Andropause and sex: Why low testosterone isn't the whole story behind low libido

As men grow older, changes in energy, mood, and sexual health are often brushed aside as "just ageing." But for many men, these shifts are linked to andropause, the gradual decline in testosterone levels that occurs with age, also known as late onset hypogonadism (LOH). We spoke to Dr. Aarthi Devi V, Consultant Endocrinologist, Sugar and Heart Clinics, Hyderabad, to understand how andropause affects sexual health, and what men should know before jumping to conclusions or quick fixes.

Low libido is the hallmark symptom

According to Dr. Aarthi Devi, the most associated symptom of andropause is low libido. But it rarely shows up alone.

"Other symptoms of late onset hypogonadism include: erectile dysfunction, decreased muscle mass and strength, increased body fat, decreased bone mineral density and osteoporosis, and decreased vitality and depressed mood," she explains.

"None of these symptoms are specific to the low androgen state, but may raise suspicion of testosterone deficiency. One or more of these symptoms must be corroborated with a low serum testosterone level."

She points to findings from the European Male Ageing Study (EMAS), a major study in this field. The EMAS proposed that the presence of three sexual symptoms, decreased libido, reduced morning erections, and erectile dysfunction, combined with a total testosterone level of less than 11 nmol/l and a free testosterone level of less than 220 pmol/l, can be considered the minimum criteria for diagnosing LOH in ageing men.

Is a drop in sex drive just a normal part of ageing?

Not always, and not something every man should dismiss without a second thought. Dr. Aarthi clarifies that "routine evaluation is not warranted in elderly men above 70 years," but a drop in sexual drive "warrants evaluation in younger men and in men with recent onset of progressive symptoms, as pathological causes of late onset hypogonadism has to be ruled out."

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In other words, age alone does not explain every case. A sudden or progressive change in libido, especially in a younger man, deserves a proper medical evaluation rather than being written off.

Stress: The silent libido killer

Hormones are not the only culprit behind a flagging sex drive.

"Chronic stress, poor sleep, and excessive work pressure can substantially reduce libido and sexual performance, sometimes as much as hormonal factors," Dr. Aarthi says.

She adds that "addressing sleep, stress, and lifestyle is therefore an important part of evaluating and treating reduced sexual desire."

This is a reminder that sexual health cannot be separated from overall lifestyle. Long work hours, disrupted sleep cycles, and constant pressure can quietly chip away at desire well before hormone levels become a factor.

Libido and erectile dysfunction are not the same thing

Many men use the terms "low libido" and "erectile dysfunction" interchangeably, but Dr. Aarthi Devi explains that they are distinct conditions.

"Libido is the desire or interest in sexual activity, whereas erectile dysfunction (ED) is difficulty achieving or maintaining an erection sufficient for sexual activity," she explains.

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"A man can have normal desire but ED, or low desire with normal erections."

Understanding this distinction matters because the underlying causes, and the treatment approach, can be quite different depending on which symptom a man is actually experiencing.

The risks of self-prescribing testosterone

With testosterone boosters widely marketed online and in stores, it can be tempting for men to try them without medical guidance.

The doctor urges caution. "Using testosterone or 'testosterone boosters' solely to enhance sexual performance can be risky, particularly when testosterone levels are already normal," she warns.

The potential consequences are significant. "Unnecessary use can cause suppression of natural testosterone production and hence infertility, increased red blood cell counts, thus increasing blood viscosity, and also augment the progression of occult prostate cancers, as they are androgen dependent," she says.

Her advice is unambiguous: testosterone therapy "should be taken only with advise of your Endocrinologist."

The biggest misconception about ageing and sex drive

When asked about the most common misunderstanding men have, Dr. Aarthi identifies a widespread but oversimplified belief: "A decline in testosterone with age inevitably means a decline in sexual desire."

The reality, she says, is far more nuanced. "Libido is multifactorial, testosterone matters, but sleep, obesity, medications, metabolic health and psychological factors can be equally important."

-Inputs from Dr. Aarthi Devi V, Consultant Endocrinologist, Sugar and Heart Clinics, Hyderabad.