Andropause: Symptoms, Age, Causes and Natural Remedies

After forty, something changes. The alarm goes off but the drive isn't there. Libido becomes more capricious, fat accumulates around the waist even though you eat as before, in the gym you struggle to recover. You feel more tired, more irritable, and sometimes you wonder if it's "age" or if there's something more specific to understand. The clinical answer has a name — andropause — and it has concrete numbers that allow you to distinguish a physiological decline from a condition that deserves attention.

In this guide we use the criteria of the EMAS (European Male Aging Study, 3,369 European men) to clarify what andropause really is, the age at which it begins, how to recognise it and which natural remedies have evidence of efficacy. We examine zinc, vitamin D, magnesium, ashwagandha and black maca, with the dosages used in clinical studies. The aim is to give you a scientific compass to understand what you can do before considering hormone therapy.

What is andropause: definition and differences from female menopause

Andropause, also called late-onset hypogonadism (LOH) or male climacteric, is a clinical syndrome characterised by progressive testosterone decline associated with specific symptoms. It is not a "male menopause" because, unlike the female one, there is no abrupt cessation of gonadal function in men: the decline is slow, gradual and does not affect everyone.

Why "male menopause" is an imprecise term

Female menopause is a clear-cut event: within a few years, the ovaries stop producing oestrogens and fertility ends. In men, by contrast, testosterone drops by about 1% per year after age 30, but many men maintain normal values into old age. Fertility can be preserved even beyond 70. To speak of "male menopause" is therefore misleading: andropause affects only a minority of men with clinically significant symptoms.

The numbers from the EMAS study

The EMAS study, published in the New England Journal of Medicine (Wu et al., 2010), studied 3,369 European men aged 40-79 and defined precise criteria for diagnosing andropause:

• Total testosterone < 11 nmol/L (320 ng/dL) in the morning
• At least three sexual symptoms present simultaneously: reduced sexual desire, reduced spontaneous morning erections, erectile dysfunction

With these strict criteria, the prevalence of clinical andropause is 2.1% in the general population, rising to 5.1% between 60-69 years and to 11.8% between 70-79 years. It is much less common than commonly thought: most of the symptoms attributed to andropause actually derive from modifiable factors (weight, sleep, stress, physical activity), not true hypogonadism.

At what age does andropause begin?

The physiological decline of testosterone after 30

Testosterone reaches its peak between 20 and 30 years, then begins a slow decline of about 1% per year. At 60 years, levels are on average 30% lower than at 30, even in healthy men. This physiological decline is not pathological in itself: for most men, values remain within the normal range (300-1,000 ng/dL).

Clinical andropause, the one defined by EMAS criteria, typically manifests between 50 and 70 years. It is rare to see it before 45: in that case, it is almost always due to secondary causes (obesity, diabetes, drugs, chronic diseases) and not to normal aging. If you are under 40 and have compatible symptoms, talking about "andropause" is wrong: it is almost certainly something else that deserves to be investigated.

Factors that accelerate testosterone decline

The EMAS study and subsequent work (Yang 2018, PMID 29665142) have identified the main risk factors that accelerate androgen decline:

• Abdominal obesity: a waist circumference > 102 cm doubles the risk of LOH (adipose tissue converts testosterone into oestradiol via aromatase)
• Metabolic syndrome: type 2 diabetes, hypertension, dyslipidaemia lower testosterone independently
• Insufficient sleep: sleeping less than 5 hours reduces testosterone by 10-15% (peak production occurs in REM sleep)
• Chronic stress: elevated cortisol inhibits the hypothalamic-pituitary-gonadal axis
• Sedentary lifestyle: inactivity reduces androgen receptor sensitivity
• Alcohol and smoking: both suppress testicular production

The good news is that most of these factors are modifiable. Before thinking about supplements or therapies, intervening on lifestyle can increase testosterone by 15-30% in 3-6 months.

Symptoms of andropause: sexual, physical and psychological

Andropause symptoms are divided into three categories, and according to EMAS only the simultaneous presence of sexual symptoms has diagnostic value. The others (physical and psychological) are frequent but not very specific.

The EMAS sexual triad

The three key sexual symptoms according to the EMAS study are:

• Reduced sexual desire (libido drop not explainable by stress or relationship problems)
• Reduced spontaneous morning erections (in particular, < 2 per week)
• New-onset erectile dysfunction in the absence of obvious vascular causes

If you have all three of these symptoms together and are over 45, it is worth measuring total testosterone in the morning (between 7 and 10 a.m., when values are physiologically higher). Having only one of the three, on the other hand, is almost never an indicator of andropause.

Physical symptoms: body composition, lean mass, energy

The physical symptoms of andropause are less specific but still important:

• Reduction of muscle mass and strength, especially during training (sarcopenia)
• Increase in abdominal fat despite unchanged diet and activity
• Persistent fatigue, especially in the afternoon
• Reduction of bone density: risk of osteoporosis and fractures (more subtle than in women but real)
• Hot flushes rare, but possible in severe cases
• Night sweats
• Normocytic anaemia in advanced cases

Cognitive and mood symptoms

Andropause has an often-underestimated neuropsychic component:

• Low mood, irritability, loss of interests
• Reduced motivation and initiative
• Difficulty concentrating and mental fog
• Reduction of working memory
• Sleep disturbances: difficulty maintaining sleep, less deep sleep

Attention: these symptoms overlap almost completely with those of clinical depression. If they are present without sexual symptoms and with normal testosterone levels, a depressive syndrome is much more likely than andropause.

How to diagnose andropause: the tests to do

If you are over 45 and have the symptoms of the EMAS sexual triad, the first test to do is total testosterone in the morning, between 7 and 10 a.m. It is essential to do it on an empty stomach and not immediately after a sleepless night (both factors artificially lower the result).

The international reference values for the diagnosis of LOH are:

• Total testosterone < 11 nmol/L (320 ng/dL): EMAS threshold for LOH
• Free testosterone < 220 pmol/L (6.5 ng/dL): indicated in case of SHBG alterations (obesity, diabetes)
• SHBG (sex hormone binding globulin): useful for calculating bioavailable testosterone

If the first measurement is low, it must always be confirmed with a second sample 2-4 weeks apart. A single low measurement is not diagnostic because testosterone has strong daily variations. In addition, LH, FSH, prolactin, TSH and oestradiol should be investigated to identify secondary causes.

Natural remedies for andropause: what really works

Lifestyle: the indispensable foundation

Before any supplement, lifestyle is the factor with the greatest impact on testosterone. The clinical evidence is solid:

• Sleep 7-8 hours: sleeping less than 5 hours reduces testosterone by 10-15%. REM sleep is the phase in which the greatest amount of testosterone is produced
• Resistance training (weights): acutely increases testosterone and GH. Studies show +15% baseline testosterone after 12 weeks of serious programme
• Weight loss: in obese men, losing 10% of weight increases testosterone by an average of 30% (Yang 2018)
• Stress management: techniques such as meditation and breathing lower cortisol and improve the HPG axis
• Reduce alcohol: over 2 units per day alcohol suppresses testicular production

Key micronutrients: zinc, vitamin D, magnesium

Three micronutrients have solid clinical evidence on testosterone:

Zinc: it is an essential cofactor for testosterone synthesis. The Prasad study (1996, PMID 8875519) showed that zinc supplementation (30 mg/day for 6 months) doubles testosterone levels in elderly men with marginal deficiency. Most men over 60 have a suboptimal intake. Typical dose: 15-30 mg/day.

Vitamin D: the Pilz study (2011, PMID 21154195) showed that 3,332 IU/day for a year increases total testosterone by 25% in men with deficiency. Considering that over 60% of Italians over 50 are deficient, dosing 25-OH vitamin D is always recommended. Typical dose: 2,000-4,000 IU/day based on deficit.

Magnesium: increases the share of bioavailable testosterone by reducing its binding to SHBG. Studies show +25% free testosterone in athletes who supplemented magnesium. Best forms: bisglycinate (high bioavailability) or citrate. Dose: 300-450 mg/day.

Adaptogenic plants: maca, ashwagandha, tribulus

Among the plants with the greatest clinical evidence for andropause, three adaptogens stand out:

Black maca (Lepidium meyenii): does not directly increase testosterone (this is important: maca is neither a phytoestrogen nor a phytoandrogen), but acts on the hypothalamic-pituitary-gonadal axis improving libido, energy and erection quality. Clinical studies show significant effects on libido within 8-12 weeks. Black maca is the most studied variety for men.

Ashwagandha (Withania somnifera): the Lopresti study (2019, PMID 30854916) on men aged 40-70 with standardised ashwagandha (Shoden 240 mg/day, 8 weeks) showed +14.7% total testosterone and +18% DHEA-S, with improvement in general well-being. An excellent option when stress is part of the picture.

Tribulus terrestris: the evidence on testosterone is controversial, but the saponins (particularly protodioscin) have documented effects on libido and erectile function, probably through non-androgenic mechanisms. Formulations with > 90% saponins are the most studied.

INCA FORCE: the synergistic formula for men over 40

When it comes to natural remedies for andropause, the key is synergy: no single ingredient performs miracles, but well-dosed combinations can produce clinically relevant effects on energy, libido and overall vitality.

INCA FORCE is the RedMoringa formula designed specifically for men over 40 who want to support energy and vitality without resorting to hormone therapies. The composition combines three active ingredients with clinical evidence:

• Black maca extract 100:1 (the most studied variety for male libido, in a concentration 100 times higher than the raw root)
• Tribulus terrestris standardised to 90% saponins (the level of concentration used in clinical studies)
• Moringa oleifera organic as micronutritional support (zinc, B-group vitamins, antioxidants)

Black maca works on the HPG axis improving libido and energy, tribulus supports sexual function and moringa provides the micronutritional base that is often missing in men over 40 with a non-optimal diet. The product is designed for cycles of 8-12 weeks, in line with the duration of clinical studies on maca.

For those who want a more complete protocol, the Energy Boost Treatment combines INCA FORCE with other supplements for those who combine andropause and training. The Magnesium Bisglycinate + D3 + B6 covers instead the sleep/stress component and the share of bioavailable testosterone, often reduced after 50.

FAQ — Andropause and natural testosterone

What is the difference between "low testosterone" and andropause?

Low testosterone (hypogonadism) is a condition that can occur at any age and is defined by total testosterone values < 300 ng/dL (12 nmol/L). Andropause, or LOH, is the subset of hypogonadism that manifests after age 45-50 with the EMAS sexual triad and testosterone < 11 nmol/L. A young man with low testosterone does not have andropause, he has hypogonadism: the distinction is important because causes and treatments may differ.

At what age does andropause really begin?

The physiological decline of testosterone begins around age 30 (-1% per year), but clinical andropause typically manifests between 50 and 70. Under 45, the diagnosis of andropause is inappropriate: if compatible symptoms are present, secondary causes should be sought (obesity, metabolic diseases, drugs, pituitary pathologies). The EMAS criteria do not apply to younger men.

Is testosterone therapy (TRT) always necessary?

No, TRT is indicated only in confirmed cases of LOH with testosterone < 8 nmol/L and important symptoms that do not respond to lifestyle correction. For most men with mild-moderate symptoms, intervening on weight, sleep, physical activity, micronutrients and natural adaptogens is the first step, and often sufficient. TRT carries side effects (polycythaemia, axis suppression, dependence) that must be carefully evaluated.

How long does a natural treatment for andropause last?

The minimum cycles documented in studies are 8-12 weeks for adaptogens (maca, ashwagandha) and 3-6 months for micronutrients (zinc, vitamin D, magnesium). Lifestyle should instead be maintained stably. It makes sense to do a baseline testosterone measurement, start the protocol for 12 weeks, and recheck to evaluate efficacy.

What are the contraindications of natural remedies for andropause?

Maca and ashwagandha are generally well tolerated. Maca is contraindicated in case of uncontrolled thyroid disorders (may interfere with thyroid drugs). Ashwagandha may potentiate the effects of sedatives and antihypertensives. Tribulus should be avoided in case of active prostate disorders (hyperplasia, neoplasms). In the presence of chronic disorders or drug therapies, always consult a doctor before starting supplementation.

Does andropause always lead to erectile dysfunction?

No. Complete erectile dysfunction is present only in a minority of LOH cases. More frequent is the reduction of spontaneous morning erections and sexual desire. Important: erectile dysfunction after 50 often has vascular causes (penile atherosclerosis, diabetes, hypertension) more than hormonal. Cardiovascular evaluation is always recommended.