Men don’t experience menopause in the same way women do, but testosterone levels generally decline as men get older. That can contribute to decreased sexual desire, changes in erections, reduced muscle mass and other symptoms.
The term “male menopause,” or andropause, is sometimes used to describe those changes, but the comparison has limits. Men do not experience the relatively abrupt hormonal change that occurs with menopause. Testosterone typically declines gradually, and not every older man develops abnormally low levels or symptoms.
That distinction matters because testosterone replacement therapy, commonly called TRT, is increasingly available — but whether a man should receive it and whether insurance will pay for it are two different questions.
Low Testosterone Takes More Than One Blood Test
Feeling tired or noticing a change in sexual desire does not automatically mean testosterone is the problem.
The Endocrine Society recommends diagnosing testosterone deficiency only when a man has symptoms consistent with low testosterone and repeatedly low testosterone measurements. Levels are generally checked in the morning, when testosterone is highest, and an abnormal result should be confirmed with another test. Doctors may then look for conditions involving the testes, pituitary gland or hypothalamus, as well as medications, obesity and other health problems that can lower testosterone.
That is important because symptoms such as low energy, reduced sex drive, mood changes and erectile dysfunction can have many causes.
Obesity, diabetes, sleep problems, medications, cardiovascular disease, depression and relationship issues can all contribute.
What Can Men Realistically Expect From TRT?
For men who truly have low testosterone, TRT can help — but the results are generally more modest than advertisements for testosterone clinics sometimes suggest.
Sexual desire appears to be one of the areas most likely to improve.
In a major National Institutes of Health-supported study of men 65 and older with low testosterone, men receiving testosterone experienced increases in sexual activity, sexual desire and erectile function compared with men receiving a placebo. Overall, researchers described the improvement in sexual function as moderate.
A larger study involving men ages 45 to 80 with confirmed low testosterone also found benefits to sexual function in men who began treatment with low libido.
Men should not, however, expect testosterone to work like Viagra or Cialis.
TRT primarily addresses desire and the hormonal component of sexual function. It may improve erections in men whose erectile problems are partly caused by low testosterone, but studies have found the improvement in erectile function is generally smaller than that produced by medications specifically designed to treat erectile dysfunction.
And if testosterone levels are already normal, research does not show the same sexual benefit from simply adding more testosterone.
When could changes show up?
Some effects can appear fairly quickly.
Research reviewing the timing of TRT effects found sexual interest can begin improving within about three weeks and often levels off after several weeks. Changes in erections can take several months.
Changes in muscle and body composition generally take longer — often several months — while improvements in bone density may take six months or much longer.
TRT can increase lean muscle mass and reduce body fat in men with testosterone deficiency, but that does not necessarily translate into dramatic improvements in strength or physical ability.
And men taking TRT strictly because they feel tired may be disappointed. Large studies have not found a substantial improvement in overall vitality or energy among many older men receiving testosterone.
What Happened to the Heart-Risk Warning?
This is one area where medical guidance has changed significantly.
For years, testosterone products carried prominent warnings about a possible increased risk of heart attack and stroke.
In 2025, the U.S. Food and Drug Administration removed the boxed-warning language about increased cardiovascular events after reviewing results of the large TRAVERSE clinical trial.
That study followed more than 5,200 men with low testosterone who had cardiovascular disease or were at increased cardiovascular risk. Major cardiovascular events occurred in 7% of men receiving testosterone gel compared with 7.3% receiving placebo — not a meaningful increase.
In June 2026, the FDA went further, requesting removal of labeling language stating that the safety and effectiveness of testosterone for age-related hypogonadism had not been established.
That doesn’t mean TRT is risk-free.
The FDA requires warnings that testosterone can raise blood pressure, and researchers continue to study other possible risks. The Endocrine Society noted in July 2026 that the TRAVERSE studies found an increase in pulmonary embolism — blood clots traveling to the lungs — as well as an increase in fractures among testosterone-treated men.
Doctors also monitor red blood cell levels, testosterone levels and prostate health during treatment. Testosterone can reduce sperm production and is generally not recommended for men trying to father children.
Will Medicare Pay For TRT?
Sometimes — but this is where the distinction between medical hypogonadism and normal aging becomes important.
Medicare coverage is strongest when a doctor can document a medical condition causing testosterone deficiency.
A current Medicare contractor coverage policy, for example, covers symptomatic hypogonadism caused by disorders of the testes, pituitary gland or brain. It requires documentation that can include two separate low morning testosterone tests and additional laboratory evaluation.
That same Medicare policy specifically lists age-related hypogonadism and “male menopause” as conditions that are not considered medically necessary for testosterone treatment.
So a 70-year-old whose testosterone has gradually declined with age should not assume Medicare will pay simply because his level is lower than it was at 30.
Coverage also depends on how the drug is obtained. Some doctor-administered testosterone treatments may fall under Medicare Part B, while prescriptions filled at a pharmacy are generally handled through a Part D prescription drug plan or a Medicare Advantage plan with drug coverage.
Each Part D plan has its own formulary and may require prior authorization or use of a particular form of testosterone.
The FDA’s recent change concerning age-related testosterone does not automatically change Medicare coverage rules.
What About Medicaid?
Medicaid coverage varies by state, but the general issue is similar: testosterone may be covered when there is a medically supported diagnosis, while normal age-related decline by itself may not satisfy medical-necessity requirements.
Plans can also require prior authorization or require patients to use preferred testosterone products.
For example, Missouri’s MO HealthNet preferred-drug list includes testosterone cypionate, testosterone enanthate and a generic 1.62% testosterone pump among its preferred androgen products. However, the state specifically cautions that appearing on its preferred list does not guarantee coverage.
Patients should have their doctor or pharmacist check their specific Medicaid or Medicare plan before assuming treatment will be paid for.
What if Insurance Doesn’t Cover it?
TRT doesn’t necessarily have to be extremely expensive.
And a man does not have to sign up for one of the monthly men’s-health subscription programs increasingly advertised online. Testosterone is a prescription medication, but a regular physician can prescribe it and a patient can fill the prescription at a pharmacy.
The least expensive option is often generic injectable testosterone.
As of September 2026, GoodRx listed a common testosterone cypionate prescription for about $24 to $31 using a free pharmacy discount, depending on pharmacy and quantity. Average retail prices were higher, but still generally far below the cost of newer brand-name treatments.
Generic testosterone gel can also be reasonably priced with discounts. A common 1.62% gel pump had an average retail price of about $399, but a listed discount price of about $43. Other gel formulations ranged considerably depending on dose and packaging.
Oral testosterone can be dramatically more expensive. Jatenzo, for example, ranged from roughly $493 to more than $1,000 for 60 capsules with discounts, depending on the dose, with retail prices reaching more than $1,300.
Those prices are only for the medication. Doctor visits, blood tests and ongoing monitoring can add to the cost.
Discount-card prices also cannot be combined with Medicare or Medicaid. A patient can choose to pay the discounted cash price instead of using insurance, but that purchase generally will not count toward Medicare prescription-drug spending limits.
Lifestyle Still Matters
Medication isn’t the only way to address declining testosterone.
Obesity is strongly associated with lower testosterone, and the Endocrine Society says weight loss is generally the first treatment for men whose low testosterone appears related to being overweight or obese rather than a disorder of the testes or brain.
Regular resistance and aerobic exercise, adequate sleep and losing excess weight can improve overall health and may improve testosterone levels as well.
The bottom line: aging does change testosterone, but getting older alone does not necessarily mean a man needs TRT.
Men experiencing persistent loss of sexual desire, erectile changes, loss of muscle mass or other symptoms should talk with their health care provider and have testosterone properly tested rather than assuming the symptoms are simply something they have to live with — or that testosterone is automatically the answer.