By Javier Luna (Registration number – 03622-CV).
Andropause is a term used to describe the decline in testosterone levels that some men experience with age. Unlike the female menopause, it does not mark the end of fertility. A man with low testosterone levels may continue to produce sperm and can therefore father children naturally or through assisted reproductive techniques.
From a medical perspective, it is more accurate to refer to late-onset hypogonadism or age-related testosterone deficiency.
Men do not stop producing sperm when they reach a particular age. However, ageing can cause hormonal, sexual and reproductive changes that may reduce the chances of achieving a pregnancy.
Testosterone plays a role in functions such as sexual desire, erectile function, muscle mass and bone density and, together with other hormones, in maintaining sperm production.
Testosterone levels may gradually decline with age, although this does not occur in the same way in all men. Other factors can also affect hormone production, including obesity, diabetes, certain medications, sleep disorders and testicular or pituitary conditions.
Therefore, a low testosterone concentration on a blood test is not sufficient to diagnose andropause. Compatible symptoms must also be present.
Symptoms can vary considerably from one man to another. The most common include:
These symptoms can have multiple causes, so a medical assessment is necessary before attributing them to testosterone deficiency.
Diagnosis combines an assessment of symptoms with various hormone tests. Total testosterone is measured using a blood sample taken in the morning. The European Association of Urology (EAU) guidelines state that the diagnosis of male hypogonadism requires compatible symptoms and low testosterone levels confirmed in at least two morning measurements.
Depending on the individual case, hormones such as LH, FSH and prolactin may also be assessed, together with other metabolic parameters. If there is a desire to have children, a semen analysis is particularly important, as it assesses parameters such as sperm concentration, motility and morphology.
Having andropause or low testosterone levels does not necessarily mean that a man is infertile. Unlike female ovarian reserve, sperm production does not suddenly become exhausted at a particular age. Many men continue to produce sperm throughout their lives, although sperm quantity or quality may decline with ageing.
The chances of achieving a pregnancy depend on several factors, including:
For this reason, a man’s fertility cannot be determined solely from his testosterone levels.
Although andropause is sometimes referred to as “male menopause”, the two are distinct processes.
Female menopause | Andropause or late-onset hypogonadism |
Involves the cessation of ovarian function and ovulation. | Does not involve the cessation of sperm production. |
Occurs in all women who reach this stage. | Not all men develop symptomatic testosterone deficiency. |
Marks the end of natural female fertility. | May reduce fertility, but does not necessarily result in infertility. |
Hormonal changes are more pronounced. | Hormonal decline usually occurs gradually. |
One of the most important considerations when a man wishes to become a father is testosterone treatment. It may seem logical to think that administering testosterone to a man with low levels will improve his fertility. However, externally administered testosterone can reduce sperm production.
This occurs because it can suppress the production of LH and FSH, hormones involved in regulating testicular function. As a result, some men may experience a significant reduction in sperm numbers and even temporary azoospermia, meaning an absence of sperm in the ejaculate.
For this reason, the guidelines of the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) recommend carefully assessing the use of exogenous testosterone in men who wish to preserve their current or future fertility. However, other strategies are available to preserve or stimulate testicular function.
As men age, changes may occur in certain semen parameters, as well as an increase in sperm DNA fragmentation. However, these changes do not affect all men in the same way, and there is no specific age at which fertility disappears.
For this reason, sperm DNA fragmentation testing may be considered in situations such as recurrent miscarriage, unexplained infertility, certain previous reproductive failures or specific male-factor conditions.
As long as viable sperm are available, assisted reproductive techniques can help achieve pregnancy, even in cases of andropause or impaired semen quality.
Treatment is selected taking into account both the male and female factors:
Although age-related changes cannot be completely prevented, some factors affecting both hormonal health and semen quality can be modified.
General recommendations include maintaining a healthy weight, engaging in regular physical activity, avoiding smoking and anabolic steroids, limiting alcohol consumption, getting adequate sleep and managing conditions such as diabetes and hypertension.
In general terms, a fertility assessment is recommended after 12 months of regular unprotected sexual intercourse without achieving a pregnancy. Assessment may be brought forward to six months when the woman is aged 35 or over, and it may be appropriate even earlier when there is a history of factors that could affect fertility.
It is also advisable to seek medical advice without waiting when there are factors such as testosterone or anabolic steroid treatment, testicular disease or surgery, previous chemotherapy or radiotherapy, erectile or ejaculatory disorders, or an abnormal semen analysis. The assessment should consider the reproductive situation of both partners together.
European Association of Urology (EAU).
EAU Guidelines on Sexual and Reproductive Health: Male Hypogonadism.
.
2026;
EAU Guidelines on Sexual and Reproductive Health:
https://uroweb.org/guidelines/sexual-and-reproductive-health
European Association of Urology (EAU).
EAU Guidelines on Sexual and Reproductive Health: Male Infertility.
.
2026;
EAU Guidelines on Male Infertility:
https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-infertility
American Urological Association (AUA).
Evaluation and Management of Testosterone Deficiency: AUA Guideline.
.
2018;
AUA Guidelines: Testosterone Deficiency:
https://www.auanet.org/guidelines-and-quality/guidelines
American Urological Association (AUA), American Society for Reproductive Medicine (ASRM).
Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline.
.
2024;
AUA/ASRM Guideline on Diagnosis and Treatment of Infertility in Men:
https://www.auanet.org/documents/Guidelines/PDF/2024%20Guidelines/Male%20Infertility%20Unabridged%20Final.pdf
World Health Organization (WHO).
WHO Laboratory Manual for the Examination and Processing of Human Semen.
.
2021;
276
WHO Laboratory Manual for the Examination and Processing of Human Semen:
https://www.who.int/publications/i/item/9789240030787
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