Andropause: why your energy, drive, and workouts aren't the same after 40
Testosterone declines gradually with age, and the changes are easy to write off. Here's what andropause is, the signs worth paying attention to, and how testing works.
Your energy isn't what it used to be. Workouts take longer to recover from. You sleep, but you still wake up tired. Your patience is shorter, your waistline is bigger, and you can't pinpoint when you stopped feeling like yourself.
Most men chalk this up to getting older, work stress, or not trying hard enough. Sometimes that's part of it. But these changes also line up with a gradual shift in hormones that many men have never heard named: andropause.
What is andropause?
Andropause is the gradual decline in testosterone that happens as men age. In medical literature you'll also see it called age-related testosterone decline or late-onset hypogonadism.
Unlike menopause, it doesn't happen over a few years. In the Massachusetts Male Aging Study, which followed men for about a decade, total testosterone fell by about 1.6% a year and free testosterone, the portion your body can actually use, fell by 2 to 3% a year.1 That adds up slowly, which is why it's easy to miss.
Signs worth paying attention to
Testosterone affects much more than sex drive. Many men who come to see us describe a mix of:
- Low energy or motivation, even when life is going fine
- Less strength or stamina, and slower recovery from workouts
- Broken sleep, or feeling "wired but tired"
- More fat around the middle, even without big changes in diet
- Trouble focusing, or losing your edge at work
- Lower libido or changes in sexual function
In a large European study of men aged 40 to 79, the symptoms most closely tied to low testosterone were sexual: fewer morning erections, lower desire, and erectile changes.2 Fatigue, low mood, and weight gain were common too, but they have many possible causes, which is why testing matters.
Feeling off after 40 is common. That doesn't mean you have to accept it without looking into why.
"Normal" testosterone covers a wide range
Most labs flag testosterone as low when total testosterone falls below about 300 ng/dL, and the American Urological Association uses that cutoff for diagnosing testosterone deficiency.3 A harmonized reference range for healthy young men runs from about 264 to 916 ng/dL.4 A man at 320 and a man at 850 are both "normal," but they may feel very different.
In functional medicine, we look for an optimal range, where your body feels and functions its best, not just a number above the cutoff. For most men, we aim for a total testosterone of about 800 to 1,000 ng/dL, read alongside free testosterone, estradiol, and how you actually feel.5
It’s rarely just one hormone
Testosterone doesn't work alone. Sleep, body fat, blood sugar, thyroid function, and stress all affect it, and it affects them back. In one study, healthy young men who slept five hours a night for a week saw their daytime testosterone drop by 10 to 15%.6 That's why a good workup looks at the whole picture, not only a single testosterone number.
How we look at men’s health
At Balanced Health, we start with comprehensive labs: total and free testosterone, estradiol, thyroid, metabolic markers, micronutrients, and stress markers. Clinical guidelines recommend measuring testosterone in the morning and confirming low results with a second test, and we follow that.3,7
From there, your plan depends on what we find. Options range from sleep, nutrition, and targeted supplements to testosterone replacement therapy when it's appropriate, and we recheck labs and adjust as your body responds. If you're planning to have kids, tell us up front, because testosterone therapy can affect fertility.
What you can do next
- Notice which of the signs above sound familiar, and roughly when they started.
- If you’ve had labs, check whether both total and free testosterone were measured, and what time of day the blood was drawn.
- Look at your sleep. It’s one of the simplest things that affects testosterone.
You can learn how we approach men's health, or book a free discovery call to talk it through. We see patients in person in Hammonton and virtually anywhere in New Jersey.
Founder of Balanced Health and a Georgetown University–trained women's health nurse practitioner with 25+ years in medicine and advanced training in functional medicine.
Meet our teamSources
- Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87(2):589–598.
- Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–135.
- Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432.
- Travison TG, Vesper HW, Orwoll E, et al. Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the United States and Europe. J Clin Endocrinol Metab. 2017;102(4):1161–1173.
- EVEXIAS Health Solutions. Practitioner clinical training in hormone optimization.
- Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305(21):2173–2174.
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744.
This article is for education only and isn't medical advice. Talk with your provider before starting or changing any treatment.