Most men have heard of menopause - but far fewer realise there’s actually a male equivalent. “Endopause” is a term used to describe the gradual decline in testosterone that occurs as men age. During endopause, testosterone slowly drops over many years, and the changes can be subtle at first. But subtle doesn’t mean insignificant.
Men in their 40s, 50s, and 60s often report feeling “not quite themselves”: lower energy, reduced strength, changes in sleep, irritability, heavier limbs, slower recovery after exercise, or a general sense of feeling flat. Many assume it’s just “getting older.” But in many cases, these changes are linked to hormonal shifts - and understanding them can make a huge difference to your quality of life.
Here’s what you should know about endopause - and when physiotherapy can help.
What Is Endopause?
Endopause refers to the age-related decline in testosterone, the primary male hormone responsible for maintaining muscle mass, bone density, energy production, libido, mood regulation, and overall physical resilience.
Testosterone levels peak in late adolescence and early adulthood, then gradually decline at around 1% per year after age 30. This drop is so slow and steady that men often miss the early signs - until the symptoms begin affecting their daily life. While the term “endopause” isn’t a formal medical diagnosis, it’s a useful way to describe the cluster of changes that happen when testosterone dips below the level your body is used to functioning at.
Why Testosterone Matters
Testosterone is often associated with sexual function, but its role is much broader. It influences:
- Muscle mass and strength
- Energy levels and fatigue resistance
- Mood, confidence, motivation, and mental clarity
- Sleep quality and recovery
- Bone density and joint support
- Metabolism and body composition
Think of testosterone as your body’s “performance hormone.” It affects how well you move, sleep, recover, build strength, and regulate your emotions. When it declines, the effects can ripple through your whole body.
Common Signs of Endopause Men Often
Overlook Men rarely come into a clinic saying, “I think my testosterone is dropping.” Instead, they describe day-to-day frustrations that have slowly built up over months or years. Here are the most common ones:
1. Low energy and persistent fatigue
If you’ve noticed that your usual routine now feels harder - workouts take more effort, days feel longer, and you’re tired earlier in the evening - hormonal changes may be contributing. This isn’t laziness or lack of willpower. Low testosterone reduces the body’s ability to regulate energy, maintain muscle function, and recover from physical stress. It’s like running your day with your energy level permanently stuck at 60%.
2. Mood changes and irritability
Many men report feeling flatter, less motivated, more irritable, and less resilient under stress. This can be particularly confusing because men don’t always associate mood with hormones, but testosterone plays a major role in stabilising brain chemistry. When levels drop, the emotional “buffer” feels thinner.
3. Poor sleep and restless legs
Sleep disturbances are one of the most overlooked symptoms of endopause. Men report:
- Waking frequently
- Difficulty falling asleep
- “Tired but wired” evenings
- Twitching or restless legs at night
Lower testosterone affects sleep cycles, muscle relaxation, and overall nervous system balance, making restorative sleep harder to achieve.
4. Reduced muscle strength and slower recovery
You may notice that weights that used to feel light now feel heavy, slower progress in the gym, more soreness after activity or stiffness or sluggishness in the morning. With declining testosterone, the body becomes less efficient at building and repairing muscle. This is why men in their 40s and 50s often feel they aren’t getting the same return on their effort, despite training just as hard.
5. Generalised aches and reduced physical resilience
Many men describe a vague, persistent heaviness or discomfort - particularly through the back, hips, and legs. They feel “less springy,” “less powerful,” or simply “not as strong as I used to be.” Some of this is normal aging. But part of it comes from changes in muscle mass, tendon strength, and joint support, all influenced by testosterone.
Men Often Dismiss These Symptoms
Because endopause doesn’t happen overnight, men tend to rationalise the changes as:
- “I’m just getting old”
- “I’m just unfit at the moment”
- “I’m too busy to exercise”
- “Maybe I need more coffee”
- “I guess this is normal for my age”
But the problem with ignoring these symptoms is that the underlying changes can accelerate physical decline if not addressed early. The good news is that you can slow, and even reverse, much of the physical impact with the right approach. This is where physiotherapy comes in.
How Physiotherapy Helps Men During Endopause
Physiotherapy isn’t just for injuries. It plays a major role in maintaining strength, mobility, and vitality as testosterone declines. Here’s how physios help men feel stronger, clearer, and more in control during this stage of life:
1. Strength training designed for hormonal changes
Men experiencing endopause benefit enormously from targeted, progressive strength training. A physiotherapist can design a program that:
- Builds lean muscle mass
- Increases strength without overloading joints
- Supports bone density
- Boosts metabolism
- Improves sleep quality
- Regulates hormones naturally
Strength training is one of the most powerful tools for managing the physical symptoms of hormonal decline.
2. Improving posture and joint support
Reduced muscle strength often leads to stiffer hips, rounded shoulders, and an increased lower-back load. A physio can identify which muscles need strengthening and which need releasing, helping your body move more efficiently and comfortably.
3. Managing fatigue and energy levels
Endopause often affects recovery. Physios help by adjusting training loads, pacing high-energy activities and improving movement patterns to reduce unnecessary energy expenditure. This helps you stay active without burning out.
4. Restoring mobility and reducing aches
A decline in testosterone can make muscles and tendons feel tighter or more sensitive. Physiotherapy can:
- Improve flexibility
- Release tight areas
- Restore normal joint mechanics
- Reduce chronic aches linked to reduced muscle mass or poor sleep
This helps you feel more like your “old self” again.
5. Holistic support and health education
While physios focus on movement and physical conditioning, they also help you navigate broader health questions by:
- Discussing sleep routines
- Supporting stress and breathing patterns
- Encouraging safe and effective exercise habits
- Coordinating care with GPs for blood tests or further assessment
- Guiding lifestyle choices that help regulate hormones naturally
You don’t need to wait for symptoms to become severe. Speak with a physiotherapist if you’ve noticed:
- Increasing fatigue
- Reduced strength
- Sleep difficulties
- Persistent aches
- Slower recovery
- Changes in mood or energy
Your health and well-being are our priority. We have Pelvic Health Physiotherapists who can help you navigate through endopause. Book an appointment online by clicking here or call us on +852 2801 4801