Andropause: Myths and Management

Eviatar Fields; Naeem Bhojani; Bilal Chughtai; Dean Elterman

doi:10.58931/cpct.2026.4156

Authors

Eviatar Fields, PhD
Naeem Bhojani, MD
Bilal Chughtai, MD
Dean Elterman, MD

Abstract

Over the past two decades, prescription rates for testosterone have risen sharply, due to direct‑to‑consumer advertising and the spread of online misinformation. As a result, the topic of andropause, or aging-associated testosterone deficiency, is increasingly encountered by Canadian primary care physicians. Despite its growing visibility, up to 25% of healthcare practitioners report challenges in accurately diagnosing and managing andropause. In this article, we clarify the common myths around andropause to better inform primary care physicians and their patients. We discuss the Canadian guidelines on diagnosis and management of testosterone deficiency. Finally, we provide insight into the safety of testosterone-replacement therapy. By implementing structured monitoring and shared decision making, primary care physicians can ensure safe, effective, and evidence-based care for aging Canadians.

Author Biographies

Eviatar Fields, PhD

Dr. Eviatar Fields is a third-year medical student at McGill University. Prior to medical school, he completed his undergraduate degree in psychology at York University, followed by a PhD in neuroscience at McGill University. He has a strong background in basic and clinical research, as well as innovation. His work spans multiple disciplines, with a focus on research translation, evidence synthesis, and patient-centered care. Dr Fields has contributed to numerous peer-reviewed publications, and he has been supported by several funding agencies including CIHR and FRQS. He was recently recognized as the recipient of the 2026 Canadian Urological Association Medical Student Award. He is passionate about patient education and bridging the gap between bench research and clinical care to improve healthcare delivery and patient outcomes.

Naeem Bhojani, MD

Dr. Naeem Bhojani is a Montreal-born academic urologist and internationally recognized endourologist with a clinical and research focus on kidney stone disease and BPH. He completed undergraduate degrees in Microbiology and Immunology as well as Physiotherapy at McGill University, followed by medical school and urology residency training at the Université de Montréal. He then undertook a fellowship in BPH and stone disease at Indiana University. Recruited to the Université de Montréal in 2013, he established one of Canada’s first comprehensive multidisciplinary kidney stone programs and a novel patientcentered BPH clinic. He currently holds the rank of Full Professor and serves as a clinician-scientist. His research, supported by the CIHR, FRQS and other national funding agencies, focuses on innovation in endourology, patient-reported outcomes and quality of life. He led the development of the CEGSSS, a patient-centered stent symptom questionnaire. Dr. Bhojani has authored more than 290 peer-reviewed publications in the fields of stone disease and BPH. He serves on numerous editorial boards and is an Associate Editor for the Canadian Urological Association Journal. His contributions have been recognized with multiple prestigious awards, including the American Urological Association Young Urologist of the Year in 2017, the FRQ-S Clinical Research Scholar Award in 2019, and finally, in 2025 Dr. Bhojani was named the Best Endourologist of the Year by the European Association of Urology.

Bilal Chughtai, MD

Dr. Bilal Chughtai completed his medical degree followed by residency in urologic surgery at Albany Medical Center. Dr. Chughtai completed his fellowship in Male Voiding Dysfunction, Neuro-Urology, Female Pelvic Medicine Reconstructive Surgery at Memorial Sloan-Kettering Cancer Center and New York Presbyterian Hospital/Weill Cornell Medical College in New York City. Dr. Chughtai is currently Chief of Urology at Plainview and Syosset Hospital who specializes in Female Pelvic Medicine and Reconstructive Surgery and Male Voiding Dysfunction. Dr. Chughtai maintains a deep, longitudinal interest in these highly prevalent and debilitating conditions and has focused both his clinical, research, and teaching activities on these areas. Dr. Chughtai has mentored students, residents, and fellows in clinical and basic science research projects which has allowed his team to be investigators in numerous clinical trials, as well as translational, and outcomes research including National Institute of Health and industry support. Dr. Chughtai has published over 300 peer reviewed articles, authored chapters in several urologic texts, published 4 textbooks, and has presented numerous national and international meetings.

Dean Elterman, MD

Dr. Dean Elterman is an Associate Professor of Urology at the University of Toronto, sub-specializing in functional urology. He holds the Lang Family Endowed Chair in Urologic Innovation. As an attending urologist at the University Health Network (Toronto), his clinical and research interests include voiding dysfunction, novel technologies for BPH, sacral neuromodulation, male incontinence, and men’s health. He trained at the University of Toronto, Memorial Sloan-Kettering Cancer Center and New York Presbyterian/Weill Cornell Medical College. He holds a Master’s degree in Clinical Epidemiology and Health Services Research from Cornell. He is the Medical Director of the Sexual Health Clinic at Princess Margaret Cancer Center and Fellowship Director for functional urology. He is the recipient of the 2022 SIU Innovators award, leads numerous clinical trials in BPH and neuromodulation, and has published over 280 peer reviewed manuscripts including the lead author of the Canadian guidelines for Male LUTS/BPH. Dr. Elterman is the Associate Editor of European Urology Focus, and is an Associate Member of both the EAU Section of Section of Functional Urology and the EAU Section of Endourology. He sits on the Board of Directors for the Société Internationale D’Urologie (SIU) as the Innovators Chair, and is the Chief Medical Officer of MedTech Syndicates, a platform which supports clinicians to fund MedTech innovation.

References

Grober ED, Krakowsky Y, Khera M, Holmes DT, Lee JC, Grantmyre JE, et al. Canadian Urological Association guideline on testosterone deficiency in men: evidence-based Q&A. Can Urol Assoc J. 2021;15(5):E234-E243. doi:10.5489/cuaj.7252

Jasuja GK, Bhasin S, Reisman JI, Berlowitz DR, Rose AJ. Ascertainment of testosterone prescribing practices in the VA. Med Care. 2015;53(9):746-752. doi:10.1097/MLR.0000000000000398.

Morales A, Bebb RA, Manjoo P, Assimakopoulos P, Axler J, Collier C, et al. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. CMAJ. 2015;187(18):1369-1377. doi:10.1503/cmaj.150033

Mok SF, Fennell C, Savkovic S, Turner L, Jayadev V, Conway A, et al. Testosterone for androgen deficiency-like symptoms in men without pathologic hypogonadism: a randomized, placebo-controlled cross-over with masked choice extension clinical trial. J Gerontol A Biol Sci Med Sci. 2020;75(9):1723-1731. doi:10.1093/gerona/glz195

Bandari J, Ayyash OM, Emery SL, Wessel CB, Davies BJ. Marketing and testosterone treatment in the USA: a systematic review. Eur Urol Focus. 2017;3(4-5):395-402. doi:10.1016/j.euf.2017.10.016

Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86(2):724-731. doi:10.1210/jcem.86.2.7219

Kanabar R, Mazur A, Plum A, Schmied J. Correlates of testosterone change as men age. Aging Male. 2022;25(1):29-40. doi:10.1080/13685538.2021.2023493

Kwong JCC, Krakowsky Y, Grober E. Testosterone deficiency: a review and comparison of current guidelines. J Sex Med. 2019;16(6):812-820. doi:10.1016/j.jsxm.2019.03.262

Wu FCW, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123-135. doi:10.1056/NEJMoa0911101

Araujo AB, Esche GR, Kupelian V, O’Donnell AB, Travison TG, Williams RE, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92(11):4241-4247. doi:10.1210/jc.2007-1245

Miner M, Barkin J, Rosenberg MT. Testosterone deficiency: myth, facts, and controversy. Can J Urol. 2014;21 Suppl 2:39-54.

Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611-624. doi:10.1056/NEJMoa1506119

Mian AH, Yang DY, Kohler TS. Current management and controversies surrounding andropause. Urol Clin North Am. 2022;49(4):583-592. doi:10.1016/j.ucl.2022.07.003

Krakowsky Y, Conners W, Morgentaler A. Serum concentrations of sex hormone–binding globulin vary widely in younger and older men: clinical data from a men’s health practice. Eur Urol Focus. 2019;5(2):273-279. doi:10.1016/j.euf.2017.05.007

Carrageta DF, Oliveira PF, Alves MG, Monteiro MP. Obesity and male hypogonadism: tales of a vicious cycle. Obes Rev. 2019;20(8):1148-1158. doi:10.1111/obr.12863

Vingren JL, Kraemer WJ, Ratamess NA, Anderson JM, Volek JS, Maresh CM. Testosterone physiology in resistance exercise and training. Sports Med. 2010;40(12):1037-1053. doi:10.2165/11536910-000000000-00000

Cheng H, Zhang X, Li Y, Cao D, Luo C, Zhang Q, et al. Age-related testosterone decline: mechanisms and intervention strategies. Reprod Biol Endocrinol. 2024;22(1):144. doi:10.1186/s12958-024-01316-5

Liu PY, Reddy RT. Sleep, testosterone and cortisol balance, and ageing men. Rev Endocr Metab Disord. 2022;23(6):1323-1339. doi:10.1007/s11154-022-09755-4

Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, Basaria S, Boden WE, et al. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med. 2023;389(2):107-117. doi:10.1056/NEJMoa2215025

Luther PM, Spillers NJ, Talbot NC, Sinnathamby ES, Ellison D, Kelkar RA, et al. Testosterone replacement therapy: clinical considerations. Expert Opin Pharmacother. 2024;25(1):25-35. doi:10.1080/14656566.2024.2306832

Andropause: Myths and Management

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Abstract

Author Biographies

Eviatar Fields, PhD

Naeem Bhojani, MD

Bilal Chughtai, MD

Dean Elterman, MD

References

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