone booster’, typically containing fenugreek, tribulus, ashwagandha, D-aspartic acid, zinc or vitamin D. The NIH Office of Dietary Supplements and the clinical literature agree on the headline: small, short trials, inconsistent results, and nothing that approaches the effect of correcting sleep or weight. Correcting a true vitamin D or zinc deficiency can nudge levels; adding more to a replete man does nothing. These products are also unregulated for potency, and some have been found adulterated with undeclared drugs.

The second is prescription testosterone offered through online platforms. Testosterone is a controlled substance in the United States, approved only for diagnosed hypogonadism. Platforms that prescribe after a questionnaire and a single afternoon lab, without the second morning test, without checking pituitary hormones, without a PSA and blood count, are not following the diagnostic standard described above. The medicine may be real; the diagnosis often is not.

The third is the grey market: selective androgen receptor modulators (SARMs), research peptides, and compounded or imported hormone products marketed as ‘legal’ alternatives. SARMs are investigational compounds with no approved medical use in the US; they are not for sale for human consumption and have been linked to liver injury. Peptides sold ‘for research’ are not approved medicines and are not for self-use. Compounded hormones lack the evidence base and quality controls of approved products.

The through-line is simple. A hormone is a medicine. The only version of it that has been tested for benefit and harm is an approved product, prescribed after a proper work-up, monitored by the clinician who prescribed it.

When to see a doctor: red-flag signs

Most men wondering about andropause do not need urgent care; they need an unhurried appointment. A few situations, though, should move that appointment up or send you to emergency services.

Book a routine visit if you have persistent loss of libido, fewer or absent morning erections, or new erectile difficulty lasting more than a few months; unexplained loss of muscle or an unexplained fracture; breast tissue enlargement or tenderness; infertility; or low mood and fatigue that are not improving. Bring a list of medicines, your sleep pattern and your alcohol intake, because the doctor will ask.

Seek care promptly, within days, if you notice a lump or swelling in a testicle, persistent headaches with changes in vision (a possible pituitary cause), or a sudden, dramatic drop in sexual function with no obvious trigger.

If you are already on testosterone therapy, contact the prescribing clinician without delay for calf pain or swelling, shortness of breath or chest pain (possible blood clot), a racing or irregular heartbeat, severe headaches, worsening snoring with daytime sleepiness, or very dark urine. These can signal clots, atrial fibrillation, blood thickening or kidney problems. Do not stop, skip or alter the medicine on your own; decisions about continuing, adjusting or pausing belong to the doctor who prescribed it.

Call emergency services for crushing chest pain, sudden weakness or numbness on one side, slurred speech or difficulty breathing, whatever hormones you take.

Finally, a note for men over 50 with symptoms: a PSA test and prostate assessment are standard before any hormone treatment. That is screening in context, not a diagnosis, and your doctor will explain what the result means for you.

Living well after 40: what the evidence says matters most

Strip away the marketing and a clear priority list emerges from the trials and the population studies. It is not the list most men expect.

Body weight comes first. A waist that keeps growing drags testosterone down and raises blood pressure, blood sugar and sleep apnea risk at the same time, each of which independently produces the fatigue and low mood that get blamed on hormones. Losing even 5 to 10 percent of body weight improves most of those measures and raises testosterone in men with obesity.

Sleep is a close second, and the fastest to fix. Seven to eight hours, with snoring or witnessed pauses in breathing investigated rather than tolerated, can shift hormone levels by an amount that would otherwise take a decade of aging to produce.

Resistance training twice a week protects muscle and bone whether or not testosterone changes, and it is the only intervention that reliably reverses the strength loss men notice in their fifties. Aerobic activity, moderate alcohol, and treatment of depression and diabetes round out the list.

Only after those are addressed does a properly diagnosed deficiency enter the picture, and for the minority of men who truly have one, modern testosterone therapy is a reasonable, evidence-supported option with known benefits and known risks, prescribed and monitored by a clinician.

The man in the waiting room, it turned out, had sleep apnea and a morning testosterone level comfortably in the normal range. Six months of treated sleep did more for his energy than any hormone could have. His story is not universal, but it is far more common than the videos admit, and it is the version of andropause that the evidence actually describes.

Frequently asked questions

At what age does a man go through andropause?

There is no set age, because the decline is gradual rather than an event. Testosterone starts drifting down by about 1 percent a year from the 30s, and symptoms attributed to andropause are most often reported after 50. Weight, sleep apnea, diabetes and alcohol change the timing more than birthdays do, so a healthy 68-year-old can have higher levels than an unwell 42-year-old.

Can andropause be reversed or treated?

The age-related slope cannot be stopped, but the avoidable part often can. Weight loss, treating sleep apnea, cutting alcohol and reviewing medicines with a doctor all raise testosterone in men whose levels are low for those reasons. For confirmed late-onset hypogonadism that persists, testosterone therapy is an evidence-supported option, prescribed and monitored by a clinician after other causes are excluded.

What is the difference between menopause and andropause?

Menopause is universal, relatively abrupt and permanent: estrogen falls steeply and fertility ends. Andropause, better called late-onset hypogonadism, is gradual, affects a minority of men, leaves fertility intact and keeps most men inside the normal hormone range. Menopause is diagnosed by age and periods stopping; male deficiency requires symptoms plus two low morning blood tests.

What are the first signs of male menopause?

The earliest and most specific signs are sexual: fewer morning erections, reduced sexual thoughts and desire, and erectile difficulty. Physical changes such as loss of muscle, more abdominal fat and breast tissue enlargement come later. Fatigue, low mood and poor concentration are common complaints but usually have other causes, most often poor sleep, depression or excess weight.

Is male menopause a real medical diagnosis?

No. ‘Male menopause’ is a popular term, not a diagnosis, and the NHS calls it misleading. The recognized condition is late-onset hypogonadism, defined by consistent symptoms together with repeatedly low morning testosterone and an evaluation for other causes. Age-related decline alone, without those elements, is considered normal aging rather than a disease.

How is low testosterone after 40 diagnosed?

A doctor orders a total testosterone blood test in the morning, usually between 7 and 10 a.m., and repeats it on another day if it is low. Two low readings plus symptoms prompt further tests: luteinizing hormone, prolactin, blood count, blood sugar, thyroid function and, in older men, PSA. Free testosterone may be added when obesity or age distorts the total.

Does testosterone therapy increase heart attack risk?

The best available evidence says no for men with confirmed deficiency. The 2023 TRAVERSE trial of 5,246 men found similar rates of heart attack, stroke and cardiovascular death on testosterone and placebo over about three years. It did find more atrial fibrillation, pulmonary embolism and kidney injury, and a modest rise in blood pressure, so monitoring remains essential.

Will testosterone therapy give me more energy?

Usually less than men hope. In the Testosterone Trials, a year of treatment in older men with low levels improved sexual function moderately but produced no meaningful change in vitality, walking ability or memory. Energy problems in midlife are more often explained by sleep apnea, depression, low fitness or excess weight, which respond to their own treatments.

Do testosterone boosters or supplements work?

No over-the-counter booster has shown a meaningful rise in testosterone in well-designed trials. Correcting a genuine vitamin D or zinc deficiency can help slightly; adding more to a man who is not deficient does nothing. Supplements are unregulated for potency and have occasionally been found adulterated. Investigational products such as SARMs are not approved and not for self-use.

Can I still have children on testosterone therapy?

Often not while taking it. External testosterone switches off the brain signals that drive sperm production, and counts can fall to zero. The testes also shrink. Recovery after stopping can take months and is not guaranteed. Any man who may want children should raise this with the prescribing clinician before starting, because alternative approaches exist for preserving fertility.

References

• NHS: The 'male menopause'
• Cleveland Clinic: Low Testosterone (Male Hypogonadism)
• MedlinePlus: Aging changes in the male reproductive system

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.