Indirect Associations of Perceived Stress and Sleep Quality in the Relationship Between Andropause Symptoms and Quality of Life Among Middle-Aged Men: A Cross-Sectional Study.
Lee J & Park H • American journal of men's health • 2026
Perceived stress and poor sleep quality serve as significant indirect pathways linking andropause symptoms to reduced quality of life among middle-aged men, providing empirical evidence that 'acute and sustained psychosocial burdens associated with andropause symptoms contribute substantially to a decline in overall well-being and health.'
Key Findings
Results
The majority of middle-aged men in the sample screened positive for andropause symptoms, and more than half reported poor sleep quality.
Sample consisted of 186 middle-aged men who completed all questionnaires
83.3% of participants screened positive for andropause symptoms using the Androgen Deficiency in Aging Males (ADAM) Scale
58.6% of participants reported poor sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI)
Study used a cross-sectional quantitative mediation analysis design
Results
Andropause syndrome was significantly associated with an increased risk of poor sleep quality.
Binary logistic regression revealed andropause syndrome was associated with poor sleep quality (OR = 6.168, 95% CI = [2.013, 18.896], p = .001)
This indicates men with andropause symptoms were approximately six times more likely to report poor sleep quality
Analysis was conducted using binary logistic regression
Results
Perceived stress was significantly associated with an increased risk of poor sleep quality.
Perceived stress was associated with poor sleep quality (OR = 1.279, 95% CI = [1.159, 1.410], p < .001)
Perceived stress was measured using the Perceived Stress Scale (PSS)
Each unit increase in perceived stress was associated with a 27.9% increase in odds of poor sleep quality
Results
Perceived stress significantly mediated the relationship between andropause symptoms and quality of life.
Baron and Kenny mediation analysis indicated perceived stress explained the link between andropause symptoms and QoL (B = -0.033, p < .001)
Bootstrapped mediation analysis confirmed perceived stress as a significant indirect pathway (B = -0.861, 95% CI = [-1.210, -0.514])
The confidence interval for the indirect effect did not include zero, confirming significance
Quality of life was measured using the World Health Organization Quality of Life (WHOQOL) instrument
Results
Sleep quality significantly mediated the relationship between andropause symptoms and quality of life.
Statistical mediation analysis indicated poor sleep quality explained the link between andropause symptoms and QoL (B = -0.060, p < .001)
Bootstrapped mediation (Hayes PROCESS macro) revealed sleep quality as a significant indirect pathway (B = -1.566, 95% CI = [-2.054, -1.035])
The indirect effect of sleep quality (B = -1.566) was larger in magnitude than that of perceived stress (B = -0.861)
The confidence interval for this indirect effect did not include zero, confirming significance
Results
Both perceived stress and sleep quality together explained the indirect pathway from andropause symptoms to quality of life.
Two significant indirect associations between andropause symptoms and QoL were identified: through perceived stress and through sleep quality
The direct association between andropause symptoms and QoL was also significant (B = -0.052, p < .001)
Three-variable mediation models were tested using both Baron and Kenny approach and Hayes PROCESS macro bootstrapping
Findings suggest andropause symptoms influence QoL both directly and indirectly through psychosocial and sleep-related pathways
What This Means
This research suggests that andropause — the gradual hormonal changes men experience in middle age, sometimes called 'male menopause' — is strongly linked to lower quality of life, and that this link is largely explained by two factors: increased psychological stress and poorer sleep. In a study of 186 middle-aged men, over 80% showed signs of andropause symptoms, and nearly 60% had poor sleep quality. Men with andropause symptoms were about six times more likely to report poor sleep, and higher stress levels also substantially raised the odds of sleep problems.
The study's key contribution is showing that stress and sleep quality act as 'bridges' connecting andropause symptoms to reduced well-being. Rather than andropause directly lowering quality of life on its own, the research suggests it does so partly by increasing psychological stress and disrupting sleep, both of which then erode overall well-being. Notably, poor sleep appeared to be a stronger indirect pathway than stress alone.
This research suggests that addressing andropause in middle-aged men should go beyond hormone-related concerns to also include attention to mental health and sleep. Interventions targeting stress reduction and sleep improvement could potentially help protect quality of life in men experiencing andropause symptoms. Because this was a cross-sectional study (a snapshot in time), it cannot confirm that andropause symptoms directly cause stress or poor sleep, only that these factors are associated.
Lee J, Park H. (2026). Indirect Associations of Perceived Stress and Sleep Quality in the Relationship Between Andropause Symptoms and Quality of Life Among Middle-Aged Men: A Cross-Sectional Study.. American journal of men's health. https://doi.org/10.1177/15579883251412966