https://www.todayonline.com/daily-focus/more-men-seeking-help-problems-related-low-testosterone
SINGAPORE — Persistent fatigue and an inability to perform in bed spurred 58-year-old Patrick Tan (not his real name) to seek medical attention. Aged 47 at the time, he felt he was too young to experience these bothersome symptoms, which he initially thought were side effects from previous surgeries to treat an overactive bladder.
“Having erectile dysfunction affected me psychologically. But it was the constant lack of energy and drowsiness that was very disturbing because I used to have a lot of drive at work,” said the managing director working in the electronics industry, who is married with two adult sons.
Blood tests revealed the symptoms were due to lower-than-normal levels of testosterone.
Mr Tan has since gone on testosterone replacement therapy to restore the dwindling male sex hormone.
Instead of dismissing low testosterone symptoms as part of normal ageing, an increasing number of men have come forward to seek help for what used to be a hush-hush condition, doctors told TODAY.
More are also enquiring about testosterone replacement therapy, which is usually administered through injections, oral doses or gels applied over the shoulder or abdomen.
It is estimated that about one in four men aged 45 and above in Singapore suffers from some form of testosterone deficiency, according to Professor Peter Lim, a urologist at Gleneagles Hospital, who said therapy costs an average of S$150 a month.
Prof Lim, who is also founder of the Society for Men’s Health Singapore, currently sees at least 40 patients on testosterone replacement therapy each month — a figure that he estimated is four to five times higher than it was a decade ago.
“The level of health education in Singapore is very high. These days, men are more open about discussing sex, and seem more concerned about their sexual health and male ageing,” he said.
Age management specialist Julinda Lee from the Singapore Medical Group has noted an increase of about 20 per cent in the number of male patients with symptoms seeing a doctor and enquiring about treatment in the last five years.
Tan Tock Seng Hospital’s (TTSH) urology department has observed a similar increase.
Dr Lee said the men are typically in their late 50s to 60s and are married or have a partner. But the doctors also see a small proportion of men under the age of 40 as well as those above the age of 90.
“One 91-year-old patient came into the office complaining that ‘everything is useless and nothing works’. Once we replaced the testosterone, he was up and running. In younger men, the cause is likely to be due to cancer, infection or trauma to the testes,” said Prof Lim.
NOT JUST A SEX HORMONE
More than just a sex hormone, testosterone is essential in men’s overall health, including the maintenance of muscle strength and mass, healthy energy levels, good sleep, bone health and even mental agility.
In the natural course of ageing, testosterone levels gradually decline over time; it has been reported that the hormone decreases by 0.4 to 2 per cent each year after the age of 40, said Dr Ronny Tan, consultant and director of andrology in the Department of Urology at TTSH.
Factors such as chronic conditions like diabetes, as well as stress and a sedentary lifestyle, can also speed up the process, added Prof Lim.
Common symptoms include erectile dysfunction, loss of morning erections, lower sex drive and energy levels, said Dr Tan.
But many patients who are testosterone-deficient also tend to display classic physical signs such as “flabby” muscle tone and a paunch, due to increased fat around the waist, said Prof Lim.
In extreme cases, the severe loss of muscle mass can affect quality of life.
“My oldest patient, who is 95, came to me when he was 85 with an unusual complaint of pain at his tail bone which turned out to be related to the wasting of buttock muscles, commonly seen in low-testosterone patients,” said Dr Lee.
“The pain disappeared after he went on replacement therapy and an appropriate exercise programme to help him build muscle mass.”
Low testosterone is linked to a host of health conditions including osteoporosis, heart disease, diabetes, dementia and lower life expectancy.
By replacing testosterone to normal levels, the men do show improvements in their health with respect to blood pressure control, sugar control and lower risk of heart diseases, said TTSH’s Dr Tan.
One of the most significant differences Mr Tan experienced after supplementing the male hormone — in the form of injections administered every three months — was renewed vigour.
“I’m a lot more energetic now and I don’t think I will be stopping the treatment anytime soon,” he said.
Still, there are possible risks associated with the therapy.
For example, it can cause fertility issues by reducing sperm count and size of the testes, affecting younger patients who have not completed their family planning, warned Dr Lee.
Men who have a history of cardiovascular disease (heart disease or stroke), prostate problems, sleep apnoea or cancer should also be particularly careful about starting the therapy, she added.
Testosterone replacement therapy should be administered by trained medical professionals, and patients must also undergo regular follow-ups and blood tests to monitor potential side effects.
When used appropriately, the treatment can benefit men who are genuinely testosterone-deficient but it should not be used as a preventive measure against ageing concerns. The treatment is not an “elixir of youth”, said TTSH’s Dr Tan.
Said Prof Lim: “Some men come into the clinic asking for testosterone to make them look beefier or to enhance their sports performance. If their testosterone levels are normal, why would they need treatment? That’s bad medicine.”
