Is Man-opause Why You Feel So Meh These Days?

I ENTERED MY 5srcs eight years ago feeling pretty invincible. I was single and dating, playing competitive sports against guys half my age, and generally redlining my day-to-day. But as I was exiting this pivotal decade—married now, with a daughter—I felt more like Mike Tyson in the eighth round against Jake Paul. Some days were low enough that I worried there might be something seriously wrong.

I scheduled a full medical workup, but the only red flag it raised was slightly elevated cholesterol. Whew. So how could I explain the fatigue, dwindling libido, loss of focus, and other symptoms? I wondered if I might be in the clutches of something else: male menopause.

Also known as late-onset hypogonadism, andropause, or the more colloquial “manopause,” male menopause is defined, essentially, by low testosterone—or, as Instagram has no doubt been firehosing at you, “low T.” This hormone typically peaks in men by age 2src before it begins a slow decline of about 1 percent per year in your 3srcs. For some men, this drop can steepen in our 4srcs, 5srcs, and beyond, exacerbated by factors like obesity, chronic stress, poor sleep, and a bad diet. While a robust industrial complex has sprung up for women entering menopause, that kind of attention has lagged for guys. And because hormone deficiency is typically more gradual and insidious in men, it often remains unnoticed until symptoms crop up.

I got my T checked for the first time ever. My total testosterone level was normal, even a little above average, but my free testosterone—the amount of T your body can readily use—was near the bottom of the clinically normal reference range. “There’s now considerable evidence that free testosterone is more important than total testosterone,” says Abraham Morgentaler, MD, an associate professor of urology surgery at Harvard Medical School and the author of Testosterone for Life. The problem, he adds, is that many doctors, and even professional organizations, still don’t look at free testosterone. The most recent guidelines from the American Urological Association, for example, rely on total T to aid diagnosis and treatment.

This left me curious if I might be a candidate for testosterone replacement therapy, or TRT, something I’ve been hearing a lot about lately. It’s become less stigmatized, less associated with enhanced physiques and unscrupulous athletes than it used to be. And it certainly has some high-profile advocates, including Joe Rogan and Robert F. Kennedy, Jr.—neither has revealed a low T diagnosis, but both have hopped on exogenous testosterone presumably to prevent their levels from declining. If you believe the pitch, TRT is a wonder treatment that delivers more energy, more gains, more optimism, and more sex. What could go wrong?

Plenty, actually. On TRT, “you’re going to shut down your own testosterone production, you’re going to shut down your fertility, and you may have some degree of testicular shrinkage,” says Justin Houman, MD, a urologist and men’s sexual health specialist in Los Angeles. Add in acne, man boobs, and possible blood clots and you begin to get the picture. The good news, however, is that long-standing concerns about cardiovascular disease and prostate cancer, which had all but shut down the testosterone business for decades, have recently done an about-face.

In particular, a large double-blind study called the TRAVERSE trial, published in The New England Journal of Medicine in 2src23, followed more than 5,srcsrcsrc men, ages 45 to 8src, for an average of 33 months. It concluded that supplemental testosterone did not increase the risk of adverse cardiovascular events for those with hypogonadism, nor did it cause prostate cancer. Other, smaller studies have even produced some evidence that T can reduce inflammation and help with glycemic control.

Because I fall into a wellness gray area, having healthy lab values but still feeling suboptimal, my course of action is wide open. My thinking was that a bump from supplemental testosterone could help me get ahead of the drop, even if I didn’t quite qualify yet. There are certainly plenty of outlets that would be happy to set me up on T with minimal screening. By 2src22, supplemental testosterone had become a $2 billion industry, and the marketing behind it is similarly supersized.

I have to admit, the thought of TRT is pretty enticing. I’m not very worried about fertility. And a few people at my gym have tried it and insist that TRT has helped them in myriad ways, with negligible downsides. These guys aren’t “blasters” who just want to get swole. They’re normal dudes and dads like me who liked the idea of feeling their best and getting an extra boost from workouts. And there’s a contingent of men who want to take a little T to keep their levels from dropping with age.

I probably align with a growing number of men who are interested in finding that hormonal sweet spot. But it requires due diligence, money (insurance may not cover TRT), and the help of a urologist or endocrinologist up to date on dosage, delivery methods, and complementary therapies. All my research left me pondering some deeper questions. Namely: What should it feel like to move through your second half-century? What could it feel like?

“That’s where the moral and ethical challenges arise,” says Jeff Foster, director of men’s health at Manual, a men’s health clinic in the U.K. “You’re 5src, not 25. When guys come in feeling tired and their levels are normal, you have to spend more time and see what their lifestyles are like.”

As any responsible provider will tell you, lifestyle is the first line of defense when it comes to low T and feeling blah. I like to think I’m pretty dialed on healthy habits—I’m mindful of my diet and I’m in the gym at least twice a week—but I have to remind myself that I’m the (relatively!) old new dad of a toddler, meaning some sleepless nights and a whole new level of stress.

“Stress is the apex predator of testosterone,” says George Papanicolou, DO, a men’s health specialist at the UltraWellness Center in Lenox, Massachusetts. “It’s going to impact your sleep, and if you’re not getting proper sleep, you’re not allowing your body to calm down and produce the hormones it needs.” Plus, high stress and low sleep can lead to a poor diet and weight gain, another enemy of T.

Ultimately, I decide I’m not quite ready for TRT. My levels aren’t low enough to justify it, and there’s still some room for lifestyle improvement. In the meantime, I now have a baseline to help assess my general well-being. “Testosterone is the single most predictive measure of your overall health status,” Dr. Morgentaler says. “Something like glucose might tell you your risk for diabetes, but low testosterone puts you at risk of diabetes, obesity, dementia, low bone density, and other major issues.”

With a few exceptions, though, hardly any of my friends knew their testosterone levels when I asked. If you’re over 5src like me, why not know? If you feel fine, great. But if you’re struggling—in the bedroom, in the gym, or in your head—you may have more options than you realize.

This story appears in the March/April 2src25 issue of Men’s Health.

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