Penopause: does male menopause actually exist?

Penopause is not an official medical term, but millions of men recognise the pattern: after 40, energy drops, libido fades, sleep gets restless. From age 30 your testosterone declines by roughly 1 to 2 percent per year. In some men these changes line up with what doctors call late-onset hypogonadism, a recognised clinical condition. This article explains what penopause is and is not, which blood values clarify what is going on, and when to see your GP.

What is penopause, and is it real?

Penopause is a popular, non-medical term for the gradual hormonal decline in men over 40. The Dutch GP society (NHG) does not recognise penopause as a separate diagnosis. What does exist is late-onset hypogonadism: a clinical syndrome where lowered testosterone occurs together with specific symptoms. Penopause describes a feeling, LOH describes a diagnosis.

The term suggests men go through something similar to the female menopause. That is only partly accurate. In women, ovarian function stops within a few years, with sharp hormone drops and clear symptoms. In men, testosterone declines much more gradually, with large individual variation. A healthy 60-year-old can have higher testosterone than a stressed, sleep-deprived 30-year-old.

What the term does well: it acknowledges that men also go through a phase of hormonal change. Denying that is as unhelpful as overstating it. The real question stays the same: which biomarker pattern matches your symptoms?

What are the symptoms of male menopause?

Common symptoms include persistent fatigue, low libido, erectile difficulties, hot flushes, mood swings, irritability, poor sleep, muscle-mass loss and abdominal-fat gain. In about 2 percent of men aged 40 to 79, these symptoms are linked to lab-confirmed low testosterone (Wu et al., NEJM 2010). For most others the cause lies elsewhere.

The typical symptom groups:

• Physical: fatigue, reduced strength, abdominal-fat gain, muscle-mass loss, hot flushes, night sweats.
• Sexual: lower sex drive, fewer spontaneous morning erections, gradually worsening erectile dysfunction.
• Mental: irritability, low mood, reduced concentration, lower motivation, emotional flattening.
• Sleep: difficulty falling asleep, restless sleep, waking unrefreshed.

One or two of these signs in isolation says little. Three or more lasting longer than six weeks deserve attention. Symptoms alone are not enough for a conclusion: blood work is needed.

At what age does penopause start?

Testosterone begins a gradual decline around age 30 at roughly 1 to 2 percent per year (Travison et al., J Clin Endocrinol Metab 2007). Most men notice little until their 50s. Symptoms that affect daily life usually appear between 50 and 70, with large individual differences.

Age is not the only driver. A healthy 60-year-old sometimes has higher values than a stressed 35-year-old with poor sleep and excess weight. Sleep, weight, training, stress and alcohol each have their own, measurable effect on testosterone.

For most men it makes sense to get a baseline around age 40. Not because you expect symptoms yet, but because a measurement during a symptom-free period gives you a personal reference point. If symptoms appear later, you know how far you have moved from your own normal.

Penopause, andropause or late-onset hypogonadism: the difference

Penopause and andropause are popular terms for the same phenomenon, but neither is a formal diagnosis. Late-onset hypogonadism (LOH) is the medical diagnosis according to the European Association of Urology (EAU Guidelines on Sexual and Reproductive Health, 2024). Criteria: low total testosterone on two morning measurements, combined with at least three typical symptoms (such as low libido, reduced morning erections, or erectile difficulties).

The distinction matters in practice:

• Penopause / andropause: informal, lay-friendly terms. No treatment indication on their own.
• Late-onset hypogonadism: clinical diagnosis based on lab values plus symptoms. Only here would a doctor discuss treatment options, including lifestyle changes or in select cases testosterone therapy.

About 23 percent of men over 60 have biochemically low values, but only around 2 percent meet the full LOH criteria of lab plus symptoms (Wu et al., 2010). The rest either have symptoms without low values, or low values without symptoms. Both situations call for a different conversation with the GP.

Which blood values give clarity?

Four markers tell the story together: total testosterone, free testosterone (or SHBG), LH and FSH. Low testosterone with low LH points to a central brain-signal problem. Low testosterone with high LH suggests the testes are at fault. Normal total testosterone with high SHBG can still cause symptoms because too little free testosterone is available.

The four core markers and their typical adult-male reference ranges:

• Total testosterone: typically 10 to 35 nmol/L. Always sample in the morning, when testosterone is highest.
• SHBG (sex hormone-binding globulin): 18 to 54 nmol/L. High SHBG can make a normal total testosterone clinically low.
• Free testosterone: 0.225 to 0.725 nmol/L (calculated or measured). This is the biologically active fraction.
• LH (luteinising hormone): 1.5 to 9.3 IU/L. Indicates whether the brain is signalling testosterone production.
• FSH (follicle-stimulating hormone): 1.4 to 18.1 IU/L. Most relevant for fertility questions.

The biomarker decision aid, four common patterns:

• Low testosterone + low LH: brain signal is reduced. Often a result of stress, sleep deprivation, excess weight or medication. Responds best to lifestyle.
• Low testosterone + high LH: testes not responding adequately. Suggests primary hypogonadism and warrants medical evaluation.
• Normal total testosterone + high SHBG + symptoms: too little free testosterone available. Measuring free testosterone or SHBG is the key.
• Normal total testosterone + normal SHBG + symptoms: cause likely lies elsewhere. Check thyroid, iron, cortisol or sleep.

To map the full pattern in one go, the Hormones Man test covers all four core markers plus free testosterone. For a broader view including thyroid and metabolism, see the Men 40+ Panel.

Symptom overlap: penopause, burnout or something else?

Many penopause symptoms overlap heavily with burnout, sleep apnoea, depression, hypothyroidism and iron deficiency. Fatigue, irritability and low libido fit each of these. Blood work is what separates them: TSH points to thyroid, ferritin to iron, cortisol to stress, and the testosterone-LH pattern to the hormonal track.

Which biomarker fits each overlapping cause:

• Penopause / LOH: low total testosterone, often with low or normal LH, often elevated SHBG. Symptoms match if fatigue plus low libido plus reduced morning erections persist beyond six weeks.
• Burnout / chronic stress: disturbed cortisol rhythm (low morning or high evening), testosterone secondarily reduced, sleep restless. Treatment: stress and recovery first.
• Sleep apnoea: fatigue and low libido without clear testosterone or cortisol abnormality. A sleep study (polysomnography) or partner-observed snoring and breath pauses point the way.
• Depression: mood and energy symptoms dominate, libido secondary. Blood values normal or mildly off. Symptoms match DSM-5 criteria for a depressive episode.
• Hypothyroidism: elevated TSH, often reduced free T4. Fatigue, cold intolerance, weight gain, dry skin, constipation. Thyroid panel quickly clarifies.
• Iron deficiency: low ferritin (below 50 ug/L for active men), possibly low haemoglobin. Fatigue and breathlessness on exertion. More common than expected in men who train intensively.

A single marker without context can mislead. A broader panel is usually wiser than testosterone alone.

What can you do yourself about symptoms?

Lifestyle has more impact on testosterone than age alone for many men. The four interventions with the strongest evidence are sleep, resistance training, body composition and stress reduction. What the research consistently supports:

• Sleep 7 to 9 hours per night: at 5 hours per night, testosterone drops 10 to 15 percent within a week (University of Chicago research).
• Resistance training with compound movements: squats, deadlifts, bench press, overhead press at 70 to 85 percent of 1RM, 3 to 5 times per week.
• Keep body-fat percentage between 12 and 20 percent: excess abdominal fat converts testosterone to oestrogen, while extremely low body fat suppresses hormone production.
• Limit chronic stress: high cortisol suppresses testosterone via the HPA axis. Breathing exercises, walking in nature, and recovery time work.
• Limit alcohol: more than 7 standard drinks per week measurably lowers testosterone.

For depth on these interventions, see our guide on understanding testosterone, the broader overview of male hormonal health and the full overview in men's health after 40.

Over-the-counter testosterone boosters show no clinically relevant effect in healthy men in well-designed trials. Vitamin D and zinc are exceptions, but only if your values are already low. Measure first, supplement second.

When to see your GP?

Make an appointment if you recognise three or more typical symptoms lasting longer than six weeks that affect your daily life. Also if your blood values fall outside reference range, or if sudden erectile difficulties appear: do not wait. Your GP can rule out other causes (thyroid, iron, depression, sleep apnoea) and refer you to an endocrinologist or urologist if needed.

What to bring to the consultation:

• Your symptom list with start date and intensity per complaint.
• Recent blood results, ideally with a morning measurement of testosterone, SHBG, LH and FSH.
• A list of your medications and supplements: some drugs (opioids, glucocorticoids, certain antidepressants) suppress testosterone.
• Notes on sleep, alcohol, weight and stress factors.

Your GP decides next steps with you. Testosterone replacement therapy (TRT) is a serious, lifelong intervention and not a first-line solution for age-related complaints. Only when lifestyle has had no or insufficient effect, and LOH criteria are met, does TRT enter the conversation.

Frequently asked questions

How long does male menopause last?

Unlike in women, men have no sharply defined phase. The gradual testosterone decline of 1 to 2 percent per year begins around age 30 and continues lifelong. Symptoms affecting daily life are usually visible between 50 and 70, but duration and intensity differ widely. Some men experience little change; others go through a recognisable transition lasting several years.

Can penopause cause hot flushes, like in women?

Yes, hot flushes can occur in men with markedly low testosterone, though less often and less intensely than in female menopause. In men receiving testosterone-suppressing therapy for prostate cancer, hot flushes are a known side effect. In gradual age-related decline, hot flushes are rarer and usually indicate either substantially low testosterone or another cause (such as thyroid or stress).

Does testosterone replacement (TRT) help penopause?

TRT only helps men who meet the clinical LOH criteria: repeatedly measured low testosterone combined with matching symptoms. In men with normal values or mild age-related decline, TRT offers no demonstrated benefit, and the side effects (reduced fertility, thickened blood, acne, lifelong dependence) do not outweigh the gains. For most men with symptoms, lifestyle is the first and most effective route.

What is the difference between penopause and burnout?

The symptoms can feel nearly identical: fatigue, irritability, low mood, reduced libido. The difference shows in the biomarker pattern. In burnout the cortisol rhythm is disturbed (low morning cortisol or a flat day curve), testosterone is usually secondarily reduced, and recovery improves symptoms. In penopause or LOH, testosterone is primarily reduced, often with abnormal LH or SHBG, and rest plus stress reduction alone often does not resolve it. The two can also coexist.

Can I test myself for penopause at home?

Finger-prick and saliva tests give an indicative value but less reliable numbers than a venous morning draw at an accredited lab. For a reliable baseline we recommend at least a venous measurement of total testosterone, SHBG, LH and FSH, drawn before 10 a.m. The Hormones Man test from Caliberhealth uses a venous draw at a sample-collection point near you, with results typically within 24 to 72 hours.

References

1. Wu FCW et al. Identification of late-onset hypogonadism in middle-aged and elderly men. New England Journal of Medicine. 2010;363(2):123-135. PMID: 20571035.
2. Travison TG et al. A population-level decline in serum testosterone levels in American men. Journal of Clinical Endocrinology and Metabolism. 2007;92(1):196-202. PMID: 17062768.
3. EAU Guidelines on Sexual and Reproductive Health. European Association of Urology. 2024.
4. NHG Practice Guideline on Erectile Dysfunction. Dutch College of General Practitioners. Revised 2023.
5. Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305(21):2173-2174. PMID: 21632481.

Disclaimer

This article provides general information and is not a substitute for medical advice from a GP or specialist. A Caliberhealth blood test is a tool to inform your conversation with your doctor, not a diagnosis on its own. For severe symptoms, sudden erectile dysfunction, or concerns about your health: contact your GP, or call 112 in case of emergency.