Andropause Treatment Options: A Complete 2026 Guide

Andropause is not a theory. It is a measurable decline in testosterone and other hormones that affects millions of men starting in their late 30s and accelerating through their 40s, 50s, and beyond. The Mayo Clinic acknowledges that testosterone levels decline approximately 1% per year after age 30, and by the time many men seek help, they have lost 20-40% of their peak hormone levels.

The good news: andropause is treatable. The options available today are more varied, more effective, and better studied than at any point in medical history. This guide walks through every evidence-based treatment approach, from testosterone replacement therapy to lifestyle interventions, so you can have an informed conversation with your provider about what is right for you.

When lab work confirms low testosterone -- the Endocrine Society defines this as two separate morning measurements below 300 ng/dL accompanied by symptoms -- TRT is the first-line treatment. It works by supplementing your body's declining natural production with exogenous testosterone, restoring levels to a healthy physiological range.

TRT is not a one-size-fits-all prescription. There are four primary delivery methods, each with distinct advantages, drawbacks, and ideal use cases. A comparative study published in the Journal of Clinical Endocrinology and Metabolism examined the effects of gels, injections, and pellets on serum hormones and found meaningful differences in hormone level stability and side effect profiles across methods.

Injectable Testosterone

Injections account for over 70% of TRT prescriptions in the United States, and for good reason. Testosterone cypionate or enanthate is injected intramuscularly or subcutaneously, typically once weekly. Injections deliver reliable dosing, are the most cost-effective option, and produce robust clinical outcomes.

The main drawback is hormonal fluctuation. Levels peak within 24-48 hours of injection and trough before the next dose, which some men experience as energy swings. More frequent, smaller injections (such as twice weekly) can minimize this effect. The same comparative study found that erythrocytosis (elevated red blood cell count) was more common with injections at 66.7% than with gels at 12.8%, making regular blood monitoring essential.

• Best for: Men who want maximum effectiveness at the lowest cost
• Frequency: Weekly or twice weekly
• Cost: $30 - $80 per month (often the most affordable option)
• Considerations: Requires self-injection; peak-and-trough hormone pattern; requires regular hematocrit monitoring

Testosterone Gels and Creams

Topical testosterone is applied daily to the shoulders, upper arms, or abdomen and absorbed through the skin. Gels provide more stable daily hormone levels than weekly injections, closely mimicking the body's natural circadian testosterone pattern. About 20% of men on TRT use topical formulations.

The primary concern with topicals is transfer risk -- testosterone can be passed to partners or children through skin contact if the application site is not covered or washed. Absorption also varies between individuals, which can make dosing less predictable. However, the lower rate of erythrocytosis (12.8% vs 66.7% for injections) is a significant safety advantage for some men.

• Best for: Men who want stable levels without needles and can commit to daily application
• Frequency: Daily
• Cost: $100 - $400 per month (brand-dependent)
• Considerations: Transfer risk to others; variable absorption; daily compliance required

Testosterone Patches

Transdermal patches deliver a steady 24-hour dose of testosterone through the skin. They offer consistent hormone levels similar to gels but with a simpler application method -- just apply the patch and forget about it until the next day. Approximately 5% of men choose this delivery method.

The most common complaint is skin irritation at the application site, which affects a significant percentage of users. Patches also have limited dose flexibility compared to injections or gels, and they can be visible under clothing or come loose during physical activity.

• Best for: Men who want steady levels with minimal daily effort and no injection concerns
• Frequency: Daily
• Cost: $200 - $500 per month
• Considerations: Skin irritation common; limited dose adjustability; may detach during exercise

Testosterone Pellets

Subcutaneous pellets are small, rice-sized cylinders of crystallized testosterone inserted under the skin (typically in the hip area) during a brief in-office procedure. They dissolve gradually over 3 to 6 months, providing some of the most physiologically stable testosterone levels of any delivery method.

The convenience factor is high -- no daily applications, no weekly injections. However, pellets require an in-person procedure for insertion, carry a small risk of infection or extrusion, and offer limited flexibility if a dosage adjustment is needed mid-cycle. If you have a side effect, you cannot simply stop treatment; the pellet continues releasing testosterone until it dissolves.

• Best for: Men who want a set-it-and-forget-it approach and have already dialed in their optimal dose
• Frequency: Every 3 - 6 months (in-office procedure)
• Cost: $500 - $1,000 per insertion
• Considerations: Requires in-person procedure; difficult to adjust mid-cycle; minor surgical risks

Human chorionic gonadotropin (HCG) is a critical option for men who want to address low testosterone without sacrificing fertility. Standard TRT suppresses the body's natural testosterone production, which in turn reduces sperm production -- often dramatically. The AUA guidelines specifically recommend against starting TRT in men who are planning fertility in the near term.

HCG works differently. It binds to the same receptors as luteinizing hormone (LH) in the testes, stimulating your body's own testosterone production rather than replacing it. This maintains testicular function and sperm production while still raising testosterone levels. It is the only FDA-approved drug specifically indicated for male hypogonadotropic hypogonadism.

HCG can be used as a standalone therapy for men with secondary hypogonadism or combined with TRT to preserve testicular size and fertility. Typical dosing ranges from 1,500 to 5,000 IU administered subcutaneously two to three times per week. The main limitations are higher cost compared to standard TRT and the need for more frequent injections.

Regardless of whether you pursue TRT, lifestyle changes are not optional -- they are the foundation that determines how well any treatment works. Research consistently shows that exercise, sleep, diet, and weight management have measurable effects on testosterone levels and overall hormone health.

Exercise

Resistance training is the single most effective lifestyle intervention for testosterone. A study in the Journal of Clinical Biochemistry and Nutrition found that increased physical activity has a greater effect on testosterone levels than reduced caloric intake alone. Compound movements like squats, deadlifts, and bench presses that recruit large muscle groups produce the strongest hormonal response. Aim for 3-4 resistance training sessions per week, supplemented with moderate cardiovascular exercise.

Sleep

Most testosterone is released during REM sleep, making sleep quality as important as sleep duration. Men who consistently sleep fewer than 6 hours show significantly lower testosterone levels than those getting 7-9 hours. Harvard Health identifies adequate sleep as one of the key lifestyle strategies for preventing age-related testosterone decline. Prioritize sleep hygiene: consistent schedule, cool and dark room, no screens 30 minutes before bed.

Weight Management

Excess body fat is one of the most powerful suppressors of testosterone. Adipose tissue contains aromatase, an enzyme that converts testosterone to estrogen, creating a cycle where more fat leads to less testosterone and less testosterone leads to more fat. Research published in Cureus (2025) found that weight loss can increase testosterone levels by up to 30% in overweight men. For many men, losing 15-20 pounds can make a clinically meaningful difference.

Nutrition

A balanced diet rich in healthy fats, quality protein, and micronutrients supports hormone production. Very low-fat diets have been shown to decrease testosterone levels. The Mediterranean diet pattern -- rich in olive oil, fish, vegetables, and moderate red wine -- is associated with healthier testosterone levels. Key nutrients for testosterone production include zinc, vitamin D, magnesium, and omega-3 fatty acids.

The supplement industry markets heavily to men with low testosterone, but the evidence for most products is thin. Here is what the research actually supports:

• Vitamin D: Men deficient in vitamin D show lower testosterone levels, and supplementation in deficient individuals can improve levels. Not effective if you are already vitamin D sufficient.
• Zinc: Essential for testosterone synthesis. Supplementation helps if you are deficient (common in men who exercise heavily or sweat frequently), but does not raise levels above baseline in replete individuals.
• Ashwagandha: Several small studies show modest improvements in testosterone and stress markers. The evidence is promising but not definitive.
• D-Aspartic Acid: Mixed evidence. Some short-term studies show a temporary increase in testosterone, but longer-term studies show the effect diminishes.
• DHEA: A precursor hormone that can convert to testosterone. May benefit men over 50 with documented DHEA deficiency, but effects are modest and should be monitored by a provider.

The bottom line on supplements: they are not a replacement for TRT when your testosterone is clinically low. They can support overall hormone health as part of a comprehensive plan, but expecting a supplement to fix a 200 ng/dL testosterone level is unrealistic. Your provider at Man UnPaused can help determine which supplements, if any, make sense alongside your treatment protocol.

Any andropause treatment requires ongoing monitoring. This is not optional -- it is the difference between safe, effective therapy and unnecessary risk. The Endocrine Society and AUA guidelines both recommend:

• Baseline labs before treatment: Total testosterone, free testosterone, SHBG, estradiol, PSA, CBC (complete blood count), metabolic panel, thyroid function, and lipid panel
• Follow-up labs at 6-12 weeks: To confirm levels are in therapeutic range and adjust dosing
• Ongoing monitoring every 3-6 months: Testosterone levels, hematocrit (to watch for erythrocytosis), PSA (prostate safety), and estradiol
• Annual comprehensive panel: Full metabolic workup including lipids, liver function, and cardiovascular markers

At Man UnPaused, monitoring is built into every treatment plan. Your provider reviews labs at each check-in and adjusts your protocol based on your numbers and how you feel -- because optimal treatment means both your labs and your symptoms are improving.

The right andropause treatment depends on several factors that are unique to you: your current testosterone levels, the severity of your symptoms, your age, whether fertility is a concern, your comfort with self-injection, your budget, and your personal preferences.

Here is a simplified decision framework:

• Mild symptoms with borderline levels (250-350 ng/dL): Start with aggressive lifestyle modifications. Reassess in 3 months. Consider TRT if levels do not improve.
• Moderate symptoms with confirmed low T (below 300 ng/dL): TRT is appropriate. Injectable or topical based on your preference and lifestyle. Combine with lifestyle changes.
• Significant symptoms affecting quality of life: TRT should be initiated promptly. Most providers recommend starting with injections for their reliability and cost-effectiveness.
• Fertility is a current or near-term concern: HCG therapy, either alone or combined with low-dose TRT, to preserve spermatogenesis.

The first step is always the same: get your levels tested. Without comprehensive lab work, any treatment decision is a guess. Man UnPaused's free screening quiz can help you determine if your symptoms align with andropause, and a consultation with one of our providers will give you the complete picture.

Setting realistic expectations matters. Andropause treatment is not an overnight transformation -- it is a gradual restoration. Here is the typical timeline once TRT is initiated:

• Weeks 2-4: Improved energy levels and sleep quality are often the first noticeable changes
• Weeks 4-8: Mood stabilization, reduced irritability, improved motivation and mental clarity
• Weeks 6-12: Libido and sexual function improvements become apparent
• Months 3-6: Body composition shifts -- increased lean mass, decreased abdominal fat -- become visible
• Months 6-12: Full treatment benefits realized, including bone density improvements and cardiovascular markers

The men who get the best results are those who combine TRT with the lifestyle foundations: consistent training, quality sleep, proper nutrition, and stress management. Treatment addresses the hormonal deficit, but the habits determine how far that hormonal optimization carries you.

References

1. Mayo Clinic. "Male menopause: Myth or reality?" mayoclinic.org
2. Endocrine Society. "Testosterone Therapy for Hypogonadism: Clinical Practice Guideline." endocrine.org
3. Barbonetti A, et al. "Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen." Journal of Clinical Endocrinology and Metabolism. 2015. pmc.ncbi.nlm.nih.gov
4. American Urological Association. "Evaluation and Management of Testosterone Deficiency: AUA Guideline." 2018. auajournals.org
5. Kumagai H, et al. "Increased physical activity has a greater effect than reduced energy intake on lifestyle modification-induced increases in testosterone." Journal of Clinical Biochemistry and Nutrition. 2016. pmc.ncbi.nlm.nih.gov
6. Harvard Health Publishing. "Lifestyle strategies to help prevent natural age-related decline in testosterone." health.harvard.edu
7. Ahmed M, et al. "Impact of Weight Loss on Testosterone Levels: A Review of BMI and Testosterone." Cureus. 2025. pmc.ncbi.nlm.nih.gov