The Male Menopause (Andropause) — Signs, Causes and Natural Treatment

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham, Berkshire

The male menopause — more formally called andropause or late-onset hypogonadism — is one of the most under-recognised clinical patterns I see in my practice. Unlike the female menopause, which has received decades of public awareness and is a widely understood life stage, the gradual decline in testosterone that affects men from their late 30s onward is largely ignored by mainstream medicine. Most men who are suffering have no idea what is happening to them. They present with fatigue, low mood, poor sleep, reduced libido, weight gain around the middle, and a pervasive sense of losing their edge — and are often told by their GP that their test results are "within the normal range." In traditional Chinese medicine, this constellation of symptoms has been recognised for centuries as Kidney yang deficiency and Kidney jing decline — and it responds extremely well to treatment.

On this page

1. What is the male menopause?
2. Signs and symptoms of andropause
3. Why andropause is so often missed
4. Causes of declining testosterone
5. Testing for andropause
6. The TCM understanding — Kidney yang and jing
7. Acupuncture for andropause
8. Chinese herbal medicine
9. Lifestyle and diet
10. Frequently asked questions

What is the male menopause?

The term "male menopause" is somewhat misleading — unlike the female menopause, there is no abrupt cessation of reproductive function. What actually occurs is a gradual, age-related decline in testosterone production that begins around age 30 and continues at roughly 1–2% per year thereafter. For some men this decline is clinically significant, producing a recognisable syndrome of physical, emotional, and cognitive symptoms. The formal medical term is late-onset hypogonadism or testosterone deficiency syndrome, and it is estimated to affect approximately 20–40% of men over 40, with prevalence rising with age.

The parallel with female menopause is in the hormonal transition and the symptom picture — not in the physiology itself. Men remain fertile throughout life; what declines is the metabolic, muscular, sexual, and psychological vitality that testosterone supports. The term "andropause" is more accurate and increasingly used by clinicians who take the condition seriously.

Signs and symptoms of andropause

The symptom picture is distinctive once recognised, but because each individual symptom can be attributed to "just getting older" or "stress," the pattern is frequently missed. The classical presentation includes:

Physical symptoms

• Persistent fatigue — not improved by rest; the energy for physical activity feels gone
• Reduced muscle mass and strength — noticing weights feel heavier; harder to build or maintain muscle
• Increased abdominal fat — weight gain particularly around the middle, despite no change in diet or activity
• Reduced bone density — over time, increasing risk of osteoporosis
• Hot flushes and sweating — less common than in women but can occur
• Gynaecomastia — mild breast tissue development due to oestrogen dominance relative to testosterone
• Cold hands and feet — classical TCM Kidney yang deficiency sign
• Aching joints and stiffness — particularly morning stiffness and lower back ache
• Hair thinning — including body hair, eyebrows, and scalp changes

Sexual symptoms

• Reduced libido — often the first and most noticeable symptom
• Erectile dysfunction — particularly morning erections becoming less frequent or absent
• Reduced ejaculate volume
• Testicular volume reduction — less commonly noticed

Psychological and cognitive symptoms

• Low mood — often described as "flat" rather than depressed
• Loss of motivation and drive — the ambition and competitive edge feels diminished
• Anxiety and irritability — particularly out of character for the individual
• Poor concentration and brain fog — difficulty with the focused work that used to be straightforward
• Reduced confidence and assertiveness
• Disturbed sleep — difficulty falling asleep, frequent waking, or unrefreshing sleep
• Emotional sensitivity — being affected by things that used to roll off

Why andropause is so often missed

The under-recognition of andropause is a genuine clinical problem. Several factors contribute:

Gradual onset. Unlike the female menopause, which typically announces itself with cycle changes and hot flushes, andropause creeps up over years. Men often accommodate the symptoms one by one, attributing each to normal ageing or work stress, until the cumulative picture is profound but no single change prompted investigation.

Reference range problems. Standard NHS testosterone tests use a reference range typically from around 8–29 nmol/L (total testosterone). A man with testosterone at 9 nmol/L is told his result is "normal" — despite being in the bottom 5% of the population and likely significantly below his own previous baseline. The reference range is derived from a cross-sectional sample including many older, unwell men, not from what a healthy 40-year-old man should have. A result at the lower end of the range, combined with symptoms, warrants treatment regardless of its "normal" label.

Free vs total testosterone. NHS testing typically measures total testosterone, but the biologically active fraction is free testosterone — the portion not bound to sex hormone binding globulin (SHBG). Some men have adequate total testosterone but high SHBG, leaving low free testosterone and clear symptoms despite "normal" blood work. Free testosterone and SHBG should be tested, not total alone.

Cultural stigma. Many men feel reluctant to present with symptoms that feel emasculating — low libido, erectile dysfunction, loss of drive. They may describe only the fatigue or mood changes, leaving the sexual symptoms unmentioned, which makes the pattern harder to recognise.

Attribution to depression. The mood symptoms of andropause — low mood, reduced motivation, flatness — significantly overlap with depression. Many men are prescribed SSRIs for what is actually hormonal deficiency. While SSRIs may blunt the mood symptoms, they often worsen the sexual symptoms and fatigue, and do nothing to address the underlying testosterone decline.

Lack of mainstream awareness. Unlike the menopause conversation, which has rightly moved into public awareness over the last decade, andropause remains largely invisible in both medical training and public health messaging.

Causes of declining testosterone

Age is the primary driver, but several factors accelerate the decline or tip a borderline picture into symptomatic territory:

• Age — the primary factor; testosterone declines approximately 1–2% per year from age 30
• Obesity — visceral fat converts testosterone to oestrogen via the enzyme aromatase, worsening the deficiency
• Chronic stress — sustained cortisol elevation suppresses the hypothalamic-pituitary-gonadal axis; see my article on cortisol and stress
• Poor sleep and sleep apnoea — testosterone is produced predominantly during deep sleep
• Type 2 diabetes and metabolic syndrome — insulin resistance is strongly associated with low testosterone
• Vitamin D deficiency — strong correlation with low testosterone
• Excessive alcohol consumption — directly suppresses testosterone production
• Smoking — accelerates vascular and hormonal ageing
• Overtraining — particularly excessive endurance training
• Medications — opioids, statins, SSRIs, beta-blockers, spironolactone, and anabolic steroid use/abuse all suppress testosterone
• Environmental endocrine disruptors — BPA, phthalates, and pesticides have feminising effects
• Chronic illness — any significant chronic condition reduces testosterone
• Previous anabolic steroid use — can produce long-term suppression of natural testosterone production

Addressing these modifiable factors is a crucial part of treatment, not an alternative to it.

Testing for andropause

A comprehensive hormone panel should include:

• Total testosterone — ideally measured in the morning (highest levels), on two separate occasions
• Free testosterone — the biologically active fraction; often the most informative single marker
• SHBG (sex hormone binding globulin) — high SHBG can mask low free testosterone
• LH and FSH — to distinguish primary (testicular) from secondary (pituitary) hypogonadism
• Oestradiol — frequently elevated relative to testosterone in andropause, driving symptoms
• Prolactin — elevated prolactin suppresses testosterone and warrants investigation
• Thyroid panel — hypothyroidism can mimic andropause symptoms
• Vitamin D — commonly deficient and relevant
• Fasting glucose and HbA1c — to assess insulin resistance
• Full blood count and iron studies — anaemia and iron deficiency can mimic andropause

If NHS testing comes back "normal" but symptoms strongly suggest andropause, a private hormone panel that includes free testosterone and SHBG often reveals the full picture. I routinely refer patients for private testing where the NHS results don't match the clinical presentation.

The TCM understanding — Kidney yang and jing

Traditional Chinese medicine has recognised the andropause pattern for over two thousand years. It is understood primarily through the decline of Kidney function — specifically Kidney yang (the warming, activating energy) and Kidney jing (the fundamental reproductive essence). The classical TCM text Suwen (c. 200 BCE) describes male physiological decline in 8-year cycles beginning around age 48, with progressive reduction in jing, Kidney qi, and reproductive function — a description that maps remarkably well onto modern understanding of testosterone decline.

Kidney yang deficiency

This is the central pattern in andropause. The cardinal signs are:

• Cold extremities (hands, feet, lower back)
• Profound fatigue with aversion to activity
• Reduced libido and erectile dysfunction
• Frequent night-time urination
• Lower back weakness and pain
• Pale complexion
• Preference for warm food and drinks
• A pale, swollen tongue with a moist white coating
• A slow, deep, weak pulse

Kidney yang is the "fire" that powers metabolism, reproduction, and vitality. Its decline produces exactly the cold, slow, fatigued presentation of classical andropause.

Kidney jing deficiency

Jing is the deepest level of reproductive and constitutional essence — analogous in some ways to the genetic-hormonal reserve. Its decline produces the age-related features: hair thinning or greying, reduced bone density, tinnitus, memory problems, and the loss of vitality that distinguishes andropause from ordinary fatigue.

Kidney yin deficiency

In some men, particularly those with chronic stress or excessive work, Kidney yin depletes alongside or before yang. This presents with night sweats, restlessness, poor sleep, anxiety, and a sense of burning out — with a red, dry tongue and a rapid pulse. This pattern is more common in men under 50 and in those presenting primarily with cognitive and emotional symptoms.

Mixed patterns

Most men presenting clinically show a mixed picture — some Kidney yang deficiency, some jing decline, often with Spleen qi deficiency from chronic stress, and often Liver qi stagnation from the emotional toll of the condition. The full TCM diagnosis guides which herbs and treatment strategy to prioritise.

Acupuncture for andropause

Research has shown that acupuncture can support testosterone production, improve sexual function, and address the broader symptom picture of andropause. Studies have demonstrated modest but meaningful increases in serum testosterone, improvements in International Index of Erectile Function scores, and reductions in fatigue with regular acupuncture treatment. The proposed mechanisms include:

• Modulation of the hypothalamic-pituitary-gonadal axis
• Improved testicular blood flow
• Reduction of cortisol and sympathetic nervous system overactivity
• Enhancement of parasympathetic function relevant to sexual response
• Direct neuroendocrine effects at key acupuncture points

Key acupuncture points for andropause include:

• KD 3 (Taixi) — source point of the Kidney meridian; tonifies Kidney yin and yang
• BL 23 (Shenshu) — the back-shu point of the Kidney, with moxibustion for yang deficiency
• CV 4 (Guanyuan) — the "Gate of Origin"; tonifies original qi and Kidney yang
• CV 6 (Qihai) — the "Sea of Qi"; strongly tonifies original qi
• ST 36 (Zusanli) — tonifies qi and supports overall vitality
• SP 6 (Sanyinjiao) — intersection of the three yin meridians of the leg
• GV 4 (Mingmen) — the "Life Gate"; classically used to warm Kidney yang and support Ming Men fire
• BL 52 (Zhishi) — supports Kidney jing and willpower

Moxibustion — the burning of mugwort (Ai Ye) at specific points — is particularly valuable for Kidney yang deficiency, gently warming the deep yang and producing effects that needles alone cannot achieve. I use moxa over CV 4, GV 4, and BL 23 in most andropause treatments.

Treatment is typically weekly for 3 months, with reassessment of symptoms and ideally repeat hormone testing at that point. Most men notice meaningful improvement in energy, sleep, and mood within 4–6 sessions; sexual function typically takes longer to respond (6–12 sessions).

Chinese herbal medicine

Chinese herbal medicine is highly effective for andropause and is often the single most powerful intervention. Formulas are tailored to the specific pattern:

• For Kidney yang deficiency — You Gui Wan (Restore the Right Pill), the principal formula for Kidney yang deficiency. Contains Shu Di Huang, Rou Gui, Fu Zi, and warming Kidney tonics.
• For Kidney yin deficiency — Zuo Gui Wan (Restore the Left Pill), the principal formula for Kidney yin deficiency with jing depletion.
• For mixed yin and yang deficiency — Jin Gui Shen Qi Wan, combining yin tonics with gentle yang tonics.
• For Kidney yang deficiency with cold signs — formulas incorporating Yin Yang Huo (epimedium, also known as horny goat weed), Tu Si Zi, and Ba Ji Tian.
• For jing depletion — formulas with He Shou Wu, Gou Qi Zi, and Shu Di Huang.
• For underlying qi deficiency — Bu Zhong Yi Qi Tang with Kidney tonic additions. See my article on astragalus benefits.

Ginseng (Rén Shēn) is often included as a core qi tonic; Korean red ginseng is particularly valuable for andropause — research has demonstrated improvements in erectile function and testosterone levels with sustained use. I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, tailored to the individual pattern and adjusted as recovery progresses. Treatment is typically 3–6 months for meaningful restoration.

Lifestyle and diet

Lifestyle changes compound the effects of acupuncture and herbs substantially. For many men, the cumulative effect of these changes alone produces meaningful improvement — combined with TCM treatment, the results are often transformative.

• Resistance training — the single most important intervention. Weight-bearing exercise 2–3 times weekly directly stimulates testosterone production. Heavy compound lifts (squats, deadlifts, presses) have the largest effect.
• Optimise sleep — testosterone is produced predominantly during deep sleep, particularly in the early morning hours. Aim for 7–9 hours; address sleep apnoea if suspected. See my article on acupuncture for insomnia.
• Lose excess abdominal fat — visceral fat converts testosterone to oestrogen via aromatase. Even a 5–10% weight loss produces significant hormonal improvement.
• Reduce alcohol — alcohol directly suppresses testosterone. Keep within NHS guidelines (under 14 units weekly), ideally less.
• Stop smoking — accelerates both vascular and hormonal ageing.
• Manage stress — chronic cortisol suppresses testosterone. See cortisol and stress.
• Optimise diet — adequate protein (1.6g/kg bodyweight), healthy fats (cholesterol is the precursor to testosterone), cruciferous vegetables (reduce oestrogen excess), and minimal refined sugar and ultra-processed food.
• Key supplements — vitamin D (2,000–4,000 IU daily, correct to adequate levels), zinc (25mg daily), magnesium, omega-3 fatty acids, and boron. These address commonly deficient nutrients involved in testosterone production.
• Reduce environmental endocrine disruptors — avoid heating food in plastic, reduce exposure to BPA-lined cans and phthalate-containing personal care products.
• Cold exposure — brief cold showers, cold water immersion, or sauna followed by cold plunge have been shown to support testosterone and sympathetic function.
• Limit endurance training — excessive cardio (more than 4–5 hours weekly) can suppress testosterone. Balance with strength work.

Frequently asked questions

Is the male menopause real?

Yes, though the terminology is debated. There is no abrupt reproductive cessation as in female menopause, but the gradual decline of testosterone from the 30s onward — combined with the associated symptoms — is a recognised clinical syndrome called late-onset hypogonadism or andropause. It affects a significant proportion of men over 40, and it is treatable.

At what age does the male menopause start?

Testosterone decline begins around age 30 and continues at 1–2% per year thereafter. Clinically significant symptoms typically emerge in the late 40s to 50s, though they can appear earlier in men with accelerating factors (obesity, chronic stress, poor sleep, chronic illness). Some men never develop significant symptoms; others become symptomatic in their late 30s.

How do I know if I have andropause?

The clinical picture is the combination of persistent fatigue, reduced libido, erectile dysfunction (particularly reduced morning erections), increased abdominal fat, low mood, cold extremities, and poor sleep — emerging in your 40s or later. Confirmation requires blood testing including free testosterone, SHBG, and related hormones. A symptom questionnaire (ADAM or AMS) can be useful for initial screening.

Can acupuncture increase testosterone?

Research suggests acupuncture produces modest but meaningful increases in testosterone over a sustained treatment course, along with broader improvements in symptoms. It is unlikely to match the magnitude of increase achievable with testosterone replacement therapy, but it addresses the underlying TCM pattern and avoids the complications of exogenous hormone use. Combined with Chinese herbs and lifestyle change, results can be substantial.

Should I try TCM before testosterone replacement therapy?

For mild to moderate symptoms with testosterone in the lower-normal range, TCM combined with lifestyle change is often sufficient — and it addresses the underlying cause rather than supplementing the deficiency externally. For men with clearly low testosterone and severe symptoms, or where TCM and lifestyle have not produced adequate improvement after 3–6 months, TRT becomes a reasonable option to discuss with a specialist. TCM can support alongside TRT and may reduce the dose required.

Does Korean red ginseng help with male menopause?

Yes — Korean red ginseng has stronger evidence than most herbal interventions for erectile function and testosterone support. Research has demonstrated improvements in the International Index of Erectile Function and modest testosterone elevations with sustained use. See my article on ginseng for more on why Korean red ginseng is preferred over other ginseng types.

Will my NHS GP test my testosterone?

Usually yes, if you present with relevant symptoms — but the NHS panel typically measures only total testosterone, which can miss the picture when SHBG is elevated. If your NHS result comes back "normal" but symptoms persist, a private hormone panel including free testosterone, SHBG, oestradiol, LH, FSH, and prolactin often reveals what the basic test missed.

Is andropause the same as erectile dysfunction?

No. Erectile dysfunction is a symptom that may be part of andropause but also has many other causes — vascular, psychological, medication-related, or related to specific conditions like diabetes. Andropause is the wider clinical syndrome of testosterone deficiency, of which ED is one possible feature.

Can stress cause low testosterone?

Yes — chronic stress and elevated cortisol directly suppress testosterone production through effects on the hypothalamic-pituitary-gonadal axis. Many men in demanding careers develop low testosterone essentially from overwork and chronic stress, which TCM recognises as Kidney yang depletion from sustained demand on the body's reserves.

To discuss andropause, fatigue, or low testosterone, contact me or book a consultation at my Wokingham, Berkshire clinic.

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