Men’s Midlife Change: There Is No Single That Day

 

At 64, I Owe My Daughter an Apology-What Should I Do?

Other people may not know, but I can feel what's happening in my body: my life force is fading. It's frustrating-and it scares me.

 

A few years ago, He Dong traveled from his hometown to Beijing to visit his younger daughter, He Xin. The family decided to go see the Bird's Nest.

It was one of those days when the subway felt like a sealed container-packed so tight that you couldn't count how many stops you spent pressed shoulder to shoulder before finally surfacing back into daylight. When they stepped out of the station, the Bird's Nest was right there-so close it felt like they could touch it. But then they realized the truth: to actually reach it, they still had a long walk ahead.

That was when He Dong's face suddenly flushed bright red.

He fell silent, as if someone had cut the power inside him. Something looked deeply wrong. After a few seconds, he said quietly:

Why don't we just go home?

He stood where he was, reached into his pocket, pulled out a cigarette-and the fingers holding it wouldn't stop trembling.

Later, He Xin told me her father apologized. He felt ashamed of the anxiety that had hit him so suddenly. In her memory, that wasn't a one-off. Those years, incidents like this happened again and again.

Once, during a video call, she casually mentioned she'd walked home after work-alone, for a long time. Her father snapped. He scolded her for always making weird choices and doing things different from other people.

He Xin and her older sister often teased him about his zodiac sign, joking that his nitpicking and criticism were simply classic Virgo. But the family had also noticed something real: over those years, He Dong had less and less patience.

Those years were specific-roughly the seven or eight years before he turned 60.

He is 64 now. Looking back, he remembers that period as a time when his body and emotions felt unfamiliar, unstable, and hard to control: rising blood pressure, insomnia, fatigue that never fully lifted, emotions that flared too easily, fewer morning erections, pain during urination…

He Dong believes that was his male menopause.

But unlike women, he never had a single day he could point to and say: It started today.

 

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There Is No That Day

Do men have menopause?

Women's menopause comes with a clear biological marker-menstruation stops. But for men, there is no equivalent switch. As men age, gonadal function and testosterone levels can change too, but usually slowly, gradually, almost invisibly-so there is rarely one clear moment that feels like a beginning.

Still, male menopause isn't just a folk expression. The 2025 Clinical Guidelines for the Diagnosis and Treatment of Late-Onset Hypogonadism in Men mention that male menopause has been used in the past as one of the names for late-onset hypogonadism.

Wu Xueyan, chief physician and director in endocrinology at Peking Union Medical College Hospital, believes that as a public-facing term, male menopause can be useful. It can describe the phase in which a man moves from middle age toward older age, with bodily functions gradually changing.

Compared with the more dramatic hormonal shift around menopause in women, Wu describes men's changes like this: It's like walking down a mountain-one step, then you look back, then another step. A man climbs quickly during adolescence to reach a high point of physical function, and afterward he starts descending. Day to day, the differences are small-like water heating slowly, until one day you suddenly realize the change has been happening for years.

But inside the clinic, male menopause is too broad.

Doctors now more often use a concept with clearer diagnostic boundaries: late-onset hypogonadism (LOH). LOH isn't simply a man reaches a certain age and becomes tired, sleeps poorly, or gets irritable. LOH refers to a condition in which a man develops symptoms or signs consistent with testosterone deficiency and tests confirm reduced testosterone levels.

In other words, male menopause can describe a life phase. LOH is a medical diagnosis that requires evidence.

 

Most Men Don't Say I'm in Menopause

In everyday life, men rarely announce that they've entered menopause.

Psychology researcher and counselor Zi Fei says that middle-aged men he meets more often say: I can't sleep. I'm exhausted. I have no energy. I'm angry. I'm irritable. I feel low. My sense of self-worth is dropping. Or they talk about external problems: work isn't going well, the marriage is tense, the kids are stressful.

A man may feel he's not the same as before, but he doesn't necessarily connect all the changes-and he almost never names it menopause.

Hospitals look similar. Li Hongjun, chief physician and director in urology at Peking Union Medical College Hospital, has noticed that very few patients come in saying, I think I'm in menopause. Most show up with one or two specific complaints: insomnia, fatigue, sweating, changes in libido or erection quality.

Many have already rotated through cardiology, psychiatry, orthopedics, and other departments. Some are referred by other doctors, including psychiatrists. That doesn't mean they went to the wrong place-because symptoms like insomnia, fatigue, pain, palpitations, sweating, low mood, and sexual changes don't naturally belong to a single specialty.

Li Hongjun has also noticed something else: whenever he mentions male menopause on TV health programs, his outpatient clinic suddenly gets busier afterward. People come in saying, I think I have all those symptoms.

So he formed an impression: it isn't that patients are rare-rather, awareness among both doctors and patients is still limited.

How Common Are These Symptoms, Really?

From hospital visits alone, it's hard to know how common these subtle discomforts are in the general population.

Male aging symptoms are often harder to recognize than female menopause. Fatigue, insomnia, low mood, and decreased libido can easily blur into chronic illnesses, long-term stress, and daily exhaustion.

Li Hongjun and his colleagues wanted to know: among middle-aged and older men in China, how common are these symptoms? How severe? And who is more likely to experience them?

They moved their research into communities. In each location, local community organizations would gather middle-aged and older men-sometimes over a hundred at a time. Li would first give a talk on male health, and then the medical team would guide participants through questionnaires.

They used the Aging Males' Symptoms (AMS) scale. Its 17 questions cover potential changes after midlife across physical, psychological, and sexual domains: sleep quality, anxiety/depression/irritability, joint and muscle discomfort, declines in stamina and muscle strength, sexual activity, libido, morning erections, and more. Each item is rated from 1 (none) to 5 (very severe), then totaled. The higher the score, the greater the overall distress.

This national multi-center study covered 33 research centers, ultimately analyzing data from more than 9,000 men aged 35 to 70. Results showed that roughly 1 in 10 fell into the severe symptoms range as defined by the scale.

That 10% does not mean 10% have LOH. The AMS measures how much discomfort a person is experiencing-it does not determine whether symptoms are caused by testosterone decline.

The study also found that factors like aging, diabetes, hypertension, higher waist-to-hip ratio, heavy smoking, lack of exercise, and poorer marital relationships were associated with more severe AMS symptoms.

In other words: the scale can turn vague changes into a score, but it cannot tell a doctor exactly where that score comes from. One man with a high AMS score may have severe sleep problems; another may be depressed or in chronic pain; another may indeed have androgen deficiency.

Still, the study answers something important: a substantial group of men experience serious physical, psychological, and sexual distress-and that distress is linked to chronic disease, lifestyle, and relationship factors.

 

In the Clinic, Symptoms Get Unbundled Again

Once a man actually sits in the clinic, Li Hongjun's job is usually to take the symptoms apart again.

Insomnia, fatigue, sweating, low mood, decreased libido-these can appear in LOH, but low testosterone is not the only explanation. In Li's experience, only some of the men who come in with such complaints are ultimately found to have low testosterone.

That means: feeling obviously different from before does not guarantee that lab tests will offer a neat hormonal explanation.

Symptoms may come from sleep disorders, obesity and metabolic issues, chronic illness, medications, or emotional distress. Li is less concerned with labeling everything as male menopause and more likely to start with a simpler question:

What is tormenting you the most right now?

When the Body Stops Bouncing Back

He Dong never checked his testosterone during those years. In fact, he never went to the hospital with the question of male menopause.

The changes did not arrive all at once. One thing followed another.

The earliest warning was blood pressure. After 50, he began feeling dizzy while driving home from work. Talking with friends his age, they said it might be hypertension and recommended certain medications. He remembers one drug made him urinate constantly.

Once, after a busy morning, a midday wedding banquet, and an afternoon trip home, he suddenly felt dizzy and terribly unwell. For the next half month his blood pressure seemed impossible to bring down. He went to a familiar traditional Chinese medicine practitioner, who suggested Niuhuang Jiangya Wan. For a long time afterward, he relied on it. Looking back, He Dong admits that during those years he never managed his hypertension systematically.

Then came insomnia-his longest-lasting torment.

He would be exhausted late at night, yet his mind would keep running like a machine. The moment he lay down, thoughts began looping: his daughters' childhoods, his own childhood, siblings, work. He tried audiobooks to fall asleep-at first they helped, then they didn't.

Unable to sleep, he would get up for water, sit on the balcony, return to bed, lie down again. Sometimes he wouldn't truly fall asleep until 3 or 4 a.m., yet he still went to work as usual the next day.

At its worst, he slept only two or three hours a night. This went on-on and off-for five or six years.

Later he asked friends and family not to contact him after 8 p.m. He stopped watching TV. He tried to cut off anything that might stimulate his nervous system.

But what bothered him wasn't only the insomnia itself.

When he was younger, he could work hard all day and recover fully after one night's sleep. After 50, that stopped being guaranteed. The workload and life pressure were similar, but his body could no longer rebound quickly.

 

Food Became a Calculation. Then Pain Arrived.

With poor rest, eating also became something He Dong had to study. He used to love rich meat dishes; later, every bite came with a question: Will this raise my blood pressure? Will it ruin my sleep again?

After a while, his bowel movements became irregular.

Then, later still, he developed pain during urination.

One moment stands out: on his 58th birthday, after a family meal, he went to the bathroom and the pain was intense. Still, he didn't go for a dedicated exam. Based on traditional Chinese medicine books he'd read, he assumed it was excess internal heat. He drank more water and took anti-inflammatory medication. It helped while he took it, but symptoms returned when he stopped.

This continued for three to four years.

 

Life Energy Is Dropping

He Dong also started paying attention to another change.

He had always treated morning erections as a personal health indicator. If he woke up and that was normal, he felt his vitality was still good. Around age 55, morning erections became less frequent.

He said:

Other people may not know, but I can feel what's happening in my body: my life force is fading. It's frustrating-and it scares me.

Sex itself wasn't his biggest problem. He and his partner had long been sleeping in separate beds. What he couldn't accept was that feeling of diminished life energy.

 

How Much Can Testosterone Explain?

Wu Xueyan has a phrase: A man is a work of androgens.

From fetal sex differentiation, to puberty changes in voice, body hair, muscle, and secondary sexual characteristics, to adult muscle and bone, fat distribution, blood production, and sexual function-male hormones play a role throughout life.

In midlife, if testosterone declines to a deficient level, it may affect muscle, fat distribution, bone strength, and sexual function.

But Wu emphasizes: if a man feels tired, sleeps poorly, gains belly fat, loses muscle, and experiences changes in libido and erection quality, it does not follow that all those changes should be blamed on testosterone decline.

Sleep disorders themselves create fatigue. Anxiety and depression can reduce libido. Obesity, chronic disease, and some medications can change hormone levels. Changes inside the body often tangle together.

Obesity Is a Classic Example

After midlife, increased waist circumference and lower total testosterone often appear together-but that doesn't prove that belly fat is caused by low testosterone. Obesity can change sex hormone binding and affect test results. A common change is decreased sex hormone–binding globulin (SHBG). Conversely, true testosterone deficiency can worsen muscle mass and fat distribution.

The relationship can be bidirectional. Doctors cannot simply see a beer belly and conclude testosterone is low.

That's why physicians also look at body composition, not just body weight: two men can weigh the same, yet have very different ratios of muscle and fat.

Fatigue and Insomnia Are Not Proof of Low Testosterone

Wu pays more attention to whether symptoms persist, gradually worsen, and remain hard to relieve even after rest and lifestyle adjustments.

If libido, erections, or morning erections keep changing; if physical stamina and muscle mass clearly decline; or if other discomforts simply do not go away-then it's worth checking.

Testing is not as simple as drawing blood once. Testosterone has a circadian rhythm and is usually measured in the morning. A single low result is not enough; it typically must be confirmed on another day. If necessary, doctors may evaluate SHBG, free testosterone, LH, FSH, and then consider whether obesity, chronic disease, or medications are affecting the results.

Wu specifically points out that diagnosis requires combining symptoms, signs, and repeatedly confirmed biochemical evidence-not just subjective feelings or a single lab value.

 

What If the Lab Says Normal, But You Still Feel Worse?

Even if you do the tests, there's another question:

If the lab report says normal, why does a man still feel clearly worse than before?

Wu compares it to exam scores. If someone used to score very high and later drops to average-he may still be passing, but he is still declining.

Reference ranges are built from population data. They help clinical judgment but cannot answer what matters to the individual: what was your baseline when you were younger?

A man who had high testosterone when young may decline significantly over a decade and still remain within normal range.

Wu therefore argues that if health checkups from youth onward tracked testosterone, weight, body composition, and metabolic markers, then by the time a man reaches his 50s or 60s and feels change, a doctor would see not just a single value, but a trajectory.

He repeatedly returned to the importance of individual baseline.

 

Should Testosterone Be Replaced Just Because You're Declining?

Even if a man has declined from his peak, that alone doesn't mean testosterone should be topped back up.

For men who meet treatment criteria, there is a relatively clear pathway. Controversy often exists near the borderline.

The 2025 Chinese guideline suggests that for men with sexual function decline or metabolic abnormalities and total testosterone in the range of 8–12 nmol/L, after excluding other causes of low testosterone, a trial of testosterone replacement therapy can be considered.

A trial means reassessment. If symptoms do not improve as expected, there is no reason to continue medication simply because of a number.

Wu, as one of the lead experts of the guideline, pushes the question further. When function is declining but hasn't crossed a disease boundary, he uses a metaphor:

A shirt has faded, but it hasn't torn. Some people will keep wearing it; others want it to look new and consider replacing it early.

He is asking: if we can already see function declining, must medicine wait until disease forms before intervening?

That goes beyond standard guideline boundaries. In Wu's personal view, early intervention can be discussed, but he acknowledges that many endocrinologists disagree and scientific conclusions are not complete. For healthy men without clear symptoms and without low testosterone, preemptive testosterone is not an accepted mainstream medical recommendation.

Testosterone Isn't Infinite Life Force

The desire to restore what's been lost is not new.

In 1889, 72-year-old French physiologist Charles-Édouard Brown-Séquard injected himself with animal testicular extracts and claimed improved strength and mental state. Later, people believed that extraction methods at the time could not have produced enough testosterone to create true pharmacologic effects.

That experiment became symbolic: from the earliest days of androgen research, medical treatment has been intertwined with humanity's desire to regain youth, power, and vitality.

Modern testosterone therapy is, of course, completely different. But testosterone is still not something you can increase without limits.

Wu says:

Many things have a physiological window. More is not always better.

A major historical concern was whether testosterone therapy increases heart attack, stroke, and other cardiovascular events.

In 2023, the TRAVERSE trial enrolled over 5,000 middle-aged and older men who had symptoms consistent with hypogonadism, low testosterone confirmed twice, and existing cardiovascular disease or higher cardiovascular risk. For the primary composite cardiovascular endpoint, testosterone therapy met the prespecified non-inferiority criteria. However, atrial fibrillation, acute kidney injury, and pulmonary embolism occurred more often in the testosterone group.

Wu considers that study important for defining safety boundaries: it provides additional evidence for appropriate patients receiving standardized treatment, but it cannot answer a different group's question-men with normal testosterone and no clear symptoms who simply feel older and less energetic. What happens if they use testosterone long-term?

Medication also requires monitoring. Testosterone therapy can raise hematocrit. Before treatment, contraindications such as prostate cancer must be screened for; during treatment, relevant markers must be monitored. For men with fertility plans, exogenous testosterone may suppress the reproductive axis and sperm production.

Whether someone can use it, whether it achieves the intended goals, and whether risks have changed all need ongoing reassessment.

 

Outside the Hospital, Some Men Bypass the Rules

Beyond formal medical settings, some men bypass evaluation and obtain androgens or anabolic steroids through gyms and online channels to build muscle, improve physique, sexual performance, or anti-aging.

Wu hopes these realities can be brought into the sunlight-discussed and standardized-so doctors can at least know what someone has taken and provide necessary tests and risk monitoring.

 

Beyond the Lab Report

He Dong cannot use a lab report to reconstruct what his testosterone levels were during those seven or eight years. And in truth, even a testosterone number cannot fully explain his feeling of life energy dropping.

Those years were not easy.

He Dong was originally a teacher, later transferred to work in the education bureau. Late in his career, he no longer wanted promotion, but retirement was still far away, and he took on new management and external coordination tasks. Work pressure, he felt, wasn't overwhelming. The heavier load came from family.

His wife worked away from home for long stretches, so he handled much of the household: the younger daughter's university tuition and living expenses, graduation, job hunting, exam preparation; the older daughter's graduation, relationship, marriage, childbirth-each brought new worries.

When he was 55, his mother passed away. He handled most of the funeral arrangements and then lived through a long period of grief.

All kinds of messy, relentless things came one after another, he said.

He had to stay tightly wound to deal with everything-yet his body was no longer able to bear the same pressure.

He also had few places to speak honestly. The children were young; he felt they wouldn't understand. The elderly were already old; speaking would only worry them. His relationship with his partner wasn't close.

Occasionally he would talk with male friends his age. At most they would confirm: You too? Then the topic passed.

When his mother died, He Dong remembers sitting silently, speaking very little. It wasn't that he felt nothing-he says the opposite: he was full of anger, but he couldn't explain what he was angry about. He feared that if he opened his mouth, his temper would spill out. So he said nothing.

He became less willing to attend dinners and social events. Sometimes he feared people would think: Is he getting old? Is his mind going bad?

 

Exiting Life

Counselor Zi Fei says many middle-aged men rarely talk directly about fear, loss, or loneliness.

They talk about their bodies: I'm tired. I can't sleep. I have no energy. Or they point outward: the wife has changed, the kids have problems, work is failing.

Zi Fei calls one common state exiting life.

This doesn't necessarily look like a dramatic breakdown. Sometimes it's quiet: a man gradually invests less. Things he used to care about no longer feel worth doing. Work and relationships become whatever. He stops making long-term plans, stops committing to tasks that take months or years. He just wants to lie down-or fill time with activities that offer fast feedback, like fishing or short videos.

These activities are not automatically a problem. The key warning sign is whether someone has persistently lost motivation-whether there is still anything that can hold his attention and commitment for the long haul.

Zi Fei says he has experienced a version of this himself. Before 45, he could run three or four computers at once, doing different tasks. Around 47, he clearly felt: Reading on the couch is best.

He began watching whether he might also fall into hours of short videos. If his sleep worsened, he paid attention to what might be influencing it.

So he started deliberately going outdoors, changing environments, exercising, and setting goals tied to genuine passion-goals that require long-term effort.

I'll set a goal for myself, he said, like writing a book in three years. With a goal, you can pull yourself out of that 'just lie flat' state.

 

Body and Mind Are Hard to Separate

From years of clinical work with middle-aged adults, Zi Fei has found that at this stage, physical and psychological factors are difficult to separate cleanly.

Long-term poor sleep directly affects mood and attention, worsening emotional distress. Emotional distress in turn disrupts sleep.

Life events may create low mood, but they often appear as bodily discomfort: fatigue, pain, weakness. Meanwhile, that baseline of body and mood makes people more sensitive to conflict and setbacks, more easily triggered into negative emotion.

Sexual function, chronic disease, and physical decline are not just body metrics. They enter self-evaluation and then shape relationships.

In Zi Fei's view, explaining everything with hormones is one-sided-and so is explaining everything as psychological.

To truly understand what is happening to someone-why a man suddenly avoids socializing, why he suddenly becomes short-tempered-if we want to help, we need to understand the interactions among body, sleep, life events, relationships, and long-standing coping styles.

So what crosses the line beyond normal fluctuations?

Zi Fei's boundary is simple: if fatigue and mood swings are temporary and improve with rest and adjustment, and if work and life are not significantly impacted, it can be observed.

But if sleep is chronically poor, mood is persistently low or irritable, work and relationships are clearly damaged, or there is emotional loss of control and safety risk, professional help should be sought.

Menopause cannot contain everything-but it can help a person realize that mind and body are changing.

 

What Finally Changed for He Dong

Looking back, He Dong isn't entirely sure how those years passed.

For him, those seven or eight years had no clear beginning-and no clear end.

Around age 60, he prepared for a hernia surgery. During pre-op tests, doctors found a heart problem he hadn't recognized. After further evaluation, he received a coronary stent.

From then on, he began taking medication regularly and managing blood pressure more seriously.

Around that time, he also retired.

With fewer responsibilities, life slowly became more regular. The discomforts that had troubled him for so long gradually eased over the next few years.

He Dong says the years before retirement felt like a full inspection of the lifestyle he'd lived in the first half of his life:

Where your body is weak, problems start showing up at this stage. You also have to accept that you're getting old.

At the end of the interview, I asked him: looking back, what helped him most through the days he called his menopause?

He said:

Time.

 

At 64, I Owe My Daughter an Apology-What Should I Do? (A Gentle Closing for Late Night)

If you recognize yourself in He Dong's story-the sudden anxiety, the shorter temper, the fatigue that no sleep seems to fix-start here:

Apologize without overexplaining.
I'm sorry I scared you / snapped at you. I've been struggling, and I didn't know how to say it.

Name what you can name.
You don't have to label it male menopause. You can say: My sleep has been bad for years. My energy is lower. I get anxious.

Stop carrying it alone.
Choose one person-your spouse, your child, a friend-and speak one honest sentence at a time.

Treat sleep, blood pressure, and mood like core systems, not side issues.
Many testosterone-like symptoms are actually sleep deprivation, metabolic trouble, medication effects, depression/anxiety, or cardiovascular risk.

If you're considering testosterone support, don't guess-test and monitor.
Testosterone is not a shortcut back to youth. Done properly, it's a medical decision based on symptoms + repeated morning lab results + careful follow-up.

Build one long-term goal that pulls you back into life.
Something that takes months, not minutes-walking plans, strength training, writing, learning, rebuilding a relationship.

And if tonight you're reading this in the quiet hours-feeling that life energy slipping-remember what He Dong learned the hard way:

There may be no single that day.
But there can still be a next step.