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

This study examined the associations between andropause symptoms, perceived stress, and sleep quality, and determined the indirect pathway of perceived stress and sleep quality in the relationship between andropause symptoms and quality of life (QoL) among middle-aged men. This cross-sectional study employed a quantitative mediation analysis design. In total, 186 middle-aged men completed questionnaires, including the Androgen Deficiency in Aging Males Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index, and World Health Organization Quality of Life. Data were analyzed using binary logistic regression, Baron and Kenny mediation analysis, and Hayes PROCESS macro. In total, 83.3% of the participants screened positive for andropause symptoms, and 58.6% reported poor sleep quality. Andropause syndrome and perceived stress were significantly associated with an increased risk of poor sleep quality (odds ratio [ OR ] = 6.168, 95% confidence interval [CI] = [2.013, 18.896], p = .001; OR = 1.279, 95% CI = [1.159, 1.410], p < .001). Statistical mediation analysis indicated perceived stress and poor sleep quality explained the link between andropause symptoms and QoL ( B = −0.033, p < .001; B = −0.060, p < .001; B = −0.052, p < .001). Bootstrapped mediation analysis revealed two significant indirect associations between andropause symptoms and QoL: perceived stress ( B = −0.861, 95% CI = [−1.210, −0.514]) and sleep quality ( B = −1.566, 95% CI = [−2.054, −1.035]). These findings provide empirical evidence that acute and sustained psychosocial burdens associated with andropause symptoms contribute substantially to a decline in overall well-being and health.