Testosterone drifts down slowly after 40, but most men stay in the normal range. Low testosterone is diagnosed only when symptoms and repeated early-morning lab results line up. Bring a symptom list and ask your doctor which tests fit your history, such as total and free testosterone, SHBG, PSA, A1c, and lipids. Testosterone therapy and compounded hormones are prescription-only decisions made with your doctor.
You’re more tired than you used to be. Workouts take longer to recover from, and your drive isn’t what it was. It’s easy to shrug it off as just getting older, and some of it may be. But men’s health after 40 also includes changes you can actually measure, and hormones are one of them.
Unlike menopause, men’s hormone changes are gradual and quiet. That makes them easy to overlook and just as easy to overblame. Plenty of “low T” feelings turn out to be poor sleep, stress, weight gain, or a medication side effect.
This checklist is not a sales pitch for testosterone, and it isn’t a diagnosis. It’s a practical guide to what changes after 40, which symptoms are worth mentioning, and which lab tests to ask your doctor about. We’ll also cover current guidelines, FDA testosterone label changes, and where prescribed compounded hormones fit.
What Happens to Testosterone After 40?
Testosterone generally declines about 1% a year after age 40, and some sources say the slide starts in the late 30s. The change is gradual, and most older men stay in the normal range. Only about 10% to 25% are thought to have low levels. Obesity, type 2 diabetes, sleep apnea, and certain medications can push levels lower.
Why “male menopause” is a misleading term
Mayo Clinic’s overview of aging and testosterone explains why “male menopause” doesn’t fit well. Women’s hormones drop fairly sharply at menopause, while men’s testosterone declines slowly over decades. Many men with lower levels have no symptoms.
Factors that lower testosterone besides age
Excess weight and poorly managed type 2 diabetes strongly lower testosterone levels. So are untreated sleep apnea (pauses in breathing during sleep), long-term opioid or corticosteroid use, and an underactive thyroid. Some of these causes can be treated directly.
Low Testosterone Symptoms Men Over 40 Shouldn’t Ignore
The most specific signs of low testosterone are sexual: lower libido, fewer morning erections, and erectile difficulties. Other possible signs include fatigue, low mood, poor focus, muscle loss, more body fat, and hot flashes. These symptoms overlap with stress, depression, and sleep problems, so a lab test matters.
Check what applies and bring this list to your appointment.
Sexual health
- Lower interest in sex
- Fewer morning erections
- Trouble getting or keeping an erection
Energy and mood
- Ongoing fatigue that rest doesn’t fix
- Low mood, irritability, or less motivation
- Trouble concentrating
Body changes
- Loss of muscle mass or strength
- More body fat, especially around the middle
- Breast tenderness or swelling
- Less body hair
Other
- Hot flashes or sweats
Checking boxes doesn’t mean you have low testosterone. It means it’s worth asking your doctor.
The Men’s Health After 40 Lab Checklist
If you have symptoms, ask your doctor about an early-morning total testosterone test, repeated on a separate day to confirm a low result. Depending on your history, your doctor may add free testosterone, SHBG, LH, a blood count, PSA, thyroid tests, A1c, and lipids. Each test answers a different question.
Total testosterone
Testosterone peaks in the morning, so guidelines call for two early-morning tests on separate days. The American Urological Association treats a level below 300 ng/dL (nanograms per deciliter) as a reasonable cutoff. One low reading isn’t enough.
Free testosterone and SHBG
SHBG (sex hormone-binding globulin) is a protein that carries testosterone in the blood. As MedlinePlus explains in its SHBG test guide, a high SHBG level leaves less free testosterone available for your body to use. That means a normal total testosterone result can sometimes miss a real problem.
LH and prolactin
LH (luteinizing hormone) and prolactin come from the pituitary gland, which signals the testes to make testosterone. These tests help show why testosterone is low.
Estradiol
Your doctor may check estradiol, a form of estrogen, in some situations, such as breast swelling. It isn’t routine for every man.
Hemoglobin and hematocrit
These blood count measures should be checked before testosterone therapy, per the AUA, because treatment can raise red blood cell levels.
PSA
PSA (prostate-specific antigen) is a blood test related to prostate health. Under the current USPSTF prostate cancer screening recommendation, men 55 to 69 should make an individual decision with their doctor. Higher-risk men may start earlier.
Thyroid, A1c, and lipids
An underactive thyroid can mimic or cause low testosterone, so your doctor may check it. An A1c test screens for diabetes, which the USPSTF recommends for adults 35 to 70 with overweight or obesity. A lipid (cholesterol) panel rounds out heart health. For a whole-picture view, our functional medicine approach works alongside prescribers with the same mindset.
Vitamin D: only if your doctor has a specific reason
The Endocrine Society’s 2024 vitamin D guideline suggests against routine testing in healthy adults. Your doctor may order it only for a specific reason, such as bone health concerns or a condition that affects absorption.
What the Guidelines Say About Diagnosing Low Testosterone
Two major medical groups agree on the key point: a lab number alone is never the whole story.
“Low testosterone isn’t a number or a feeling. Guidelines require both symptoms and confirmed low lab results.”
The AUA guideline
The American Urological Association’s testosterone deficiency guideline was published in 2018, and its validity was confirmed in 2024. It defines testosterone deficiency as low levels plus symptoms, using two early-morning tests on separate days. Age-related decline alone is not a diagnosis.
The AUA asks doctors to discuss fertility and advises against prescribing testosterone to men trying to conceive. It recommends regular monitoring and reassessment if symptoms don’t improve within a few months.
The Endocrine Society’s 2026 statement
In a July 2026 statement on testosterone therapy, the Endocrine Society said it does not support routine testosterone screening for men without symptoms. It urges ruling out reversible causes first and names weight loss as the first-line treatment for obesity-related low testosterone. It also calls for at least two early-morning fasting tests using CDC HoST-certified assays (lab tests checked for accuracy against a national standard).
Testosterone Therapy and the FDA Label: What’s Changed
In February 2025, the FDA removed boxed-warning language about increased cardiovascular risk from testosterone products after reviewing the TRAVERSE trial. It also added class-wide warnings about increased blood pressure. In June 2026, HHS and the FDA proposed further label updates. Those changes were still proposed, not final, as of this writing.
The 2025 label change
The FDA’s February 28, 2025, class-wide labeling update added the TRAVERSE results to testosterone labels and removed the cardiovascular-risk language from the boxed warning. The FDA kept the limitation of use, stating that testosterone is not approved for low levels due to aging alone. It also added a warning that testosterone products can raise blood pressure.
The 2026 proposal
On June 18, 2026, HHS and the FDA proposed removing that age-related limitation of use and updating the prostate cancer and BPH (enlarged prostate) warnings, according to the AUA’s summary of the HHS announcement. As of our sources, these changes were proposed rather than final. Ask your doctor or pharmacist about the current status.
TRAVERSE in plain English
The Endocrine Society summarizes the large TRAVERSE study as no meaningful increase in heart attack or stroke, but about a 50% relative increase in pulmonary embolism (a blood clot in the lungs) and more fractures in treated men.
Who should be cautious?
Talk carefully with your doctor if you hope to have children soon or have a history of prostate or breast cancer, untreated severe sleep apnea, uncontrolled heart failure, blood clots, or a recent heart attack or stroke.
Where Compounded Hormones Fit (With a Prescription)
What is compounding?
Compounding means a licensed pharmacy prepares a medication for one patient based on a prescriber’s order. Compounded medications are not FDA-approved, and they are not a shortcut around evaluation, labs, or physician care.
When a prescriber may choose a compounded option
A physician may prescribe a compounded hormone when a commercial product isn’t a good fit. Examples include an allergy or sensitivity to a dye or inactive ingredient, or a need for a different dosage form or strength. That decision comes after labs and a full evaluation. Learn more about our men’s health compounding services.
“A prescription is the start of hormone care, not the finish line. Monitoring keeps treatment safe.”
Monitoring doesn’t stop at the prescription
Men on testosterone need follow-up labs, including testosterone levels and hematocrit, on the schedule their prescriber sets. Gels and creams can transfer to others through skin contact, so ask how to prevent that. King’s Pharmacy is NABP accredited and a PCCA member, and physicians can find ordering details on our page for prescribers.
Your Next Step: Bring This Men’s Health Checklist to Your Doctor
Write down your symptoms, list every medication and supplement you take, and ask your doctor which early-morning labs make sense for your age and history.
If your doctor prescribes a compounded hormone, our pharmacists at 17500 Red Hill Ave. Ste 250 in Irvine are here Monday through Friday from 9 a.m. to 5:30 p.m. We ship by FedEx, work with nearly all insurance plans, and are licensed in California, Arizona, Colorado, Florida, Hawaii, Idaho, Nevada, New York, Oregon, Texas, Utah, Washington, and Wisconsin.
Conclusion
Men’s health after 40 isn’t about chasing a number. It’s about noticing changes, getting the right labs, and deciding with a doctor who knows your history. A low testosterone diagnosis requires both symptoms and confirmed results, and many other causes are worth ruling out first. Bring this checklist to your appointment.
Have questions about whether a compounded hormone is right for you? Talk to your prescribing physician, then connect with the pharmacists at King’s Pharmacy and Compounding Center in Irvine, CA, to get started. We listen, we answer your questions, and we work closely with your prescriber. Request a Refill or Contact King’s Pharmacy at 949.387.0780.
Frequently Asked Questions
At what age does testosterone start to decline?
Testosterone usually starts declining gradually in the late 30s or around age 40, at roughly 1% a year. Most men stay within the normal range as they age.
What time of day should testosterone be tested?
Testosterone should be tested in the early morning, when levels are highest. Guidelines call for two early-morning tests on different days to confirm a low result.
Is a total testosterone test enough?
It’s usually the starting point. If results are borderline, your doctor may add free testosterone and SHBG, since a normal total can miss a problem.
Does testosterone therapy increase heart attack risk?
The TRAVERSE trial found no meaningful increase in heart attack or stroke, and in 2025 the FDA removed that language from the boxed warning. Testosterone can raise blood pressure, and TRAVERSE showed more pulmonary embolism and fractures. Discuss your risk with your doctor.
Can I get compounded testosterone without a prescription?
No. Testosterone is a prescription-only controlled substance, and a compounded version requires a prescriber’s evaluation and order. Compounded medications are not FDA-approved, so your prescriber and pharmacist should guide and monitor treatment.
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Testosterone is a Schedule III controlled substance available only by prescription. Compounded medications require a valid prescription from a licensed prescriber and are not FDA-approved.
