Male Menopause: What’s Behind Men’s Midlife Health?

It has many names and monikers.

Male menopause.


Age-related testosterone deficiency.


Manopause, my personal favorite.

Although it isn’t as sharply defined as female menopause, male menopause is a catch-all for the gradual cascade of mental and physical health issues that men face as they approach and pass middle age and their testosterone drops. Wherever possible, I will insert “man” puns into the symptoms and conditions. Consider yourself warned.

Female menopause—as defined by the loss of fertility—happens to every woman no matter her genetics or lifestyle, dietary, or exercise choices. It’s a simple fact of human biology that women undergo menopause and the subsequent decline in sex hormones. They can certainly mitigate the negative symptoms with hormonal therapies, herbal concoctions, diet, and other means. Some will never experience any negative symptoms associated with the change. But a woman’s supply of eggs is finite. Fertility isn’t a lifelong state for women.

Not so with men. The health of an aging man entering “manopause” or male menopause depends almost entirely on the choices he makes, the food he eats (and how much of it), and the exercise he does or doesn’t do. This is liberating, but it’s also daunting: You can’t really complain if you aren’t doing anything about it. It’s all up to you. And even if it’s not up to you, acting as if it is gives you the best shot at countering the negative effects.

Today, I’m going to explore the most common changes that befall middle-aged men, why they happen, and what you can do to reduce their impact on your life.

What Tends To Happen To Men At Middle-Age?

They get fat: Middle aged men have higher rates of obesity than any other male age group.

They lose muscle: According to Harvard, after age 30, men begin losing about 3-5% of their muscle every 10 years. I’m a little skeptical of that notion—it sounds like one of those “facts” that people parrot without knowing the provenance—but it’s definitely true that and all else being equal, men lose strength as they age.

They get insulin resistant: Insulin resistance tends to rise with age, though that’s probably more a function of weight gain than chronology.

They have heart trouble: Heart attack, stroke, and heart failure rates go way up in middle aged males. The majority of them occur between the ages of 35 and 64.

They lose energy: While the previous study found that age-related insulin resistance is more a function of age-related weight gain than chronological age itself, it did find that age was a strong predictor of reduced mitochondrial production of ATP.

Their bones get weaker: Middle aged men have a lower risk of osteoporosis than middle aged women, but it’s still an issue.

They suffer mojo deficiency: Getting hard gets harder.

They get anxious: It’s not one of the classic menopausal symptoms, but it’s common. The mid 40s to the early 50s is a strange time for men. There’s a lot at stake. Either you’ve “arrived,” and you’re worried about losing everything, or you’re still drifting, and you’re worried about ever achieving anything. When I was in my mid 40s, it was my anxiety about building a life I was truly proud of that got me to take a big risk and start Primal Nutrition (with almost nothing in the bank and a wife and two kids at home).

Anxiety is there. If you harness and use it as fuel for focus and purpose, anxiety can help you.

They consider suicide: Suicide rate are highest (and still climbing) among middle-aged men.

The good news is that you are not destined to feel these effects. Before I get into that, let’s explore some of the causes of andropause.

What Explains These Age-Related Changes?

What are some causes (because “old age” isn’t a good answer)?

A lot of it comes down to the same things we talk about on this blog all the time.

Bad diets full of processed junk, industrial seed oils, refined carbohydrates, and grains.

Sedentary lifestyles bereft of regular physical activity, intense training, and low-level aerobic work.

Inadequate sleep and dysfunctional circadian rhythms.

And compound interest.

Consider this: If you’re 45 years old and you’ve spent the last twenty years getting 6 hours of sleep a night, sitting for 12 hours a day, and eating fast food five nights a week—all that damage is going to accumulate. Bad sleep compounds. Bad food compounds. A lack of exercise compounds. Part of the whole manopause thing is that middle age is when the body begins to really buckle under the weight of an unhealthy diet and lifestyle.

So, What Can Fix It?

Eat low-carb Primal, maybe even keto. But keep protein relatively high, as it will help you maintain muscle mass and bone density. Also, the older you are, the more protein you need to get the job done.

Lift heavy things twice a week. This will build muscle, strengthen bone, and improve depression.

Move around a lot at a slow pace. Long walks, hikes, easy runs/swims/cycling. Move as much as you can without making it an intense workout.

Sleep 8 hours a night. Start there and titrate up or down depending on your symptoms. But 8 is probably what you’ll need.

What About Testosterone?

Another major issue is low testosterone. As men approach middle-age, the testicles stop producing as much testosterone, and testosterone levels drop. The drop off is more gradual than a woman’s shift into menopause, but it’s a drop nonetheless.

Testosterone plays a mechanistic role in every single one of the symptoms or health conditions I listed above:

It helps you gain and maintain lean muscle mass. Testosterone activates the satellite cells that initiate muscle growth.

It has an inverse correlation with obesity. Replacing low testosterone increases fat loss.

It’s necessary for glucose uptake. For instance, after bariatric surgery, a man’s testosterone and insulin sensitivity are coupled. As the former rises, so does the latter.

It’s inversely correlated with mortality from heart failure and protects against heart attacks.

It’s required for strong bones.

It improves erectile quality and function.

Men with severe depression have lower testosterone, and augmenting testosterone in depressed older men seems to improve the depression.

If you’re suffering from these issues and the healthy diet, exercise, and lifestyle measures aren’t working like they should, talk to your doctor about your testosterone testing and even testosterone replacement therapy Get tested, get your blood work done, and see what’s going on.

Oh, and there’s one more common characteristic among middle aged men that could be causing problems: statins.

The Possible Role Of Statins?

About half of men over the age of 45 are taking statins. Now, I won’t get into the question of whether statins are advisable or even work. I’ve covered that territory before. I suggest you visit those posts. Suffice it to say, it’s a personal decision between you and your doctor based on a number of factors.

That said, statins undoubtedly contribute to many of the negative health effects associated with male menopause. They do, because they’re so good at what they do:

Statins lower cholesterol levels by inhibiting the HMG-CoA reductase, an enzyme that sits upstream of cholesterol synthesis. The problem is that many other important production pathways lie downstream of HMG-CoA reductase, too—not just cholesterol (although that’s also important). When we block HMG-CoA with statins, we impact the production of CoQ10, Vitamin K2, and even testosterone. Why do these compounds matter for middle-aged men?

CoQ10 helps generate ATP to power our cells, tissues, and structures. Deficiencies in CoQ10 have been linked to heart failure and high blood pressure, two common afflictions in male menopause. While supplemental CoQ10 is effective at countering some of the muscle-wasting effects of statins, a man’s ability to convert the inactive ubiquinone form of CoQ10 into the active ubiquinol form drops off around age 40. Go with the latter.

Vitamin K2 is crucial for the maintenance of bone health, insulin sensitivity, and testosterone production.

Testosterone is, well, testosterone. I just explained why it’s so important for middle-aged men.

Statins also make a vital practice for middle-aged men—exercise—harder to follow, less effective, and more dangerous by impairing muscle adaptations to exercise, increasing muscle pain,  increasing the risk of injury, and reducing the amount of ATP your mitochondria are able to generate. All this means that exercise is much less effective and sustainable in men taking statins.

Okay, we’re done. Take a deep breath….

Believe it or not, despite the studies and symptoms and correlations described in today’s post, there is plenty of hope to go around. All is not lost. The day can still be won. Your testicles, however middle-aged they may be, can still produce sperm and testosterone—and you can make the necessary lifestyle modifications to make it happen.

Get to it and good luck, middle-aged brethren.


Karakelides H, Irving BA, Short KR, O’brien P, Nair KS. Age, obesity, and sex effects on insulin sensitivity and skeletal muscle mitochondrial function. Diabetes. 2010;59(1):89-97.

Tuck SP, Francis RM. Testosterone, bone and osteoporosis. Front Horm Res. 2009;37:123-32.

De maddalena C, Vodo S, Petroni A, Aloisi AM. Impact of testosterone on body fat composition. J Cell Physiol. 2012;227(12):3744-8.

Fillo J, Breza J, Ondrusova M, et al. Results of long term testosterone replacement therapy in men with abdominal obesity, erectile dysfunction and testosterone deficiency. Bratisl Lek Listy. 2018;119(9):577-580.

Rao PM, Kelly DM, Jones TH. Testosterone and insulin resistance in the metabolic syndrome and T2DM in men. Nat Rev Endocrinol. 2013;9(8):479-93.

Yoshihisa A, Suzuki S, Sato Y, et al. Relation of Testosterone Levels to Mortality in Men With Heart Failure. Am J Cardiol. 2018;121(11):1321-1327.

Traish AM, Haider A, Haider KS, Doros G, Saad F. Long-Term Testosterone Therapy Improves Cardiometabolic Function and Reduces Risk of Cardiovascular Disease in Men with Hypogonadism: A Real-Life Observational Registry Study Setting Comparing Treated and Untreated (Control) Groups. J Cardiovasc Pharmacol Ther. 2017;22(5):414-433.

Giltay EJ, Van der mast RC, Lauwen E, Heijboer AC, De waal MWM, Comijs HC. Plasma Testosterone and the Course of Major Depressive Disorder in Older Men and Women. Am J Geriatr Psychiatry. 2017;25(4):425-437.

Orengo CA, Fullerton G, Tan R. Male depression: a review of gender concerns and testosterone therapy. Geriatrics. 2004;59(10):24-30.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending more than three decades educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates flavorful and delicious kitchen staples crafted with premium ingredients like avocado oil. With over 70 condiments, sauces, oils, and dressings in their lineup, Primal Kitchen makes it easy to prep mouthwatering meals that fit into your lifestyle.

If you'd like to add an avatar to all of your comments click here!