Andropause

On Andropause

BY DR SUJATA KELKAR

The Male Menopause Is Real—and So Is the Dangerous New Trend of Testosterone Misuse

If you think menopause is exclusively a women’s issue, you may be overlooking a silent problem affecting millions of men. It’s called late-onset hypogonadism, commonly known as “andropause.” Unlike the abrupt estrogen crash of female menopause, men’s testosterone declines gradually—roughly 1% per year. This “boiling frog” pattern makes symptoms easy to dismiss as “just aging” or “just stress,” by patients and doctors alike.

But in India today, the picture is becoming more complicated. On one hand, obesity, sedentary lifestyles, and chronic stress are pushing testosterone deficiency into younger men. On the other, a different danger is spreading in gyms and on social media: young men who don’t need testosterone are misusing it anyway—for muscle gain and supposed anti-aging benefits.

The Underestimated Indian Reality: From “Don’t Know” to “Won’t Admit”

The data on male testosterone health in India makes for uncomfortable reading. A Delhi study of 745 men over 40 found that 48.18% had symptoms of andropause. A Lucknow-based study of 157 men aged 40–60 put that figure at 67.5%. Yet the awareness gap is enormous: earlier research showed only 2.2% of Indian men had even heard the term “andropause.”

More alarming is the shifting age of onset. A 2024 Indian study published in Obesity Surgery focused on young men aged 18–30 with obesity (BMI > 32.5) and found that 60.4% had testosterone levels below 300 ng/dL, with another 23.9% in the borderline 300–400 ng/dL range. Lead author Dr. Shashank Shah told The Times of India that six in ten obese young patients had low testosterone—a mechanism directly linked to fat tissue converting testosterone into estrogen. Doctors now report men as young as 35 showing signs of andropause.

Why It Gets Missed

Endocrinologist Dr. Sanjay Kalra points out that while both sexes experience age-related hormonal decline, the male version is gradual and symptomatically muted compared with the abrupt drop in estrogen and progesterone in women. That makes andropause harder to recognize and easier to dismiss in a rushed clinical setting.

Diagnosis is further complicated because symptoms overlap with other conditions. What looks like testosterone deficiency may be an underlying mental health issue, work-related stress, or simply not having enough time to relax and fulfill other valued areas of life—all of which affect mood, mindset, and libido. Testosterone levels also fluctuate: one isolated low reading does not make a diagnosis. Doctors recommend testing in the morning (between 3 and 8 a.m.) and repeating the test at least once for accuracy.

Indian men are also often referred late—usually after spouses notice mood changes like irritability and loss of sexual desire, says Dr. Reema Ahmed. Dr. Kalra emphasizes that an accurate diagnosis requires an empathetic, thorough history, which is often missed in rushed consultations. And unless men are asked directly about libido changes or fatigue, they are unlikely to volunteer these symptoms.

What Counts as Andropause?

Symptoms can include fatigue, erectile dysfunction, reduced libido, and depression. Despite the impact on well-being, only 5% of men with testosterone deficiency seek treatment.

Normal total testosterone ranges from 300–1000 ng/dL, but symptoms can appear even within that range depending on each man’s physiology. A landmark 2010 NEJM study defined late-onset hypogonadism as total testosterone below 11 nmol/L (3.2 ng/mL) plus at least three sexual symptoms. Globally, about 20% of men over 60 and 30% of men over 70 show signs of testosterone deficiency.

Treatment and Management

Lifestyle changes come first:

  • Regular exercise—physical activity boosts testosterone production, and competitive sport works even better. The body’s “use it or lose it” principle applies: if testosterone isn’t used through exertion, production falls. Morning workouts align with the body’s natural testosterone peak.
  • Nutritious diet—a clean, balanced diet of complex carbs and protein is vital. Excess sugar lowers testosterone by fueling bad gut bacteria; fiber supports gut health and blunts that effect. High sugar intake also drives weight gain, which raises aromatase—the enzyme that converts testosterone to estrogen, leading to lower testosterone and a more feminine body shape.
  • Stress and sleep management—a regular sleep schedule aligned with circadian rhythm is essential. Sufficient sleep allows optimal release of luteinizing hormone (LH), which stimulates testosterone production. Staying up late disrupts the circadian clock, stresses the body, and lowers testosterone.

Testosterone Replacement Therapy (TRT) may be proposed if lifestyle changes fail. Risks include gynecomastia (male breast development), infertility, and cardiovascular issues. Formulations available in India include injections (testosterone undecanoate, enanthate/cypionate—often the most affordable), transdermal gels (Androgel, Testim—with transference concerns), patches (Androderm—skin irritation possible), oral preparations (Andriol—variable absorption, multiple daily doses; older methyltestosterone is not recommended due to liver toxicity), buccal tablets (Striant—gum irritation), and implantable pellets (Testopel—requires minor surgery).

Costs in India range from ₹500–₹2,000 per month for injections and ₹450–₹2,000 per month for oral formulations; comprehensive treatment including consultations, diagnostics, and follow-ups can run ₹10,000–₹1,50,000.

The Misuse Problem

Driven by desires for enhanced physical performance, perceived anti-aging benefits, and increased libido, a growing number of men—especially in their 30s and 40s—are turning to TRT despite having mid-normal testosterone levels (500–700 ng/dL). This trend is medically unwarranted and potentially harmful.

Testosterone is also used as a performance-enhancing anabolic steroid, often in “stacking” cycles with other steroids. Young men and amateur bodybuilders, influenced by gym culture and social media influencers, use anabolic androgenic steroids—including testosterone—in high doses, frequently without medical supervision and outside any diagnosed medical need.

According to the Endocrine Society’s 2018 clinical guidelines, TRT should only be used in men with consistently low testosterone and clear clinical symptoms of hypogonadism. When used inappropriately, TRT can suppress the body’s natural testosterone production, leading to testicular atrophy, infertility, and hormone dependence. Other risks of unsupervised use include avascular necrosis, gynecomastia, liver toxicity, and aggression or mood disorders.

Who Should Not Take TRT?

TRT is contraindicated or requires extreme caution in several groups. Fertility is one of the most common reasons to withhold it—exogenous testosterone suppresses natural sperm production, making it unsuitable for men trying to conceive. It is also contraindicated in men with existing or suspected prostate or male breast cancer, as testosterone may fuel hormone-sensitive tumors.

Men with elevated hematocrit (above 54%) face increased risk of blood clots and strokes, while those with untreated severe obstructive sleep apnea or uncontrolled heart failure may see symptoms worsen. TRT is also risky for individuals with elevated PSA levels or severe lower urinary tract symptoms from prostate enlargement. Polycythemia, uncontrolled hypertension, and liver disease are additional red flags—oral formulations in particular can be hepatotoxic.

In short, TRT is not a prescription for andropause that anyone can take without consulting a doctor. A detailed clinical history, hormone testing, and comorbidity screening are essential before prescribing. For men with contraindications, lifestyle interventions or alternative hormonal therapies should be considered under medical supervision.

If you think someone you know is suffering from andropause, encourage them to seek medical help—where they can get a proper diagnosis and a personalized treatment plan that follows established clinical guidelines.

References

  1. Midlife Wellness PDF, pp. 6, 8, 12–13.
  2. ScienceDirect (2013). Andropause: A review. https://www.sciencedirect.com/science/article/pii/S0033318213001333
  3. PubMed ID: 23508480. Awareness of andropause among Indian men.
  4. Times of India (2013). Testosterone deficiency may be striking early. https://timesofindia.indiatimes.com/india/testosterone-deficiency-may-be-striking-early/articleshow/27447456.cms
  5. NEJM (2010). Identification of late-onset hypogonadism in middle-aged and elderly men. https://www.nejm.org/doi/full/10.1056/NEJMoa0911101
  6. CNN Health (2024). Male menopause: What to know. https://edition.cnn.com/2024/01/23/health/male-menopause-wellness
  7. PubMed ID: 31015830. Delhi study of 745 men over 40.
  8. PubMed ID: 19672344. Lucknow study of 157 men aged 40–60.
  9. Kalra, S. (2023). Andropause in India. https://onlinelibrary.wiley.com/doi/10.1155/2023/4408697
  10. Mayo Clinic (2024). Male hypogonadism: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/diagnosis-treatment/drc-20354886
  11. Podcast with Dr. Rajesh Taneja. https://www.youtube.com/watch?v=YGV2MYIDoTc
  12. New York Times (2025). Everything you need to know about testosterone therapy. https://www.nytimes.com/2025/01/25/well/live/everything-you-need-to-know-about-testosterone-therapy.html
  13. Bhasin et al. (2018). Endocrine Society clinical guidelines. https://academic.oup.com/jcem/article/103/5/1715/4939465
  14. NIH. Testosterone therapy and fertility. https://www.ncbi.nlm.nih.gov/books/NBK534853
  15. PMC. Oral testosterone and hepatotoxicity. https://pmc.ncbi.nlm.nih.gov/articles/PMC2701485
  16. ohman.in. Cost of TRT in India.
  17. Obesity Surgery (2024). Indian study on obesity and low testosterone in men aged 18–30; reported by The Times of India.
  18. PMC; Ortil Healthcare; Gynogen; Wikipedia—formulation sources cited in the original document.

Dr. Sujata Kelkar is a Replenish Brand Ambassador. She is a US-trained biological scientist, resilience expert, and author focused on mental health, wellbeing, and preventive healthcare. She completed her postdoctoral research at the National Institute of Health (NIH), USA, under renowned stress researcher Dr. George Chrousos, studying the impact of stress on immunity and mental health. She is the author of two books published by Penguin Random House — 99 Not Out! and Resilience Decoded: What Every Parent Should Know About Teen Mental Health — and has written 100+ wellbeing columns for Mint.

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