Editorial
Written byMen's Health Istanbul Editorial Team
Medical reviewProf. Dr. Bülent Alıcı
Last medical reviewAwaiting reviewer sign-off
The question
“Does testosterone naturally decline after 40?”
A question men often ask us. Answered by our editorial team and reviewed by a specialist. Questions are always published anonymously.
Key takeaways
- Long-term studies show that average testosterone levels fall gradually as men age, rather than dropping suddenly.
- The decline varies a great deal between men. Weight, long-term illness, some medicines and sleep all play a part.
- A diagnosis of testosterone deficiency needs both symptoms and repeatedly low morning blood tests, not one result.
- Testosterone treatment is not a general anti-ageing therapy and is not suitable for men trying to have children.
The short answer
Yes, on average testosterone falls as men get older. Large studies that measured the same men over many years, such as the Massachusetts Male Aging Study and the Baltimore Longitudinal Study of Aging, found a slow, steady decline rather than a sudden drop. That is quite different from the menopause, when hormone levels fall sharply over a short time, which is why many doctors avoid the phrase "male menopause".
Age is only part of it
Averages hide a lot of variation. Plenty of men in their sixties have testosterone levels comparable to men decades younger. Other factors often matter as much as the birthday:
- carrying excess weight, particularly around the abdomen;
- type 2 diabetes and other long-term illness;
- some medicines, including opioid painkillers;
- poor or short sleep, and heavy alcohol use.
This matters because some of these can be improved, and levels may rise when they are.
Low levels versus a medical condition
The European Male Ageing Study looked for the combination that defines late-onset hypogonadism: consistently low testosterone together with typical symptoms, especially sexual ones such as reduced morning erections, low sex drive and erectile difficulty. It found that this combination was much less common than simply having a lower result on a blood test.
Guidelines therefore recommend testing only when there are relevant symptoms, measuring in the morning (when levels are highest) and repeating a low result before drawing conclusions.
What about treatment?
For men with a confirmed deficiency, testosterone treatment can help specific symptoms. It is not an anti-ageing treatment for men with normal levels, and it has real downsides: it switches off the body's own sperm production, so it is not suitable for men who want children, and it needs regular monitoring. Our article on the TRAVERSE trial looks at what is now known about heart safety.
When to talk to a doctor
If you have noticed a fall in sex drive, fewer morning erections, erectile difficulties or unusual tiredness that is not explained by sleep or stress, a doctor can check your hormones and look for other causes. Erectile problems in particular are worth assessing on their own merits: see our erectile dysfunction guide.
References
- Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87(2):589–598.
- Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86(2):724–731.
- Wu FCW, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–135. Source
- Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432.
This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.
