Andropause (Male Menopause) Treatment

Andropause is the gradual, age-related decline of testosterone in men — also called male menopause or late-onset hypogonadism — typically beginning after age 30. It rarely happens overnight. The workouts stop paying off, the afternoon fatigue arrives earlier, your drive — at the gym, at work, in the bedroom — quietly fades, and the mirror shows a softer version of you. Most men write it off as age or stress. But these changes often have a measurable hormonal basis — and when testing confirms low testosterone, it can be treated.

At Dramov Naturopathic Medical Center, Dr. Rob Dramov has spent more than two decades helping men restore hormone balance the right way: test thoroughly, find the cause, treat it, and monitor the results. We see men at both of our clinics — one in Arizona, one in Oregon.

Signs your testosterone may be low

Andropause develops so gradually that most men adjust around it for years before asking why. If several of these sound familiar, it’s time for a proper hormone evaluation:

• Persistent fatigue — energy that runs out by mid-afternoon no matter how well you slept or how much coffee you drink.
• Low libido — a sex drive that faded so gradually you barely noticed it leaving.
• Erectile changes — erections that are less frequent, less reliable, or less firm than they used to be.
• Shrinking strength and muscle — workouts that no longer build — or even maintain — the muscle they once did.
• Stubborn weight gain — body fat settling around the middle despite unchanged eating and exercise habits.
• Low mood and motivation — irritability, flatness, or a loss of competitive drive that doesn’t feel like you.
• Broken sleep and brain fog — restless nights, and focus and memory that slip in the middle of the workday.

What causes andropause

Andropause — often called male menopause, and known clinically as late-onset hypogonadism — is the gradual, age-related decline of testosterone. Because testosterone regulates muscle, bone, fat distribution, mood, cognition, and libido, its decline is felt everywhere. Here’s the physiology behind it:

A slow slide, not a sudden stop

Unlike a woman’s menopause, which arrives at a defined point, testosterone declines by roughly 1% per year starting in a man’s 30s — the rate measured over decades in the Baltimore Longitudinal Study of Aging. At the same time, a binding protein called SHBG rises with age and ties up more of what remains — so free testosterone, the fraction your tissues can actually use, often falls faster than total testosterone. By the 40s and 50s, that slow arithmetic becomes something you can feel.

The signaling system behind it

Testosterone production runs on a feedback loop: the hypothalamus and pituitary gland signal the testes using two hormones, LH and FSH. Decline can originate in the testes themselves or in weakened signaling from above — and lab testing can distinguish the two. That distinction matters, because it changes how the problem should be treated.

What accelerates the decline

Age sets the pace, but overall health influences it. Excess body fat is linked to faster decline — fat tissue converts testosterone into estrogen — and type 2 diabetes, chronic illness, a sedentary routine, poor sleep, and certain medications are all associated with lower levels. Chronic stress matters too: a disrupted cortisol rhythm can suppress the signaling chain behind testosterone production, which is why we evaluate stress-hormone function alongside testosterone.

Why “you’re just getting older” is a bad answer

Many men finally mention these symptoms, get a single testosterone test, and are told everything looks “normal.” The problem: standard reference ranges are built from men of all ages and health statuses, so a 50-year-old can sit inside the range while running well below the level his own body functioned well at. And if only total testosterone is checked — without free and bioavailable fractions, LH, FSH, thyroid, and cortisol — the workup can miss the actual cause entirely.

This isn’t only about feeling better, though that matters. Low testosterone is associated with declining bone density, loss of muscle mass, increased abdominal fat, insulin resistance, and low mood — a slow compounding of risks that deserves attention, not a shrug. Addressing hormone health now is how you protect your strength, metabolism, and clarity for the decades ahead.

How we diagnose it

Your care starts with an in-depth, 60-minute initial visit reviewing your medical history, existing lab results, nutrition, and lifestyle. Then we test — properly, with a morning blood draw, when testosterone naturally peaks:

• Total testosterone — measured in the morning and confirmed with repeat testing; a level below about 300 ng/dL with consistent symptoms is a widely used guideline threshold for low testosterone.
• Free and bioavailable testosterone — the fraction your tissues can actually use — often low even when the total number looks fine, because SHBG rises with age.
• LH and FSH — the pituitary signals that reveal whether the decline starts in the testes or upstream in the brain’s signaling.
• Estrogen and DHEA — men make estrogen too, and the testosterone-to-estrogen balance affects mood, libido, and body composition.
• Cortisol — because chronic stress can suppress testosterone production and contribute to the fatigue and abdominal weight gain that often come with it.
• A full thyroid panel — low thyroid function mimics andropause almost symptom for symptom — fatigue, weight gain, low mood, brain fog — and must be ruled in or out.

One low reading isn’t a diagnosis — testosterone varies from day to day, so results are confirmed and interpreted in the context of your age, symptoms, and goals, not just “within normal limits.” That is the standard set by the Endocrine Society’s clinical practice guideline, which recommends diagnosing testosterone deficiency only when a man has both symptoms and consistently low levels on more than one morning test.

How we treat andropause

There is no template protocol and no one-size dose. Your plan is built from your labs, your symptoms, and your goals — then monitored and refined as your body responds.

Testosterone replacement therapy (TRT)

When testing confirms low testosterone, restoring healthy levels can improve energy, libido, erectile function, mood, muscle mass, and body composition. We use bioidentical testosterone — molecularly identical to what your body produces — with delivery tailored to your life: injections, creams, capsules, troches, or long-acting pellets. Learn more on our testosterone replacement therapy and BHRT for Men pages.

Foundations: strength, nutrition & sleep

Resistance training, adequate protein, weight management, moderated alcohol, and genuinely restorative sleep all support your body’s own testosterone production — much of your daily testosterone release happens during sleep. These foundations can move your numbers on their own and make every other therapy work better. Your plan starts here, not with a prescription pad.

Botanical & nutritional support

Evidence-informed herbal medicine and pharmaceutical-grade supplementation, targeted to your labs — correcting the nutrient deficiencies and stress-response imbalances that undermine hormone production. Used purposefully, never as a shelf of guesses.

Retest, monitor, adjust

Hormone care is not “set and forget.” Whether you’re on injections or pellet therapy, we retest on a schedule, track your levels and relevant safety markers, and adjust dosing as your body responds. Many patients notice improvement within a few weeks — with greater gains by three months of starting their plan.

Why patients choose Dramov

• A physician who specializes in hormones — Dr. Rob Dramov, NMD: Bastyr University-trained, microbiology background, licensed in Arizona, California & Oregon.
• 23+ years of clinical experience — restoring hormone balance for men and women — this is core work here, not a side offering.
• Real appointment time — a 60-minute first visit, direct answers, and a doctor who knows your name and your labs.
• Two convenient locations — our Arizona and Oregon clinics both offer the attention of a small practice, with easy parking and no big-clinic shuffle.

Andropause FAQs