Table of Contents
- Not a Midlife Crisis—A Slow Biological Shift
- Debunking the “Male Menopause” Myth
- Understanding Male Hypogonadism
- Recognizing the Signs of Testosterone Deficiency
- The Role of Diagnosis and Blood Test
- Not All Testosterone Therapy Is Created Equal
- Lifestyle Changes That Make a Difference
- What the Experts Recommend
- Monitoring and Adjusting Treatment Over Time
- So—Is It for You?
- Final Thought
Not a Midlife Crisis—A Slow Biological Shift
Unlike women, who experience a relatively sudden and complete end to ovarian function (menopause), men face a slower, more variable process. Testosterone—your primary male hormone—starts to decline subtly, often beginning around age 30. Data suggest that the yearly loss is typically around 1%, and this gradual decrease can eventually lead to a low testosterone level, though it’s not something you’ll feel right away.
There’s no midnight bell that rings. But over time, men notice signs and symptoms that indicate changes.
A patient may say:
- “I recover more slowly from workouts.”
- “I’m getting more sleep but still waking up tired.”
- “My sex drive isn’t gone, but it’s definitely not what it used to be.”
- “I’m not angry or sad. I’m just dulled.”
Many chalk this up to stress, overwork, or age. And sometimes that’s true. But these are also classic symptoms of low testosterone—or late-onset hypogonadism.
Debunking the “Male Menopause” Myth
The term male menopause has been floating around for years. But it’s a bit of a misnomer.
Unlike female menopause, which comes with a clear drop-off in reproductive function and estrogen production, men’s testosterone decline is more subtle and not universal. Many men in their 60s and even 70s maintain healthy hormone levels and reproductive capability. In fact, most older men still fall within the ‘normal’ testosterone range—even if they’re symptomatic.
According to the Mayo Clinic, only 10% to 25% of older men have low testosterone levels that are low enough to be flagged by lab standards. Even then, the connection between levels and symptoms isn’t always straightforward. Some men with low numbers feel fine. Others within the normal range feel depleted.
What matters more than the number is the combination of symptoms and lab confirmation—preferably more than once. The testosterone level measured in blood tests is the key value used to diagnose deficiency. In addition, testing free testosterone can provide a more accurate assessment of hormonal status, especially when total testosterone results are borderline or symptoms persist despite normal total levels.
Understanding Male Hypogonadism
Male hypogonadism, sometimes called testosterone deficiency syndrome, is a medical condition where the body doesn’t produce enough testosterone—the hormone that fuels much of what makes you feel like yourself. Testosterone is essential for maintaining sex drive, supporting sperm production, building muscle mass, and keeping your mood and energy levels steady. When testosterone levels drop below what’s healthy for your age, you might notice symptoms like low energy, reduced sex drive, erectile dysfunction, mood swings, or even changes in muscle strength.
This isn’t just about getting older—male hypogonadism is a diagnosable medical condition that can impact your quality of life. Causes can range from issues with the testicles themselves to problems with the pituitary gland, which helps regulate hormone production. If you’re experiencing symptoms of low testosterone, it’s important to get a proper diagnosis. Treatment options, including testosterone replacement therapy, can help restore testosterone levels and improve symptoms. But because every case is unique, working with a healthcare provider to find the right replacement therapy is key. Addressing testosterone deficiency isn’t just about boosting sex drive or muscle mass—it’s about reclaiming your overall well-being.
Recognizing the Signs of Testosterone Deficiency
Symptoms can vary widely and often overlap with other medical conditions or life stressors. But here are some of the more common complaints:
- Decreased sexual desire or activity
- Difficulty achieving or maintaining erections
- Mild breast enlargement or tenderness
- Fertility concerns
- Mild anemia without clear cause
- Increased body fat and loss of muscle tone
- Mood changes: depression, apathy, irritability
- Trouble concentrating or remembering things
- Sleep disturbance and increased daytime fatigue
- Increased facial hair (in women, as a possible androgenic effect)
Other symptoms may also occur, such as changes in bone density, joint pain, or subtle shifts in energy levels.
Some men even report hot flashes or night sweats—often considered “female” symptoms but sometimes linked to testosterone decline in men.
Of course, these symptoms can also stem from obstructive sleep apnea, obesity, chronic illness, medications (especially opioids), or psychological stress—which is why testing should never occur in isolation.
The Role of Diagnosis and Blood Test
If symptoms are consistent and persistent, a healthcare provider may order a serum testosterone test, typically taken in the early morning. If that test confirms low blood testosterone (below 300 ng/dL), a second test is often recommended to confirm accuracy.
Additional labs might assess pituitary function, check estrogen levels, or look for other hormone deficiencies, especially if the testosterone drop seems disproportionate for age or symptoms, or if an underlying condition such as Klinefelter syndrome is suspected.
Not All Testosterone Therapy Is Created Equal
This is where the discussion often turns commercial. There are plenty of products out there—gels, shots, supplements, lifestyle coaches. Some helpful. Some hype. When considering hormone therapy as a treatment option for menopausal symptoms, sexual dysfunction, or other concerns, it’s important to compare FDA approved products, which are regulated for safety and efficacy, with compounded bioidentical hormones, which are custom-made preparations that lack FDA approval and robust safety data.
But what’s often overlooked in the noise is bioidentical hormone replacement therapy—especially in pellet form, like what we offer through Evexias. Bioidentical hormones are marketed as natural and safe alternatives to conventional therapies, but their safety and effectiveness remain debated. Compounded bioidentical hormones, in particular, are not subject to the same rigorous testing as FDA approved products, and their use may carry an increased risk of adverse effects, including weight gain, androgenic symptoms, and even endometrial cancer. Patients should be counseled about these potential adverse effects, especially when considering off-label or compounded treatments.
Most men, when they think of testosterone therapy, picture weekly injections or messy gels. Testosterone gel is a commonly used FDA-approved alternative to pellets. What they haven’t heard about is this:
- Tiny testosterone pellets, about the size of a grain of rice, are inserted just under the skin.
- These pellets release bioidentical testosterone—structurally identical to what your body naturally makes—over 3 to 6 months.
- Your body takes what it needs, when it needs it.
Compounded bioidentical hormones can also be delivered as an oral pill for patients who require alternative routes of administration. Hormone therapy, including menopausal hormone therapy, can address a range of menopausal symptoms, such as hot flashes and vaginal symptoms, but the choice of treatment option should involve shared decision-making, considering the potential for increased risk of adverse effects with compounded preparations.
That means no hormone rollercoaster, no daily chores, and just 2–4 outpatient visits per year.
Few clinics in our area offer this. That’s not just a convenience gap—it’s a clinical one. Because this method offers one of the most physiologic and consistent delivery systems available.
Lifestyle Changes That Make a Difference
While medical treatment can play a big role in managing low testosterone, your daily habits matter, too. Simple lifestyle changes can help support healthy testosterone levels and overall hormone balance. Start with a healthy diet rich in whole foods, lean proteins, and plenty of fruits and vegetables. Regular exercise—especially strength training and high-intensity interval training (HIIT)—can give your testosterone levels a natural boost, while also improving muscle mass and energy.
Getting enough quality sleep is just as important, since poor sleep can disrupt hormone levels. If you’re carrying extra weight, losing weight can help increase testosterone and improve other aspects of your health. Managing stress through mindfulness, meditation, or yoga can also help keep hormone levels in check. It’s wise to limit alcohol, avoid smoking, and steer clear of endocrine-disrupting chemicals found in some plastics and pesticides, as these can negatively impact hormone health. Small changes add up, and a healthier lifestyle can make a real difference in how you feel.
What the Experts Recommend
According to guidelines from the American College of Physicians (2020) and the Endocrine Society (2018):\
- Testosterone therapy should be considered for men with confirmed low testosterone and symptoms, particularly related to sexual function.\
- For some men, therapy may also help improve mood, energy, and cognitive sharpness—but the evidence is more variable.\
- Many providers will avoid initiating therapy if the patient has untreated sleep apnea, prostate cancer risk, recent heart attack, heart disease, or wants to maintain fertility.
Some risks remain under study. While links to prostate cancer and cardiovascular events have been debated, current data is not definitive. Testosterone therapy may have potential adverse effects, including increased risk of heart disease, stroke, and other complications. Like any therapy, it’s about weighing risk, benefit, and personal goals.
Monitoring and Adjusting Treatment Over Time
Starting testosterone replacement therapy is just the beginning—ongoing monitoring is essential to make sure your treatment is working and to keep you safe. Regular blood tests help track your testosterone levels and ensure they stay within a healthy range. Your healthcare provider may also check other hormones, like follicle stimulating hormone (FSH) and luteinizing hormone (LH), to better understand the root cause of your low testosterone and fine-tune your treatment plan.
Routine check-ups are important for catching any potential side effects early, such as blood clots, breast cancer, or prostate cancer. By keeping a close eye on your health history and making adjustments as needed, you and your provider can work together to minimize risks and maximize benefits. Monitoring isn’t just about numbers—it’s about making sure you feel your best, safely and sustainably, as you move forward with treatment.
So—Is It for You?
Let’s go back to our patient in his 50s. He doesn’t want to be a bodybuilder. He’s not chasing youth. He just wants to feel like himself again.
If you relate to that—if you’ve felt like your edge is slipping, your recovery is slower, or your drive is missing—it’s worth having the conversation.
A blood test won’t hurt. A second opinion never costs much. And if you qualify, a therapy like Evexias bioidentical pellet implants could give you back not just function—but steadiness.
Final Thought
This isn’t about selling eternal youth. It’s about being present and functional as you age—on your terms.
We don’t push testosterone therapy on everyone. But we do make sure that for the men who need it, it’s done the right way: bioidentical, consistent, and safe.
And above all: tailored to you.
Peak Masculinity
Starts Here
By Dr. Ryan Welter
September 27, 2025
