Doctors Warn of 'Manopause' as Low Testosterone Affects Millions; Hims Begins New Treatment Offerings

A growing number of clinicians are urging men and primary care providers to recognize age-related testosterone decline — commonly called andropause or “manopause” — as a significant health issue that can produce subtle symptoms and long-term consequences. Telehealth company Hims said this week it will begin offering personalized treatment plans for low testosterone that include compounded enclomiphene and plans to add an oral testosterone replacement therapy, Kyzatrex, next year.

Medical experts and company officials told The Post that many men do not associate slow declines in testosterone with the fatigue, low libido and cognitive problems they experience, and that hesitancy about treatment remains widespread. An estimated five million men in the United States struggle with low testosterone; levels typically begin to decline around age 30 and may fall by as much as 50 percent by age 70 compared with peak levels.

Dr. Pete Stahl, head of men’s health at Hims, said the signs can be "slow and insidious," leading many men to attribute changes to normal aging rather than a treatable hormone deficiency. He said some of the earliest symptoms include a drop in sex drive and persistent fatigue despite adequate sleep. Over time, men may notice loss of muscle mass and strength, gain of body fat concentrated around the midsection, erectile dysfunction, mood changes, difficulty sleeping, irritability, brain fog and poor concentration.

Stahl told The Post that testosterone deficiency affects roughly 30 to 40 percent of men by their 40s and 50s, and that declines occur more rapidly in men with chronic illnesses or obesity. He said the condition is not a direct analogue to menopause in women: while postmenopausal women experience a relatively synchronous and universal hormonal transition, men’s testosterone levels fall at different rates and not all men experience clinically significant symptoms.

Clinicians warn that the implications extend beyond quality-of-life complaints. In the longer term, low testosterone has been associated with metabolic and structural changes that can increase disease risk. Stahl cited links between testosterone deficiency and insulin resistance, which can contribute to diabetes; loss of bone mineral density that may predispose to fractures; reduced red blood cell production leading to anemia; and adverse lipid changes that can raise cardiovascular disease risk.

Treatment approaches vary depending on the cause and the patient’s goals. Physicians commonly address underlying conditions that can suppress testosterone, prescribe medications that stimulate natural testosterone production, or use testosterone replacement therapy (TRT). Stahl said medications that drive the body’s own production of testosterone are ‘‘a great first-line therapy’’ and do not impair fertility, in contrast to some forms of TRT.

He acknowledged that many men are reluctant to pursue treatment because they conflate medically supervised testosterone therapy with illicit anabolic steroid use, and because earlier, now-debunked studies suggesting cardiovascular risk have left lingering concerns among some doctors. Stahl said the stigma around treatment prevents many men from seeking help and discourages some clinicians from treating symptomatic patients.

Hims said its newly available plans will include compounded enclomiphene, a medication that can stimulate endogenous testosterone production, and that it plans to offer Kyzatrex, an oral form of testosterone replacement, next year. The company cited data indicating Kyzatrex can restore testosterone levels in a high percentage of men with minimal side effects; the company said one study showed restoration in up to 96 percent of treated men.

Restoring testosterone to a healthy range, Stahl said, can ‘‘have a tremendous impact on his quality of life and healthspan’’ for men who experience symptomatic deficiency. He urged men experiencing persistent fatigue, sexual dysfunction, mood changes or cognitive difficulties to discuss testing and treatment options with a healthcare provider rather than attributing those symptoms solely to aging.

Primary care clinicians and endocrinologists may differ on thresholds for diagnosis and the best therapeutic approach, and professional societies continue to update guidance as new evidence emerges. Clinicians and patient advocates emphasize that evaluation should include a clinical assessment, repeated morning testosterone measurements when indicated, and a discussion of benefits and risks tailored to the individual’s health profile.

Hims’ announcement reflects growing commercial and clinical attention to testosterone deficiency and the range of treatment options. Medical societies and providers stress that identifying and appropriately treating testosterone deficiency is part of comprehensive men’s healthcare, particularly for men with symptoms that interfere with daily function or are associated with metabolic or musculoskeletal risk factors.