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Feature Raffles HealthNews“MEN”Evolution of Men:PAUSEAs men age, one of the biologicalchanges they experience isandropause.Andropause, also called male menopause,is sometimes used to describe a reductionof the production of certain hormonessuch as testosterone. It is a normalpart of ageing, and for some men, it isaccompanied by a gradual and undesireddecline in their sexuality, mood and overallenergy. Sometimes, it can even exposemen to more serious health risks.Similar to the female menopause,men are affected by the onset ofandropause between the ages of 40to 55. Unlike women, however, thesymptoms of andropause are not aswidely researched, and as such, mendo not have a clear signal when they areentering the andropause stage. The mainindicator is a drop in the testosteronelevel, as well as accompanying physicaland psychological changes. A decline intestosterone level can also increase thehealth risk for the men in the areas ofheart and bones.Most men, however, will experiencesome kind of mid-life crisis when theystart to grapple with questions relating totheir careers, values, accomplishments,direction in life and self-worth as theybegan the process of internal reflection.Going downhillA man’s transition to an andropause stageis more gradual and takes place over aperiod of time, unlike women. Attitude,psychological stress, alcohol, injuries orsurgery, medications, obesity and infectionscan contribute to its onset.It is common fact that as a man ages, histestosterone level will decline. However,there is no dipstick measure to find outwhich man will experience andropausalsymptoms of a certain severity, whichnecessitates seeking medical help. Itis also difficult to predict at what agethe symptoms will occur in a particularindividual. Each man’s symptoms mayalso be different and vary with the others.CausesAfter age 30, men will experience a declinein their testosterone levels which drop byabout 10% every decade. At the sametime, another hormone known as theSex Binding Hormone Globulin, (SHBG),is increasing. SHBG traps much of thetestosterone that is still circulating andmakes it unavailable to exert its effectsin the body’s tissues. What remains isknown as “bioavailable” testosterone.Andropause is associated with lowbioavailable testosterone levels. Everyman experiences a decline of bioavailabletestosterone but some men’s levels diplower than others. When there is a loweringof bioavailable testosterone, men canexperience andropausal symptoms.These symptoms can impact their quality oflife and may expose them to other, longertermrisks of low-testosterone. Testosteroneis important as it helps to build protein andis essential for normal sexual behavior andfor producing erections. It also affects manymetabolic activities such as the productionof blood cells in the bone marrow, boneformation, lipid metabolism, carbohydratemetabolism, liver function and prostategland growth.Are You Andropausal?Men with low bioavailable testosteronelevels will find themselves experiencingsome of the following:· Low sex drive· Emotional, psychological and behavioralchanges· Decreased muscle mass· Loss of muscle strength· Increased upper and central body fat· Osteoporosis or weak bones and backpain· Cardiovascular riskTreatment for AndropauseAccording to Dr Eng Soo Kiang, FamilyPhysician, Raffles HealthScreeners,some treatment options that are found tobe effective are:· Exercise, dietary changes, stressreduction· Couple counselling, career refocusing,spiritual support· Treatment for depression· Chemical dependency treatment, sexualcompulsivity treatment· Androgen Replacement TherapyAndrogen ReplacementTherapy (ART)The most important factor in theevaluation and treatment of andropauseis the public awareness of its frequentoccurrence that will stimulate the use ofappropriate screening tests, beginningwith a morning testosterone level.“ART has been shown to produceimprovements in many of these areas. ARTcan be highly beneficial in alleviating thesymptoms of andropause and improvingquality of life,” said Dr Eng.He added that this practice is notwithout risks, both proven and theoretic.Additionally, the diagnosis of androgendeficiency and the decision to treatis not always straightforward. It isnecessary to have careful screeningand meticulous follow-ups.It is essential for anyone that the followingcriteria are met before using ART:
Raffles HealthNews Feature • The presence of symptoms and bloodtests supporting the diagnosis• Conditions that make ART undesirablemust be screened for• A doctor familiar with the diagnosis,treatment and monitoring of andropause• Patient is well-informed and is committedto diligent and competent follow-upsfor the duration of the treatmentPatients can also enquire if the doctoris sited in a multi-disciplinary centrewhere there are other specialties to lookafter the diverse and complex needs ofan andropausal man. For example, anurologist, endocrinologist, psychiatrist,cardiologist, ear, nose and throatspecialist, dietician, exercise therapist,clinical psychologist, sex therapist andother complementary health practitioners.Treatment Steps for ARTDr Eng advises that men should seek aspecialist doctor in andrology and men’shealth to draw up a comprehensivecare plan jointly that is both acceptableand beneficial to him.It involves:••••••••••Medical nutritionPrecise exercise prescriptionSleep optimisationSmoke cessationCancer screeningLiver and bone careSex therapy, marital and fertilityassistanceDiabetes, cholesterol andhypertension co-managementOrchestrating community /social support system for patientAttention to the multifaceted malegender roleIndividualised androgenreplacement therapy•
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