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Meet Sally!

In these videos Sally will give you an introduction to the blog about middle aged men and testosterone


How long is andropause

Grumpy Old Man syndrome

Did you know … 

  • Middle age is the period of a human’s life between young adulthood and the onset of old age.
  • The exact range is subject to debate, but commonly the age ranges from around 45-50 to around 60–65
  • This phase of life is marked by gradual physical, cognitive, and social decline
  • Andropause is a name given to the condition associated with the decrease in the male hormones Testosterone and DHT Di-Hydro-Testosterone
  • The medical world may address this as late-onset hypogonadism or age-related low Testosterone.
  • Testosterone decline is on average approx. 1 – 2% per year, from the age of 30.
  • By approx. age 70 the decrease in Testosterone can be 40 – 80%.
  • 30-40% of men in their 50s will experience symptoms of low Testosterone.
  • Andropause is not a phase such as perimenopause
  • It’s much more gradual, but continuous, can be easier to navigate as there is only 1 hormone to support and or replace
  • Andropause awareness is very important as many men over the age of 40 experience symptoms of low Testosterone, but are unaware that their symptoms are due to low levels of the hormone and that there are solutions.
  • Young men under 30 will have Testosterone levels exceeding 1000 ng/dl
  • Average levels for men in their 70s and 80s is 200 ng/dl.
  • Most older men still have testosterone levels within the ‘normal age related range’
  • With only an estimated 10% to 25% having levels considered to be low.
  • Because of this the medical community is not united on the topic of andropause and the need to replace Testosterone
  • BUT just because you are within your ‘normal age related range’ doesn’t mean you have enough Testosterone for optimal health or to function as a man physically, mentally and or emotionally
  • Levels of Testosterone vary during the day, with peak values in the early morning, which is why morning erections are a good sign of optimal production
  • Testosterone production increases during REM sleep, especially between 2 – 6am
  • Heart studies show that Total-Testosterone levels corresponding to the upper level of the age related range for 50-59 year olds, ie. 500-800 ng/dl to be optimal
  • Low Testosterone may cause any number of physical and mental changes and can increase the risk of serious health conditions, such as CV problems.
  • Other reasons for low Testosterone can be diabetes, thyroid problems, and medication side effects, such as finasteride for male pattern baldness.
  • BTW – men with diabetes are twice as likely to have lower levels of T than men without diabetes.

Hallmarks of Middle Age Men

Physical characteristics

  • Changes in the nervous system.
  • Decline in physical fitness
  • Greying and loss of hair
  • ED erectile dysfunction
  • Mortality rates can begin to increase from 50 onward, due mainly to health issues like

– heart problems

– cancer

– hypertension

– diabetes.


  • Decrease in processing speed
  • Memory loss

Social and personality characteristics

  • Relationships can become more difficult, especially family
  • Career satisfaction focus shifts to more inner satisfaction and contentedness and less on ambition and the desire to advance.

How Long is Andropause

  • Andropause is a condition associated with the ‘natural’ decline in the production of Testosterone and DHT / Di-Hydro-Testosterone
  • The decline start around the age of 30 and is gradual but continuous and not all men are conscious of the drop in Testosterone
  • Andropause also clinically referred to as Testosterone deficiency syndrome, androgen deficiency, and hypogonadism.
  • NB! – unlike the female menopause men don’t completely lose the ability to reproduce, their testicles keep producing Testosterone, just less of it
  • Men in their 50s can have approx. 40% less testosterone than in their 30’s.
  • Physical, sexual, and emotional changes occur as a result of a decline in Testosterone
  • Many ask the question ‘how Long does Andropause last?’
  • Because male andropause is less well-defined, slow and gradual, this is a complicated question to answer
  • According to some, the uncomfortable effects of andropause can last 15 to 20 years as the body gradually adjusts to lower testosterone production.
  • But because testosterone levels continue to decline over a lifespan, others argue that andropause lasts indefinitely
  • How andropause is experienced is very individual, just like women and menopause.

Causes of Low Testosterone

  • Andropause
  • Diabetes
  • Hypothyroidism
  • Low iron levels
  • Testicular failure due to genetic errors
  • Mumps
  • Severe trauma
  • Alcoholism
  • Cancer chemotherapy and radiation
  • Medication side effects
  • Pituitary gland problems, such as tumours, head trauma, brain surgery
  • Severe malnutrition.

Symptoms of Low Testosterone

  • Low libido / sex drive
  • Erectile dysfunction

– difficulties getting erections

– lack of spontaneous erections

– erections not as strong as usual

  • Increased fat accumulation especially around the middle and / or hips and butt
  • Man boobs
  • Higher fat% in general
  • Poor muscle definition and strength
  • Increasing muscle mass doesn’t come easy
  • Low bone density – osteoporosis
  • Height loss
  • Loss of body hair
  • Low energy
  • Hot flushes / sweats
  • Depression
  • Mood swings
  • Doubting self-worth
  • Low motivation
  • Poor decision-making
  • Procrastination
  • More cautious
  • More grumpy
  • More irritable
  • Poor sleep.

Mental & Emotional Changes during Andropause

  • Depression
  • Loss of libido / sex drive
  • ED / erectile dysfunction
  • Mood swings
  • Irritability
  • Grumpy old man syndrome
  • Decreased motivation
  • Low self-confidence
  • Difficulties with attention and concentration
  • Anger issues.

Irritable Male Syndrome aka Grumpy Old Man

  • IMS was first described in 2002 as a striking feature in mammals, like rams with seasonal breeding patterns manifesting at the end of the mating season.
  • Are you just a grumpy old man or is your breeding season closing?
  • Clinically referred to as andropause, or male menopause.
  • Like female menopause, andropause includes physical and emotional changes created by changes in hormone levels.
  • Irritable male syndrome can have a big impact on your relationships.

Symptoms of Irritable Male Syndrome

  • As the name suggests the leading symptom is irritability.
  • Depression
  • Lower self-confidence
  • Difficulty concentrating
  • Trouble sleeping
  • Reduced energy
  • Harder time losing weight
  • Poor recovery after exercise.
  • Lower libido / sex drive
  • ED / erectile dysfunction.

The Cause

  • The decline in testosterone
  • Testosterone is associated with everything male

– Confidence

– Fitness

– Energy

– Libido / sex drive

– Etc.

The Diagnosis

  • Checking testosterone levels is priority number
  • Other underlying conditions could also be responsible for your symptoms

– Diabetes – ED

– High blood pressure – ED

– Sleep apnoea – poor sleep = poor energy

The treatments

  • If the cause is low testosterone levels

– Testosterone replacement therapy / TRT

– Regular injections of bioidentical Testosterone can often help restore vitality and other characteristics

– Educate yourself as to the benefits and side effects of TRT – see the article in this blog

  • If the cause is other lifestyle issues

– Manage weight with TRE, ketogenic / low carb type diets

– Limit alcohol

– Quit smoking

– Manage sleep

– Get active – 30 minutes every day – produce those feel good endorphins

– De-stress with stress-busting and relaxation techniques, like meditation, yoga, and or breathing exercises.

Managing IMS

  • Recognize and acknowledge the symptoms, get diagnosed, and follow through with the treatment plan
  • Communication is key

– Be honest and open with your partner, your medical professional allows them to understand and support you

  • Therapy can show you how to work through your ‘new’ emotions in a positive way and communicate better with your partner.
  • Couples counselling is usually more successful when both members of the couple participate fully and patience is key.

Replacing Testosterone

Testosterone Replacement Therapy / TRT

  • Patches – every day
  • Gels – every day
  • Injections – every 2 – 4 weeks
  • Capsules – 2 x daily

NB!Always test Testosterone and Estrogen before and after starting TRT

  • Levels to aim for:

– AM. serum TT (total testosterone) – 500 – 800 ng/dl

– AM. serum Estradiol – 20 – 40 pmol/L


  • TRT is a lifetime commitment.
  • TRT is not a silver bullet, lifestyle is equally important.
  • TRT can be harmful if taken by men with normal levels – think misuse of anabolic steroids
  • TRT can reduce the hormone FSH necessary for sperm production and health, thereby reducing fertility
  • TRT is still ‘officially’ contraindicated for any man with prostate cancer
  • Decrease in Testosterone has been associated with an increase in all-cause mortality and cardiovascular (CV) risk.
  • TRT has been shown to improve myocardial ischemia in men with CAD
  • TRT has been shown to improve exercise capacity in patients with CHF
  • TRT has been shown to improve serum glucose levels, HbA1c, and insulin resistance in men with diabetes and prediabetes.
  • There are no large, long-term, placebo-controlled, randomized clinical trials to provide definitive conclusions about TRT and CV risk.
  • However, there currently is no credible evidence that TRT increases CV risk but substantial evidence that it does not.
  • In fact, existing data suggests that TRT may offer CV benefits to men.
  • See the studies in the article ‘studies supporting TRT’ in the blog ‘male health after andropause’.

Aromatase Inhibitors

  • Aromatase is the enzyme that converts Testosterone to Estrogen
  • Produced in many tissues including:

– gonads aka testicles and ovaries

– brain

– adipose tissue aka fat cells

– placenta

– blood vessels

– skin

– bone

  • BTW – this indicates how important Estrogen is
  • The negative effects exaggerated conversion could be:

– endometriosis

– uterine fibroids

– breast cancer

– endometrial cancer

  • Aromatase Inhibitors block this conversion
  • Can be used in combination with and or instead of TRT


– increases the excretion of all Estrogens and is a mild aromatase blocker – BUY HERE

Grape Seed Extract

– blocks aromatase – BUY HERE

Prescription aromatase inhibitors

– Such as letrozole – very effective in increasing Testosterone.

– In fact are used as the after treatment of postmenopausal women with breast cancer

– Careful with the amount – <2.5mg once a week is more than enough for most men.

– Work with a professional.

The Aging Penis     

The Aging Penis           


  • Age leaves its mark on every part of the body, including the penis.
  • Testosterone helps the penis grow during puberty.
  • The decline in testosterone can change the size, shape, and function of this all-important organ.

It Shrinks

  • Due to:

– Low T

– Reduced blood flow due to CV disease and Diabetes

– Extra belly fat may hide it and make it look smaller

It Curves

  • Scar tissue build-up from years of wear and tear can make the penis bend or curve during an erection.
  • Peyronie’s is the name of condition, often painful, can make sex uncomfortable, even impossible.
  • Treatments range from injections to surgery

Testicles Shrink

  • Due to:

– low T

– injuries

– less blood flow

– anabolic steroid misuse.

– a symptom of testicular cancer

Less Sensitive

  • Natural part of aging
  • More stimulation will be necessary for arousal, erection and orgasm

Less Spontaneity

  • By age 70, approx. 70% of men have trouble getting an erection

Colour Change

  • Blood flow slows leaving the penis a lighter shade
  • Can cause erectile dysfunction

The Cosmetics

It Goes Grey

  • pubes lose colour, just as the hair on your head

It Goes Bald

  • Pubes thins just as the hair on your head
  • Consider a hair transplant.

The Scrotum Sags

  • Skin becomes less elastic just like the skin of your face and neck
  • Consider scrotal rejuvenation surgery.




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