As men age, they can experience depression, mood swings, decreased energy levels, and even low sex drive. Known as andropause, or late-onset hypogonadism, this medical condition is essentially triggered by an age-related decline in testosterone, a hormone produced in the testes.
Testosterone stimulates sperm production as well as a man’s sex drive, and is responsible for male physical characteristics, such as muscle strength, body and facial hair, and deep voice.
“As men age, their testosterone levels will go down, but not all men will suffer from the signs and symptoms,” said Dr Jonathan Teo, Consultant, Department of Urology, Singapore General Hospital (SGH).
Even if they do, they may not seek treatment. “Some men may decide to just live with it. For example, for an old man who does not have sex anymore, the lowered sex drive does not affect him in any way,” added Dr Teo.
Some men may feel embarrassed, preferring to suffer in silence. Still, Dr Teo has noted an increase in the number of men seeking help for this condition.
“I think it is partly because our society is opening up to such patients wanting some help. Increasingly, we are also seeing women dragging these men into the clinic, bringing their husbands in for check-ups,” he said.
Some 26 per cent of men in Singapore suffer from low testosterone levels, according to a clinic-based health screening conducted on 1,000 men between 2007 and 2009. Andropause typically affects older men aged above 50 years, and the symptoms include erectile dysfunction, low energy levels, changes in attitude, and insomnia.
Having a blood test is often among the first steps in diagnosing low testosterone, coupled with a physical examination and whether a patient is experiencing any of the symptoms associated with andropause.
Andropause can affect those aged below 50 years if they have undergone surgery to remove testicular cancer or if the patient is under medication that lowers the testosterone in his body, said Dr Teo.
Once diagnosed, andropause can be treated with testosterone replacement therapy in the form of pills, an injection every three months, or the application of testosterone gel on the shoulders or upper arms of the patient. Those undergoing testosterone replacement therapy are closely monitored for side effects. This therapy can bring on blood thickening, which increases the risk of a heart attack or stroke, and also a drop in sperm production.
“When you give a patient testosterone, it tricks the body into producing less sperm, so such therapy will not be possible for those trying to have a family,” said Dr Teo. Once the testosterone replacement therapy stops, the sperm count will recover.
Therapy can alleviate, and in some cases, reverse many of the symptoms associated with andropause. Healthier lifestyle choices, such as diet changes, more sleep, exercise, and treatment for depression or anxiety, are also important in relieving symptoms.
Andropause and low testosterone levels are just one of a range of andrology issues. Other men-related issues include erectile dysfunction and ejaculatory disorders, said Dr Teo, who also runs a clinic for men’s health at SGH’s Diabetes and Metabolism Centre. It aims to address the gaps in men’s health screening, which contrasts with the wide range of screening initiatives for women, such as breast screening and cervical cancer screening programmes.
What is the difference between testosterone gels, pills and injections? Click here to find out.
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