Andropause in Men: Symptoms, Causes, and Treatment Options

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At East Valley Naturopathic Doctors in Mesa, our naturopathic physicians take a full individual history, run targeted lab work, and build treatment plans that combine bioidentical hormone therapy with botanical medicine, nutrition, and other natural approaches based on what each patient actually needs.

What Is Andropause?

Testosterone production begins in the hypothalamus, which signals the testes to produce both sperm and testosterone. Men are born with hundreds of millions of the cells responsible for making testosterone, and that supply naturally declines with age, typically dropping 1 to 1.5 percent per year starting as early as the mid-20s.

Because the decline is gradual rather than sudden, andropause is often multifactorial. It can be driven by natural aging alone, or it can be caused or worsened by other conditions like adrenal fatigue, hypothyroidism, and environmental toxin exposure. Getting an accurate diagnosis usually means ruling these other causes in or out with lab testing rather than assuming low testosterone is the only thing happening.

Symptoms of Andropause

Common physical and emotional symptoms include:

Decreased libido
Erectile dysfunction
Fatigue and low energy
Weight gain, especially around the abdomen
Loss of muscle mass and muscle weakness
Irritability, depression, and anxiety
Urinary symptoms related to prostate enlargement (BPH)

What Causes Andropause?

Natural Testosterone Decline

As testosterone is released into the bloodstream, some of it binds to sex hormone-binding globulin (SHBG), and some is converted into other hormones. One pathway converts testosterone into DHT via the enzyme 5-alpha-reductase, concentrated in the prostate gland. Another converts it directly into estrogen via aromatase, concentrated in fat, skin, bone, and brain tissue.

As men age, less testosterone stays "free" (unbound and usable), while SHBG and aromatase activity both tend to increase. The result is a shrinking supply of usable testosterone that becomes progressively less effective, while a larger share of what remains is converted into DHT or estrogen.

Adrenal Fatigue

The adrenal glands help regulate blood pressure, blood sugar, and reproductive hormones, including testosterone. Long-term stress can impair their ability to produce enough hormone, which can mimic or worsen andropause symptoms like fatigue, anxiety, depression, and weight gain.

Hypothyroidism

An underactive thyroid can cause the same sluggishness, fatigue, and weight gain seen in andropause, which is why thyroid function testing is part of a proper workup rather than an optional add-on.

Environmental and Xenoestrogen Exposure

Certain everyday compounds, including plasticizers, BPA, and pesticide residues, act as "xenoestrogens" that mimic estrogen in the body. By binding to the same receptors as natural hormones, they can worsen the testosterone-to-estrogen imbalance already happening with age.

Health Risks of Untreated Andropause

Low testosterone isn't just a quality-of-life issue. Left unaddressed, it's been linked to several other conditions:

Cardiovascular Disease

Testosterone appears to play a protective role similar to estrogen's role in premenopausal women. As testosterone declines, cardiovascular disease risk tends to rise, and men with existing cardiovascular disease tend to have lower testosterone than men without it.

Obesity and Metabolic Syndrome

Declining testosterone is linked to increased visceral (abdominal) fat storage and a rising waist-to-hip ratio, partly because fat tissue itself converts testosterone into estrogen, compounding the problem.

Insulin Resistance and Type 2 Diabetes

Lower bioavailable testosterone correlates with higher fasting glucose and insulin levels, and men with diabetes tend to have lower testosterone than men without it.

Benign Prostatic Hyperplasia (BPH)

As testosterone converts more readily into DHT with age, prostate cell growth increases. BPH is common, affecting roughly half of men over 50, and can cause urinary frequency, weak stream, and incomplete voiding.

Osteoporosis and sarcopenia

Falling testosterone is linked to reduced bone density and muscle mass in aging men, not just aging women.

How Andropause Is Diagnosed

Diagnosis starts with a full history and typically includes:

A male hormone panel (free and total testosterone, DHT, SHBG)
Thyroid function testing
Adrenal function testing
Prostate Specific Antigen (PSA)
A cardiovascular risk assessment

If hormone levels come back within normal limits, hormone replacement usually isn't the right next step, and other therapies may be a better fit. If levels are low and symptoms are present, treatment can begin.

Naturopathic and Natural Treatment Options for Andropause

Bioidentical Hormone Replacement Therapy (BHRT)

Bioidentical testosterone is chemically identical to what the body produces naturally, unlike the synthetic hormones that dominated hormone therapy in the U.S. for decades. Before starting BHRT, we run baseline labs (free and total testosterone, DHT, SHBG, and PSA) to confirm it's an appropriate fit and to screen for prostate cancer risk. BHRT is generally not recommended for men with a personal history of prostate cancer.

There are several ways to deliver it, each with tradeoffs:

Creams and gels: Applied daily to the thigh or back, this is generally the most favorable option. It bypasses the liver, mimics the body's natural overnight testosterone rhythm, and avoids the discomfort of injections.
Injections: Typically given every 2 to 4 weeks. Effective, but can cause swelling, nausea, and other side effects, and many patients find the injection itself uncomfortable.
Pellets: Implanted under the skin and effective for 3 to 6 months at a time. Convenient, but side effects can include acne, anxiety, and changes in hair growth.
Oral or sublingual forms: The least favorable route, since a significant portion is broken down by the liver before it reaches the bloodstream.

Potential side effects across methods can include changes in hematocrit, sleep disturbances, and rarely, breast tissue enlargement (gynecomastia) if excess testosterone converts to estrogen. We review all of this with patients before starting therapy, along with fertility considerations, since BHRT can suppress natural sperm production.

Botanical Medicine

Several herbs have research behind them for supporting men's hormonal health:

Saw Palmetto: The best-researched natural option for BPH, shown to be comparably effective to the prescription drug Finasteride for urinary symptoms, with fewer side effects.
Stinging Nettle Root: Binds to SHBG, helping keep more testosterone "free" and usable, and has been shown to improve urinary flow.
Pygeum: Supports genito-urinary health and can reduce nighttime urination and urinary urgency associated with BPH.
Tribulus terrestris: Used for centuries in Chinese and Ayurvedic medicine to support libido and fertility in men with low testosterone.
Yohimbe: A well-documented option for low libido and erectile difficulty, though it needs to be used under supervision due to potential effects on blood pressure and heart rate.

Targeted Nutrition

Essential fatty acids (omega-3 and omega-6): Required for healthy cell membranes and hormone production. Men with BPH and prostate cancer have been found to have lower omega-3 levels than men without.
Zinc: Healthy prostate tissue holds higher zinc concentrations than any other tissue in the body, and zinc levels drop in men with BPH and prostate cancer.
L-Arginine: Supports nitric oxide production, which helps blood flow to the penis in a similar way to prescription ED medications, and may support sperm count and muscle mass when paired with exercise.

Acupuncture

Used alongside the therapies above to help manage stress, support hormonal balance, and address related concerns like insomnia and mood changes.

Athletic Performance and Body Composition Program

Our 6-week, physician-supervised program is built for men dealing with the muscle loss and fat gain that come with declining testosterone. It combines nutrition guidance, exercise programming, and hormone optimization (without banned substances) to help rebuild lean muscle mass and improve energy and stamina.

Conventional Medical Treatment Options

Naturopathic physicians in Arizona have prescription rights, so if natural therapies aren't enough on their own, conventional medication is available as part of your treatment plan.

Medications for BPH

Finasteride (Proscar): Blocks the conversion of testosterone into DHT in the prostate. Most helpful for more severely enlarged prostates, though it can cause erectile dysfunction, decreased libido, or ejaculatory changes.
Alpha blockers (Prazosin, Terazosin, Doxazosin): Relax smooth muscle in the bladder and prostate to ease urinary symptoms. These can cause a significant drop in blood pressure, so they require caution, especially in men already on blood pressure medication or with a history of falls.

Medications for Erectile Dysfunction

Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra): All work by increasing nitric oxide in the penis to support erection. Cialis tends to last longer than the others. Common side effects include headache and flushing, and these medications shouldn't be combined with nitrate drugs.
In-office injection therapy: For men who don't respond to oral medication, compounded injection therapy is available and can be discussed in detail during your visit.

Take the Next Step Toward Better Hormone Health

Andropause can affect far more than testosterone levels. It may influence your energy, mood, metabolism, muscle mass, sexual health, sleep, and long-term well-being. At East Valley Naturopathic Doctors in Mesa, Arizona, our physicians look beyond symptoms alone, using targeted lab testing and a personalized combination of hormone therapy, botanical medicine, nutrition, acupuncture, and conventional treatment options when appropriate. If you are experiencing signs of low testosterone or age-related hormone changes, contact East Valley Naturopathic Doctors to schedule a comprehensive evaluation and learn which treatment options may be right for you.

Frequently Asked Questions About Andropause

Does testosterone replacement increase prostate cancer risk?

The evidence is mixed, but clinical trials have generally shown PSA levels don't rise over 3 to 5 years of testosterone therapy, and prostate cancer tends to develop more often in men with the lowest testosterone, not the highest. Even so, we don't recommend testosterone replacement for men with a personal history of prostate cancer.

At what age does andropause start?

Testosterone decline can begin as early as the mid-20s, though most men don't notice symptoms until their late 30s or 40s, since the drop is gradual rather than sudden.

Can andropause be treated without hormone therapy?

Often, yes, at least in part. Botanical medicine, targeted nutrition, and lifestyle changes can meaningfully improve symptoms, particularly when adrenal fatigue, hypothyroidism, or environmental exposures are contributing factors. Whether hormone therapy is also needed depends on your lab results and symptoms.

Is andropause the same as menopause?

Not exactly. Both involve declining sex hormones with age, but women's estrogen decline in menopause is comparatively sudden, while men's testosterone decline in andropause happens gradually over years or decades.