Welcome to running a fever, a podcast about livin’ long and lovin’ life. My name is Michael Davis. My goal is to live a long, healthy, happy, active life right up to the very end.

What if one day you woke up and felt like a stranger in your own body—but no one ever warned you it could happen?

We’re in the middle of a series on menopause. In the last episode, we discussed the emotional and mental impact and how it works in the brain and body, and shared some stories from real people on the issue. This time we’re talking about an even more taboo subject: andopause, sometimes called male menopause. I think we’ll get some insight on this. It’s not just a medical phenomenon but a cultural blind spot. Let’s start again with some true stories:

“I’ve used up all of the natural good stuff. I’ve got the MANopause…As testosterone levels drop, you find life quite tough. It’s difficult to be optimistic. You do lose a lot of your drive”-Laurence Llewelyn-Bowen.

“If I haven’t got my testosterone gel, I can’t speak. I can’t leave the house, I can’t make eye contact.” –Shaun Ryder

“I felt profoundly tired in the afternoons–I could nod off anywhere. I couldn’t concentrate, and my memory was impaired. I also had lots of muscle aches and experienced a decrease in libido. I was also depressed.” –Dr. Dan Hegarty

I’m learning more as we go along in this series. I thought this was a hardship that every man experiences, but it appears that, based on scientific evidence, that’s not the case.

In the article “Male nemopause: Myth or reality?” The Mayo Clinic staff states that “Men’s testosterone levels generally fall about 1% a year after age 40. But most older men still have testosterone levels within the standard range. Only about 10% to 25% of men have levels thought to be low.”

So what is andropause? Andropause, or late-onset hypogonadism, refers to the gradual decline in testosterone levels in men, typically starting in their 40s or 50s. Unlike female menopause, andropause is gradual and lacks a clear biological marker, making it harder to diagnose and often dismissed.

What are the symptoms? Here are a few of them:

-Fatigue and low energy
-Depression or mood instability
-Reduced libido and erectile dysfunction
-Breast tenderness or swelling
-Infertility
-Height loss, low-trauma broken bones, called fractures, or low bone mineral density
-Hot flashes and sweats
-Loss of muscle mass and increased body fat
-Difficulty concentrating or memory lapses

That’s quite a lot of symptoms, actually. But this doesn’t affect all older men. So, other than just getting older, what are the possible causes? Here are some conditions that can cause low testosterone:

-Obstructive sleep apnea
-Obesity
-Stress from a serious illness, surgery, or staying in the hospital
-Medicines such as opioid pain relievers

Treating these symptoms can return testosterone levels to the regular range.

Diagnosis often involves testing of the pituitary gland. The pituitary gland is a kidney bean-sized gland that sits at the base of the brain. It is part of the body’s endocrine system. This system encompasses all the glands that produce and regulate hormones of various types. Healthcare professionals use pituitary gland testing to help find out whether the low testosterone is due to aging. Testing can also rule out low levels of other hormones.

So what if you have low testosterone and the symptoms of andropause? What is the recommended treatment doctors use? Well, opinions vary on the subject:

In 2020, the American College of Physicians recommended that healthcare providers think about starting testosterone treatment in men with sexual dysfunction who wanted to improve their sexual function, after explaining the risks and benefits. Before that, in 2018, the Endocrine Society recommended the therapy for men with age-related low testosterone who have symptoms related to low testosterone.

What are these risks and benefits, then?

The benefits are pretty good and effectively address the symptoms. Testosterone Replacement Therapy (TRT) can help improve sexual function, restoring libido and improving erectile function. It can give the patient increased energy and mood stability. Some men report feeling more alert, less fatigued, and emotionally balanced, though results vary. He can gain muscle mass and bone density. Testosterone supports muscle strength and bone health, potentially reducing the risk of osteoporosis. TRT may help reduce body fat and improve lean muscle composition. And some recent studies suggest TRT might lower the risk of developing type 2 diabetes in certain men.

Unfortunately, the risks are also quite substantial. Earlier studies linked TRT to increased risk of heart attack and stroke, prompting FDA warnings. However, newer research shows mixed results, with some studies finding no increased risk over short-term use. Testosterone can stimulate the growth of existing cancer cells. Men with known prostate issues should be closely monitored. TRT may exacerbate sleep apnea, especially in men already at risk. TRT can also raise red blood cell counts, increasing the risk of blood clots or venous thromboembolism, a serious condition involving a blood clot in a vein, typically a deep vein thrombosis in the legs, which can break off and travel to the lungs to cause a potentially fatal pulmonary embolism. External testosterone also suppresses the natural production of testosterone, so it’s a vicious cycle in a way. It can lead to testicular atrophy and, ironically, reduced sperm count. And once in TRT, the body may stop producing testosterone entirely. Coming off the therapy can lead to a crash in energy and mood, which means one can become dependent on TRT.

Whether to get TRT is a nuanced decision, not a quick fix. Like many medical treatments, there are pros and cons. You’ll have to weigh these and choose. It’s tricky, but in most cases, the suppression of natural testosterone production is not irreversible. Recovery depends on factors such as age, duration of therapy, dosage, overall health, and testicular function. The length of time to restoration of testosterone production varies accordingly. So it is possible to try it and re-evaluate. TRT is a powerful tool, one that requires careful monitoring and informed decision-making. You should never make this decision without consulting your healthcare provider. You may need to taper off TRT, and there could be other recovery protocols only a doctor can prescribe.

So how does TRT work? The actual treatment. What will you have to go through to get these benefits, and is it worth it? I’ll go through six of the most common methods:

1. Intramuscular Injections, or IM. Testosterone is injected deep into a large muscle (usually a glute or thigh) every one to two weeks. The pros are that it’s highly effective and widely used, the cost is lower, and you can give the shots to yourself at home once you’ve been trained on how to do it properly. The cons? Hormone levels may fluctuate between doses, and, of course, some discomfort may be experienced at the injection site. I’ve certainly experienced that, and I’m sure you have too.

2. Subcutaneous Injections, aka SubQ. The testosterone is injected into the fat layer under the skin, often in the abdomen. The pros: the needle is smaller, so the injection is less painful. And it gives you more stable hormone levels than IM injections. The catch is that in order to achieve that stability, the tradeoff is that you need more frequent injections, often two to three times a week.

3. Transdermal Gels and Creams. A gel is applied daily to clean and dry skin, such as on the shoulders, arms, or abdomen. The benefits include that it’s non-invasive and easy to use, with no injections required. However, there is a risk of transferring testosterone to others through skin contact, and it’s a daily commitment.

4. Testosterone Patches. As you can guess, these are stuck to the skin. They need to be replaced daily. They provide a steady release of hormones and are very easy to use. On the other hand, you may experience some skin irritation, and this method is slightly less discreet than the others.

5. Oral and Buccal (BUH-coal) Testosterone. This is taken by mouth or absorbed through the inner cheek. It’s convenient, I mean, we’re all looking for a pill to solve our problems, right? The cons are that the absorption rate is variable, and there is a potential for liver strain with some oral forms. So, as you know from my various liver problems, I would probably not qualify.

6. Testosterone Pellets (Implants). Small pellets are inserted under the skin, usually in the hip area, every three to six months. It’s a long-lasting method, with no daily or weekly maintenance. However, it is actually a minor surgical procedure, and since you only receive it every six months, it’s more challenging to adjust the dosage.

Each of these methods has its own rhythm and impact on lifestyle, so the best choice depends on your goals, comfort level, and medical guidance.

TRT is often associated with abuse of testosterone as a performance-enhancing drug, particularly in bodybuilding. But look at the testosterone level of a bodybuilder. You may see, for example, a level ten times normal, and it might be synthetic, produced by the taking of anabolic steroids (which are much more powerful). In contrast, in a low-testosterone patient, the level should be in the normal range.

Before you start TRT, are there alternatives? Yes, actually, there are a few:

Lifestyle and foundational changes are often the first-line, low-risk interventions. These include:

-Strength training and resistance exercise — This has been proven to boost natural testosterone and improve muscle mass.
-Adequate sleep – Oh, sleep is so vital to everything. Seven to nine hours of quality sleep supports hormonal balance.
-Weight Management – Reducing excess body fat, especially visceral fat, the kind that forms around internal organs, can improve testosterone levels.
-Stress Reduction – Chronic stress elevates cortisol, which can suppress testosterone; mindfulness, yoga, or breathwork may help.
-Balanced Nutrition – Adequate protein, healthy fats, and micronutrients like zinc, magnesium, and vitamin D are key. I actually get these in a daily multivitamin for men. The store brand I use is called Centry Men, but you can probably find something similar in your grocery store, possibly under a different name.

There are prescription drugs that stimulate natural production as well. These don’t replace testosterone directly; they encourage your body to produce more of its own.

-Clomiphene Citrate (Clomid) – Blocks estrogen receptors in the brain, prompting the pituitary to release more LH (luteinizing hormone) and FSH (follicle-stimulating hormone), which stimulate testosterone production.
-Human Chorionic Gonadotropin (hCG) – Mimics LH to directly stimulate the testes. It is often used to preserve fertility during treatment.
-Selective Estrogen Receptor Modulators (SERMs) – Similar to Clomid, this is used in some instances to boost endogenous production.

There are several over-the-counter and herbal supplements. Be warned that evidence on the viability of these varies. Ashwagandha may help reduce stress and modestly increase testosterone levels. Fenugreek has been linked to improved libido and small testosterone increases. And DHEA (dehydroepiandrosterone) is a precursor hormone that can convert to testosterone, though results are mixed, and it’s not for everyone. And of course, supplements like these are unregulated, and you should definitely ask your healthcare provider if it is a good idea, or even safe, to take them.

Several emerging and adjunctive therapies are available. One is peptide therapies. These are experimental compounds that may influence hormone balance. Early research also suggests that cold exposure and heat therapy may have possible hormonal benefits, but evidence is still developing. Intermittent fasting has also been linked to insulin sensitivity and indirectly supports testosterone production.

These alternative treatments may be more or less beneficial and potentially carry a lower risk than TRT.

So it’s a real thing. There has been some debate about whether andropause was just a joke and it didn’t really exist. But I think it does, and so do some medical experts. Unfortunately, andropause is often ignored due to cultural expectations of male stoicism and productivity. Internalized capitalism and patriarchal norms discourage men from acknowledging weakness or seeking help. By the way, if you’ve never heard the term “internalized capitalism,” It’s basically the adoption of capitalist values–such as competition, productivity, and self-worth tied to achievement–into one’s personal belief system, often to the detriment of mental health and well-being. This can lead to feeling guilty for resting, constant anxiety about one’s productivity, prioritizing work over relationships and health, and experiencing burnout or depression. So it looks like that could be a cause for andropause as well as the ones we related earlier.

As a result of the cultural taboo, many men suffer in isolation, misattributing symptoms to aging or stress. The emotional impact can include identity loss or an identity crisis. This is rarely discussed. It’s an internal disruption men often feel when their physical, emotional, and social roles begin to shift–especially in ways that challenge long-held beliefs about masculinity, strength, and purpose.

As testosterone declines, symptoms like reduced libido, muscle loss, and fatigue can make men feel like “less than themselves.” If their identity has been tied to physical vitality or sexual performance, this change can feel like a personal unraveling. Mood swings, irritability, and depression may lead to emotional withdrawal. Some men feel they are no longer the “rock” in their relationships, which can trigger shame or confusion about their role.

Fatigue and cognitive shifts may affect work performance. For men who equate their worth with productivity, this can feel like a loss of value or relevance. Because andropause in general is not widely discussed, many men suffer alone and silently. Without language or support to process these changes, they may feel invisible or invalidated. This phase often prompts deep introspection. Some men begin to question their goals, relationships, and legacy–leading to either a crisis or a transformation, depending on the support they receive.

It’s not just about hormones–it’s about how those hormonal shifts ripple through a man’s sense of self. That’s why this episode is so important: we’re giving voice to a transition that’s often endured in silence.

What can you do to help make a change? First, start a conversation with your primary care provider. Or even a friend or spouse. Effective communication can go a long way toward alleviating the suffering caused by andropause. Check for symptoms and take action accordingly. Speak out. Share a comment on this YouTube video, or even make your own, or post on social media. Get the public conversation going.

References:
https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056
https://tinyurl.com/raf-thromboembiolism
https://www.youtube.com/shorts/VGzSDkg-8NE