Testosterone doesn’t fall off a cliff at 50. It slips, quietly, year after year. Most men never notice the moment it starts. They just notice, one day, that they don’t feel like they used to.
Key takeaways
- From about 40, total testosterone falls by around 1.6% a year, and the free testosterone your body can use falls faster.
- Extra weight, short sleep, some health conditions and medicines, and heavy drinking all push levels down, and several of these can be changed.
- For men with genuinely low levels and symptoms, treatment has good evidence behind it, but it isn’t for everyone and needs regular blood tests.
The trendIt falls every year from middle age
The Massachusetts Male Aging Study followed about 1,700 men aged 40 to 70 for up to a decade. Their total testosterone fell by about 1.6% a year. The “free” testosterone your body can actually use fell faster, by 2 to 3% a year.1 Over ten years, that adds up.
Illustration based on the average yearly falls in the Massachusetts Male Aging Study.1 Individual men vary widely.
It’s not only ageing. The same research group found that men had lower testosterone than men of the same age a generation earlier, a population-wide drop that age alone doesn’t explain.2
How commonLow levels are more common than most men think
In a large US study of men aged 45 and over who visited their GP for any reason, 38.7% had low testosterone on a blood test.3 That’s a group that skews less healthy than the general population, and a blood result alone isn’t a diagnosis. But it shows how often low levels turn up once someone actually looks.
When researchers apply the strict clinical definition, low levels plus symptoms, the figure is lower. In a European study of more than 3,000 men aged 40 to 79, the symptoms most closely tied to low testosterone were sexual.4
The causesWhat pushes it down
The good news is that several of these are things you can change.
Why it mattersMore than sex drive
Low testosterone isn’t just about sex drive. It’s linked to energy, mood, muscle, body fat and bone strength.7 It’s also easy to confuse with other problems: poor sleep, stress, low iron and depression can all feel similar. That’s why guessing, or buying something online, is a bad idea.
The symptoms overlap with poor sleep, stress, low iron and depression. A blood test, read by a doctor, is how you tell them apart.
The evidenceWhat the evidence says about treatment
For men with genuinely low levels and symptoms, testosterone therapy has clear evidence behind it. In a trial of older men with low testosterone, treatment improved sex drive, erections and sexual activity.8 In the largest safety trial so far, more than 5,000 men at higher risk of heart disease had no more heart attacks or strokes on testosterone than on a dummy treatment.9
How Oryx helpsBlood tests, a doctor and a plan
An Oryx doctor looks at your symptoms, your health and blood tests. If your levels are low and treatment is right for you, you’ll get a personalised plan and regular reviews. If they’re normal, your doctor will help you find what’s really going on.
QuestionsFrequently asked questions
How fast does testosterone fall with age?
In men aged 40 to 70, total testosterone fell by about 1.6% a year in the Massachusetts Male Aging Study. Free testosterone, the part your body can use, fell faster, by 2 to 3% a year.
What are the symptoms of low testosterone?
The symptoms most closely tied to low testosterone are sexual: a lower sex drive, fewer morning erections and weaker erections. It’s also linked to energy, mood, muscle, body fat and bone strength. Poor sleep, stress, low iron and depression can feel similar, which is why a blood test matters.
What lowers testosterone?
Carrying extra weight, short sleep, diabetes, some long-term medicines and heavy drinking can all play a part. Several of these are things you can change, and your doctor will look at them with you.
Is testosterone therapy safe for the heart?
In the largest safety trial so far, more than 5,000 men at higher risk of heart disease had no more heart attacks or strokes on testosterone than on a dummy treatment. Treatment still needs regular blood tests and a doctor’s oversight.
Can I have testosterone therapy if I want children?
Testosterone therapy usually lowers sperm production, so it isn’t recommended for men who want children soon. Tell your doctor if this applies to you.
How much does the Oryx testosterone programme cost?
Testosterone programmes start from R700 a month. Your doctor will give you the full cost before you commit.
Wondering whether testosterone is part of the picture? Start with the free two-minute eligibility check.
The free eligibility check takes two minutes, it’s private, and there’s no obligation. If you’re a good fit, you’ll speak to one of our doctors.
References
- Feldman HA et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. J Clin Endocrinol Metab 2002
- Travison TG et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab 2007
- Mulligan T et al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract 2006
- Wu FCW et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010
- Wu FCW et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab 2008
- Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA 2011
- Bhasin S et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2018
- Snyder PJ et al. Effects of testosterone treatment in older men. N Engl J Med 2016
- Lincoff AM et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med 2023
