Andrological Consultation

Andropause is an informal term for symptoms attributed to hormonal changes in ageing men. Reduced libido, fewer morning erections or persistent fatigue may warrant diagnostic evaluation, but these symptoms alone do not confirm testosterone deficiency. Diagnosis requires an assessment of both symptoms and test results.

In this article, you will learn which symptoms should be discussed with a doctor, how to prepare for a testosterone test and why treatment does not always involve hormone therapy.

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Prepared by: Wyspa Medycyny Przyjaznej Editorial Team · Updated: 24 September 2026

This educational material is based on the medical sources listed at the end of the article. It is not a substitute for an individual medical consultation.

Andropause — key facts

• Not every man develops symptomatic testosterone deficiency as he ages.
• Fatigue, reduced libido and erectile problems may also have causes unrelated to hormones.
• A low testosterone result should be confirmed with another properly performed test.
• Treatment depends on the cause of the symptoms; TRT is one option, but it is not suitable for everyone.

What is andropause?

The word “andropause” suggests an abrupt cessation of hormone production similar to menopause. In men, the process is usually different. Testosterone production may gradually decline with age, but this does not happen at a single point in time and does not lead to symptomatic deficiency in every man.

More precise terms are late-onset hypogonadism or symptomatic testosterone deficiency. This is a clinical condition in which characteristic symptoms are accompanied by persistently low testosterone levels. Age alone, fatigue alone or a single low result is not enough to make the diagnosis.

Symptoms of andropause and testosterone deficiency

Symptoms may develop gradually and vary in severity. Sexual symptoms are the most diagnostically relevant, but the doctor will assess the complete clinical picture.

Sexual symptoms

• a marked and persistent reduction in libido,
• fewer spontaneous or morning erections,
• difficulty achieving or maintaining an erection,
• reduced frequency of sexual activity,
• reduced fertility.

Physical symptoms

• reduced muscle strength and mass,
• increased body fat, particularly around the abdomen,
• reduced physical capacity and slower recovery,
• reduced beard growth or loss of body hair,
• hot flushes in more severe deficiency,
• reduced bone mineral density and an increased risk of osteoporosis.

Psychological and general symptoms

• persistent fatigue and reduced energy,
• low mood, irritability or reduced motivation,
• difficulty with concentration and memory,
• sleep disturbances.

Important: many of these symptoms are non-specific. They may be caused by depression, sleep apnoea, hypothyroidism, anaemia, diabetes, cardiovascular disease, chronic stress, physical inactivity, alcohol use or medication side effects, among other conditions.

When is it worth testing testosterone?

A testosterone test is most useful in a man with persistent symptoms that may indicate androgen deficiency. Routine testosterone testing in all men without symptoms is not recommended.

Consultation and diagnostic evaluation are particularly warranted in cases of reduced libido, loss of morning erections, erectile dysfunction, unexplained loss of muscle strength and mass, osteoporosis, infertility, hot flushes or a history of treatment that may have damaged the testes or pituitary gland.

How should testosterone be tested correctly?

Testosterone levels vary throughout the day and are affected by sleep, meals, acute illness and certain medicines. To reduce the risk of a falsely low result, the first test should be planned carefully.

1. Have total testosterone measured in the morning — usually between 7:00 and 10:00 a.m.
2. Attend fasting and after an adequate amount of sleep. For shift workers, the sampling time is determined in relation to their sleep pattern rather than solely by the clock.
3. Do not have the test during an acute illness, fever or immediately after severe physical strain if it can safely be postponed.
4. Repeat a low result on another day before a diagnosis is made or TRT is started.
5. Do not stop any medicine on your own, but tell your doctor about all medicines, supplements, opioids, glucocorticoids, testosterone and anabolic-androgenic steroids you use.

According to the EAU Guidelines, a result below 12 nmol/L (approximately 346 ng/dL) may support a diagnosis of late-onset hypogonadism in a patient with typical symptoms, but it should not be interpreted in isolation. The repeatability of the result, laboratory method, SHBG level, co-existing conditions and the entire clinical picture are all important.

Which tests may be ordered if andropause is suspected?

The range of tests should be based on the medical history and physical examination. Not every patient requires the same “hormone panel”. Tests commonly considered include:

• total testosterone — at least two morning measurements on separate days if the first result is low,
• SHBG and albumin — when total testosterone is borderline or factors that alter SHBG are present; these values allow free testosterone to be calculated,
• LH and FSH — to help distinguish testicular failure from disorders involving the pituitary gland or hypothalamus,
• prolactin — particularly when libido is reduced, LH is low or inappropriately normal, or secondary hypogonadism is suspected,
• full blood count with haematocrit — also important before possible TRT,
• blood glucose or HbA1c and a lipid profile — to assess metabolic and cardiovascular risk,
• TSH, liver function tests, ferritin or other tests — if the medical history suggests an alternative cause of the symptoms,
• PSA and prostate assessment — when indicated, including during assessment for treatment; these are not used to diagnose testosterone deficiency itself,
• semen analysis — when the patient reports fertility problems or is planning fatherhood.

Direct laboratory measurement of free testosterone is not reliable with every method. In practice, it is often calculated from total testosterone, SHBG and albumin, or measured using a reference method in a suitably equipped laboratory.

Do similar symptoms always mean andropause?

No. Sleep deprivation, chronic stress, depression, anaemia, thyroid disease, diabetes and medication side effects can cause similar symptoms. Erectile dysfunction may also have a vascular cause. A consultation should therefore not be limited to the assessment of a single hormone.

If testosterone deficiency is confirmed, the doctor will investigate its cause. Possible causes include diseases of the testes, pituitary gland or hypothalamus, obesity, chronic illness, certain medicines or previous use of anabolic-androgenic steroids. Do not stop prescribed medicines without medical advice.

What really helps with symptoms attributed to andropause?

Management depends on the diagnosis. It is worth discussing hormone test results, sleep, body weight, current medicines and chronic conditions with your doctor.

• Reducing excess body weight: in men with obesity, this may improve hormonal balance and sexual function.
• Exercise and recovery: regular physical activity supports strength, fitness and well-being; it does not guarantee that testosterone levels will return to normal.
• Sleep and assessment for sleep apnoea: snoring, pauses in breathing and daytime sleepiness should be reported to a doctor.
• Treatment of diagnosed conditions: management should be tailored to the actual cause of the symptoms.

Do not start testosterone or other hormonal products on your own. Supplements advertised as “testosterone boosters” are not a substitute for proper diagnostic evaluation.

Does andropause always require testosterone therapy?

No. TRT is considered in appropriately selected men who have symptoms and confirmed testosterone deficiency. Before treatment, the cause, contraindications and the feasibility of regular follow-up must be assessed. Age alone or a single low result is not sufficient to start therapy.

Exogenous testosterone may suppress sperm production. If you are planning fatherhood, tell your doctor before starting treatment. The Endocrine Society recommendations emphasise the importance of reproductive plans when assessing a patient for TRT.

Information about eligibility, treatment and follow-up is available here: testosterone replacement therapy (TRT) in Gdańsk.

Do you have symptoms or an abnormal testosterone result?

You can book an andrology consultation at Wyspa Medycyny Przyjaznej in Gdańsk. The doctor will discuss your symptoms and previous test results and select any further diagnostic tests required. You do not need to complete a full hormone panel before your first appointment.

Consultations are provided, among others, by Jakub Krukowski, MD, PhD, a specialist in urology with a clinical focus on andrology.

Find out what happens during an andrology consultation.

What should you bring to the appointment?

• Any available test results, including the date and — if known — the time when the sample was taken.
• A list of medicines, supplements and hormones used currently or in the past.
• Information about how long the symptoms have lasted, your sleep quality and any chronic conditions.
• Information about whether you are planning fatherhood.

Andropause — questions and answers

At what age does andropause begin?

There is no single age threshold. Symptoms attributed to andropause may develop gradually, but not every man in his 40s or 50s has testosterone deficiency.

How long does andropause last?

It is not a stage with a fixed duration. Symptoms depend on their cause, co-existing conditions and the management undertaken. Persistent symptoms should not be assumed to resolve on their own.

Is an online andropause test enough to make a diagnosis?

No. A questionnaire may help organise your symptoms, but it cannot confirm testosterone deficiency and is not a substitute for a medical consultation or laboratory tests.

Which doctor should I see if I suspect andropause?

You may start with a general practitioner, an andrologist or a urologist specialising in male hormonal health. If a pituitary, thyroid or other hormonal disorder is suspected, an endocrinology consultation may be required.

Medical sources

1. European Association of Urology — Male Hypogonadism. Symptoms, diagnosis and principles of managing testosterone deficiency.
2. Endocrine Society — Testosterone Therapy for Hypogonadism Guideline Resources. Diagnosis of hypogonadism and eligibility for testosterone therapy.