I searched something innocuous about midlife and low energy about eighteen months ago, and within a day the advertising had decided what was wrong with me. Supplements, telehealth clinics, and a chart of a line sloping downwards from thirty. The word attached to most of them was andropause.

The pitch is tidy. You are forty-eight, you have stopped ringing anyone, you are flat by seven in the evening, and here is a hormone that explains all of it and a subscription that fixes it.

I went and read the studies, mostly because the pitch was too tidy. Half of it is well documented. The other half is advertising sitting on top of a real but much narrower clinical thing.

I am not a clinician. Nothing below is a diagnosis and none of it should be used as one.

The late-forties peak is real, and Australian data measures it

This is the half with good evidence behind it, so it goes first. Note what is being counted, because it matters later: this is loneliness, self-reported on a seven-point item. Nobody in this study measured whether the men saw fewer people.

Botha and Bower published a study in BMC Public Health on 10 May 2024 using HILDA, the Australian household panel survey. They used waves 2 to 21, covering 2002 to 2021: 118,667 person-year observations from 12,117 Australian men aged 15 to 98, analysed with linear fixed effects. That design follows the same men over time rather than comparing different men at different ages.

Loneliness in Australian men does not rise steadily with age. It peaks twice. Once in young adulthood, and again in middle age, specifically the late forties. The lowest levels in the whole span sit around seventy.

Three other findings from the same paper stayed with me:

  • Having a partner was protective at every age, worth between 0.32 and 0.81 points on a seven-point scale.
  • Being employed reduced loneliness.
  • Couples with children reported higher loneliness in middle age than couples without them.

That last one describes my reader, and no supplement advertisement will ever show it to you. Partnered, employed, kids in the house, and lonelier than the couple down the road with none of it. The late-forties peak is not a personal failure. It is where the curve goes.

I have written elsewhere about what that actually feels like from the inside.

Where the hormone explanation comes from

There is a real clinical entity underneath the marketing, and it is narrower than the word andropause suggests.

The European Male Ageing Study is what everyone is loosely citing. Wu and colleagues published it in the New England Journal of Medicine in July 2010, working with 3,369 community-dwelling men aged 40 to 79 across eight European centres. They set out to identify which symptoms actually track with testosterone level.

In the training set, six did: poor morning erection, low sexual desire, erectile dysfunction, inability to perform vigorous activity, depression, and fatigue.

Then they tested which of those held up well enough to define a syndrome. The definition that survived requires three sexual symptoms together with a total testosterone below 11 nmol/L and a free testosterone below 220 pmol/L.

The gap between those two paragraphs is the whole article. Depression and fatigue were associated with testosterone level in the training set, and neither made it into the diagnostic criterion. The symptoms most likely to describe a flat, withdrawn man in his late forties are exactly the ones that were not specific enough to diagnose on.

How rare the real condition is

The same group put a number on it. In the Journal of Clinical Endocrinology and Metabolism in May 2012, working with 2,966 community-dwelling men aged 40 to 79, they found 63 men who met the criterion for late-onset hypogonadism. That is 2.1 per cent, of whom 36 were moderate and 27 severe.

One man in fifty, across an age range of 40 to 79.

Not most men in midlife, and not the general condition of being forty-eight and tired. If you have arrived here because your evenings have gone quiet, the base rate says the hormone is unlikely to be the explanation, and the ads are working off a denominator they never show you.

What moves testosterone more than age does

The same cohort, reported in the same journal in July 2008 with 3,200 men, compared what actually shifts the number. A BMI between 25 and 30 was associated with a total testosterone lower by 2.32 nmol/L. A BMI of 30 or over, lower by 5.09 nmol/L. Existing illness added a further 0.80 nmol/L.

Those are the authors' own figures. The comparison against age is mine and the paper does not print it that way, so treat it as arithmetic rather than a finding: on their coefficients the obesity gap is the larger of the two across this age range. It also runs through a different mechanism: ageing works through the testes, while obesity suppresses the signal further upstream.

It also moves. A follow-up of 2,395 of these men over a mean of 4.4 years found weight loss associated with a proportional increase in testosterone.

So the honest version of the ad is that the largest modifiable input is your weight, that the association runs in both directions in the follow-up data, and that nobody has a subscription to sell you for it. Losing weight being associated with a rising number is not the same as showing that losing weight raises it.

One blood test is not an answer either

If you do get tested, the number that comes back is softer than it looks.

The Endocrine Society's 2018 clinical practice guideline sets out two things worth knowing first. Around 30 per cent of men whose initial testosterone falls in the hypogonadal range have a normal result on a repeat test. And when 1,133 laboratories measured the same sample using 14 assays, the values ranged from 45 to 365 ng/dL.

The guideline is explicit that diagnosis requires symptoms and signs and consistently low testosterone. A low number on its own is not sufficient.

It also splits symptoms into two lists. The specific ones are things like incomplete sexual development, loss of body hair, unusually small testes. The non-specific ones are decreased energy, low motivation, poor concentration, disturbed sleep, reduced muscle bulk.

Every symptom the advertising leads with sits on the non-specific list. Those symptoms are on that list because they have a hundred other causes, and a kit posted to your house cannot tell them apart.

The connection nobody has actually tested

Here is the gap, stated plainly. There is a well-measured second peak of loneliness in men in their late forties. There is a real, uncommon endocrine condition that becomes more likely with age. Both are true, both sit in the same decade of a man's life, and the advertising treats that overlap as a mechanism.

I went looking for the study that connects them and could not find one. As far as I can tell, nobody has properly asked whether testosterone level relates to friendship, social contact or withdrawal, in either direction. That is not the same as the question being asked and answered no. It means the causal claim in the ad is not a contested finding. It is not a finding.

Which leaves the ordinary explanations. A colleague moved interstate. A club folded. Nobody organises anything anymore. The mechanism behind that has nothing to do with hormones, and it responds to being contacted.

What I would do with all this

Go to the GP. Say the flat thing out loud in plain words and let someone qualified decide what to measure. If low testosterone is genuinely part of it, that is the room where it gets found properly, with a repeat test and a lab you did not choose off an ad.

The avoidance is well documented here. The ABS National Study of Mental Health and Wellbeing, collected from December 2020 to October 2022, which is to say across the pandemic and the two years after it, and released on 26 July 2024, found 16.5 per cent of men aged 45 to 54 had a twelve-month mental disorder, and 16.0 per cent of men aged 55 to 64. Among men with a twelve-month disorder, only 36.4 per cent consulted a health professional.

Two in three did not. The survey does not record what they did instead, so I am not going to tell you they were all reading about it the way I was.

The blood test is a good idea. It is cheap, quick, and much more likely to rule the hormone out than in. And if it comes back unremarkable, you still have the quiet Friday nights, and those have a different fix.

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