Andropause Management: Lifestyle, Testosterone Therapy, and Holistic Care

Treating Late-Onset Hypogonadism (Andropause)

1. Lifestyle Foundation

• Mediterranean diet: plants, lean protein, olive oil, nuts.
• Exercise: 150 min/week moderate aerobic + 2× resistance training.
• Sleep: 7–9 hrs; treat apnea.
• Stress reduction: mindfulness, therapy.
• Limit alcohol; quit smoking.

2. Testosterone Replacement Therapy (TRT)

• Indicated: symptomatic + consistently low total T (<300 ng/dL) + free T low.
• Forms: IM/SC injections (weekly/biweekly), transdermal gel/patch, pellets, oral (undecanoate).
• Benefits: libido, energy, mood, muscle, bone.
• Risks: erythrocytosis, fertility suppression, possible CV risk (monitor), prostate monitoring.

3. Adjunct Medications

• PDE5 inhibitors (ED).
• Sleep aids, antidepressants if needed.

4. Counseling

Address midlife identity, relationship, mood changes.

5. Alternative Therapies

Evidence weak for herbs (ashwagandha, fenugreek, DHEA). Discuss with provider; avoid unregulated supplements.

Key

Comprehensive evaluation (labs, history, exam) before any treatment. Shared decision-making.