Andropause – explained by Dr Derek Koh


The term ANDROPAUSE, otherwise referred to as male menopause is a natural age related condition that some men experience. The andropause transition is attributed to a steady and progressive loss of testicular function that is associated with ageing. Its meaning is derived from the Greek ‘andro’ meaning male, and ‘pause’ to stop.

What is testosterone?

Testosterone is a sex hormone produced in the testes that provides men with their male characteristics. These hormones are crucial for the male sexual and reproductive function.
As men age their testes stop working as well, and over time testosterone levels decrease. Testosterone levels reduce by around 1% each year from the forties and fifties. By their mid-fifties some 30% of men experience andropause. There are also an increasing number of younger men, some only in their twenties having low testosterone. Among reasons for premature low levels of testosterone, are factors such as obesity, high levels of stress and alcohol use.

Symptoms & outcome of andropause

Lowered production of testosterone is the main factor that influences andropause and its accompanying symptoms
The most common symptom of andropause is fatigue, especially in the morning. Other symptoms include, lack of motivation, lowered sperm production, body composition changes, erectile problems, lack of libido, sleep disruption, impaired memory, difficulty concentrating, hot flushes, irritability and mood swings.
Optimal testosterone levels are needed for good function of the heart, blood vessels, brain, skeleton, blood, genitourinary tract, skin and almost every other body system. In particular, the brain is rich in receptors for testosterone. A normal testosterone level is protective against Alzheimer’s dementia, symptoms of Parkinson’s disease, and cognitive or mental decline. Testosterone improves mental sharpness, concentration, and memory. Testosterone also improves flexibility, mobility, balance, and coordination
Since andropause often often occurs during middle age, at, it is easily overlooked as simply a ‘mid-life crisis’. However if ignored, andropause can result in a gradual deterioration in health. In turn, this can lead to frailty and premature ageing.

Andropause self-assessment

For a self-assessment of whether you have the symptoms of andropause, the answers to these ten questions may be a starting point.
1) Have you noticed a decrease in your sex drive? 
2) Do you lack energy and are tired more often?
3) Have you lost strength and endurance (or both)? 
4) Do you get less enjoyment from life? 
5) Have you lost some height? 
6) Have you noticed a deterioration in your ability to play sports? 
7) Do you find yourself falling asleep after dinner?  
8) Has your performance at work deteriorated?
9) Are you prone to feeling moody and sad? 
10) Are you lacking in self-confidence?

Measures to manage andropause

Weight management

A reduction in waist circumference is one of the most modifiable risk factors for testosterone deficiency. A man’s testosterone falls as his Body Mass Index (BMI) increases. Male obesity is associated with lowered testosterone

Regular exercise

Regular workouts can boost testosterone levels and help to slow down the decline in this hormone. High-intensity exercises combined with intermittent fasting can be beneficial in increasing testosterone.

Stress management

When physically or mentally stressed, your body releases cortisol and increases blood sugar. This hormone can block the effects of testosterone. This is because stress and disease states accelerate the decline of ‘Leydig cells’ that are located in the testes and responsible for the production of testosterone

Adequate sleep

Testosterone is produced mainly during sleep. Morning testosterone levels are partly predicted by total sleep time. So getting plenty of uninterrupted sleep does matter.

Dietary management

Consume adequate ZINC. Zinc is vital for hormonal balance and reproductive health. Without zinc, the pituitary gland cannot release the hormones that stimulate the testes to produce testosterone. Insufficient zinc can lead to a reduction in testosterone levels, lowered sperm production, and reduced muscle endurance.
Reduce SUGAR consumption. Testosterone levels decrease after sugar consumption. Studies have found that a 75g of sugar intake causes a 25 per cent drop in testosterone levels for up to two hours after consumption
Reduce ALCOHOL consumption. Alcohol intake lowers testosterone levels and it can also affect your libido and erectile function. Excessive alcohol consumption can also increase estrogen which can counter the effects of Testosterone.


Hormone replacement therapy for declining levels of testosterone involves the correction of the testosterone deficiency by introducing the hormone back into the body to counteract hormonal imbalance.
Middle aged men that have symptoms of andropause often find that their testosterone level is in the low normal range. In these scenarios, men who have hormone therapy find that their energy levels are restored when their testosterone levels increase to the upper range.
There are a wide variety of ways in which testosterone treatment can be administered. They include oral capsules, injections, creams and gels. These can all be quite effective and have minimal side effects.