Male Andropause and Suicide Risk: Exploring the Hidden Link
In recent decades, increasing attention has been given to men’s mental health, particularly surrounding the often-overlooked phenomenon of andropause—sometimes referred to as “male menopause.” Unlike the relatively abrupt hormonal changes experienced by women in menopause, andropause is a gradual decline in testosterone levels that can begin in men as early as their 30s or 40s. While this condition is still not universally recognised in all clinical circles, a growing body of evidence suggests that andropause may be a significant factor in midlife male depression, and alarmingly, in increased suicide risk among men.
What Is Andropause?
Andropause refers to age-related testosterone deficiency or late-onset hypogonadism. According to the European Male Aging Study (EMAS), testosterone levels decline approximately 1–2% per year after the age of 40 in men (Wu et al., 2008). Symptoms can include fatigue, reduced libido, erectile dysfunction, loss of muscle mass, increased body fat, irritability, and depression.
Andropause doesn’t affect all men in the same way or with the same intensity. It is often under-diagnosed, partly due to the lack of awareness and partly due to overlapping symptoms with other medical or psychological conditions. Nonetheless, hormonal changes in men during midlife have now been well-documented, and their impact on mental health is becoming increasingly evident.
Rising Suicide Risk in Middle-Aged Men
Globally, suicide rates are highest among middle-aged men. According to the World Health Organization (WHO), men are nearly three times more likely to die by suicide than women in many countries, including the UK, Canada, and Australia. In the UK, suicide remains the leading cause of death for men under 50, with a notable spike in rates between ages 45–59, as reported by the Office for National Statistics (ONS, 2023). Similarly, Canadian data show that men aged 40–59 have consistently higher suicide rates than both younger and older men.
Is There a Link Between Andropause and Suicide?
The overlap in age between rising suicide risk and the typical onset of andropause is striking. While correlation does not equal causation, several lines of scientific evidence point to a meaningful connection between the two.
1. Testosterone and Mood Regulation
Testosterone plays a crucial role in modulating neurotransmitters such as serotonin, dopamine, and GABA, which are closely linked to mood and emotional regulation. Research indicates that low testosterone levels are associated with an increased risk of depressive symptoms and suicidal ideation.
A large-scale longitudinal study by Shores et al. (2005) found that men with low testosterone were four times more likely to be diagnosed with clinical depression than those with normal levels. Additionally, a 2009 meta-analysis published in Psychoneuroendocrinology confirmed that testosterone supplementation in hypogonadal men significantly improved mood and reduced depressive symptoms (Zarrouf et al., 2009).
2. Depression as a Mediator
Depression is a well-known risk factor for suicide. In many men, andropause-related hormonal changes may act as a trigger for depression, especially when coupled with life stressors such as divorce, job loss, or chronic illness—common in midlife. Yet, male depression often manifests differently from female depression: it is more likely to be externalised through anger, substance abuse, or risk-taking behaviours, which can mask the underlying issue and delay diagnosis and treatment.
Men also face cultural stigmas that discourage emotional expression or help-seeking behaviours, which compounds the risk. As a result, depression often goes untreated in men until it reaches crisis levels.
3. Loss of Identity and Purpose
Andropause can contribute to a broader existential crisis for men, sometimes referred to as the “male midlife crisis.” The physical symptoms—such as decreased libido, loss of strength, and increased fatigue—may be perceived as a loss of virility or masculinity. For many men, especially those who strongly identify with traditional masculine roles, these changes can lead to a sense of inadequacy or diminished self-worth.
This psychosocial decline can intersect with hormonal changes to deepen emotional instability, increasing the risk of self-harm or suicide.
Testosterone Replacement Therapy (TRT) and Mental Health
If andropause is a contributing factor to male suicide risk, could treatment with testosterone (particularly bio-identical hormone optimisation as offered by Valens Health) mitigate this risk?
Evidence suggests it might. Several studies have shown that testosterone replacement therapy can improve not only sexual function and physical vitality but also mood and well-being in hypogonadal men. A 2019 meta-analysis by Walther et al. found that TRT significantly reduced depressive symptoms in men with low testosterone.
However, TRT is not without controversy, especially in relation to potential exacerbation of prostate conditions. Therefore, the decision to pursue TRT and hormone optimisation therapy should ONLY be individualised and closely monitored by healthcare professionals. Valens Health offers a completely bespoke hormone optimisation package, tailored to each individuals symptoms, blood biomarkers and needs.
Importantly, addressing andropause-related mental health risks should not rely solely on hormonal interventions. Psychotherapy, lifestyle changes (such as exercise, sleep, and nutrition), and community support all play crucial roles in promoting emotional resilience.
The Need for Awareness and Screening
Despite the mounting evidence, andropause is still under-recognised in clinical practice. Routine screening for testosterone levels is rarely conducted in men presenting with depressive symptoms, especially in primary care settings; with medication for mood usually being the go-to primary care option (rather than treating the root cause). Moreover, mental health assessments often fail to consider hormonal contributions to mood disorders in men.
A more integrative approach is needed—one that incorporates hormonal evaluation into the assessment of middle-aged men presenting with psychological distress. General practitioners and mental health professionals should be trained to recognise the signs of andropause and consider it in the differential diagnosis of midlife male depression. Valens Health is a strong advocate of this.
Conclusion
While more research is needed to firmly establish causality, the growing body of evidence indicates that andropause may be a significant contributing factor to the heightened suicide risk seen in middle-aged men. Declining testosterone levels can profoundly affect mood, sense of identity, and overall mental health. Combined with sociocultural pressures and under-diagnosis of male depression, this biological shift may play a dangerous role in pushing some men toward suicidal ideation.
Addressing this silent crisis requires a multidisciplinary approach—one that integrates hormonal, psychological, and social perspectives. By acknowledging andropause as a legitimate and impactful condition, we can improve screening, reduce stigma, and ultimately save lives.