A SOFT APPROACH: THELOWDOWN ON ANDROPAUSE
BY DR. SAM PEH
Andropause, otherwise known as late-onset hypogonadism (LOH), presents itself with several symptoms including erectile dysfunction, reduced libido, decreased muscle strength, osteoporosis, metabolic syndrome, hot flushes, reduced self-motivation, depression, irritability, cognitive impairment, and insomnia. It must be noted that these may not all occur together or at the same time. The incidence in men age over 60 years old is about two per cent.
This is the natural phase of aging in males. The hypothalamic-pituitary-testicular axis decline with age resulting in a gradual decline in testosterone level. With the improvement in healthcare and nutrition, the average lifespan of a man in Singapore is now 83 years old. Correspondingly, the incidence of LOH increases in developed countries like Singapore.
The usual age when LOH begin to present itself is after the age of 50 years. Presence of severe illness, diabetes mellitus, obesity, testicular disease, and certain medicines can precipitate LOH earlier in life.
Once it occurs, LOH is a lifelong problem – with the likelihood of it progressively getting worse as a man ages. So, the effects described above persist and progress.
The changes in the body of a man with LOH is directly related to the declining levels of testosterone. Testosterone is both an anabolic steroid as well as a virilizing hormone. Organ atrophy and increased cell death are the main effects of reduced testosterone level.
To reduce or delay the effects of LOH, a man should maintain a healthy lifestyle from an early age. Regularly eating healthily and exercising build up reserves in the body, and allow them to mitigate the effects of LOH better or delay its onset.
Once LOH sets in, treatment would depend on individuals.
Some men are happy to age naturally, while others are more proactive and would seek to correct the declining testosterone level with testosterone replacement therapy (TRT). It involves introducing exogenous testosterone into the body and can be done by daily topical application, daily oral capsules, or intramuscular injections once every ten to 12 weeks.
There are pros and cons to each route of replacement, but topical therapy is most popular at the moment. A man with LOH should check with his doctor to discuss if TRT is suitable for him, and which mode of replacement serves him best.
Like all medicine, testosterone replacement has its potential side effects. These include polycythemia, abnormal liver function, and a theoretical risk of prostate cancer. Therefore, a person undergoing TRT must be monitored regularly with full blood count, liver function test, and PSA level.
Dr Sam Peh Oon Hui is a Consultant Urologist at PanAsia Surgery Group (panasiasurg.com).