Andropause

In brief

Andropause is a gradual process with decline of especially free testosterone, partly due to rising SHBG and aging of Leydig cells
Insulin resistance, overweight and especially abdominal fat accelerate testosterone decline via mitochondrial damage and aromatase activity
Lifestyle is the foundation: diet, exercise, sleep, stress, alcohol and smoking are modifiable factors
Systematic self-observation and measurement helps to see which changes really work
Testosterone replacement therapy can be a follow-up step, but self-management and lifestyle optimization form the core

1. What is andropause?

In men, testosterone levels do not drop suddenly, but gradually from around age 30 to 40. This age-related decline in male hormones is called andropause or late-onset hypogonadism.

Most important is the decline of free testosterone, the portion that is actually active in the body. With aging, the protein SHBG (sex hormone binding globulin) rises. This means a larger portion of testosterone becomes bound and inactive, while total testosterone in the blood sometimes still appears normal.

Andropause is not an acute failure of the testes, but a slow process in which hormonal balance, muscle mass, fat distribution and metabolism gradually change. This process is strongly influenced by diet, exercise, sleep, stress and fat mass, especially around the abdomen.

2. Hormonal basis: testes, mitochondria and insulin

Testosterone is produced in the Leydig cells in the testes under the influence of the hormone LH from the pituitary gland.

For proper testosterone production, healthy mitochondria are needed - the energy factories in the cell. Over the years, the following processes can occur:

Mitochondria function less well and produce more oxidative stress
The proteins needed for hormone production decrease in number and activity
The supporting tissue of the testes becomes stiffer, which can further disturb the Leydig cells

Metabolism plays a major role here. Insulin resistance and overweight accelerate the aging process of the Leydig cells. High insulin and fat accumulation in the cells make the Leydig cells less sensitive to LH and promote mitochondrial damage. This causes testosterone production to decline faster than in men with healthy metabolism and limited abdominal fat mass.

3. Fat mass, abdominal fat and the estrogen loop

Fat tissue is an active organ and contains the enzyme aromatase. This enzyme converts testosterone into estradiol, an estrogen.

More fat, especially around the abdomen, means:

More aromatase activity and thus more conversion of testosterone to estrogen
Higher estrogen levels that slow down the signal from the brain to the testes
Less LH release, causing the testes to produce even less testosterone

Less testosterone in turn leads to loss of muscle mass and further increase in fat mass. This creates a vicious cycle of low testosterone, more abdominal fat and worsened insulin resistance.

4. Recognizing symptoms and patterns

Not every man with lower testosterone values has symptoms. In some men, a recognizable symptom pattern develops. The better you recognize these patterns, the more targeted your lifestyle choices can be.

Common signals

Less energy, fatigue more quickly, decreased capacity
Decrease in muscle strength and muscle mass, increase in abdominal fat
Less interest in sex, erectile dysfunction, fewer morning erections
Depressed mood, irritability, less stress resistance
Decreased concentration, feeling of brain fog
Poorer recovery after exertion, more muscle pain
In the longer term, increased risk of bone loss (osteopenia or osteoporosis)

It is important not to see symptoms in isolation, but as part of a broader picture of hormones, metabolism, sleep, stress and lifestyle.

5. Self-observation: your own data

Many people want to first gain insight into their situation and recognize patterns before possibly considering medical steps. That can be very useful.

Useful self-observations

Energy and capacity per day (for example in a diary or app)
Sleep duration and quality (time to bed, waking up at night, waking up refreshed)
Mood, irritability, motivation and concentration
Libido, erection quality and morning erections (without judgment, purely as information)

Body composition

Weight 1 time per week in the morning
Waist circumference at navel level, 1 time every 2 to 4 weeks

Exercise capacity

How does a fixed walk or climbing stairs feel?
Does this become lighter after a few weeks of lifestyle adjustment?

By tracking this data for a number of weeks to months, it becomes clearer which lifestyle changes really make a difference and which do not.

6. Lifestyle as the core of treatment

The core of andropause is strongly connected to metabolism, fat distribution and mitochondrial health. These are precisely areas where you have a lot of influence yourself. Lifestyle is therefore not a side issue, but the central treatment pillar.

6.1 Weight and abdominal fat

Goal is reduction of visceral abdominal fat.

Possible actions:

Aim for gradual decrease in weight and waist circumference, for example 0.5 to 1 kilogram per 2 to 4 weeks
Eat at fixed times, less snacking in between
Become aware of emotional eating and look for alternatives, such as a short walk, breathing or another moment of rest

Less abdominal fat means less aromatase activity, less estrogen load and better insulin sensitivity. This also indirectly supports testosterone balance.

6.2 Diet and carbohydrate restriction

A therapeutic carbohydrate restriction or ketogenic metabolic approach can help break through insulin resistance. The exact implementation differs per person, but some general starting points are:

Limit highly processed carbohydrate-rich products:

Soft drinks, fruit juices and sweetened yogurts
Bread, pasta, rice and potatoes in large portions
Cookies, candy, chips and snacks

Choose mainly whole foods:

Sufficient protein, for example from meat, fish, eggs, full-fat dairy or legumes depending on the personal plan
Fats from real food, such as fish, meat, eggs, nuts and olives
Lots of vegetables and possibly some berries or small fruit

Experiment yourself with:

A low-carb breakfast, for example eggs, yogurt with nuts or leftovers from the hot meal
A clear structure in meals, for example 2 to 3 substantial meals per day and little to no snacks
Calm evaluation after 2 to 4 weeks: how are energy, hunger, cravings, weight and waist circumference?

6.3 Muscles and strength training

Muscle mass is one of the most powerful allies for hormones and metabolism.

Possible steps:

Start where you are now. For some, that is 2 times per day 10 minutes of brisk walking plus some bodyweight exercises. For others, a structured strength training program in the gym is appropriate.

Aim for 2 to 3 times per week strength training with large muscle groups:

Legs: for example squats at your own level or calmly getting up from a chair
Core and back: for example plank variants or rowing movements
Chest and shoulders: for example pushing and pulling movements

Focus on technique, slow build-up and sufficient recovery days between heavier sessions. More muscle mass gives better insulin sensitivity and a more favorable body composition.

6.4 VO2max and daily movement

In addition to strength training, cardiometabolic fitness is important.

Concrete possibilities:

Daily 30 to 60 minutes of moderate exercise, such as walking, cycling or gentle swimming, possibly divided into multiple blocks
For those who can, 1 to 2 times per week slightly higher intensity, for example:
- Faster walking intervals of 2 minutes brisk walking and 3 minutes calmer
- Cycling up a hill and then riding out calmly

Goals include improving VO2max, better circulation, more favorable blood pressure and a noticeably lighter feeling during daily activities.

6.5 Sleep and stress

Sleep and stress are often underestimated factors in hormonal complaints.

Possible self-actions:

Aim for 7 to 9 hours of sleep per night
Ensure structure, for example a fixed bedtime and fixed time of getting up
Switch off screens at least one hour before sleep
Avoid caffeine from the afternoon and do not use alcohol as a sleep aid
Build in micro-breaks during the day, for example a few times per day 2 to 5 minutes of calm breathing or short walking
Consider simple relaxation exercises, such as calm belly breathing, a body scan or a short guided meditation via an app

Chronic sleep deprivation and prolonged stress suppress testosterone production and worsen insulin resistance. Improvement often goes step by step, but can yield much gain in energy, mood and recovery.

6.6 Alcohol, smoking and micronutrients

Alcohol reduce easily, for example first 2 alcohol-free days per week and expand this later, or choose to stop completely
Stopping smoking gives gains in circulation, oxygen supply and oxidative stress
Attention to micronutrients: regularly eat foods rich in magnesium, zinc and vitamin D or ensure sufficient sunlight. Only consider supplements if there is a conscious choice or measured deficiency behind it.

7. Extra stimuli: cold and other interventions

Cold exposure, for example a short cold shower or a short dip in cool water, can support metabolic health in some people. See it as a possible extra stimulus, not as basic therapy.

Self-management with cold stimuli:

Start with lukewarm cold finishing of the shower, for example 20 to 60 seconds
Build up duration and intensity slowly, depending on how it feels
Preferably do not apply cold stimuli directly after heavy strength training, to not inhibit muscle building

8. Testosterone replacement therapy as a follow-up step

For many people, the focus is on lifestyle and self-management. Testosterone replacement therapy (TRT) is not a first step, but can be a follow-up step in some situations.

Important considerations

TRT is a medical treatment for proven androgen deficiency, not a general rejuvenation remedy
TRT can suppress natural testosterone production. For those wanting children, this is usually unsuitable
TRT requires a clear diagnosis with repeated measurements, a weighing of risk and benefit and regular checks of blood, prostate, blood pressure and symptoms

For those who want to explore this path, it is useful to first:

Work seriously on lifestyle for several months
Systematically track symptoms, sleep, diet, exercise, weight and waist circumference
Then assess whether additional medical steps are desired

9. Step-by-step plan: from insight to action

Step 1: Gaining insight (first 2 to 4 weeks)

Start with a simple diary for energy, sleep, mood and exercise.

Preferably note daily briefly:

Energy, for example on a scale of 1 to 10
Sleep duration and quality
Mood and irritability
Exercise per day, number of minutes and type
Measure weight and waist circumference 1 time per week

Step 2: First dietary steps

Eliminate or limit soft drinks, fruit juice, cookies and candy, chips and quick snacks
Add:
- A protein-rich component with every meal
- Extra vegetables with at least 2 meals per day

Step 3: Exercise and strength

Daily at least 20 to 30 minutes of walking or cycling
Two to three times per week simple strength exercises at your own level, such as chair exercises, wall push-ups or light weights

Step 4: Sleep and stress

Choose 1 or 2 concrete actions, for example:

A fixed time to go to bed
No screens the last hour before sleep
One or two times per day a short breathing break

Step 5: Evaluate and adjust

After 4 to 8 weeks:

Which symptoms have decreased, remained the same or increased?
Has weight or waist circumference changed?
How is energy, sleep and mood?

Based on this, lifestyle actions can be continued, sharpened or adjusted.

10. Summary

Andropause is a gradual process with decline of especially free testosterone, partly due to rising SHBG and aging of Leydig cells
Insulin resistance, overweight and especially abdominal fat accelerate the decline of testosterone via mitochondrial damage, aromatase activity and higher estrogen levels
Lifestyle is the foundation: many people can take major steps themselves in diet, exercise, sleep, stress, alcohol and smoking
Systematic self-observation and measurement helps to see which changes really work
Medical testosterone replacement can be a follow-up step for some men, but is not central. Self-management and lifestyle optimization form the core of the approach

Veelgestelde vragen

What is andropause?

Andropause is the gradual decline of testosterone in men starting around age 30 to 40. Unlike menopause in women, it is not a sudden cessation, but a slow process. Free testosterone especially declines, while total testosterone sometimes still appears normal.

What are the symptoms of andropause?

Common symptoms include: less energy and fatigue, decreased muscle strength and increased abdominal fat, reduced libido and erectile dysfunction, depressed mood and irritability, decreased concentration and poorer recovery after exertion.

Can I do something myself about andropause?

Yes, lifestyle is the central treatment pillar. Reduction of abdominal fat, carbohydrate restriction, strength training, sufficient sleep and stress reduction can indirectly support testosterone balance. Many men can make great strides without medication.

When is testosterone replacement therapy (TRT) an option?

TRT is not a first step, but a follow-up step for proven androgen deficiency after repeated measurements. It is not a rejuvenation remedy and can suppress natural testosterone production. For those wanting children, TRT is usually unsuitable. First working seriously on lifestyle for several months is advisable.

Medische Disclaimer: De informatie van Stichting Je Leefstijl Als Medicijn over leefstijl, ziektes en stoornissen mag niet worden opgevat als medisch advies. In geen geval adviseren wij mensen om hun bestaande behandeling te veranderen. We raden mensen met chronische aandoeningen aan om zich over hun behandeling goed door bevoegde medische professionals te laten adviseren.

Medical Disclaimer: The information provided by Stichting Je Leefstijl Als Medicijn regarding lifestyle, diseases, and disorders should not be construed as medical advice. Under no circumstances do we advise people to alter their existing treatment. We recommend that people with chronic conditions seek advice regarding their treatment from qualified medical professionals.