Andropause & Low Testosterone Treatment

What andropause is

Andropause — also called late-onset hypogonadism or male menopause — describes the cluster of symptoms many men experience as testosterone declines through middle age. Total testosterone falls roughly 1% per year after age 30 in healthy men; some lose it faster. The condition is recognised by the Endocrine Society when a man has symptoms consistent with low T and repeated morning total testosterone measurements below ~10 nmol/L (~300 ng/dL).

Common symptoms

• Persistent fatigue, especially in the afternoon.
• Loss of libido and reduced morning erections.
• Erectile difficulty.
• Reduced lean muscle mass; increased central body fat.
• Mood: low mood, irritability, reduced motivation.
• Cognitive: “brain fog”, reduced focus.
• Sleep: poor quality, more night-time waking.
• Bone density loss over the longer term.

Diagnosis

Andropause is a clinical-plus-laboratory diagnosis. A reputable workup includes:

• Morning total testosterone (08:00–10:00), repeated on two separate days.
• Free testosterone (calculated or measured).
• Sex hormone–binding globulin (SHBG).
• LH and FSH (to distinguish primary vs secondary hypogonadism).
• Prolactin (rule out pituitary cause).
• PSA + DRE (if considering testosterone replacement therapy).
• Haematocrit, lipid panel, HbA1c, vitamin D, thyroid panel.

Treatment of low T without symptoms is not recommended.

Treatment options

If a doctor diagnoses symptomatic low T and the patient has no contraindications (prostate cancer, untreated severe sleep apnoea, polycythaemia, untreated CHF, fertility plans in next 12 months), options include:

• Lifestyle: resistance training, sleep optimisation, weight loss, alcohol moderation, stress reduction. These can move testosterone by 10–20% on their own.
• Commercial TRT: Nebido (testosterone undecanoate) intramuscular every 10–14 weeks; Androgel transdermal gel.
• Compounded TRT: custom-dose testosterone cream, gel, troche, or capsule — useful when the patient needs a strength not available commercially, an excipient-free vehicle, or a daily transdermal dose finer than what off-the-shelf provides.

How Lynnity compounds testosterone

Common compounded forms:

• Testosterone cream 100 mg/g in PCCA Lipoderm or HRT cream base — applied to inner forearm or scrotum (the latter increases absorption significantly).
• Testosterone gel 1% / 2% / 4% in a hydroalcoholic gel.
• Testosterone troche (sublingual) for patients who can’t or won’t use transdermals — typically 25–50 mg dose.
• Combination compounds — testosterone + DHEA, or testosterone + anastrozole, where prescriber-specified.

Standard turnaround 3–5 working days. Prescription required.

Adjuncts the prescriber may consider

• DHEA — adrenal support, also a testosterone precursor.
• HCG (human chorionic gonadotropin) — preserves testicular function and fertility on TRT (specialist supervision).
• Anastrozole — low-dose aromatase inhibitor for men converting too much T to estradiol on therapy.
• Tadalafil (low daily dose) — for concurrent ED.

Safety

The most common adverse effects of TRT are:

• Rising haematocrit (the doctor will monitor; sometimes a periodic blood donation is needed).
• Acne or oily skin (especially in the first 8 weeks).
• Increased prostate-specific antigen (PSA) — usually a small rise; large rises require investigation.
• Testicular shrinkage and reduced fertility — preventable with HCG co-therapy.

Lifelong contraindications: active prostate or breast cancer.

How to start

Speak to your GP, urologist, or anti-ageing physician about a workup. If they prescribe compounded testosterone, the prescription can be sent to Lynnity by email or WhatsApp. Standard turnaround 3–5 working days.

FAQ

At what age do men start to need testosterone replacement?

There is no fixed age. Some men develop symptomatic low T in their 30s; others maintain normal levels into their 70s. Treatment decisions are based on symptoms plus repeated morning laboratory values, not on age alone.

Is compounded testosterone safer than commercial TRT?

No reliable evidence either way. Compounded forms are useful when the patient needs a custom dose, custom vehicle, or a form not commercially available. Safety considerations (haematocrit, prostate, fertility) are the same regardless of source.

Can I get testosterone without a prescription in Malaysia?

No. Testosterone is a controlled substance under the Poisons Act 1952. Any compounded testosterone formulation requires a current prescription from a registered Malaysian medical practitioner.

Does TRT affect fertility?

Yes. Exogenous testosterone suppresses pituitary LH and FSH, reducing the body’s own testicular testosterone production and sperm count. Men planning future fertility should discuss HCG co-therapy or alternatives (clomiphene, enclomiphene) with a specialist before starting TRT.

Will TRT give me prostate cancer?

Long-term data does not support a causal link between TRT and de novo prostate cancer. However, TRT can accelerate growth of an existing undiagnosed prostate cancer — that’s why a baseline PSA + DRE is mandatory before starting therapy.