Male Menopause in NZ: Is Andropause Real, and What to Test

In short: there is no male menopause in the sense women go through one. Testosterone falls slowly with age, by roughly 1% a year from your 30s or 40s, and many healthy men in their 60s still have normal levels. What does exist is late-onset hypogonadism: low testosterone plus symptoms, confirmed on two morning blood tests. It affects a minority of older men, and the same symptoms are more often caused by sleep, stress, weight, alcohol or mood.

If you're in your 40s or 50s, tired, flat and less interested in sex than you used to be, "male menopause" is the phrase that turns up first. This guide explains what is and isn't happening to your hormones, how a doctor tells low testosterone apart from everything that mimics it, and what to do next in New Zealand.

Is male menopause real?

Not as the name suggests. Menopause in women is a universal event: over a few years the ovaries stop releasing eggs, oestrogen falls steeply and periods end for good. Nothing like that happens to men.

The NHS describes the label as misleading for exactly this reason: it implies a sudden drop in testosterone, when the real change is gradual (NHS, The "male menopause"). New Zealand's primary-care guidance makes the same contrast. BPAC notes that male total testosterone begins to fall from around age 35, declines "very slowly", and that the change is "not inevitable or universal" (BPAC NZ 2024).

At what age does male menopause start?

There's no set age, because there's no single event. BPAC notes that total testosterone begins to fall gradually from around 35 (BPAC NZ 2024), and the NHS puts the decline at about 1% a year from around 30 to 40 (NHS). Healthify, New Zealand's health information service, says levels start to decrease from about age 30 (Healthify). The symptoms people blame on male menopause tend to show up in the 40s and 50s, which is also when sleep, weight, work stress and alcohol are changing.

How fast does testosterone fall with age?

Slowly. The Massachusetts Male Aging Study followed about 1,150 men aged 40 to 70 for seven to ten years. Within the same men, total testosterone fell by about 1.6% a year and the "bioavailable" fraction by 2–3% a year, because a carrier protein (SHBG) rises with age and binds more of it (Feldman et al., 2002).

The same study found that men in good health, with no chronic illness, obesity, regular prescription medicines or heavy drinking, had androgen levels 10–15% higher than their peers. In other words, a good part of what looks like ageing is actually health. A large European study found the same thing from the other direction: men who lost weight over four years saw their testosterone rise, and men who gained weight saw it fall (Camacho et al., 2013).

What is late-onset hypogonadism?

Late-onset hypogonadism is the medical term for the real version of what people mean by male menopause: testosterone low enough to cause symptoms, in a man who previously had normal levels.

The best evidence on it comes from the European Male Ageing Study, which surveyed 3,369 men aged 40 to 79 and measured their morning testosterone (Wu et al., 2010). Several symptoms tracked with lower testosterone, but only three sexual symptoms clustered together with it:

• fewer morning erections
• lower sexual desire
• erectile dysfunction

Fatigue, low mood and reduced physical vigour were also linked to lower levels, but much less specifically. Using strict criteria (three sexual symptoms plus low total and free testosterone), the study classified only 2.1% of men aged 40 to 79 as having late-onset hypogonadism, rising from 0.1% of men in their 40s to 5.1% of men in their 70s.

BPAC lists the same three sexual symptoms as the ones most indicative of low testosterone (BPAC NZ 2024). That's the practical point: tiredness on its own is a weak clue. Tiredness plus a clear fall in libido and morning erections is a stronger one.

Male menopause symptoms, and what else causes them

The symptoms people attach to male menopause are real. They just have many causes, and most of them aren't hormonal.

The NHS lists stress, depression, anxiety, lack of sleep, poor diet, lack of exercise, alcohol and smoking as common causes of the same symptom set (NHS). Low testosterone can also be the result of something else rather than the cause: excess weight, heavy drinking, sleep deprivation and some medicines, including opioids and high-dose corticosteroids, all lower it (BPAC NZ 2024). Healthify adds emotional stress and obstructive sleep apnoea to that list (Healthify).

This is why a symptom checklist can't diagnose anything. A checklist is useful for organising what you've noticed (see low testosterone symptoms), but the answer comes from blood tests read alongside your history.

How is low testosterone diagnosed?

A diagnosis needs two things together: symptoms, and low testosterone confirmed properly. In practice that means:

1. Morning blood tests. Testosterone peaks in the morning, so BPAC advises testing between 7 and 11 am, ideally fasting. For shift workers, BPAC advises two to three hours after waking instead (BPAC NZ 2024).
2. Two results, not one. A single low result is repeated, preferably about four weeks later, because acute illness, or recent food or alcohol, can push testosterone down temporarily (BPAC NZ 2024).
3. The right panel. Total testosterone, plus SHBG so free testosterone can be calculated, plus LH and FSH to show whether the problem starts in the testes or the pituitary, and general health markers.
4. A look for reversible causes first. Weight, sleep, alcohol, medicines and mood are worked through before anyone reaches for treatment.

Enhanced Men diagnoses low testosterone when a man has symptoms and two morning results, three to four weeks apart, both below 12 nmol/L total testosterone (the European Association of Urology threshold) or 225 pmol/L free testosterone. Above that line is not low testosterone, and we don't prescribe for it. Guidelines differ on the exact number: BPAC says local expert opinion is that the threshold for diagnosing low testosterone and starting treatment should be low, under 8 nmol/L, and suggests GPs discuss results between 8 and 12 with an endocrinologist (BPAC NZ 2024). Our article on normal testosterone levels in NZ lists every published lab range.

Can male menopause be treated?

If the tests show late-onset hypogonadism, testosterone treatment is an option, prescribed by a doctor and monitored with regular blood tests. If they don't, testosterone isn't the answer, whatever your age. Healthify puts it plainly: only men with symptoms and blood tests that confirm low testosterone should consider testosterone replacement (Healthify).

The best trial evidence in older men sets realistic expectations. In the Testosterone Trials, men aged 65 and over with low testosterone and symptoms were given testosterone gel or placebo for a year. Testosterone moderately improved sexual function and slightly improved mood, but did not improve energy (vitality) or walking distance more than placebo (Snyder et al., 2016).

On safety, the TRAVERSE trial followed 5,246 men aged 45 to 80 with low testosterone and heart disease or high heart risk. Testosterone was no worse than placebo for heart attacks, strokes and cardiovascular deaths (7.0% vs 7.3% over about three years), but atrial fibrillation, acute kidney injury and pulmonary embolism were more common in the testosterone group (Lincoff et al., 2023). Testosterone also lowers sperm production, so fertility plans are discussed before any treatment starts (Bhasin et al., 2018).

For men whose levels are normal, the evidence points to the unglamorous list: sleep, weight, strength training, alcohol, and treating depression or sleep apnoea where they're present. New Zealand's activity guidelines recommend muscle-strengthening on at least two days a week (Health New Zealand).

Can andropause be reversed?

Often, at least in part. Because a good share of the fall in testosterone tracks health rather than age, fixing the drivers can lift it. Weight loss raises testosterone in men carrying extra weight (Corona et al., 2013), and men who lost weight over four years in the European Male Ageing Study saw their levels rise (Camacho et al., 2013). Better sleep, less alcohol and reviewing medicines that lower testosterone can help too. Low testosterone in older men isn't always permanent: in the European Male Ageing Study, 43% of men with secondary hypogonadism (low testosterone without a raised LH) were back in the normal range about four years later, mostly those who weren't obese or who had lost weight (Rastrelli et al., 2015). Where low testosterone is confirmed on repeat testing, no fixable cause is found and symptoms are troublesome, that's when a doctor will talk with you about treatment.

What to do next

• Write down what's changed and when. "Less interested in sex over the last year, waking with fewer erections, flat at work" is more useful to a doctor than "I feel old".
• Take the free AMS self-check. It's an anonymous 17-question symptom score. It can't diagnose low testosterone, but it tells you whether your symptom load is worth a blood test.
• Get morning bloods, twice. Your GP can request them, or you can see a doctor privately. See where to get tested, below.
• If you've already been told you're normal, our guide on what to do when your GP says your testosterone is normal explains why different doctors read the same number differently.

Where to get tested in NZ

There's no test for male menopause. The test is for low testosterone, which means two morning blood tests. The two usual routes are below, and neither needs a referral.

Your GP. Your GP can request the same morning tests, repeat them and start treatment when low testosterone is clearly there. If two morning results fall between 8 and 12 nmol/L, BPAC suggests your GP consider discussing them with an endocrinologist.

A private doctor by video. Enhanced Men, which publishes this guide, is a New Zealand telehealth clinic run by Dr Jack Yeoman, who does every consult himself. He's registered with the Medical Council of New Zealand in general scope (MCNZ 89436). General scope isn't a specialist registration, and it isn't general practice either: he isn't vocationally registered as an endocrinologist, a urologist or a GP, and he refers you on when your case needs a specialist. You see him by video wherever you live in New Zealand, with no GP referral. Your bloods are taken at your local community lab; if you're eligible for publicly funded healthcare, funded tests cost you nothing, and the lab bills you for any test that isn't funded. He diagnoses low testosterone only when you have symptoms and two morning results, three to four weeks apart, both below 12 nmol/L total or 225 pmol/L free testosterone. Above that line is not low testosterone, and he doesn't prescribe for it. Testosterone treatment usually suppresses sperm production. If you may want children, say so before you start.

Whichever route you choose, take copies of any earlier results, with the time each sample was taken, and what your GP made of them.

FAQ

Is male menopause real? Not in the way menopause is real for women. Men don't have a sudden, universal hormone drop. Testosterone falls slowly with age, and only a minority of older men develop late-onset hypogonadism, which is low testosterone plus symptoms confirmed on two morning blood tests.

At what age does male menopause start? There's no set age, because there's no single event. BPAC notes that total testosterone begins to fall gradually from around age 35, but the decline is slow and not universal. Symptoms blamed on male menopause most often appear in a man's 40s and 50s, when sleep, weight, work stress and alcohol are also changing.

What are the three symptoms of andropause? The three symptoms most specifically linked to low testosterone in older men are low sexual desire, fewer morning erections and erectile dysfunction. Tiredness, low mood and less muscle are common too, but they have many other causes.

What are the symptoms of male menopause? The symptoms usually linked to it are low sex drive, fewer morning erections, erectile dysfunction, tiredness, low mood, loss of muscle and more belly fat. The three sexual symptoms are the ones most specifically linked to low testosterone; tiredness and low mood have many other causes.

How do I find out if I have male menopause? Ask for two morning testosterone tests, about four weeks apart, with SHBG, LH and FSH, and have them read alongside your symptoms and history. A symptom questionnaire can tell you whether testing is worthwhile, but only blood tests can show whether testosterone is low.

Can male menopause be treated in NZ? If tests confirm late-onset hypogonadism, testosterone treatment can be prescribed by a doctor in New Zealand and monitored with regular blood tests. If testosterone is normal, treatment focuses on the actual cause, such as sleep, weight, mood or alcohol.

Where can I get tested for male menopause in NZ? The test is for low testosterone: two morning blood tests, three to four weeks apart, with SHBG, LH and FSH. Your GP can request them. Enhanced Men, Dr Jack Yeoman's telehealth clinic, does the same assessment by video anywhere in New Zealand with no referral, using your local community lab, and diagnoses low testosterone only when you have symptoms and both results are below 12 nmol/L total or 225 pmol/L free.

References

1. NHS. The "male menopause". Last reviewed 13 October 2022. https://www.nhs.uk/conditions/male-menopause/
2. BPAC NZ. Prescribing testosterone in ageing males. 25 November 2024. https://bpac.org.nz/2024/testosterone.aspx
3. Feldman HA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 2002;87(2):589–98. https://doi.org/10.1210/jcem.87.2.8201
4. Camacho EM, et al. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur J Endocrinol. 2013;168(3):445–55. https://doi.org/10.1530/EJE-12-0890
5. Wu FCW, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123–35. https://doi.org/10.1056/NEJMoa0911101
6. Snyder PJ, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611–24. https://doi.org/10.1056/NEJMoa1506119
7. Lincoff AM, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med. 2023;389(2):107–17. https://doi.org/10.1056/NEJMoa2215025
8. Bhasin S, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–44. https://doi.org/10.1210/jc.2018-00229
9. Corona G, et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol. 2013;168(6):829–43. https://doi.org/10.1530/EJE-12-0955
10. Rastrelli G, et al. Development of and recovery from secondary hypogonadism in aging men: prospective results from the EMAS. J Clin Endocrinol Metab. 2015;100(8):3172–82. https://doi.org/10.1210/jc.2015-1571
11. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health, 2026 edition: Male hypogonadism (section 3.3.5). https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-hypogonadism
12. Healthify NZ. Testosterone deficiency. Reviewed 13 December 2024. https://healthify.nz/health-a-z/t/testosterone-deficiency
13. Healthify NZ. Testosterone replacement therapy. Reviewed 5 April 2024. https://healthify.nz/medicines-a-z/t/testosterone-replacement-therapy
14. Health New Zealand | Te Whatu Ora (HealthEd). Be active every day: physical activity for adults (HE2311). Updated May 2025. https://healthed.govt.nz/resource/be-active-every-day-physical-activity-adults

This article is general health information, not personalised medical advice. Symptoms of low testosterone overlap with many other conditions, so the right next step is a doctor reading your results in the context of your history.