Is andropause a reality or a myth? Is it biologically determined, or is it a social construct? Are there similarities between andropause and menopause, both in terms of symptoms and treatment? What happens during andropause on a physiological and psychological level? Is andropause marginalised compared to menopause?

These are just some of the questions related to the so-called male climacteric, andropause, or the more recently used term "aging male syndrome." A review of the literature that has dealt with this issue shows that the answers to these questions have changed significantly over time.

Understanding the phenomenon of andropause has been a journey spanning over exactly two centuries, from the belief that it is a (climacteric) disease that leads to a decline in strength and vitality in men, to views that andropause is a normative event triggered by changes in endocrine status, and finally to the understanding that it is a psychological phenomenon linked to stress and midlife crisis. Alongside the evolving understanding of the origins of andropause, its perceived symptomatology has also changed – from the view that a decrease in sexual drive is not related to andropause, to the understanding that it is just one (of many) symptoms, and eventually to the view that it is the central symptom and the key reason why andropause is discussed.

Authors who regard it as a biological phenomenon caused by changes in hormonal status point to sharp differences between andropause and menopause. Although research in endocrinology, genetics, and physiology refutes this dichotomy, it has long been the dominant paradigm, associated with the question of whether andropause is a developmentally normative event (like menopause in women), or a crisis, non-normative event that does not happen to everyone and has the potential to lead to pathology.

The question of whether the symptoms associated with andropause (nervousness, reduced sexual potency and libido, irritability, fatigue, depression, poor concentration) have an endocrinological or psychological cause has led, since the 1980s, to the abandonment of the idea of a male climacteric based on endocrinology. Instead, it has been viewed as a psychological phenomenon within the framework of a midlife crisis triggered by stress and seen as a psychological and emotional upheaval – a life turning point with no biological roots. Therapeutic advice during this period thus became "tranquilizers instead of testosterone." According to these views, the pathological potential of andropause lies in an individual's inability to accept the newly emerged changes (including reduced sexual function) and adapt to the decline in strength, vitality, and masculinity. A large number of developmental tasks in middle age must be mastered in order to maintain life satisfaction, such as accepting and adapting to physiological changes, achieving and maintaining success in one's profession, adapting to aging parents, providing care and support to adolescent children so they can become responsible and satisfied adults, relationships with spouses, etc. This suggests that andropause is seen as a social phenomenon, emerging from the relationship between aging processes, sexual identity, and lifestyle.

One reason why andropause has been long overlooked compared to menopause (which has been researched and discussed far more) is that men are less likely to seek professional help for symptoms they experience. Furthermore, concern for men's health has long been marginalised within the healthcare system. Serious interest in andropause began in the late 1990s, and the mission of the International Society for the Study of the Aging Male sheds a light on this interest: "In the coming decades, whether rightly or wrongly, men will control economic resources worldwide. The average lifespan of men is shorter than that of women, meaning there are significantly more women in the oldest age groups. Because of these reasons, optimal aging and survival of men have a critical impact on families and society as a whole, which is why it is important to give them special attention." (International Society for the Study of the Aging Male, 1999). This quote clearly reveals the discourse of male dominance (not just in the economic sphere) and highlights how andropause has been shaped by societal attitudes toward gender roles and power distribution.

During this period, the term "andropause" was replaced with the phrase "male aging syndrome" (critics would argue this was to differentiate it from menopause), which includes four symptom groups:

1. Vasomotor and neurological symptoms (hot flashes, sweating, insomnia)
2. Mood swings and changes in cognitive functioning (irritability, lethargy, lack of motivation, depression, low self-esteem)
3. Changes related to masculinity (reduced strength and physical energy, decreased muscle mass, abdominal obesity)
4. Sexuality (reduced sexual desire and activity, weakening of erectile function, quality of orgasm).

It is interesting how these symptoms reflect what is culturally considered masculinity: energy, strength, virility, sexual drive, and the appearance associated with masculinity (muscle mass). Despite the many symptoms associated with andropause, sexual function (erectile dysfunction) remains the central symptom and the primary reason why men seek help.

Today, andropause is viewed as a permanent hormone deficiency resulting from the aging process, which can be treated with hormone therapy. There are numerous dilemmas surrounding hormone therapy, ranging from its effectiveness to the potential health risks it may pose. However, the consensus among professionals working in aging research from various perspectives is clear: raising awareness about the symptoms of andropause and deconstructing the stigma surrounding it are crucial steps in preventing the issues that arise during this period and alleviating their impact on life satisfaction and self-esteem.