You can feel the shift. Workouts take more out of you. Sleep doesn't refill the tank the way it used to. Focus slips when you need it most. Your usual drive isn't what it was. You're not "sick," but you're definitely not yourself either.
That pattern has a name: andropause—sometimes called male menopause—and it's far more common than most men realize. If you're in your 40s, 50s, or beyond and experiencing these changes, you're not alone, and you're not imagining things.
At The Center for Fully Functional Health in Carmel, we don't just treat numbers on a lab report; we treat the whole person behind those numbers. We test with purpose, explain what's happening in plain language, and build treatment plans that actually fit into real life. You'll work with board-certified physicians who take time to listen, connect the dots between your symptoms, and guide you toward feeling like yourself again—without pressure or one-size-fits-all protocols.
Your Signals, in Plain English
Andropause describes the age-related hormonal changes that many men experience, particularly the gradual decline in testosterone that occurs with aging. Unlike menopause in women, which happens relatively suddenly, andropause is a slow, progressive shift that can unfold over years or even decades.
But testosterone doesn't decline in isolation. Changes in other key hormones and body systems happen alongside it: DHEA levels drop, growth hormone production slows, thyroid function may shift, insulin sensitivity can decrease, vitamin D levels may fall, and your stress response often becomes more pronounced. When these signals drift together, the cumulative effect shows up in everyday life.
Common symptoms of andropause include:
Research shows that the most reliable symptom pattern for testosterone deficiency involves sexual symptoms—particularly low desire, fewer morning erections, and erectile issues—combined with consistently low testosterone levels on blood tests. This research-backed approach shapes how we diagnose and treat andropause today.
What’s Going On Biochemically
Understanding what's happening inside your body helps explain why you're feeling the way you do. Think of your hormones and body systems as an interconnected network rather than separate specialties:
Testosterone supports multiple crucial functions including muscle mass and strength, bone density, sexual function, mood regulation, and cognitive clarity. When levels decline, you feel it across all these areas—slower recovery from workouts, loss of muscle mass, lower sexual desire, and sometimes a shorter fuse when dealing with stress.
Cortisol, your primary stress hormone, rises with chronic stress and can gradually chip away at your muscle tissue and energy reserves. When cortisol stays elevated—whether from work pressure, poor sleep, or other stressors—it actively works against testosterone production.
Aromatase is an enzyme found in fat tissue that converts testosterone into estradiol (a form of estrogen). As abdominal fat increases during midlife, more testosterone gets converted to estrogen, which can contribute to mood changes, weight gain, and decreased libido.
Insulin resistance often develops alongside andropause, making it harder to maintain healthy weight and contributing to fatigue. This creates a frustrating cycle where weight gain worsens hormone imbalances, which makes weight management even more challenging.
Thyroid hormones set your metabolic pace. Even small shifts in thyroid function can change how you generate heat, sustain energy, and maintain mental focus.
Pituitary signals (specifically LH and FSH hormones) help determine whether hormone issues originate in the testes themselves (primary hypogonadism) or in the pituitary gland and hypothalamus (secondary hypogonadism). This distinction guides treatment decisions.
Sleep quality and sleep apnea can significantly amplify andropause symptoms. When sleep is disrupted, everything from hormone production to recovery gets compromised, making the whole picture louder and more challenging.
Additional factors like chronic inflammation, higher body mass index, cardiovascular risk factors, chronic illnesses, and certain medications can all increase the likelihood of experiencing significant andropause symptoms.
The Real-World Red Flags
Understanding the why’s of andropause is important. But when you leave behind the clinical analysis, here’s how “manopause” affects your everyday life:
Not every symptom automatically points to testosterone deficiency. But when several of these issues line up together—especially the sexual symptoms paired with fatigue and mood changes—it's time for comprehensive testing to understand what's really happening.
Test First, Then Decide.
Your initial consultation sets the direction for everything that follows. We start by listening to your story and understanding your specific symptoms, then we test what actually matters:
Core hormone testing:
Supporting systems:
Additional workup when needed:
We follow evidence-based diagnostic guidelines emphasizing that testosterone deficiency should be diagnosed based on both symptoms and consistently low testosterone levels—not one or the other alone. This thoughtful approach ensures we're treating real hormone deficiency rather than normal aging variations.
Andropause Treatment at CFFH
Foundations matter tremendously. Before considering hormone replacement, we address the lifestyle factors that genuinely move the needle on the outcomes that matter most to you: energy, strength, mood, and sexual function.
Core lifestyle optimizations:
Hormone replacement therapy enters the picture when symptoms and lab results align. We use testosterone therapy thoughtfully and monitor your response closely throughout treatment:
Testosterone replacement therapy options:
We choose your delivery method based on your preferences, how your body responds, and what fits into your lifestyle. Regular follow-ups allow us to track both your symptoms and hormone levels, making adjustments as needed. We also monitor estradiol, hematocrit, PSA, and blood pressure throughout treatment, revisiting risk factors as they change.
Sexual function often improves with hormone optimization, but we address it comprehensively by supporting endothelial health (the lining of your blood vessels), sleep quality, glucose control, and pelvic blood flow. While medication can certainly help with erectile dysfunction, addressing the underlying terrain—hormones, metabolism, sleep, and physical fitness—frequently changes the entire story.
Bone health remains on our radar throughout treatment. While testosterone can support bone density, maintaining strong bones also depends on resistance training, adequate vitamin D and protein intake, and fall prevention strategies.
What Real Progress Looks Like
Everyone’s body and experience are different, and andropause may be affected by other health factors, including stress and activity levels, chronic infections or toxin exposure, and ongoing inflammation caused by diabetes or autoimmunity. However, when those are addressed, bioidentical hormone replacement typically involves a timeline such as:
Weeks 2–6: Many men notice steadier mornings, better sleep quality, fewer mood swings, and rising sexual desire and function.
Weeks 8–12: Clearer thinking, improved cognitive function, and visible changes in muscle mass and body fat distribution become apparent.
Months 3–6: Stronger recovery from workouts, more durable energy throughout the day, continued improvements in sexual function, and real momentum in your training and daily activities.
Longer term: Enhanced bone health, healthier metabolic markers, and the kind of confidence that comes from genuinely feeling like yourself again.
Follow-up visits are key to monitor your progress, fine-tune dosing based on how you're feeling and what your labs show, and keep an eye on both symptoms and safety markers. This ongoing partnership ensures your improvements hold and that treatment continues working for you over time.
Why Choose The Center for Fully Functional Health
You'll work with physicians who genuinely listen, explain things clearly, and act with purpose. Dr. Ellen Antoine and Dr. Scott Antoine bring decades of medical experience to every consultation—drawing on years of emergency medicine practice, complex case management, and deep clinical problem-solving skills similar to those used in endocrinology.
The Antoines have built a reputation for taking on cases that didn't progress in conventional settings. Other physicians trust them with their most challenging patients, and their approach combines evidence-based medicine with genuine compassion and hope.
We keep our patient panel intentionally manageable so visits remain unhurried and decisions are made collaboratively. This is how men achieve lasting improvements in their health and vitality—through thoughtful, personalized care that addresses root causes rather than just managing symptoms.
Ready When You Are
If you're seeing the signs—low testosterone symptoms, slower recovery, cognitive fog, changes in sexual function—we're here to help. We'll check your hormone levels, discuss your options for testosterone replacement therapy and comprehensive treatment, and map out a path that genuinely fits your life.
Call (317) 989-8463 or reach out online using the form at the bottom of this page.
Yes, absolutely. Many aging men experience a gradual decline in testosterone levels. When this decline occurs alongside specific symptom patterns, particularly sexual symptoms like low desire, fewer morning erections, and erectile difficulties. We investigate and test accordingly. Large-scale research studies continue to refine our understanding of this common condition.
Normal ranges vary somewhat between laboratories and by age. We look at both total testosterone and free testosterone levels, your specific symptoms, and the timing of your blood tests (since testosterone levels naturally fluctuate throughout the day). Context matters significantly more than any single cutoff number, and current medical guidelines reflect this nuanced approach.
No single therapy addresses all aspects of health. Testosterone replacement helps when there's confirmed low testosterone paired with matching symptoms. The best results consistently show up when hormones, sleep quality, physical training, nutrition, and stress management are all addressed together as part of a comprehensive plan.
Recent large-scale research (including the TRAVERSE trial) showed no increase in major cardiovascular events in men using testosterone therapy compared to placebo over approximately two years of follow-up. That said, we still screen for cardiovascular risk factors before starting treatment and monitor heart health throughout therapy, because individual cardiovascular disease risk varies from person to person.
We do not prescribe testosterone therapy for men with active prostate cancer or breast cancer, and we follow appropriate screening protocols while you're on therapy—consistent with current medical guidelines. Regular monitoring helps ensure your safety throughout treatment.
If erectile dysfunction stems partly from low testosterone, many men do see improvement in sexual symptoms with hormone therapy. However, we still address the other crucial factors affecting erectile function: vascular health, sleep quality, stress management, and physical fitness. Erections rely on multiple body systems working together, not just hormones alone.
Some men notice changes within the first few weeks of treatment—improved energy, better mood, stronger morning erections. Changes in body composition and bone density take longer to develop, typically becoming apparent over several months. We track your progress at regular intervals and adjust your treatment plan as your system responds and settles into its new balance.
Yes. Andropause frequently occurs alongside other hormone imbalances, including thyroid dysfunction and insulin resistance. We test for these conditions, treat them as part of your comprehensive care, and coordinate with your primary care physician or specialists when appropriate.
Insurance coverage varies significantly for labs, medications, and office visits related to andropause treatment. We'll outline costs clearly upfront and provide all necessary documentation for reimbursement if your insurance plan allows it.
Schedule an Appointment Today.
The Center for Fully Functional Health® is led by a team of award-winning, internationally recognized physicians, committed to providing personalized, life-changing care.
