Also called: Male Menopause · Late-Onset Hypogonadism · Testosterone Deficiency Syndrome

Andropause in Men — What It Is, Why It Matters, and How to Treat It

Q: Is andropause the same as erectile dysfunction?

No — but they frequently co-exist. Andropause is a hormonal condition (low testosterone) affecting energy, mood, muscle, and sexual function broadly. ED is specifically the inability to achieve or maintain an erection. In many men with andropause, ED is present — but low testosterone is only one cause of ED. Both need assessment. Dr. Aggarwal evaluates both simultaneously.

Q: Will TRT affect my fertility?

Yes — exogenous testosterone suppresses sperm production by inhibiting LH and FSH. Men who wish to preserve fertility should NOT use standard TRT. An alternative protocol using clomiphene or hCG can raise testosterone while preserving sperm production. Dr. Aggarwal advises on this before starting any treatment.

Q: How long before I feel the effects of testosterone therapy?

Energy and mood typically improve within 3–4 weeks. Libido usually improves by 6–8 weeks. Muscle mass and body composition changes become visible around 3–6 months. Full effect on bone density takes 1–2 years.

Q: Can andropause cause depression?

Yes. Low testosterone is associated with reduced serotonin activity and dopamine response — the mood-regulating neurotransmitters. Men with undiagnosed andropause are frequently treated for depression with antidepressants when the root cause is hormonal. If a man over 40 presents with new-onset depression, a testosterone test should be routine.

Unlike female menopause, andropause happens gradually — most men don't notice it for years. By the time they do, testosterone levels may be 40–50% lower than in their 30s. The symptoms are real. They are measurable. And they are treatable.

1–2%

Testosterone decline per year from age 30

25–35%

Lower T in average Indian man by age 45

15–20 yrs

Duration of the andropause transition

80%+

Of men respond well to appropriate treatment

Take the AndroScore Assessment →

Men's Health Programme Dr. Nitin Aggarwal Dr. Anil Bhansali Diabetes Treatment

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Andropause Specialist Care

Gini Hospital Mohali
Dr. Nitin Aggarwal (Urologist & Andrologist)
+ Dr. Anil Bhansali (Endocrinologist)

The only team in the region combining urology and endocrinology for andropause management.

Integrated Andropause Care

Understanding the Condition

What Is Andropause — And Why Most Men Don't Realise They Have It

Testosterone declines at 1–2% per year beginning around age 30. By age 45, the average Indian man has 25–35% lower testosterone than he did at 25. By 55, many men are clinically hypogonadal — meaning their hormone levels fall below the threshold for normal male function. This is not speculation; it is documented in endocrinological literature and confirmed repeatedly in Indian population studies.

Unlike female menopause, which occurs over a defined 2–3 year period with unmistakable symptoms, andropause is a slow 15–20 year fade. This is precisely why most men never identify it. The decline is gradual enough that each year feels only slightly different from the last — making it easy to attribute every symptom to "just getting older," stress, overwork, or lifestyle. By the time the cumulative effect becomes undeniable, years of suboptimal health have already passed.

The symptoms of andropause are not vague or psychological. They are specific, physiological, measurable, and — critically — they respond to treatment. Fatigue that doesn't resolve with rest, libido that has meaningfully declined over several years, muscle mass that is falling despite regular exercise, mood that has shifted toward irritability or depression: these are not inevitable features of ageing. They are signs of a treatable hormonal condition.

A single morning blood test — total testosterone drawn before 10am — can confirm or exclude the diagnosis in most cases. Testosterone is highest in the morning; afternoon samples frequently return falsely low results, leading to unnecessary uncertainty. Despite this, the majority of Indian men over 40 have never had a testosterone level checked. At Gini, we correct this: a comprehensive hormone panel is standard in every andropause assessment.

Know the Signs

Symptoms of Andropause — A 3-Category Checklist

If you have 3 or more of these symptoms and are over 35, a testosterone test is warranted. These symptoms are not simply signs of ageing — they are clinically recognised indicators of testosterone deficiency. The more categories they span, the stronger the case for formal assessment.

⚡ Fatigue and persistently low energy
💪 Muscle loss and physical weakness
⚖️ Weight gain especially around the abdomen
🦴 Reduced bone density and joint aches
🌡️ Hot flushes and night sweats
💇 Hair thinning and changes in body hair

❤️ Reduced libido (sex drive)
🔴 Erectile dysfunction
🌅 Reduced or absent morning erections
💧 Reduced ejaculation volume
🔇 Reduced intensity of orgasm
😴 Reduced interest in sexual activity

😟 Mood changes and irritability
🧠 Depression and anxiety (often unrecognised)
🎯 Reduced motivation and drive
🌫️ Brain fog and poor concentration
😔 Reduced confidence and self-worth
😴 Poor sleep quality

Not sure how many apply to you? Take the formal AndroScore screening — free, 3 minutes, validated questionnaire.

Take the AndroScore Free →

Uniquely Important at Gini — Dr. Bhansali + Dr. Aggarwal Together

The Connection Between Andropause, Diabetes, and Heart Disease

The relationship between testosterone and metabolic health is cyclical and self-reinforcing. Low testosterone increases insulin resistance, which raises blood sugar. Higher blood sugar then suppresses testosterone production further — creating a vicious cycle that quietly accelerates both conditions over years. Men with Type 2 diabetes have 2.5 times the rate of low testosterone compared to men without diabetes. At Gini, correcting testosterone deficiency as part of a comprehensive metabolic programme routinely improves HbA1c by 0.5–1.0 points — a clinically meaningful outcome that most endocrinologists do not achieve through medication adjustment alone.

This is precisely why Dr. Anil Bhansali and Dr. Nitin Aggarwal manage andropause together at Gini — the endocrinology and the urology are inseparable in this condition. Most hospitals treat them as separate departments with no formal communication. We do not. Our andropause clinic is a joint consultation: the hormonal picture and the urological picture are reviewed together, in the same session, with a shared treatment plan.

For men who are patients of the Gini Diabetes Control Programme, testosterone optimisation is now integrated into the metabolic review — not treated as an add-on. Treating andropause can directly improve diabetes outcomes by reducing visceral fat, restoring insulin sensitivity, improving lean muscle mass (the body's primary glucose disposal site), and supporting the dietary and exercise components of the programme.

2.5×

Men with Type 2 diabetes have 2.5× the rate of hypogonadism (low testosterone) compared to men without diabetes. In most of these men, the testosterone deficiency is never tested for, never diagnosed, and never treated — despite it being a major, modifiable driver of their metabolic outcomes.

The Evidence Has Changed

Testosterone and Heart Health — The Evidence Has Changed

Contrary to old fears from the 1990s, modern clinical evidence shows low testosterone is associated with higher cardiovascular risk — not lower. The paradigm has shifted substantially over the past decade.

What Low Testosterone Correlates With

→ Higher LDL cholesterol
→ Lower HDL cholesterol
→ Increased visceral fat
→ Higher resting blood pressure
→ Increased risk of metabolic syndrome
→ Higher risk of cardiovascular events

What the Evidence Now Shows

✓ TRT improves LDL/HDL ratios in hypogonadal men
✓ Reduces visceral fat mass significantly
✓ Associated with improved exercise tolerance
✓ Reduces markers of systemic inflammation
✓ Appropriately treated testosterone deficiency is associated with improved cardiac risk markers in well-conducted trials

Key point: This must be managed by a specialist. The cardiac risk profile of TRT applies to physiological replacement — restoring normal levels — not supraphysiological abuse as seen in sport. Dr. Bhansali's team conducts a full cardiac risk assessment before and during every TRT programme at Gini, including lipid profiles, blood pressure monitoring, haematocrit tracking, and ECG where indicated. Learn more: Testosterone and Heart Health — The Evidence →

Accurate Assessment First

How Andropause Is Diagnosed at Gini

Blood Tests Required for Andropause Assessment

01 Total Testosterone — must be a morning sample drawn before 10am. Testosterone peaks between 6–10am; afternoon samples frequently return falsely low results.
02 Free Testosterone + SHBG (sex hormone binding globulin) — high SHBG reduces the biologically active fraction even when total testosterone looks normal.
03 LH + FSH (pituitary hormones) — essential to distinguish primary hypogonadism (testicular) from secondary (pituitary/hypothalamic). This changes the treatment approach.
04 Prolactin — elevated prolactin can suppress testosterone significantly. A prolactinoma must be excluded before starting TRT.
05 Oestradiol (oestrogen) — elevated oestrogen, common in overweight men, suppresses testosterone and must be measured.
06 Full Blood Count, Lipid Profile, HbA1c — baseline metabolic assessment and cardiovascular risk evaluation.
07 PSA (prostate specific antigen) — baseline is mandatory before considering TRT. Elevated PSA requires urology review before starting.

The Diagnosis Is Clinical + Biochemical

Symptoms alone are not sufficient for diagnosis — they overlap significantly with depression, thyroid disorders, sleep apnoea, anaemia, and other conditions that must be excluded first. Blood tests are essential and non-negotiable.

At the same time, a testosterone level in the 'normal' range does not rule out andropause. Free testosterone and symptom correlation matter more than a single total testosterone number. A man with a total testosterone of 380 ng/dL but high SHBG may be functionally hypogonadal — and may benefit substantially from treatment.

What the Gini Andropause Panel Includes

The full Gini Andropause Assessment — ₹3,500 — includes blood panel collection, laboratory processing, results interpretation by Dr. Aggarwal and Dr. Bhansali's team, and a written clinical summary with treatment recommendations.

Personalised, Evidence-Based Protocol

Treatment Options for Andropause

Step 1 — Always First

Lifestyle Foundation

Before any hormone intervention is considered, lifestyle optimisation is mandatory — both because it can meaningfully raise testosterone in its own right, and because TRT works significantly better in men who have addressed the modifiable drivers of testosterone suppression.

🏋️

Resistance Training

3× per week

🥩

Adequate Protein

1.6g/kg bodyweight

😴

Sleep Quality

Optimisation

🚫

Alcohol Reduction

Major T suppressor

⚖️

Body Weight

Visceral fat ↓ T

Lifestyle changes alone can raise testosterone by 15–20% in men with mild andropause — especially those who are overweight and sedentary. This is always the first protocol, not an afterthought.

Step 2 — When Indicated

Testosterone Replacement Therapy (TRT)

When lifestyle optimisation has been implemented and testosterone remains below the therapeutic threshold — or when symptoms are severe enough to warrant earlier intervention — TRT is the evidence-based standard of care. At Gini, TRT is never initiated without the full blood panel, cardiac risk assessment, and baseline PSA.

Three Delivery Methods Available at Gini

Injectable Testosterone

Most common in India — enanthate or undecanoate formulations. Administered every 2–12 weeks depending on the specific preparation. Cost-effective, reliable, and well-tolerated. The preferred option for most patients at Gini.

Transdermal Gels

Daily application to skin (shoulder, upper arm). Maintains steady physiological testosterone levels without the peaks and troughs of injections. Available as Cernos Gel and other licensed brands. Preferred for men who prefer to avoid injections.

Subcutaneous Pellets

Implanted under the skin every 3–4 months under local anaesthetic. Less common in India but available at Gini. Provides the most consistent steady-state levels. Preferred by patients who want a "set and forget" approach.

TRT Monitoring Protocol at Gini — Every 3 Months in Year 1

Testosterone level Haematocrit (RBC count) PSA Lipid profile Oestradiol Symptoms review

What TRT Will Improve (Usually Within 3–6 Months)

✓ Energy levels and stamina
✓ Libido and sexual function
✓ Mood and motivation
✓ Muscle mass and fat distribution
✓ Bone density (longer term)
✓ Sleep quality

What TRT Will NOT Do

✗ Restore fertility (a separate protocol is needed — ask Dr. Aggarwal)
✗ Work overnight — allow 3–6 months for full effect
✗ Replace lifestyle changes — both are required for optimal outcome

View the Gini Men's Health Programme →

Know the Difference

Andropause vs Normal Ageing — How to Tell the Difference

Many men are told their symptoms are simply "part of getting older." Sometimes they are. But there are specific patterns that distinguish normal ageing from a treatable hormonal condition. This table shows the key differences.

Symptom	Normal Ageing	Andropause
Fatigue	Mild, predictable — improves with adequate rest	Persistent, not explained by activity level or sleep
Libido	Modest gradual decline over decades	Significant drop, often more sudden, noticeable to partner
Muscle loss	Gradual after 50, responds to training	Accelerated, even with regular resistance exercise
Mood	Generally stable, minor fluctuations	Irritability, depression, poor motivation as a pattern
Morning erections	Occasional, may reduce after 60	Absent or very rare before 55
Response to sleep/rest	Feels genuinely refreshed after 7–8 hours	Still tired after 8 hours — unrefreshing sleep
Blood testosterone	May be low-normal but above threshold	Below diagnostic threshold or low-normal with clear symptoms

Key message: If three or more of the 'andropause' column apply to you, a testosterone test is the right next step — not another year of feeling below par. The test is a single morning blood draw. The result is available within 24 hours. If andropause is confirmed, treatment can begin within days. There is no clinical justification for continuing to feel this way without at least checking.

Common Questions

Frequently Asked Questions About Andropause

Answered by Dr. Nitin Aggarwal and Dr. Anil Bhansali's team at Gini Hospital, Mohali.

Is andropause the same as erectile dysfunction?

No — but they frequently co-exist. Andropause is a hormonal condition (low testosterone) that affects energy, mood, muscle, bone, and sexual function broadly across many systems. Erectile dysfunction is specifically the inability to achieve or maintain an erection sufficient for intercourse.

In many men with andropause, ED is present — but low testosterone is only one cause of ED. Vascular disease, neurological factors, psychological causes, and medication side effects all play independent roles. Both conditions need formal assessment and may require separate treatment strategies. Dr. Aggarwal evaluates both simultaneously in andropause consultations at Gini.

At what testosterone level should treatment be started?

In India, treatment is generally considered when total testosterone falls below 300 ng/dL AND symptoms are present. A low testosterone level without symptoms does not necessarily require intervention.

However, the threshold is not absolute. Some men are symptomatic at 350–400 ng/dL if their free testosterone is low (due to high SHBG) or if their baseline testosterone was historically high. Symptom correlation matters more than a single number. This is why the full panel — including free testosterone, SHBG, and LH/FSH — is essential for accurate diagnosis. Dr. Bhansali's team reviews all results together to make a clinical determination, not a purely numerical one.

Will TRT affect my fertility?

Yes — this is critical and must be discussed before starting any treatment. Exogenous testosterone (given from outside the body) suppresses the pituitary signals LH and FSH that stimulate the testes to produce both testosterone and sperm. This can significantly reduce or eliminate sperm production — sometimes within weeks of starting TRT.

Men who wish to father children should NOT use standard TRT. An alternative protocol using clomiphene citrate or hCG (human chorionic gonadotropin) can raise endogenous testosterone while preserving — and in some cases improving — sperm production. Dr. Aggarwal advises on this explicitly at the initial consultation, before any treatment is prescribed. Never start TRT without discussing fertility intentions first.

How long before I feel the effects of testosterone therapy?

The timeline varies by symptom domain and individual, but a general guide based on clinical evidence:

3–4 weeks: Energy levels and mood typically begin to improve. Many men notice reduced fatigue and improved sense of wellbeing first.
6–8 weeks: Libido usually improves. Morning erections may begin to return.
3–6 months: Muscle mass and body composition changes become visible. Physical performance improves. Erectile function continues to improve.
12–24 months: Full effect on bone density becomes measurable on DEXA scan.

Patience is essential. Men who expect immediate results often discontinue TRT prematurely, before the full benefit has developed. The Gini monitoring protocol at 3-month intervals is designed to track improvement and adjust dosing accordingly.

Is TRT safe for men with diabetes?

Yes — and in men with diabetes and low testosterone, TRT is often especially beneficial. The relationship between testosterone and glucose metabolism is well-established: testosterone improves insulin sensitivity, reduces visceral adiposity, and promotes lean muscle mass — all of which directly improve glycaemic control.

Multiple studies show TRT in diabetic hypogonadal men reduces HbA1c, decreases visceral fat, and improves insulin sensitivity. At Gini, men in the Diabetes Control Programme who are also hypogonadal typically see HbA1c improvements of 0.5–1.0 points from testosterone optimisation alone — on top of the gains from the broader programme.

Dr. Bhansali's endocrinology team monitors glucose control closely during TRT, adjusting diabetes medications as insulin sensitivity improves to prevent hypoglycaemia.

Can andropause cause depression?

Yes — and this is one of the most under-recognised aspects of the condition. Testosterone has direct effects on the neurotransmitter systems that regulate mood. Low testosterone is associated with reduced serotonin activity and impaired dopamine response — the two primary mood-regulating neurotransmitters.

Men with undiagnosed andropause are frequently treated for depression with antidepressants when the root cause is hormonal. The antidepressants provide partial or no relief because the underlying hormonal deficit remains unaddressed — and some antidepressants further suppress testosterone, worsening the problem.

If a man over 40 presents with new-onset depression — especially combined with fatigue, reduced libido, and muscle loss — a testosterone test should be routine, not optional. At Gini, we do not treat these as separate conditions. Both are assessed simultaneously.