Men's Health: when andropause meets menopause
Men’s health awareness, provision and access to it, still lags way behind that for women, with worrying statistics as a result: on average, men live 4.5 years less than women, 20% of men in the western world die before reaching 64 and three in five men die before 75 – with most of these deaths, especially from cardiovascular incidents, being preventable. And men live longer in ill-health than women.
The UK government’s Men’s Health Strategy, a 10-year plan to increase male lifespan and health-span, was launched in November 2025, and Movember has become an annual global event to raise awareness and support for men’s critical health issues. In the meantime, men’s health, particularly the understanding, services and support around the mid-life, often-dubbed ‘andropause’, is 20 years behind that of menopause support. Whilst the change in men’s hormones throughout their lifespan, isn’t as dramatic as those for women, they are still significant and can cause physical, psychological and emotional ill health.
Hormones are important because, as chemical messengers, they’re constantly responding to information from both outside and inside the body (depending on the food eaten, temperature, light/dark, sleep quality, hydration status, movement, stress, etc) and make subtle adjustments to ensure you’re working as efficiently as your human body should. All hormones work in ‘opposing pairs’ but also interlink with each other, forming an exquisite network of communication and action.
For example, insulin is a hormone adjusting blood sugar, as excess sugar in the blood (more than 1 teaspoon) is inflammatory and causes damage, so insulin is produced to remove it. Glucagon is the ‘opposing’ hormone which increases your blood sugar, when energy is low. Cortisol is the primary hormone to manage stress, but also influences inflammation, the sleep/wake cycle, blood pressure and body composition. Serotonin and melatonin are the opposing hormones. And testosterone is the primary sex hormone in men, but controls not only libido and sexual function, it’s vital for bone density, muscle mass and strength, fat distribution around the middle, red blood cell production in terms of energy, cognition, memory and attention, as well as mood regulation, motivation and confidence. And it needs to be in balance with oestrogen – yes, men have oestrogen too!
So, there’s a lot of cross-over between male and female hormones, but with differences in their levels, when they’re produced and what action they effect.
Men’s hormones are as important as those of women’s; male health is as important as that of female health. The difference is how and when men seek help, how available it is, the support available to them and the social, racial, and cultural barriers stopping them from doing so.
Sub-optimal or ill-health is often multi-factorial, which means there are multiple opportunities to improve it - it’s ‘multi-fixable’. And because many health issues evolve from our lifestyle, what we choose to eat and drink, how and when we move, our sleep habits and even our stress levels, are all modifiable, meaning we can affect positive health outcomes. Yes, we all want a quick fix, a pill and a potion to get us back to full health as quickly as possible, but the human body doesn’t actually work in that superficial way. It’s evolved over millennia to keep us safe, alive and at the top of the food chain. It knows what we need, even if we don’t…and even if our daily actions sabotage our health, it’ll do it’s best to counteract them.
What strikes me most is that the routes to better hormone balance, and therefore health, is actually pretty similar for both men and women.
Men in their middle years onwards are at a greater risk of weight gain especially around the middle, body composition changes regarding high fat mass alongside muscle loss, osteoporosis and bone fragility fractures, poor sleep quality, nocturia (night-time peeing) and incontinence issues, as well as mood changes. Sound familiar?
These are often symptoms associated with the menopause…So is the solution testosterone therapy, just like HRT? Not necessarily. Levels of testosterone are affected by numerous things, not necessarily the actual amount secreted. And if your natural testosterone is being converted to oestrogen (see below), giving yourself more testosterone will only increase the problem. For most people, and like most hormones, testosterone levels are affected by the daily things we do, as well as having a natural rhythm during the day. This means you can influence your testosterone and overall hormone balance yourself. We can all modify our own health, irrespective of being male or female.
Weight
Weight gain is an indicator of hormone imbalance and systemic inflammation (causing bodily systems to go wrong). Being an overweight or obese male is the strongest risk factor for low testosterone. The higher your weight, the lower your testosterone, and sperm-count, is likely to be. Moreover, excess fat converts testosterone to oestrogen, resulting in less testosterone and higher oestrogen - which together drive obesity in a viscous cycle. Plus, you’re likely to get man-boobs with higher oestrogen…
Increased weight increases your risk of sleep apnoea, reducing your sleep quality. This can lead to stimulatory-food seeking behaviour in order to keep you awake in the day, again driving high sugar intake and poor blood sugar control. Fat-around-the middle is the most dangerous as it wraps around the internal organs and secretes the highest levels of inflammatory chemicals.
Aim for a waist circumference of less than 102cm, or 96cm if you’re non-caucasian.
Diet
High sugar intake not only adds excess calories, but sugar is the most inflammatory substance you can put in your body. Inflammation causes disruption of body systems, and when the body’s natural, automatic systems don’t work, ill health results. Sugar damages nerves and the lining of blood vessels, leading to high blood pressure and an increase in cardiovascular risk. Sugar increases your risk of insulin resistance, when the hormone insulin no longer works. Low testosterone correlates with an increased risk of insulin resistance, leading to a diagnosis of type 2 diabetes.
Consuming too much sugar isn’t the end of it – the effects cause widespread disease throughout the body. Type 2 diabetes is essentially a disease of the blood vessels, affecting those to the heart, kidneys, eyes, feet and skin, liver and brain. And this includes those blood vessels to the penis, and can largely be attributed to erectile disfunction. Damage to blood vessels equals disrupted blood flow to the penis. In fact, erectile dysfunction is one of the earliest warning signs of early cardiovascular disease, and is now used as a marker in the QRisk score.
Crowd out the sugar by increasing intake of natural, less processed foods which contain good levels of fibre. Fibre is your friend. For every 10g of fibre eaten daily, cardiovascular risk is reduced by 7%. Fibre reduces your prostate risk. It also supports gut health - a healthier gut absorbs cholesterol, positively affecting cholesterol status as well as helping to expel visceral fat. 10g of fibre is essentially a small portion of porridge oats, with a medium chopped pear sprinkled with a tablespoon of chia seeds. Or bran flakes with raspberries, or two slices of wholemeal toast with half an avocado. Or a large jacket potato with baked beans. Or add some brown rice, broccoli and peas to your meat.
Vegetables, especially green leafy and cruciferous ones, provide nutritious low carbohydrate energy, a great alternative health-wise to pasta, bread, cakes and biscuits. Studies show that visceral fat is reduced with a low carbohydrate diet, alongside 15-20 minutes of high intensity training, three times a week (see below). Vegetables also provide micronutrients essential for testosterone production, including zinc and magnesium. Magnesium is also essential for energy production, muscle firing, bone health, relaxation and sleep…
And don’t forget that alcohol is essentially sugar. Other than the taste and short-term effect when you’re drinking it, it has no nutritional value whatsoever. It is in fact an anti-nutrient, it damages health. The government guidelines are a maximum of 14 units a week – if you don’t want to get sick. These guidelines are not if you want to live well. It may relax you temporarily but it disturbs deep sleep. And blood vessels…and gut health…and weight…. More than three units a week has been associated with reduced fertility (as has more than one shot of caffeine a day).
Including lean, good quality protein (not processed meat such as sausages/bacon, takeaway burgers and deep-fried chicken, as well as veggie burgers, substitute meats/dairy and vegan alternatives if they’re over-processed) helps keep us fuller for longer. The same goes for good quality fat (olives, natural full fat live yogurt, a limited amount of dairy, hummus, nuts and seeds). The general guideline for protein intake is 1-1.5g per kilogram of bodyweight a day. However, to avoid sarcopenia (muscle loss), intake should be increased to 1.8g+, especially if you take regular exercise. But don’t think that the higher your protein intake, the bigger your muscles will get: too much protein cause organ damage, and muscle doesn’t magically materialise. You have to stimulate the body to use the protein to build that muscle – which is where resistance or strength training comes in (see below).
Sleep
Disturbed sleep increases your stress hormone cortisol which decreases fat loss, increases muscle loss and further reduces testosterone. Sleep apnoea is associated with high fat and low testosterone. Poor sleep affects mood and motivation, as well as food/drink choices.
Deep sleep is a vital time for clearing out malfunctioning and dead cells, particularly in the brain. Accumulation of these can lead to cognitive issues including dementia. Sleep is also when the body produces growth hormones, important to repair tissues, strengthen bone and build muscle. Darkness and relaxation positively affect sleep quality. Bright lights and stimulatory activities such as watching video games, scrolling on social media, drinking caffeine and alcohol, working and eating late at night and even late-evening exercise, all keep cortisol levels high, preventing the natural secretion of melatonin, your sleep hormone. We live in a 24/7 world now. Shut out the noise and allow both your body and brain to relax. It won’t sleep to order - you have to practise it and stick to a night-time routine. You likely did this as a child, why not as an adult? Aim for 7-8 hours sleep, or at least rest, a night.
Exercise
Fitness is the most modifiable predictor of how long you’ll live. And there’s a positive correlation between intensity of exercise and a reduction in all-cause mortality. As we age, we’re told to slow down, take it easy and drift into lower intensity, longer duration exercise such as walking, golf, Pilates and yoga. We play doubles tennis instead of singles, and go for longer, less hilly bike rides. All these are great for overall health and social interaction, but they won’t mitigate the ageing effects of muscle loss, reduction in cardiovascular capacity, weight changes and bone density. Or maintain testosterone levels.
Strength training stimulates dopamine, a feel-good hormone, which then stimulates the production of testosterone. High intensity interval training (HIIT) has a direct effect on visceral fat as well as cardiovascular strength. Both lower the stress hormone cortisol. The mechanical pull of muscles on bone stimulates further bone production. An increase in muscle means more blood sugar receptors within the muscle, meaning better regulation of blood sugar. More muscle means more and healthier blood vessels to feed it. Exercise helps with weight regulation, and a more favourable body composition with more muscle to fat ratio. You’ll look thinner, your clothes will fit better and your confidence, as well as mood, will increase.
Hard work isn’t something to avoid. It’s good for us, it stimulates the body into becoming stronger, literally, in terms of physical, physiological and psychological effects. The weights have to be heavy enough and you need to be prepared to work hard, to sweat, to stimulate the testosterone production as well as muscle synthesis. But you need to start as a level which is appropriate to your current fitness, otherwise you’ll just get injured. Fitness develops over time…
And a cautionary note on over-training. Over-training is when the amount of exercise, or the level/intensity of it, exceeds the body’s capacity. I’ll repeat that: exceeds the body’s capacity, not what the brain (ie. you) thinks you should be able to do. More is not necessarily more. Excessive exercise, particularly when linked with poor nutrition provides the perfect storm for messing up your health. Exercise should be a controlled stress on the body, enough to stimulate getting stronger/fitter but not too much that it results in breakdown: injury, mood irregularities, sleep disturbance, reliance on stimulants, poor food choices – in fact, the very things that exercise should all help! With not enough focus on rest and recovery, exercise becomes stress-on-stress, leading to increased inflammation (injury), increased oxidative stress (ill-health) and a reduction in brain/gonad communication and hormone balance. Cortisol goes up, blood sugar becomes erratic, sleep is affected, testosterone levels sink, alongside muscle mass and bone density. Rest is when the body recovers, repairs and builds to grow stronger. Without it, you’re doing the opposite to what you think you’re doing…pretty stupid, eh? So, exercise needs to be hard enough based on your current ability, and balanced by appropriate rest to achieve the ‘super-compensation’ ie. you get stronger/fitter as a result of the exercise, not weaker and injured.
Fasting
Fasting has grown in popularity in recent times, often seen as a cure-all for ageing and overall health. When done appropriately, this can be true, but like exercise, it has to be appropriate to the person, what they want to achieve (different fasting lengths result in different physiological effects) and what exercise they’re taking. Fasting can have a number of meanings; appropriate time without food is what I’m talking about – not eating late at night, having your food intake earlier in the day so using the energy consumed rather than storing it overnight, and optimising metabolic flexibility ie. the body’s ability to use different fuel types depending on the level of activity.
There’s no point going into an early morning strength training or HIIT session in a fasted state. You won’t build muscle, you’ll lose it: in its ‘starved’ state, the body will breakdown muscle to use to fuel your training session. The workout will feel harder as it takes longer to convert muscle protein to energy. You won’t recover stronger because there are less nutrients, including minerals and vitamins, to use to do so. Small musculo-skeletal niggles may become full-blown injuries, potentially stopping you from training at all. The stress of the session in its already weakened state will increase cortisol, not lower it. That in turn will increase blood sugar and the body will further protect its fat stores, just in case you do this to it again. The body is working in exact opposite to what you think you’re achieving.
That doesn’t mean that fasting has no place: done appropriately by each individual, it can certainly help with weight loss including the body’s ability to lose fat rather than muscle. But over-fasting can deplete testosterone levels; it has to be done with care and consideration, otherwise for the body, it just becomes another stress. Start with eating earlier at night and no snacking/drinking before bed, increasing the time without food overnight to 8-10 hours.
If you’re doing light exercise first-thing in the morning, such as a dog walk, easy swim or yoga session, doing this fasted will help encourage the body to burn fat. BUT, the exercise must be light and slow, giving the body time to breakdown fat for energy. Anything of harder intensity needs fuelling. And all exercise, irrespective of intensity/duration, needs replenishment afterwards, especially if you’ve fasted, in order to support its nourishment, supercompensation and fuelling for the day or next exercise session ahead.
Community
Women discuss, men want solutions. Okay it’s a generalisation, but it tends to be true. Most women find it easier to meet up, discuss and share their feelings, hopes and worries. A problem shared is a problem halved and talking can help both the talker and listener. It engenders a sense of community, that we all go through it, that we’re not the only ones and we’re all human. There can be cultural reasons for not seeking help regarding their health, but there’s still out-dated social expectations that ‘real men don’t cry’ or that men have too much responsibility to show ‘weakness’. For men, strength is in action, not in emotions, whereas for women, it's often the other way round.
But connection is still vitally important, especially for male mental health. There are now a number of initiatives where men can connect, but these still tend to be fringe-type or charity-led, rather than mainstream. This is where sport can be really helpful, or activity-based, interest-led events like photography, hiking or woodwork, where men can come together for another reason, rather than just to talk.
Test, don’t guess
Having a yearly blood test – full blood count, including testosterone and PSA - can provide a lot of information, especially if analysed fully and in relation to an individual’s specific health and lifestyle context. Bear in mind that incorrect analysis can lead to worry and health-anxiety, especially regarding PSA…
If testosterone levels are tested, the blood test should be taken first thing in the morning (this is when testosterone peaks), and in a fasted state (no food, tea or coffee with milk beforehand), as testosterone temporarily lowers after eating. Most standard blood tests only test total serum (blood) testosterone, but most of this is bound/inactive – it’s the active or free testosterone level which is key. Asking for oestrogen and SHBG (sex hormone binding globulin) can also be very helpful, as both need to be in balance with testosterone.
As with all tests, it can be useful to consider results over time (6-12months) as testosterone levels can fluctuate due to sleep quality, illness, over-exercise, opiates and other medications, as well as anabolic steroids.
The use of AI can be very useful if you don’t want to speak to the GP (or can’t get an appointment), or prefer to find information yourself. Whilst it’s safer in terms of possible judgement from elsewhere, it’s not necessarily safer regarding accuracy. AI is only as good as the data you input: like food, junk in equals junk out. It’s best to see AI as a starting tool rather than the destination/diagnosis itself, and make sure you input the information which is specific to you – all your health history, your age, your social/marriage/socioeconomic status, your symptoms, etc. Bear aware that other health issues, such as diabetes, anaemia and thyroid issues often have similar symptoms to those of low testosterone…
Life-load strain
Allostatic load is the sum of everything, or the accumulation of living. Working long hours, caring for an elderly relative, busy weekend schedules with the kids, the pressure of a mortgage, holiday or car finance can all take their toll, especially on top of a body which is already feeling the physical strain of sub-optimal health and lack of appropriate exercise. There is a two-fold increase in cardiovascular incident risk with a higher life-load strain.
On top of this, men often find themselves adrift in mid/later life, just like some women do when the children leave home. It requires a realignment of identity, especially as retirement approaches, to reassess who they are, what they enjoy, and what their values are. Our values often change as we age, but we often don’t recognise this; you may be holding onto the values of a younger you. Just like the advice given to women, it’s vital to find some space to think, reflect and ‘just be’. Just five minutes to yourself in the morning, without a phone or computer or TV, before letting the outside in. I do this every day for five minutes, allowing myself to sit quietly with a mug of good coffee and the dogs. I do an energy audit: who or what’s draining and energising to me – then set my intentions for the day regarding what I’ll do about it. Being busy or stressed can become a habit – it won’t change unless we do. We may not be able to choose the stresses around us, but we can choose how we react to them.
Hormone Balance
Can you see how hormone balance (and health) is all interlinked? Modifying one aspect can affect every aspect of health; and the positive effects grow further when you modify several actions at once.
Start slowly with a couple of changes and once they become habitual, add in other actions. Get the base right first – food, exercise, sleep. Prioritise the symptoms which point to the area(s) most out of balance. Only add in supplements such as vitamins, minerals and botanicals if they’re needed, and if it’s safe to do so regarding other medications you might be taking. Supplements are not benign; they’re also an expensive waste of money if they’re unwarranted.
Start now - it’s easier to maintain health rather than change it. Good health develops with consistent actions over time, so keep it consistent. Holidays, birthdays and celebrations are part of daily life - modify accordingly, don’t start/stop your good intentions just because Christmas is around the corner.
It might sound boring, but there’s nothing as boring as ill health.
Good health doesn’t suddenly start, but it can suddenly stop.
References available on request.
Amanda Heading, BSc (Hons), DipION
10/11/2026
Injury treatment, rehab and training plans, nutrition; sports performance nutrition, health maintenance.
