Male Menopause (Andropause) Explained to Africans: Causes, Symptoms, Treatment, and Myths

By: Foluke Akinwalere.  Health & Wellness Writer. Medical reviewed by Tii N. Munghieng, MD.

 

Image of three smiley African men of menopausal age in casual wear seated on a three-seater sofa chair with large and small potted plants in the background. One of them (centrally seated) holds a small-sized cardboard sign saying “Let’s talk about male menopause”. (Image from ChatGPT).

 

Highlights

• Male menopause (andropause) refers to the age-related decrease of testosterone in men, typically starting from their late 40s to early 50s.

• It is not as sudden as female menopause, but it causes significant physical, emotional, and sexual health changes over time.

• Symptoms include fatigue, low libido, erectile dysfunction, mood changes, memory issues, sleep disturbance, muscle loss, and weight gain around the abdomen.

• Testosterone levels decline naturally with age, but lifestyle factors like chronic stress, poor diet, obesity, smoking, and underlying illnesses can worsen the condition.

• A proper diagnosis requires a blood test to measure testosterone levels, along with a medical and lifestyle evaluation.

• Treatment options include lifestyle improvements, psychological counseling, and testosterone replacement therapy, where necessary and under medical supervision.

• Many African culture beliefs mislabel male menopause symptoms as spiritual attacks, curses, or signs of infidelity, preventing men from seeking help.

• The condition impacts relationships and mental health, causing marital strain, emotional distress, and lowered productivity in affected men.

 

Introduction

In many African cultures, aging is associated with wisdom, honor, and respect, especially for men.  However, a silent health challenge that affects many aging men across the continent is rarely discussed:  Male Menopause, medically known as Andropause.

Unlike female menopause, which is widely recognised and supported in African communities, male menopause remains largely misunderstood, ignored, or dismissed altogether.  Many African men may silently struggle with symptoms like fatigue, low sex drive, mood swings, and depression, often attributing them to spiritual attacks, stress, or even personal weakness.

But male menopause is real.  Learning about it could improve not just the health of African men, but also the quality of their relationships, work performance, and family life.

This article explains the causes, symptoms, diagnosis, and treatment of male menopause in simple terms, while also addressing cultural myths and misinformation that often prevent African men from seeking help.

 

What is male menopause?

Male menopause (or Andropause), is an age-related hormonal change in men. It refers to the gradual decrease of testosterone—the hormone responsible for male sexual development, muscle mass, mood, and energy in men – with age (see fig. 1).

Fig. 1: Testosterone level in men by age. Image from: Freepik. Click on image to enlarge

 

According to American College of Physicians, men typically undergo gradual decrease in testosterone levels as they get older, beginning around their mid-30s, with an average decline of about 1 percent per year. [1] A study also calculated that at the age of 75 years, a man will have lost about 30% of the testosterone he had at the age of 25 years. [2]

While it’s not as abrupt as menopause in women (which involves a sudden drop in estrogen and progesterone, hormones that control menstruation in a woman), male menopause usually starts in the 40s or 50s and progresses slowly with age.  

Medical experts refer to this condition as Late-Onset Hypogonadism or Androgen Deficiency in the Aging Male (ADAM).  But to put it simply, it's what happens when a man’s testosterone level starts dropping naturally as he ages, and brings with it a range of physical, emotional, and sexual changes—though not all men may experience these changes in the same way.

 

What Causes Male menopause?

Several factors can contribute to the cause of male menopause such as:

1. Age-related testosterone decline

The main cause of male menopause or andropause is the natural drop in testosterone levels that begins around age 40 and continues with age. As a man ages, testosterone levels gradually decrease, leading to both physical and emotional changes.

2. Medical conditions and treatments

• Medical conditions (Obesity, Thyroid disorders, and Type 2 diabetes): These conditions are known to interfere with testosterone production and disturb hormone balances through mechanisms like insulin resistance and inflammation. Conditions such as HIV and chronic kidney disease also increase the risk of andropause symptoms.

• Hypogonadism: This occurs when the testes don’t produce enough hormones. It can be present from birth or develop later in life, causing symptoms similar to andropause. [3]

• Cancer treatments: Some cancer treatments such as chemotherapy, hormone-blocking therapies, and radiation can lead to significant drop in testosterone levels.

3. Lifestyle factors

     Possible lifestyles cause of male menopause include:

• Unhealthy diet: Consuming too much processed food, sugar, and unhealthy fat can interfere with the body’s ability to produce and regulate hormones, including testosterone. 

• Sedentary lifestyle:  Lack of physical activity can lead to weight gain which is linked to lower testosterone levels.

• Substance abuse, smoking and heavy alcohol use:  Research shows that alcohol, cigarette smoking, caffeine, cannabis, cocaine and others can lower the production of testosterone and worsen symptoms. [4]

• Poor sleep:  Different sleep disorders, like poor sleep quality, not getting enough sleep, irregular sleep patterns, and breathing issues during sleep, can lead to lower testosterone levels. [5]

4. Psychological factors

• Anxiety and depression:  Chronic stress, a major factor in both conditions, increases cortisol levels, which can suppress testosterone production. Also, depression can directly lower testosterone levels by disrupting the brain’s signals to the testes to produce testosterone.  This creates a vicious cycle: low testosterone can worsen anxiety and depression, while the same mental health challenges can further reduce testosterone levels. [6]

5. Medications

• Drugs like antidepressants, statins, opioids, and some blood pressure medications, e.g. beta-blockers, can reduce testosterone levels and contribute to symptoms. [7]

 

What Are the Common Signs and Symptoms of Male Menopause?

 

Figure 2: Symptoms and signs of male menopause (Andropause). Click on image to enlarge.

 

The signs are often subtle at first and may be mistaken for other health problems or simply “getting old.”  The common signs and symptoms (fig. 2) include:

Sexual health

• Decreased libido (sexual drive): A noticeable reduction in sexual desire is a common symptom.

• Erectile dysfunction:  Difficulty achieving or maintaining an erection can occur.

• Reduced sperm production: Andropause can affect fertility because as a man ages, both the quality and quantity of healthy sperm he produces tends to decrease due to declining testosterone levels. [8]

Physical changes

• Fatigue and low energy:  A persistent feeling of tiredness and lack of motivation is often reported.

• Loss of muscle mass and strength: With lower levels of testosterone, muscle mass may decreases, and strength can be reduced. This impacts physical strength generally.

• Increased body fat (especially around the abdomen): As testosterone drops, the body tends to store more fat, particularly around the belly.

• Hot flashes and sweating: Although many associate hot flashes with women’s menopause but some men experience them too. Many may feel sudden warmth or break out in sweat—especially at night (night sweats), which can disturb sleep and cause discomfort.

• Sleep disturbance:  Many find it hard to fall asleep, wake up frequently, or feel like sleep is not refreshing. This lack of rest can worsen fatigue, mood swings, and concentration problems.

• Bone density loss:  Bones can become weaker and more fragile, which increases the risk of fractures or breaks—especially in the hips, back, or wrists. This is similar to osteoporosis in women.

• Breast pain or swelling (Gynecomastia):  Some men may notice swelling or pain in the chest area.  This is caused by hormonal imbalance and should be medically assessed.

Psychological changes

• Mood swings and irritability:  Men going through andropause may find themselves easily annoyed or angry over small things. You might feel calm one moment and upset the next, similar to mood swings seen in women during menopause.

• Depression and sadness:  Hormonal changes can lead to feelings of hopelessness, sadness, or emptiness. This isn’t simply “feeling down.” It is a deep emotional struggle that may affect how you think, act, and engage with others.

• Loss of self-confidence and motivation: As testosterone falls, many men lose their sense of drive or purpose.  You might feel unsure of yourself, avoid things you once enjoyed, or struggle to stay motivated at work or in relationships.

• Difficulty concentrating:  Some men experience a “mental fog”—trouble focusing, remembering things, or making decisions. Tasks that used to feel easy may now seem harder, and conversations may be harder to follow.

It’s important to note that the severity of these symptoms can vary.  Also, some of these signs and symptoms can be caused by other medical conditions, so it’s important to consult with a healthcare professional for proper diagnosis and treatment.

 

How is Male Menopause Diagnosed?

The diagnosis of male menopause is based on a combination of reported symptoms, physical examination and blood tests to measure testosterone levels.  When you are experiencing several of the symptoms of male menopause, it’s time to see a doctor.

What to expect during your visit to your doctor:

• History

The doctor will ask you for what brought you in, ask several question about your condition, ask about your past medical history, family and social history, and the medications that you are taking, etc.

The questions your doctor may ask about your medical and social history may include:

• Whether you drink alcohol or smoke, and if so how much drinks and how many cigarettes you take per day?
• How your diet is and if you exercise?
• Whether you are stressed, depressed, or not sleeping well?
• Whether you have been hospitalised or had any operations?
• The work you do
• How active you are sexually?

These questions help the doctor to understand if your symptoms are from low testosterone or something else.

• Physical examination

After taking your history, your doctor will then check your body, your weight, blood pressure, and any visible signs like swollen breast tissue or belly fat, etc.

• Blood test (especially in the morning)

Testosterone levels are highest in the morning, so the doctor may order a blood test between 7-10 a.m. to check your hormone levels. [9] Repeat testosterone testing is often needed to confirm low levels because they fluctuate.

• Screening for other illnesses

Sometimes, other health problems like diabetes, obesity, high blood pressure, thyroid disease, or depression can cause similar symptoms.  You may be tested for these as well to exclude them.

• Referral to a specialist (If Needed)

If your symptoms are complicated, or your testosterone level is very low, your doctor may refer you to:

• Urologist - a doctor who specialises in male reproductive health
• Endocrinologist - a hormone specialist who can manage testosterone issues.

Getting tested can bring peace of mind and a clear plan for treatment. Ignoring your symptoms can lead to worse health issues like:

• Depression
• Sexual dysfunction
• Relationship problems
• Weak bones and fractures
• Loss of productivity at work

The earlier you find out, the easier it is to start managing it with lifestyle changes, counseling, or medication.

 

How is Male Menopause Treated?

The choice of treatment depends on the severity of your symptoms and health status.

• Lifestyle changes

Making healthier choices can significantly improve your symptoms:

• Exercise

Regular physical activity, especially cardio (aerobic exercise) and strength training can help maintain your muscle mass, bone density, and improve energy levels.

• Diet

A balanced diet with adequate protein, healthy fats, complex carbohydrates, and hydration can support hormone production and your overall health.

• Stress Management

Techniques like mindfulness, meditation, or yoga can help reduce stress, improve your hormone levels and improve your symptoms.

• Sleep

Ensuring adequate and restful sleep is crucial for hormone regulation and can improve mood.

• Alcohol and Smoking

Reduce alcohol intake and quit smoking.

• Medications: Testosterone Replacement Therapy (TRT) 

Testosterone Replacement Therapy (TRT) can be used to treat symptoms associated with low testosterone.  

The goal of the therapy focuses on two main areas: relieving symptoms and restoring normal body functions.

Symptom relief may include better sexual health, increased physical activity, improved mood, and enhanced quality of life. Restoring body functions involves improving bone density, muscle strength, body composition, and cognitive performance—areas that may have been negatively affected by low testosterone levels. [10]

TRT can be administered through:

• Injections:  Short-acting or long-acting injections into the muscle.
• Gels:  Topical gels applied to the skin.
• Patches:  Transdermal patches that release testosterone through the skin.
• Implant:  Pellets implanted under the skin which provide a sustained release of testosterone.

TRT is not suitable for everyone and carries potential risks with side effects.  It’s important to consult with a healthcare professional to determine if TRT is appropriate for you.  Discuss potential risks and benefits before starting treatment.

• Other Considerations

These include:

• Counseling or Therapy

Talking to a counselor or psychologist may help you manage emotional or mental health symptoms such as depression or anxiety.

• Addressing Underlying Conditions

Conditions like diabetes or cardiovascular disease can contribute to symptoms and require specific management.

• Regular Check-ups

Regardless of the treatment approach, regular check-ups with a doctor are important to monitor symptoms and manage any potential side effects.

 

Common African Myths and Misinformation about Male Menopause

In many African cultures, there are common misunderstandings about male menopause (andropause), and this can prevent proper awareness and care.  These false beliefs often arise from limited knowledge, lack of open conversations, and traditional views on aging and masculinity. 

Common myths include:

Myth:  Only women have menopause

Truth: Men also experience hormonal changes. Though different from female menopause, the effects on health are real and should not be ignored.

Myth: Male menopause is not a real condition

Truth: While male menopause is different from female menopause, it is a real medical condition. As men age, the low testosterone levels lead to symptoms that affect physical, emotional and sexual health. 

Myth: Symptoms are just a normal part of aging

Truth: While aging does bring some changes, symptoms like constant fatigue, low sex drive, mood swings and loss of muscle mass can be linked to low testosterone. These are not just “normal” signs of aging and can be treated when properly diagnosed.

Myth: “Seeking help is a sign of weakness”

Truth:  Seeking medical advice for changes in health is a sign of strength and self-care. Hormonal imbalances can affect a man’s quality of life, and addressing them can lead to better physical and emotional wellbeing.

Myth: “Taking herbal mixtures will solve everything”

Truth:  Many herbal remedies are untested and can interact negatively with medications or worsen symptoms.  Professional advice is better.

Myth:  “Real men don’t get tired or weak”

Truth:  This toxic masculinity prevents men from seeking help. Fatigue and weakness can be signs of underlying health issues—not weakness of character.

 

Conclusion

Male menopause is real. It’s not a curse, weakness, or shameful secret. It’s a hormonal transition that all men experience—usually in silence. The good news is that with adequate and appropriate health education, you can have a better understanding of how and why it happens, and live a good quality life as you age.

Breaking the silence around male menopause is essential to improving the well-being of men across Africa.

 

References:

1. Amir Qaseem, Carrie A. Horwitch, Sandeep Vijan, et al; for the Clinical Guidelines Committee of the American College of Physicians . Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians. Ann Intern Med.2020;172:126-133. [Epub 7 January 2020]. doi:10.7326/M19-0882. Available from here.

2. Decaroli MC, Rochira V. Aging and sex hormones in males. Virulence. 2017 Jul 4;8(5):545-570. doi: 10.1080/21505594.2016.1259053. Epub 2016 Nov 10. Available from here.

3. NHS UK, “The Male Menopause”, [Internet. 13, October 2022]. Accessed 16, June 2025. Available from here.

4. Duca Y, Aversa A, Condorelli RA, Calogero AE, La Vignera S. Substance Abuse and Male Hypogonadism. J Clin Med. 2019 May 22;8(5):732. doi: 10.3390/jcm8050732. Available from here.

5. Wittert G. The relationship between sleep disorders and testosterone in men. Asian J Androl. 2014 Mar-Apr;16(2):262-5. doi: 10.4103/1008-682X.122586. Available from here.

6. SynergenX, High Stress Can Cause Testosterone to Drop, [Internet. June 12, 2024]. Accessed June 18, 2025. Available from here.

7. Richmond M. M.D. Obsidian Men’s Health, What Medications Cause Low Testosterone, [Internet. February 1, 2024]. Accessed June 17, 2024. Available from here.

8. Akinwalere F. Male Infertility in Nigeria: Causes, Symptoms, Diagnosis, and Treatment.  Datelinehealth Africa Inc. [Internet. May 12, 2025]. Accessed June 19, 2025 Available from here.

9. WebMD. Keep Testosterone in Balance, [Internet. May 22, 2024]. Accessed June 19, 2025. Available from here.

10.  Brawer MK. Testosterone replacement in men with andropause: an overview. Rev Urol. 2004;6 Suppl 6(Suppl 6):S9-S15. Available from here.

 

Related 

Male Infertility in Nigeria: Causes, Symptoms, Diagnosis and Treatment

Why African Men Need Regular Health Checks, Screenings

Erectile Dysfunction in Nigerian Men

 

 

Published:  July 6, 2025

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