Why are men ignoring their hormonal health?
Hormones such as testosterone, cortisol, thyroid and even estrogen play critical roles in men’s physical and mental health, but lack of awareness and social conditioning stops them from seeking medical advice or taking hormone tests
For decades, conversations around hormonal health have almost exclusively been centered on women. From PMS to menopause, fluctuating hormones have been recognized as key drivers of mood, metabolism, and emotional well-being—for women. Meanwhile, men’s fatigue, irritability, or sudden dips in libido are often dismissed as consequences of ageing, stress, or just “a rough patch." But growing medical evidence suggests a more complex picture. Hormones such as testosterone, cortisol, thyroid—and even estrogen—play critical roles in men’s physical and mental health too. When these go out of sync, the symptoms can look strikingly similar to common psychiatric conditions, leading to misdiagnoses, inappropriate treatments, and prolonged suffering.
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“In men, hormones regulate everything from metabolism and fertility to sleep, mood, and even heart health," says Dr Sandeep Kharb, senior consultant of endocrinology at Asian Hospital, Faridabad. “Yet routine screening for hormonal imbalances in men remains rare. And as a result, we’re often treating symptoms without understanding the root cause."
One of the key issues, experts say, is that men rarely seek medical help for subtle or early signs of hormonal dysregulation. “Most male patients come to us with vague complaints like low energy or trouble sleeping," says Dr Praveen Gupta, principal director and chief of neurology, Fortis Hospital, Gurugram. “Unless there’s a major psychological event or an obvious stressor, these symptoms are brushed off. The cultural narrative around masculinity doesn’t allow men to admit vulnerability especially when it’s invisible." This under-reporting, Gupta argues, leads to a broader failure in diagnosis. Many patients are first assumed to be struggling with anxiety or depression. While talk therapy or medication may help some, others fail to respond. That’s when a more biological explanation begins to take shape.
“When someone doesn’t get better with counselling, we begin to wonder if there’s a hormonal component," Gupta adds. “Sudden mood swings, loss of libido, sleep disturbances—those are red flags."
In Kharb’s endocrinology practice, patients with long-ignored symptoms often arrive only after significant decline: erectile dysfunction, obesity, even major depressive episodes. “By then," he notes, “the condition has been festering for years." Dr Mangesh Patil, head of minimal invasive urology and endourology at Sir HN Reliance Foundation Hospital in Mumbai, echoes the sentiment. “Men often present with urinary or sexual dysfunction, perceiving them as isolated issues. However, these symptoms frequently reflect underlying hormonal imbalances such as low testosterone or thyroid dysfunction," he says. “In my practice, I find that up to 30–40% of such cases involve hormonal contributors. Symptoms like fatigue, decreased libido, erectile dysfunction, and nocturia often overlap with endocrine issues."
UNDERSTANDING MALE PMS
The medical community is now beginning to recognize the concept of “male PMS" and andropause. The latter being a mid-life decline in testosterone somewhat analogous to menopause in women. Yet, even with a growing body of research, there’s lack of clarity and awareness around how hormonal shifts manifest in men. According to a seminal study published in the Journal of Clinical Endocrinology & Metabolism in 2007, Prevalence of Symptomatic Androgen Deficiency in Men, 45% of men between the ages of 50–59 and 60% of men aged 60–69 have low free testosterone levels.
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“Low testosterone, for instance, doesn’t just affect libido," explains Kharb, “It can make men depressed or irritable. High cortisol levels, often a result of chronic stress, can mimic anxiety or panic attacks. These are often misread as psychiatric disorders, but they have a biochemical basis." What complicates diagnosis further is that psychological and hormonal symptoms overlap. The DSM (Diagnostic and Statistical Manual of Mental Disorders), long considered the gold standard for psychiatric diagnosis, doe not require hormonal screening as part of the mental health evaluation.
“There’s no suggestion in the DSM that if a patient reports feeling low, we should first check thyroid or testosterone levels," reveals Gupta. “That integrated approach is missing. We need to train psychiatrists and psychologists to consider hormonal causes, especially when therapy or antidepressants aren’t working." Patil adds that erectile dysfunction (ED)—often the first symptom men report—is frequently a red flag for deeper endocrine or metabolic disorders. “It’s a diagnostic gateway to broader health concerns," he says. “Distinguishing between psychological, hormonal, and physiological causes requires a detailed history, physical exam, and targeted tests. Hormonal profiling, glucose control, vascular assessment, and mental health screening all play a role."
Meanwhile, Testosterone Replacement Therapy (TRT), often touted as a fix for everything from low energy to fading libido, has sparked intense debate. While some consider it overprescribed, others argue it remains severely underdiagnosed due to stigma. “In India, the bigger problem is underdiagnosis," says Kharb. “Men rarely get tested unless symptoms become severe. But on the flip side, we’re also seeing people seek TRT at gyms or through non-specialist providers, which is dangerous." As per guidelines from the Endocrine Society of India, TRT should only be administered by trained endocrinologists after thorough clinical evaluation and testing. “It’s not a one-size-fits-all therapy," he emphasizes. “We weigh the benefits and risks, monitor patients closely, and only recommend it when absolutely necessary."
A NEW MODEL FOR MEN’S HEALTH
So what would a more proactive, gender-aware model of men’s hormonal health look like? “It starts with awareness," Kharb says. “We need to destigmatize hormonal testing for men, just as we did for women decades ago. Screening should be part of routine checkups, especially for men over 40 or those in sedentary lifestyles." This is particularly critical, as testosterone levels decline naturally by about 1% per year starting at age 30, as reported by Harvard Health Publishing. Gupta agrees adding, “We need more interdisciplinary collaboration. In large hospitals, referrals between psychologists and endocrinologists are becoming more common. But in smaller towns and clinics, this system is broken. Physicians need to be trained to identify hormonal red flags and refer patients early."
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The doctors stress that cultural narratives need to shift alongside clinical practices. “It’s okay for men to feel exhausted, to not feel like themselves, to seek help," Gupta says. “Biology doesn’t discriminate based on gender. Our healthcare system shouldn’t either."
HORMONAL IMBALANCE SYMPTOMS TO WATCH OUT FOR
Some common signs of hormonal imbalance in men include:
- Persistent fatigue or low energy
- Mood swings, irritability, or depression
- Sleep disturbances
- Low libido or erectile dysfunction
- Unexplained weight gain or loss
- Anxiety or panic-like symptoms
- Loss of motivation or cognitive fog
Who should get tested: Men over 40, those with high-stress lifestyles, or who’ve undergone sudden emotional changes, or experience chronic fatigue should consider checking their testosterone, thyroid (TSH, T3, T4), and cortisol levels as part of a routine health screening.
Tanisha Saxena is a Delhi-based independent journalist. She writes stories that are on the intersection of art, culture and lifestyle.
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