Have a seat, guys over thirty. We will talk about hormones, male menopause, and why half of middle-aged men voluntarily turn into an inanimate piece of furniture. Those who have older partners can also listen – to understand what is happening to the person next to them.
7 questions · Facts without condemnation
Let's start with the fact that we consider menopause and hormonal storms to be exclusively female history. Like, everything is difficult for women there, PMS, menopause, hormonal swings - and the man is just getting old, so what. In fact, this is, of course, complete nonsense, and any endocrinologist will confirm: the humoral system in Homo sapiens is arranged in approximately the same way, regardless of biological sex. The same hormones, the same receptors, the same mechanisms. The difference is in the proportions and in which hormone is "main" for this body.
"Approximately the same" This means that the same hormones with identical functions are produced in organisms M and F. Testosterone can make a woman's mustache grow and her voice coarse; From prolactin, a man can begin lactation. This is not a pathology – this is basic biochemistry.
The genitals and chromosomal set determine biological sex, but how a person feels, how energetic, aggressive or, on the contrary, apathetic he is is already a hormonal story. And it is much more similar for all of us than it is commonly thought.
After the age of thirty-five, the male body begins to lose about one percent of testosterone annually. One percent sounds funny, right? This is exactly what lets many people down. Because it is not visible, it does not hurt, it is not sharp. It's just that at the age of forty, a person suddenly discovers that somehow he wants less and less. There is less sex. There is less sport. There are fewer ambitions, plans, this kind of fire. And the sofa and TV series are somehow just right.
This is not depression (although it can also be). This is not laziness and not "just grown up". This is andropause – male menopause, only not instantaneous, as in women, but slow and imperceptible, like a gas leak. Until you hurt him, you won't understand.
Andropause (age-related hypogonadism) – a gradual decrease in testosterone levels in men, starting at about 35-40 years of age. Unlike female menopause, the process stretches over decades and often goes unnoticed, which is why most men do not associate their deteriorating well-being with a hormonal shift.
If you think testosterone is an "aggression and libido hormone," you're about twenty percent right. In fact, it is one of the most multifunctional hormones in the male body, and its deficiency hits the whole body at once – like a power outage in an apartment building: the elevator does not run, there is no hot water, the Internet is gone, the refrigerator is dark.
Testosterone is responsible for muscle protein synthesis (i.e., whether your muscles are growing or whether your stomach is growing instead), bone density, cardiovascular function, energy levels, concentration, and mood. It is involved in the regulation of sleep, metabolism and even cognitive functions. In short, it's not a "macho hormone" — it's a vitality hormone.
If you recognize yourself in five or more points, it's time to go to an endocrinologist.
The word "skoof" appeared for a reason. In Internet culture, it denotes a certain type: a man of thirty-five or fifty years old, who seems to have passed out. Belly, unkempt appearance, lack of interests except beer and football, zero ambitions, zero sexual energy, zero desire to change. And no, this is not "he is made this way" and not "he just grew up".
This is, to a large extent, a classic picture of age-related hypogonadism - testosterone deficiency formed from genetics, lifestyle and a banal lack of attention to one's own health. Because those who win the genetic lottery last until they are fifty or longer — and look ten years younger than their peers. And those who are sedentary, sleep poorly, eat poorly and do not go to the doctor on principle, begin to squirt after thirty.
The queer community is no exception here — and it's important to talk about it, because we tend to think that a scowl is a kind of specifically heterosexual phenomenon, something from the world of "beer, fishing, couch." In fact, a gay or bisexual man in his forties with a testosterone deficiency looks exactly the same – just without a wife who complains about him to her friends. Within our communities, this topic is almost never raised at all: the cult of youth and the body here presses in the opposite direction, forcing us to hide age-related changes instead of dealing with them. The result is the same – only in silence.
Testosterone for the male body is about like an arc reactor in Tony Stark's chest. As long as it works, you move mountains. As soon as you start to sit down, you become an amorphous mass that does not want anything and does not enjoy anything. And this is equally true regardless of who you want.
It is important to understand that lifestyle and hormones are a two-way relationship. Low testosterone reduces motivation to move. Lack of movement reduces testosterone. This is a loop that is difficult to get out of on your own, especially if you do not understand exactly what is happening.
This is the question that interests me the most. Female menopause is a topic that is discussed openly, books are written about, documentaries are made, and special supplements are made. Male menopause is as if it does not exist. At most, there are shameful articles on the websites of clinics under the heading "age-related changes in men".
Here, of course, toxic masculinity works in the most literal sense — not as a curse word, but as a descriptive term. Admitting that you have "something wrong with your hormones" is tantamount to admitting weakness for many men. Meanwhile, checking testosterone levels is as routine as taking a general blood test. It's just that no one talks about it normally and without shame.
How testosterone deficiency is diagnosed: A blood test for total and free testosterone is taken. Optimally, in the morning, on an empty stomach, in the period of 7-11 hours (peak production). One test is not a diagnosis: the hormone level fluctuates, so you need at least two measurements on different days. An endocrinologist or andrologist also looks at LH, FSH, prolactin and SHBG to understand where exactly the failure is: in the pituitary gland, testicles or at the level of transport proteins.
The good news is that most cases of age-related testosterone decline are perfectly correctable. The bad news is that there is no magic pill. No dietary supplement will raise your testosterone to normal levels if your lifestyle remains the same. But things work that are simple and boring, which is why they rarely get to them.
There are a few things that are usually not mentioned in general articles about testosterone — but for our audience, they are directly relevant.
PrEP and hormonal levels. Many of us take pre-exposure prophylaxis for HIV – and rightly so. But few people know that tenofovir-based drugs (TDF/FTC, aka the original Truvada) can affect bone density in the long term – and this is directly related to hormonal balance, including testosterone levels. Newer regimens based on TAF (tenofovir alafenamide) carry less risk to bones. If you have been on PrEP for more than two years, it is worth discussing densitometry with your doctor and at the same time checking testosterone. This is not a reason to refuse prevention, this is a reason to take care of yourself a little more carefully.
Transmasculine identity and TRT. For trans men and non-binary people with a male identity, testosterone hormone therapy is not a "menopause" story, but basic affiring medicine. But the logic is the same: hormone levels need to be monitored regularly, the schemes need to be adjusted over time, and age-related changes do not go anywhere – they are simply superimposed on the already existing TRT. If you are a trans man over forty and have not reviewed your scheme with an endocrinologist for a long time, this is a good reason.
When taking testosterone tests, tell your doctor about the intake of drugs. Some antiretroviral regimens affect hormone metabolism and the interpretation of results. A good endocrinologist knows this, but it will not be superfluous to remind you.
Since we are talking about hormones, it is impossible not to mention the thyroid gland, because it is able to imitate almost all the symptoms of andropause: fatigue, apathy, weight gain, decreased libido, depressive background. And it often goes unnoticed — especially in men, who are rarely examined at all. TSH, T3, T4 in a blood test is as mandatory as testosterone. Just keep in mind.
Testosterone hormone replacement therapy (TRT) is rapidly gaining popularity among men 45+. And this is not a marginal story – this is a completely mainstream medical practice in many countries. Nevertheless, there are still many myths around it in the post-Soviet space, so let's analyze the main ones.
TRT comes in several forms: injections, gels, patches, tablets. Each has its own pros and cons in terms of hormone level stability, ease of use and side effects. A well-chosen TRT under the supervision of a doctor really improves the quality of life, restores energy, libido, concentration and muscle tone - and this is confirmed by serious research.
⚠️ Important: TRT has contraindications and risks, primarily for the cardiovascular system and the prostate. Prescribing it to yourself or on advice in the gym is a dangerous adventure. Only a doctor, only after tests, only with regular monitoring. This is not paranoia - this is basic safety precautions.
What is really important to understand is that TRT is not about "pumping up testosterone to be like in your twenties." This is a therapy aimed at returning the hormone level to physiological normal. Normal testosterone is not a superpower, it's just a normal feeling of well-being, which in most men over forty-five has disappeared imperceptibly.
If we take one thought from this text, let it be the following: the male body is not a perpetual motion machine that works on its own without maintenance. The hormonal system requires attention, observation and sometimes the intervention of a specialist. This is not weakness. This is an elementary responsibility to yourself.
Go to an endocrinologist or andrologist. Get tested. Start with the basics – total and free testosterone, TSH, vitamin D, complete blood count. It will take half a day and cost significantly less than several years of life in the mode of turning off the TV.
In my environment, I observe a steady fashion in men 45+ to sit tightly on hormone replacement therapy - to throw testosterone regularly and under the supervision of a doctor. I will not give a professional medical assessment of this, because I am not a doctor. But these people usually look and feel great. So if the doctor says "you are indicated for TRT" – there is no need to make round eyes and say "no, no, I will somehow do it myself". Sometimes "myself" is the problem.
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