Andropause: What males should know for quality of life

Andropause, also known as male menopause, manopause, testosterone deficiency syndrome, or androgen deficiency in the ageing male (ADAM), refers to the decline in testosterone that many men experience with age. While the names vary, the effects are consistent: reduced testosterone can bring a cascade of physical, mental, and emotional changes that impact quality of life.

Lower testosterone levels have been linked to a wide range of issues, from reduced energy and muscle loss to increased risk of chronic diseases such as cardiovascular conditions, diabetes, obesity, and bone density loss.

Though andropause differs from the hormonal shifts of female perimenopause and menopause, it is no less significant. Understanding how your testosterone changes with age, and what you can do about it, can be a game-changer for vitality, quality of life and long-term health.

What is normal and healthy testosterone for males?

Studies suggest that symptoms of low testosterone are more likely when total testosterone falls between 8 and 13 nmol/L (2.3 to 3.7 ng/ml), and free testosterone dips between 160 and 280 pmol/L (46 to 81 pg/ml). Whilst total testosterone is the metric most commonly used, symptoms associated with low testosterone are more closely correlated with low free testosterone. 

When either total or free testosterone is a concern, other hormones such as sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicular stimulating hormone (FSH), and cortisol may help to identify contributory factors.

It is often written that male testosterone levels fall about 1% per year after age 40. This is an oversimplification which obscures an important reality. Some men maintain solid levels into their 70s and beyond, while others experience sharp declines starting in their 40s. This growing variation between individuals means personal testing - not averages - is your best guide.

Knowing your numbers and tracking changes over time allows you to make informed, proactive choices to support hormonal health.

Does low testosterone always result in negative symptoms?

No, not necessarily. Some men have naturally lower testosterone and still feel great. That’s why diagnosis is not based on lab results alone. It is instead about considering testosterone and symptoms.

• Physical symptoms like loss of muscle and strength, increased body fat, diminished morning erections, reduced libido, erectile issues, and disrupted sleep.
• Mental symptoms such as brain fog, depression, anxiety and difficulty concentrating.
• Emotional symptoms, including a loss of drive or passion, decreased confidence and mood swings.

Of all these, it is the triad of poor morning erections, low sexual desire and erectile dysfunction that is given most diagnostic weight.

To help identify risk, many men's health clinics use a tool called the ADAM questionnaire, which asks questions about signs and symptoms indicating potential deficiency.

Can testosterone be influenced through diet and lifestyle?

Absolutely, and the science backs this up. Nutrition, targeted supplementation, and lifestyle upgrades can all support natural testosterone production. Functional testing adds even more power to this process by personalising your approach and tracking progress over time.

Intervention studies that have improved diet and lifestyle behaviours and enabled improved body composition have demonstrated significant increases in testosterone.

Key dietary factors for andropause

Start with the fundamentals:

• Adequate calories and protein (matched to your age, activity level, and goals).
• Sufficient carbohydrates to fuel performance - unless you’re following a ketogenic diet.
• Healthy fats, including omega-3s and essential fatty acids.

Dietary quality and diversity also play a major role. Greater consumption of ultra-processed foods (UPF) is associated with a greater risk of lower testosterone. A diverse, wholefoods, colourful and plant-rich dietary pattern, such as Mediterranean style diets, is associated with a lower risk.

Micronutrients have a critical role, too. Important vitamins include A, all the B-vitamins, D and K2, while essential minerals include boron, copper, iron, magnesium, selenium and zinc. Dietary diversity can help a lot to enable regular intakes of these key micronutrients. A food tracking tool that includes micronutrient analysis can help you pinpoint gaps and fine-tune supplementation as needed.

Key lifestyle factors for andropause

For males, greater lean mass and lower fat mass are both positively associated with greater testosterone. Body fat is effectively an endocrine organ, meaning that it produces hormones and cytokines which have systemic body-wide effects. Some of these, including leptin, adiponectin and pro-inflammatory cytokines, have the ability to negatively impact testosterone production. So, increasing lean mass and reducing body fat can be an especially positive intervention for men with overweight and obesity.

Cardiovascular fitness is also positively associated with better testosterone levels, so including forms of exercise that improve endurance is a great start, and this can include running, cycling, swimming, tennis, soccer, and many outdoor team sports.

More intense exercise, including resistance exercise, sprint or high-intensity interval training that increases muscle mass, is also very helpful, so an ideal exercise routine will incorporate some forms of this, too.

Outside of the gym or sports field, rest and recovery also play major roles. Sleep quality and quantity are critical. In the absence of any clinical sleep disorder, practising excellent sleep hygiene can have a very positive impact on sleep and testosterone. 

Very helpful and often overlooked is a regular practice and skill that helps mitigate stress reactivity. Examples are regular practice of activities like breathwork, mindfulness-based stress reduction (MBSR), meditation and non-sleep deep relaxation. These can help limit the potential negative impact of stressors and to spend more time in rest and digest mode. Picking a tool and practising it regularly develops the skill that enables the practice to be used in times of higher stress, when it is most needed.