The review discusses the contribution of age-related male hypogonadism to the formation of cerebral microangiopathy (disease of small brain vessels) (CMA/SVD). The current explanation of the nature of CMA by an ischemic-hypoxic process, which is based on hypo- or hyperperfusion of the white matter of brain due to a complex of various causes, does not explain the etiopathogenesis of CMA. The article considers a violation of the neuroglyovascular connection, represented by a vessel, astrocytic glia, and a neuron, as the cause of SVD development. The main role in the CMA formation is assigned to endothelial dysfunction, all variants of which (vasomotor, thrombophilic, adhesive, angiogenic) can be traced in SVD. The role of disorders of the main functions of arterial vessels — conducting and damping, as well as liquorodynamics disorders in the CMA pathogenesis is discussed. The data indicating the involvement of testosterone and its derivatives in the formation of cerebral vascular pathology are presented. It is emphasized that this participation can be of one kind in men with early physiological uncomplicated hypogonadism, when the hypothalamic-pituitary system is involved in the process, and of another kind in complicated or late climax. At that, an increase in the production of gonadotropin — releasing hormone (GnRH), the content of FSH and LH in peripheral blood is considered as a reaction to an age-related decrease in androgen function, and the vegetative dysfunction, metabolic and other disorders inherent in this period of life – as a result of changes in the functioning of the entire hypothalamus-pituitary-testicular axis. In complicated age-related hypogonadism, the resulting endocrine or somatic pathology is included in the process of small vessel disease formation. In late hypogonadism, the androgen function fades, and the hypothalamic-pituitary system begins to function in a different mode. Often, the clinic and mechanism of CMA formation are determined by diseases inherent in old age. The differences in the pathogenetic mechanisms of CMA development at various periods of IgG determine the need for a differentiated approach to the preventive means and methods of CMA therapy in men of the involutional period. The presented information may be useful for better understanding of CMA development in individuals with age-related hypogonadism.