Currently, testosterone levels in men decline by approximately 1–2% per year after age 30. As many as 40% of men over 45 have below-normal testosterone levels. Despite this, the vast majority go undiagnosed and untreated — because many men don't realise they have a hormonal condition, or mistake symptoms for normal ageing, stress, or depression. Andropause — also called male hypogonadism or testosterone deficiency syndrome — is a real and treatable hormonal condition that responds well to targeted therapy.
Testosterone levels in men decline by approximately 1–2% per year after age 30. As many as 40% of men over 45 may have below-normal testosterone levels.
Complete the following questionnaire to check whether you may be experiencing symptoms of andropause (male hormone decline).
Choose the option that best describes your experience.
Andropause Assessment — HRT.org
Andropause is the gradual decline in testosterone and other male hormones — including DHEA and growth hormone — that occurs with ageing in men. Unlike menopause in women, andropause is not a sudden event but a slow, progressive decline that typically begins in the early 30s and accelerates after 45–50. The result is a broad range of symptoms affecting energy, mood, body composition, sexual function, cognitive performance, and bone density — many of which are mistakenly attributed to normal ageing or other conditions.
Testosterone is the primary male sex hormone, produced mainly in the testes and regulated by the hypothalamic-pituitary-gonadal (HPG) axis. It plays a fundamental role in maintaining muscle mass and strength, bone density, red blood cell production, fat distribution, libido and sexual function, mood and motivation, cognitive function, and energy levels. Testosterone also converts to oestradiol — which is essential for bone health, cardiovascular function, and mood regulation in men. When testosterone declines, all of these systems are affected simultaneously.
- Persistent fatigue and low energy despite adequate sleep
- Reduced sex drive (libido)
- Erectile dysfunction or reduced morning erections
- Loss of muscle mass and strength — despite regular exercise
- Increased body fat — particularly around the abdomen
- Mood changes — depression, irritability, or low motivation
- Brain fog, poor concentration, and memory difficulties
- Difficulty sleeping or non-restorative sleep
- Reduced bone density or unexplained fractures
- Hot flashes or sweating episodes (less common)
- Reduced body and facial hair
- Testicular atrophy
- Reduced exercise tolerance and slower recovery
- Decreased sense of wellbeing and confidence
Yes, you can test your testosterone levels at home using a reliable at-home male hormone test kit. A comprehensive male hormone panel measuring total testosterone, free testosterone, SHBG, LH, FSH, oestradiol, and DHEA-S provides the most complete clinical picture. You can also use our quiz above as a validated screening tool to assess whether your symptoms are consistent with andropause before deciding whether to order a full hormone panel.
- Primary hypogonadism — caused by a problem with the testes themselves (e.g. Klinefelter syndrome, orchitis, injury, or chemotherapy). LH and FSH are elevated as the pituitary attempts to stimulate inadequate testes.
- Secondary hypogonadism — caused by a problem with the hypothalamus or pituitary gland failing to send adequate signals to the testes. LH and FSH are low or normal despite low testosterone. Includes age-related (late-onset) hypogonadism.
- Late-onset hypogonadism (LOH) — the most common form in ageing men; a combination of reduced testicular output and declining HPG axis signalling. Responds well to testosterone replacement therapy.
- Functional hypogonadism — testosterone suppressed by reversible factors including obesity, type 2 diabetes, chronic stress, sleep apnoea, opioid use, or excessive alcohol. Addressing underlying causes can partially or fully restore testosterone.
The following blood tests are available to assess male hormonal status and identify testosterone deficiency:
- Total testosterone — primary screening test; two morning readings below 10–12 nmol/L (300–350 ng/dL) confirm testosterone deficiency
- Free testosterone — the biologically active fraction; more clinically relevant than total testosterone when SHBG is elevated
- SHBG (Sex Hormone-Binding Globulin) — elevated SHBG reduces free testosterone; increases with age
- LH (Luteinising Hormone) — helps distinguish primary from secondary hypogonadism
- FSH (Follicle-Stimulating Hormone) — elevated in primary hypogonadism; assesses testicular function and fertility status
- Oestradiol (E2) — testosterone converts to oestradiol; elevated oestradiol causes symptoms of feminisation and suppresses HPG axis
- DHEA-S — adrenal androgen that declines significantly with age and stress
- Prolactin — elevated prolactin suppresses testosterone; screens for pituitary adenoma
- PSA (Prostate-Specific Antigen) — baseline measurement before initiating TRT
- Full metabolic panel including HbA1c, lipids, and liver function
Total Testosterone Test—This is usually the first test ordered to assess testosterone status. Two morning readings (before 11am) below 10–12 nmol/L on separate occasions confirm testosterone deficiency. Testosterone peaks in the morning, so afternoon testing may miss borderline deficiency.
Free Testosterone Test—This test measures the fraction of testosterone not bound to SHBG or albumin. Free testosterone is the biologically active form and is more clinically meaningful in men with elevated SHBG — common in older men and those on certain medications.
LH and FSH Tests—These tests help identify whether low testosterone originates in the testes (primary hypogonadism — elevated LH/FSH) or the pituitary/hypothalamus (secondary hypogonadism — low or normal LH/FSH).
Oestradiol Test—Men require a small amount of oestradiol for bone health and cardiovascular function, but elevated oestradiol — from excess aromatisation of testosterone — causes breast tissue growth, water retention, mood changes, and suppression of the HPG axis.
DHEA-S Test—DHEA is the most abundant adrenal hormone and a precursor to testosterone. Low DHEA-S alongside low testosterone indicates combined adrenal and gonadal involvement.
Total Testosterone—Two morning readings below 10–12 nmol/L (300–350 ng/dL) confirm testosterone deficiency. Borderline levels between 8–12 nmol/L in the presence of symptoms warrant a trial of treatment.
Free Testosterone—A low free testosterone despite a normal-range total testosterone indicates functional testosterone deficiency due to elevated SHBG. Treatment targets are based on both values.
LH and FSH—Elevated LH alongside low testosterone confirms primary hypogonadism (testicular failure). Low or normal LH alongside low testosterone confirms secondary hypogonadism (hypothalamic or pituitary origin). You can also assess this using our Male Hormone Home Test Kit.
Oestradiol—An oestradiol above 150–200 pmol/L in men suggests excess aromatase activity, often from obesity or liver dysfunction. Aromatase inhibition may be indicated alongside TRT.
- Natural age-related decline in testicular function and HPG axis signalling
- Obesity — adipose tissue produces aromatase, converting testosterone to oestradiol
- Type 2 diabetes and insulin resistance — directly suppresses testosterone production
- Chronic stress and elevated cortisol — suppresses HPG axis and testosterone synthesis
- Sleep deprivation and sleep apnoea — testosterone is produced primarily during deep sleep
- Chronic illness — inflammatory conditions suppress the HPG axis
- Alcohol excess — directly toxic to testicular Leydig cells
- Opioid medications — potently suppress LH and testosterone
- Prior chemotherapy or radiation
- Genetic conditions (Klinefelter syndrome, haemochromatosis)
Treatment for andropause and testosterone deficiency may include:
- Testosterone replacement therapy (TRT) — available as daily transdermal gel, weekly injections, or long-acting pellets; restores testosterone to normal physiological levels
- hCG (human chorionic gonadotropin) — stimulates endogenous testosterone production; preserves testicular size and fertility; often used alongside TRT
- Clomiphene citrate — a selective oestrogen receptor modulator (SERM) that stimulates LH and FSH, increasing endogenous testosterone; used as an alternative to TRT in younger men wishing to preserve fertility
- DHEA supplementation — for confirmed low DHEA-S; supports adrenal androgen production
- Aromatase inhibitors — reduce conversion of testosterone to oestradiol when oestradiol is elevated
Natural support may also include resistance training (the most effective lifestyle intervention for raising testosterone), optimising sleep duration and quality, reducing alcohol consumption, achieving a healthy body weight, zinc (the most important mineral for testosterone synthesis), vitamin D3 (2000–4000 IU/day), and ashwagandha which has clinical evidence for raising testosterone and reducing cortisol.
Based on your andropause assessment and symptoms, you may be experiencing testosterone deficiency or andropause.
See a healthcare practitioner to discuss your symptoms and possible testing, or order tests on your own and share results with your doctor.
References
1Bhasin S, et al. "Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline." J Clin Endocrinol Metab. 2018;103(5):1715–1744.
2Wu FC, et al. "Identification of late-onset hypogonadism in middle-aged and elderly men." N Engl J Med. 2010;363(2):123–135.
3Morales A, et al. "Investigation, treatment and monitoring of late-onset hypogonadism in males." Aging Male. 2006;9(2):97–100.
A deficiency of testosterone and related hormones can affect virtually all body functions in men. The severity of symptoms ranges from mild reductions in energy and libido to significant impairment of physical performance, mental health, and quality of life. It is estimated that up to 40% of men over 45 have testosterone levels below the normal range, yet the vast majority go undiagnosed and untreated.
Self-assessment Questionnaire
Because many symptoms of andropause and low testosterone are similar to those of depression, thyroid disorders, sleep disorders, and cardiovascular disease, they can easily be confused or misinterpreted. The key distinguishing features of testosterone deficiency are the combination of reduced libido, fatigue, loss of muscle mass, mood changes, and reduced morning erections — particularly in men over 40. A morning testosterone blood test is the essential next step for any man with these symptoms.
We strongly suggest that you contact your healthcare provider if you have any concerns that you may be experiencing andropause or testosterone deficiency. The self-assessment above should not be substituted for hormonal testing by your provider.
An andropause assessment is typically done by combining a validated symptom questionnaire — such as the one on this page — with a morning blood test measuring total testosterone, free testosterone, SHBG, LH, FSH, and oestradiol. Testing should be done before 11am on two separate occasions, as testosterone levels peak in the morning and vary from day to day. DHEA-S, prolactin, and a full metabolic panel are also recommended as part of the initial workup.
Yes, most home testosterone tests are accurate when used correctly and processed by certified laboratories. Blood spot measurements of total testosterone are clinically comparable to venous blood draws and provide a convenient and private way to assess hormonal status. Free testosterone and SHBG measurements from at-home kits are particularly useful in older men.
Online andropause assessments using validated symptom questionnaires — including the Androgen Deficiency in the Aging Male (ADAM) questionnaire, on which this quiz is based — and at-home hormone test kits are effective and widely used in men's health and urology practice. They provide a practical, accessible starting point for identifying men who should proceed to full hormonal evaluation.
Yes, physical signs of andropause and low testosterone include loss of muscle mass and strength, increased abdominal fat, reduced body and facial hair, testicular atrophy, gynaecomastia (breast tissue development), reduced skin thickness, and pale complexion. Reduced grip strength and bone density changes may also be present in longer-standing testosterone deficiency.
