Editorial
Written byMen's Health Istanbul Editorial Team
Medical reviewer (awaiting sign-off)Prof. Dr. Bülent Alıcı
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The question
“Does testosterone naturally decline after 40?”
A question men often ask us. Questions are always published anonymously.
The short answer
Yes, on average, but slowly. Long-term studies that followed the same men for years show that testosterone falls gradually with age rather than dropping suddenly, so the idea of a "male menopause" is misleading. The decline varies widely between men: weight, diabetes, some medicines, poor sleep and heavy drinking can matter as much as age. A lower number on a blood test is not a condition in itself. Doctors diagnose testosterone deficiency only when typical symptoms, such as low sex drive and fewer morning erections, occur together with repeatedly low morning blood results.
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.
Is there such a thing as the male menopause?
Not in the way the phrase suggests. 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 in average testosterone 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".
What else lowers testosterone apart from age?
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.
Is low testosterone the same as testosterone deficiency?
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.
Does testosterone treatment help?
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 should I get my testosterone checked?
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.
Questions men also ask
What time of day should testosterone be tested?
In the morning, when levels are usually highest. A low result is normally repeated before any conclusion is drawn.
Can testosterone levels rise again?
Sometimes. When factors such as excess weight, poor sleep, heavy drinking or certain medicines are addressed, levels may improve.
Does testosterone treatment affect fertility?
Yes. It switches off the body's own sperm production, so it is not suitable for men who are trying to have children.
Sources & further reading
- 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. View source (opens in a new tab)
- Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432.
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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.
