“Andropause” is the popular name for low testosterone that develops with age. Unlike menopause, it is gradual and only affects some men, and it needs bloodwork to confirm.
- Common signs: low libido, erectile problems, fatigue, low mood, less muscle and more belly fat.
- Diagnosis needs symptoms plus two low morning testosterone tests.
- Treatment in Canada includes injections, gels and oral capsules, often covered by drug plans.
Testosterone falls by roughly 1% a year from about age 40. For most men that drop is small and causes nothing noticeable. For some, especially with obesity, diabetes, sleep apnea or chronic illness, levels fall low enough to cause symptoms. Doctors call it late-onset hypogonadism; most people call it andropause.
Symptoms to watch for
- Lower sex drive and fewer morning erections
- Erectile difficulties
- Tiredness that does not improve with rest
- Low mood, irritability or poor concentration
- Losing muscle and strength despite training
- Gaining fat around the middle
- Hot flushes or sweats, in more marked cases
- Reduced bone density over time
Many of these have other causes, from poor sleep and stress to thyroid problems and medications. That is why bloodwork matters.
How it is diagnosed in Canada
Your family doctor will ask about symptoms and order a total testosterone test taken in the morning, ideally between 7 and 11 a.m., when levels are highest. Because levels vary day to day, a low result is confirmed with a second test.
Your doctor may also check LH and FSH (to find where the problem starts), prolactin, iron studies, blood sugar, a blood count and PSA before considering treatment. Tests ordered by a doctor are covered by provincial health plans in every province.
Andropause or something else?
Low testosterone shares symptoms with several common conditions, and treating the wrong one wastes months. Before settling on andropause, a good doctor will look at:
- Thyroid problems. An underactive thyroid causes fatigue, weight gain and low mood. A simple TSH test checks it.
- Depression. Low mood, poor sleep, low libido and loss of interest overlap heavily with low testosterone.
- Sleep apnea. Loud snoring, gasping at night and daytime sleepiness are clues, and apnea itself lowers testosterone.
- Medications. Opioids, some antidepressants and steroids such as prednisone can lower testosterone or libido.
- Diabetes and high blood sugar, which are closely linked with low testosterone in Canadian men over 50.
Often two or more of these exist together. Treating sleep apnea or losing weight may fix testosterone without any hormone at all.
Lifestyle first
For men in the grey zone, lifestyle changes can raise testosterone meaningfully:
- Lose excess weight. Fat tissue converts testosterone to estrogen. Losing 10% of body weight often lifts levels noticeably.
- Treat sleep apnea. Untreated apnea is a common hidden cause. Ask about a sleep study; CPAP coverage varies by province.
- Strength train two to three times a week.
- Limit alcohol and review medications such as opioids that lower testosterone.
Treatment options
If testosterone is clearly low and symptoms fit, testosterone replacement therapy (TRT) is the usual treatment. Options available in Canada include:
| Form | How it is used | Notes |
|---|---|---|
| Injection (enanthate or cypionate) | Every 1–2 weeks | Cheapest; usual medical dose about 75–100 mg a week |
| Gel (AndroGel, Testim) | Daily on skin | Steady levels; avoid skin contact with partners and children |
| Oral testosterone undecanoate | Capsules with meals | No needles; must be taken with fat to absorb |
Coverage depends on your province and insurance. Injections are commonly covered; gels sometimes need special authorization. Your pharmacist can check your plan.
Monitoring and risks
On TRT, your doctor will repeat testosterone, blood count and PSA at about three to six months, then yearly. The main concern is a rise in hematocrit, which thickens the blood; treatment is paused if it passes about 54%. TRT also lowers sperm production, so men who want children should say so before starting. Our comparison of TRT and steroid cycles explains why replacement doses carry far less risk than performance doses.
Where to start
Book an appointment with your family doctor or a walk-in clinic and describe your symptoms honestly. If you do not have a doctor, virtual clinics in most provinces can order bloodwork. Men’s health clinics are another option, often with shorter waits but extra fees. For background on testosterone forms, see the compound profiles.
Frequently asked questions
At what age does andropause start?
Testosterone declines gradually from about 40, but only some men develop symptoms, usually from their late forties onward, and often alongside weight gain or chronic illness.
What testosterone level is low in Canada?
Below about 8 nmol/L is considered low; 8–12 nmol/L is a grey zone where symptoms and free testosterone guide treatment.
Is testosterone therapy covered in Canada?
Often. Injectable testosterone is covered by many provincial and private plans for diagnosed low testosterone; gels may need special authorization.
Photo: Direct Media, StockSnap (public domain).
General health information, not medical advice. See a doctor for diagnosis and treatment of low testosterone.
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