The Aging Male Endocrine System: Clinical Insights into Andropause Management

Andropause, or late-onset hypogonadism, represents a clinically significant condition affecting an increasing proportion of aging men worldwide. This syndrome is characterized by the gradual decline of serum testosterone levels accompanied by a constellation of symptoms including sexual dysfunction, reduced energy, mood alterations, and changes in body composition. Unlike the abrupt hormonal cessation observed in female menopause, andropause involves a progressive testosterone decline beginning in the fourth decade of life, continuing at approximately 1%–2% annually, which often leads to underdiagnosis and delayed therapeutic intervention. The prevalence of symptomatic androgen deficiency demonstrates significant age-related variation, ranging from 0.1% to 7% in men aged 30–69 years to 18.4% in those over 70 years. The European Male Aging Study has established that the most reliable diagnostic criteria require the presence of sexual symptoms (erectile dysfunction, reduced sexual thoughts, and decreased morning erections) combined with biochemically confirmed low testosterone levels (below 264 ng/dL on two separate morning measurements). The pathophysiology involves complex age-related changes in the hypothalamic–pituitary–gonadal axis, increased sex hormone-binding globulin levels, and peripheral factors including visceral adiposity and insulin resistance. Clinical presentation encompasses sexual, physical, psychological, and metabolic manifestations that significantly impact quality of life and overall health outcomes. Current evidence supports testosterone replacement therapy in appropriately selected patients with confirmed biochemical hypogonadism and clinically significant symptoms. However, treatment requires careful patient selection, individualized approaches, and regular monitoring for both efficacy and potential adverse effects. This review examines the current understanding of andropause pathophysiology, diagnostic approaches, and evidence-based treatment strategies to optimize clinical outcomes in aging men.