Testosterone Deficiency: Understanding the ‘Male Menopause’ and the Role of Early Intervention
As awareness of menopause continues to grow, a parallel but less understood condition in men is beginning to gain attention: Testosterone Deficiency (TD), often referred to as ‘male menopause’ or andropause. Despite being a recognised medical condition, it remains underdiagnosed and frequently misunderstood, with many men either unaware of the symptoms or reluctant to seek help.
Irish Pharmacy News interview with Dr Deirdre Forde, Medical Director and Founder of Ceile Medical
Source: Irish Pharmacy News, May 2026, pages 24.
Dr Deirdre Forde, Medical Director and Founder of Ceile Medical, explains that Testosterone Deficiency is both a clinical and biochemical syndrome associated with advancing age and underlying health conditions. It is characterised not only by low levels of testosterone in the blood, but also by a range of physical, psychological and sexual symptoms that can significantly impact quality of life.
A recognised but overlooked condition
While TD is a recognised medical issue, Dr Forde highlights that it is still poorly understood in general practice and often overlooked as a contributing factor to many common symptoms in men.
“Men frequently present with issues such as low mood, fatigue or poor concentration, but the underlying cause may not be immediately identified as testosterone deficiency,” she explains.
Certain groups are at higher risk. Men with chronic conditions such as type 2 diabetes, obesity, liver or renal disease, sleep apnoea, or HIV are more likely to have low testosterone levels. In addition, a range of medications — including opioids, corticosteroids, anti-psychotics and some chemotherapy drugs — can contribute to reduced testosterone.
Other causes include natural ageing, testicular injury or disease, pituitary tumours, genetic conditions such as Klinefelter’s syndrome, and lifestyle factors such as alcohol use and chronic stress.
Recognising the early signs
One of the key challenges with TD is recognising the early symptoms, which can often be subtle or dismissed. According to Dr Forde, some of the first signs men may notice include:
- Loss of early morning erections
- Reduced libido
- Poor sleep
- Decreased muscle strength
- Difficulty concentrating
Importantly, the loss of night-time erections may also be an early indicator of cardiovascular risk. “Up to 67% of men experience erectile dysfunction before developing cardiovascular disease within three to five years,” she notes, highlighting the importance of early assessment.
How men present in practice
In clinical settings, men rarely present directly with concerns about testosterone levels. Instead, they may report symptoms such as depression, low motivation, mood swings or relationship difficulties.
“Very often, the real issue — erectile dysfunction — is not mentioned unless the healthcare professional asks directly and sensitively,” says Dr Forde. “There can be a strong sense of embarrassment or perceived failure, which prevents men from opening up.”
Routine blood tests may reveal clues such as anaemia or borderline diabetes, which should prompt further investigation, including testosterone testing. Interestingly, Dr Forde notes that women are often the ones who first recognise the symptoms in their partners and encourage them to seek help.
Breaking the taboo
Despite increasing awareness, TD remains a sensitive topic for many men. Reluctance to seek medical advice continues to be a significant barrier, contributing to poorer health outcomes.
“Many men will avoid attending their GP until they are significantly unwell,” Dr Forde explains. “Education is key — both for patients and healthcare professionals.”
She recommends that men adopt a proactive approach to their health, including regular check-ups. Testosterone levels naturally decline by approximately 1% per year from the age of 35–40, but younger men are not immune, particularly in the context of stress or lifestyle factors.
Treatment and lifestyle approaches
Management of Testosterone Deficiency typically involves a combination of medical treatment and lifestyle interventions.
Testosterone Replacement Therapy (TRT) is the mainstay of treatment and is available in several forms, including gels and injectable preparations. However, it is not suitable for all patients — particularly those wishing to maintain fertility, as TRT can suppress sperm production. In such cases, alternative treatments such as clomiphene may be considered.
TRT is also contraindicated in men with certain conditions, including prostate cancer, male breast cancer, severe heart failure, or elevated haematocrit levels.
Alongside pharmacological treatment, lifestyle plays a crucial role. Dr Forde emphasises the importance of:
- A balanced diet including healthy fats
- Managing stress to reduce cortisol levels
- Adequate sleep, as testosterone production peaks during sleep
- Supplementation where appropriate, including vitamin D3, omega-3, zinc and magnesium
In some cases, medications such as PDE5 inhibitors (e.g. tadalafil) may also be prescribed, not only to address erectile dysfunction but also for their potential cardiovascular benefits.
A role for early intervention
Ultimately, increasing awareness of Testosterone Deficiency is essential to improving outcomes for men. Earlier recognition, open conversations, and proactive health management can all help to reduce the long-term impact of the condition.
As Dr Forde concludes, “We need to normalise these discussions and ensure men feel comfortable seeking help. With the right approach, TD is a highly manageable condition — but only if it is recognised.”
