When most people hear the word “menopause,” they immediately think of women. However, men also experience age-related hormonal changes that can significantly impact their health, function, and quality of life. This transition is often referred to as andropause, though many researchers prefer the term late-onset hypogonadism (LOH) because hormonal changes occur gradually rather than abruptly.
While andropause does not occur as suddenly as menopause, declining testosterone levels can contribute to a wide range of physical and emotional symptoms. Many of these symptoms directly affect the musculoskeletal system, pelvic floor function, cardiovascular health, and overall physical performance—areas where physical therapy can play an important role.
What Is Andropause?
Testosterone levels naturally begin to decline around age 30-40, typically decreasing by approximately 1% per year. For some men, these changes are gradual and barely noticeable. For others, declining hormone levels can lead to significant symptoms that affect daily activities, exercise tolerance, sexual function, and overall well-being.
Common symptoms associated with andropause include:
- Fatigue and reduced energy
- Decreased muscle mass and strength
- Increased body fat
- Joint and muscle aches
- Reduced exercise performance
- Changes in libido and sexual function
- Mood changes, irritability, or depression
- Sleep disturbances
- Reduced bone density
Because many of these symptoms overlap with normal aging or other medical conditions, andropause is often overlooked.
Does Andropause Increase Musculoskeletal Pain?
Many men report increased stiffness, muscle soreness, joint discomfort, and slower recovery from physical activity as testosterone levels decline.
Testosterone plays an important role in:
- Muscle protein synthesis
- Tissue repair and recovery
- Bone health
- Strength maintenance
- Physical performance
As hormone levels decrease, individuals may notice:
- Increased muscle fatigue
- Reduced tolerance to exercise
- Longer recovery times
- Generalized aches and pains
- Increased risk of tendon and overuse injuries
In addition, age-related decreases in physical activity can further contribute to weakness, mobility limitations, and chronic pain. Men with low testosterone often demonstrate reductions in lean muscle mass and physical performance, both of which may contribute to musculoskeletal complaints and decreased participation in meaningful activities.
Functional Decline: More Than Just Aging
One of the most significant yet overlooked consequences of andropause is its impact on physical function and independence. Declining testosterone levels are associated with reductions in muscle mass, strength, power, and overall mobility. Over time, these changes may contribute to sarcopenia, the age-related loss of muscle mass and function.
Many men notice subtle changes before they recognize significant weakness, including:
- Difficulty lifting or carrying heavier objects
- Fatigue during routine activities
- Reduced participation in exercise or recreational activities
- Difficulty climbing stairs
- Slower walking speed
- Trouble rising from a chair without using the arms
- Reduced balance and stability
These changes can create a cycle of declining activity levels. As physical tasks become more challenging, men may exercise less, leading to further muscle loss, cardiovascular deconditioning, and reduced functional capacity.
Research has shown that lower testosterone levels are associated with decreased physical performance and impaired mobility in older men. Muscle power—the ability to generate force quickly—often declines faster than strength and is an important factor in preventing falls and maintaining independence.
Physical therapists can identify early signs of functional decline and develop individualized programs to improve:
- Strength and muscle mass
- Balance and fall prevention
- Mobility and movement efficiency
- Cardiovascular endurance
- Functional performance during daily activities
Rather than accepting these changes as a normal part of aging, targeted exercise interventions can help preserve independence and quality of life.
Pelvic Floor Dysfunction in Men: An Overlooked Issue
When discussing pelvic floor dysfunction, women often receive most of the attention. However, men can also experience significant pelvic floor symptoms, particularly during periods of hormonal and age-related change.
Potential pelvic floor concerns associated with aging and declining testosterone include:
- Urinary urgency
- Increased urinary frequency
- Post-void dribbling
- Erectile dysfunction
- Pelvic pain
- Chronic prostatitis-like symptoms
- Reduced sexual satisfaction
Although research directly linking andropause to pelvic floor dysfunction remains limited, testosterone deficiency is strongly associated with erectile dysfunction and sexual health concerns. Additionally, cardiovascular disease, diabetes, obesity, and prostate conditions—which become more common with age—can further contribute to pelvic floor dysfunction.
Pelvic floor physical therapy can help men improve bladder control, address pelvic pain, optimize sexual function, and improve quality of life.
Cardiovascular Health and Andropause
Cardiovascular disease remains one of the leading health concerns for aging men.
Lower testosterone levels have been associated with:
- Increased abdominal fat accumulation
- Insulin resistance
- Metabolic syndrome
- Elevated cardiovascular risk factors
- Reduced exercise capacity
At the same time, reduced physical activity and declining muscle mass can contribute to worsening cardiovascular fitness and overall health.
Physical therapists are uniquely positioned to help men improve cardiovascular fitness through safe, progressive exercise programs that address:
- Aerobic conditioning
- Strength training
- Balance and mobility
- Weight management
- Functional endurance
Regular exercise remains one of the most effective interventions for improving cardiovascular health and reducing the impact of age-related hormonal changes.
Bone Health Matters Too
Many people associate osteoporosis with women, but men are not immune to bone loss.
Testosterone helps maintain bone density throughout life. Declining levels can contribute to:
- Osteopenia
- Osteoporosis
- Increased fracture risk
Physical therapy interventions such as resistance training, impact-loading activities when appropriate, and balance training can help preserve bone health and reduce fracture and fall risk.
The Role of Physical Therapy During Andropause
Physical therapy is not a treatment for low testosterone itself, but it can address many of the symptoms and functional limitations that accompany hormonal changes.
A comprehensive physical therapy program may focus on:
Strength Preservation
Progressive resistance training can help combat age-related muscle loss, improve muscle power, and maintain independence.
Pain Management
Targeted interventions can address joint pain, stiffness, mobility restrictions, and chronic musculoskeletal conditions.
Pelvic Floor Rehabilitation
Men experiencing urinary, bowel, sexual, or pelvic pain symptoms may benefit from specialized pelvic floor therapy.
Cardiovascular Conditioning
Exercise prescription can improve endurance, energy levels, and cardiovascular health.
Balance and Fall Prevention
Maintaining strength, coordination, and stability becomes increasingly important with age and can help reduce injury risk.
Lifestyle Education
Physical therapists can help patients develop sustainable exercise habits that support long-term health and function.
When Should Men Seek Help?
Men should consider discussing symptoms with their healthcare provider if they experience:
- Persistent fatigue
- Loss of strength
- Unexplained muscle or joint pain
- Changes in sexual function
- Urinary symptoms
- Reduced exercise tolerance
- Significant changes in mood or energy
- Difficulty performing routine daily activities
A multidisciplinary approach involving primary care providers, endocrinologists, urologists, and physical therapists can often provide the most comprehensive care.
Final Thoughts
Andropause is a real and often underrecognized phase of aging that can affect multiple body systems. While hormonal changes may contribute to musculoskeletal pain, pelvic floor dysfunction, reduced cardiovascular fitness, declining bone health, and functional limitations, these symptoms do not have to be accepted as an inevitable part of aging.
Physical therapy offers evidence-based strategies to help men maintain strength, mobility, continence, cardiovascular health, and overall quality of life. By addressing these concerns early, men can continue to stay active, independent, and engaged in the activities that matter most.
References
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Corona G, Vignozzi L, Sforza A, Maggi M. Risks and Benefits of Late-Onset Hypogonadism Treatment. The Aging Male. 2013.
Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European Consensus on Definition and Diagnosis. Age and Ageing. 2019;48(1):16-31.
Perheentupa A, Huhtaniemi I. Does the Andropause Exist? Nature Clinical Practice Endocrinology & Metabolism. 2007;3:670-671.
Shahani S, Braga-Basaria M, Basaria S. Andropause: Current Concepts. Indian Journal of Endocrinology and Metabolism. 2009;13(3):121-124.
Wu FCW, Tajar A, Pye SR, et al. Hypothalamic-Pituitary-Testicular Axis Disruptions in Older Men Are Differentially Linked to Age and Modifiable Risk Factors. Journal of Clinical Endocrinology & Metabolism. 2008;93(7):2737-2745.
Zhang Z, Kang D, Li H. The Effects of Testosterone on Bone Health in Males with Testosterone Deficiency: A Systematic Review and Meta-Analysis. BMC Endocrine Disorders. 2020;20:33.