Overview
Andropause - clinically known as late-onset hypogonadism (LOH) or age-related testosterone decline - describes the gradual fall in testosterone that begins for most men in their early 30s. Unlike female menopause, andropause is gradual (~1-2% per year) and does not affect every man. By age 70, around 20-30% of Australian men have total testosterone below the young-adult reference range.
In Australia, the Endocrine Society of Australia and the Androgen Study Group define androgen deficiency as **two early-morning (before 10 am) fasting total testosterone results below the lower reference limit, plus consistent clinical symptoms**. The lower reference limit is generally 8 nmol/L for total testosterone; symptomatic men in the 8-12 nmol/L "grey zone" with low SHBG or low free testosterone may also benefit from treatment.
LH and FSH are measured to distinguish primary hypogonadism (testicular failure - LH/FSH high) from secondary hypogonadism (pituitary or hypothalamic - LH/FSH inappropriately normal or low). PSA, prolactin, full blood count, iron studies, HbA1c and lipids round out the standard work-up.
Treatment options in Australia include testosterone undecanoate (Reandron, PBS-listed for confirmed androgen deficiency), testosterone cypionate or enanthate compounded weekly/twice-weekly, transdermal gels (Testogel, Androforte) and patches. PBS subsidisation requires confirmed pathological hypogonadism - age-related decline alone is generally not subsidised.
Common Symptoms
- •Persistent fatigue not improved by rest
- •Reduced libido and fewer spontaneous morning erections
- •Erectile dysfunction
- •Loss of muscle mass and strength
- •Increase in central/abdominal fat
- •Low mood, irritability, reduced motivation
- •Poor concentration, brain fog
- •Reduced exercise tolerance
- •Hot flushes (in severe cases)
- •Reduced bone density (with long-standing deficiency)
Key Blood Markers
Total Testosterone
Persistently low (<8 nmol/L) or low-normal with symptomsThe primary diagnostic marker. Two morning fasting samples below 8 nmol/L (or 8-12 nmol/L with symptoms and low SHBG) confirm androgen deficiency in Australia.
SHBG
Often low if metabolic causes; high in elderly or hyperthyroidismLow SHBG (common in obesity, T2DM, metabolic syndrome) reduces free testosterone even when total T looks normal. Used to calculate free or bioavailable testosterone.
LH (Luteinising Hormone)
High in primary hypogonadism, low/normal in secondaryDistinguishes primary (high LH) from secondary (low/inappropriately normal LH) hypogonadism. Critical for treatment decisions.
FSH
High in primary, low/normal in secondaryReported alongside LH. High FSH supports primary testicular failure; both low suggest pituitary/hypothalamic cause.
Oestradiol (E2)
Variable at baseline, often rises on TRTBaseline before TRT and monitored on therapy. Excessive aromatisation on TRT can drive gynaecomastia, water retention and mood changes.
Prolactin
Normal (exclusion); elevated in prolactinomaElevated prolactin (e.g. from a pituitary adenoma) suppresses LH/FSH and causes secondary hypogonadism. Excludes a treatable pituitary cause.
Haematocrit
Normal at baseline; can rise on TRTBaseline before TRT and the most-monitored safety marker on TRT. Threshold for venesection is 0.52.
PSA
Normal at baseline (age-dependent reference range)Required baseline in men 40+ before starting TRT, then 3-6 months and annually. Does not increase prostate cancer risk per the 2023 TRAVERSE trial, but baseline screening remains standard.
Frequently Asked Questions
At what age does andropause start in Australian men?
What testosterone level is considered low in Australia?
Is TRT covered by Medicare or PBS in Australia?
What is the difference between andropause and male menopause?
Can lifestyle changes raise testosterone naturally?
Quick Facts
- Key Markers:8
- Common Symptoms:10