Testosterone replacement therapy is sometimes recommended in men diagnosed with 'late onset hypogonadism' (colloquially known as the andropause or male menopause): the Drug and Therapeutics Bulletin (DTB) has examined the evidence for this syndrome as a distinct medical entity and for the use of testosterone in men with the diagnosis.

The review notes that while testosterone levels in men do decline with age, most older men will still have levels within the normal range for younger men. The decline is exacerbated by modifiable risk factors such as obesity, and the absence of these and presence of a healthy lifestyle seem to be more important in determining androgen concentrations. On efficacy, the review notes that there is no consensus on the indications or cut-off level for testosterone supplementation, and a lack of large, long-term studies on its benefits, costs, and risks. Testosterone supplementation is associated with significant adverse effects; in particular the risk of raised haematocrit may be of concern in exacerbating cerebro- and cardio-vascular disease and in those who already have raised haematocrit (e.g. in COPD).

Overall, the review concludes that there is no place for supplemental testosterone in men without symptoms or without clearly low testosterone levels. Even when possibly appropriate, it should not be offered without a discussion of the uncertainty over its benefits and longer term risks. Patients on it should be monitored for prostate disease, haematocrit, and symptoms of sleep apnoea. It should be stopped if there is no improvement in clinical symptoms.