Quick summary: Andropause is the gradual decline in testosterone that many men notice between ages 40 and 60. Symptoms range from fatigue and mood changes to reduced libido and muscle loss. Hormone replacement therapy (HRT) can restore testosterone to a healthier range — but candidacy depends on lab work, health history, and a clinical evaluation. This article explains what andropause is, how HRT works, what delivery options exist, and what risks and contraindications every patient should understand before starting treatment.
Medically reviewed by the clinical team at OC Weight Loss & Med Spa. Last updated: June 12, 2026.
What Is Andropause?
Unlike the relatively abrupt hormonal shift women experience during menopause, testosterone levels in men decline slowly — typically around one percent per year after age 30. By the time a man reaches his mid-40s or 50s, the cumulative drop can be significant enough to produce noticeable symptoms. Clinicians sometimes call this late-onset hypogonadism; the lay term is andropause.
Symptoms vary in severity and do not appear in every man, but may include:
- Persistent fatigue that rest does not fully resolve
- Low mood, irritability, or reduced motivation
- Decreased libido and changes in erectile function
- Loss of lean muscle mass and increased abdominal fat
- Disrupted sleep, including difficulty staying asleep
- Reduced bone density over time
A symptom pattern alone is not sufficient to diagnose low testosterone. Blood tests measuring total and free testosterone — ideally drawn in the morning when levels peak — are required to confirm the diagnosis and rule out other causes.
How Testosterone Replacement Therapy Works
The goal of hormone replacement therapy is to restore circulating testosterone to a range that relieves symptoms while staying within physiologically normal limits. It is not about maximizing testosterone — it is about finding the level at which a patient feels and functions well, under regular clinical supervision.
Several delivery methods are used, each with a different absorption profile and dosing schedule.
Testosterone Injections
Injectable testosterone (typically cypionate or enanthate) is administered intramuscularly, usually every one to two weeks. Levels peak in the first few days after injection and taper before the next dose, which some men notice as an energy or mood cycle. Injections are cost-effective and well-studied.
Topical Gels and Patches
Daily application to the skin provides a steadier hormone level than injections. The main practical concern is inadvertent transfer to a partner or child through skin contact, so application sites must be covered and hands washed thoroughly after use.
Pellet Therapy
Small pellets are inserted under the skin of the hip or upper buttock during a brief in-office procedure. They release testosterone continuously over three to five months, eliminating the need for daily or weekly dosing. Many patients find this the most convenient option once an effective dose has been established. OC Weight Loss & Med Spa offers hormone pellet therapy as part of its men’s HRT program.
Oral Testosterone
Newer oral testosterone formulations (such as testosterone undecanoate) are available by prescription. Earlier oral forms carried hepatotoxicity concerns; modern capsules are absorbed through the lymphatic system, reducing liver exposure. Oral testosterone is not appropriate for every patient and is assessed on a case-by-case basis.
What Patients Typically Experience
Response to TRT varies by individual. In clinical studies, patients with confirmed low testosterone who received therapy typically reported improvements in energy, mood stability, libido, and body composition over weeks to months. Individual results vary, and some men see meaningful changes within four to six weeks while others require dosage adjustments over several months. Ongoing lab monitoring guides those adjustments.
Safety, Side Effects, and Who Should Not Use This Treatment
Testosterone replacement is an effective treatment for appropriately selected patients — but it carries real risks that every prospective patient should understand.
Common side effects include acne or oily skin, fluid retention, mild breast tissue sensitivity (gynecomastia in some cases), increased red blood cell count (erythrocytosis), and sleep apnea worsening.
Fertility suppression is a significant consideration. Exogenous testosterone suppresses the body’s natural hormone signals, which reduces or eliminates sperm production. Men who wish to father children in the future should discuss this with their provider before starting TRT, as alternative approaches exist.
Cardiovascular considerations. TRT can raise hematocrit (red blood cell concentration), which increases blood viscosity and, in susceptible individuals, the risk of clotting events. Patients with a history of heart attack, stroke, or thromboembolic disease require careful risk-benefit evaluation before starting therapy.
Prostate health. Testosterone does not appear to cause prostate cancer, but it can stimulate growth of existing prostate tissue. Men with active or suspected prostate cancer are generally not candidates for TRT. A baseline PSA test and prostate assessment are standard before initiating treatment.
Who should not use TRT:
- Men with active or high-risk prostate or breast cancer
- Men with untreated severe obstructive sleep apnea
- Men with a hematocrit above 54%
- Men with uncontrolled heart failure
- Men planning to conceive in the near term (without fertility preservation planning)
Candidacy is determined at a clinical consultation that includes a full health history review and lab work. Self-diagnosing low testosterone and obtaining hormones without medical supervision carries serious health risks.
Frequently Asked Questions
How do I know if I have low testosterone?
Symptoms are a starting point, but a blood test is required to confirm. Total testosterone is typically drawn in the morning; free testosterone may also be measured. A reading below roughly 300 ng/dL alongside consistent symptoms is generally considered clinically low, though interpretation depends on the full clinical picture.
How long does it take to feel results?
Some patients notice improved energy and mood within two to four weeks. Libido and body composition changes typically take longer — three to six months for meaningful shifts. Lab levels are rechecked at regular intervals to guide dose adjustments.
Will I need to stay on HRT indefinitely?
Many men who start TRT continue long term because the underlying decline in natural production does not reverse. If treatment is stopped, testosterone levels will return to baseline and symptoms typically return. Some men prefer periodic breaks with lab monitoring; your provider will help determine the right approach for your situation.
Is pellet therapy painful?
The insertion procedure is performed under local anesthetic and takes only a few minutes. Mild soreness at the insertion site for a day or two is common. Most patients return to normal activity the same day, though strenuous lower-body exercise is typically avoided for the first few days post-procedure.
Does insurance cover HRT for men?
Coverage varies by plan and diagnosis code. Injectable testosterone is often covered when a confirmed low-testosterone diagnosis is on file; pellet therapy is more commonly paid out of pocket. OC Weight Loss & Med Spa accepts CareCredit, Cherry, and Alle financing to help make treatment accessible.
Talk to a Provider at OC Weight Loss & Med Spa
If you are experiencing symptoms that may be consistent with low testosterone, the next step is a consultation — not a supplement purchase or self-directed protocol. At OC Weight Loss & Med Spa in Mission Viejo, CA, Lindsay Short, NP evaluates each patient with a full health history, symptom review, and lab work before recommending any treatment. The clinic is physician-supervised by Dr. Nezar Dahdal, MD, board-certified in Internal Medicine. To learn more or schedule an appointment, reach out to the team or book below.
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