Andropause or male climacteric: media myth or medical reality?

Unlike menopause, which corresponds to a sudden halt of ovarian function, men generally experience a gradual decline in testosterone production with age.

A hormonal decline linked to ageing

From the age of 30 to 40, testosterone levels decline by an average of 1 to 2% per year. For most men, this change has no clinical consequences. Some, however, develop an age-related androgen deficiency, when the hormonal decline is accompanied by suggestive symptoms.

A testosterone deficiency can present as reduced libido, erectile difficulties, persistent fatigue, loss of muscle mass and strength, increased fat mass, decreased bone density, and mood or concentration difficulties. These symptoms are not specific, however, and may also be related to other conditions, certain treatments, stress, lack of sleep, or normal ageing.

Diagnosis is never based on symptoms alone. It requires a full clinical assessment and a blood hormone test.

Beyond promises of “performance”

A hormonal work-up is not limited to testosterone. Depending on the clinical picture, it may also include measuring other hormones, notably oestradiol and progesterone, which are also present in men and play an important role in hormonal balance, bone health, metabolism, the cardiovascular system, sexual function and overall well-being.

Amid the media attention around “low T”, some providers offer hormone treatments promising more energy, vitality or physical performance. A rigorous medical approach is clearly distinct from this: prescribing testosterone is only justified in the presence of a confirmed biological deficiency associated with compatible symptoms, after weighing the benefits, risks and contraindications.

In medicine, the goal is not to optimise performance, but to treat a documented hormonal deficiency when it affects the patient's quality of life.