Evolution of Men:
“Men” nopause
Article contributed by:
Raffles Medical Group
As men age, one of the
biological changes they
experience is andropause.
Andropause, also called
male menopause, is
sometimes used to
describe a reduction of
the production of
certain hormones such as
testosterone. It
is a normal part of
ageing, and for some
men, it is accompanied
by a gradual and
undesired decline in
their sexuality, mood
and overall energy.
Sometimes, it can even
expose men to more
serious health risks.
Similar to the female
menopause, men are
affected by the onset of
andropause between the
ages of 40 to 55. Unlike
women, however, the
symptoms of andropause
are not as widely
researched, and as such,
men do not have a clear
signal when they are
entering the andropause
stage.
The main indicator is a
drop in the testosterone
level, as well as
accompanying physical
and psychological
changes. A decline in
testosterone level can
also increase the health
risk for the men in the
areas of heart and
bones.
Most men, however, will
experience some kind of
mid-life crisis when
they start to grapple
with questions relating
to their careers,
values, accomplishments,
direction in life and
self-worth as they began
the process of internal
reflection.
Going Downhill
A man’s transition to an
andropause stage is more
gradual and takes place
over a period of time,
unlike women.
Attitude, psychological
stress, alcohol,
injuries or surgery,
medications, obesity and
infections can
contribute to its onset.
It is common fact that
as a man ages, his
testosterone level will
decline. However, there
is no dipstick measure
to find out which man
will experience
andropausal symptoms of
a certain severity,
which necessitates
seeking medical help.
It is also difficult to
predict at what age the
symptoms will occur in a
particular individual.
Each man’s symptoms may
also be different and
vary with the others.
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Causes
After age 30, men will
experience a decline in
their testosterone
levels which drop by
about 10% every decade.
At the same time,
another hormone known as
the Sex Binding Hormone
Globulin, (SHBG), is
increasing. SHBG
traps much of the
testosterone that is
still circulating and
makes it unavailable to
exert its effects in the
body’s tissues.
What remains is known as
“bioavailable”
testosterone.
Andropause is associated
with low bioavailable
testosterone levels.
Every man experiences a
decline of bioavailable
testosterone but some
men’s levels dip lower
than others. When
there is a lowering of
bioavailable
testosterone, men can
experience andropausal
symptoms. These symptoms
can impact their quality
of life and may expose
them to other,
longer-term risks of
low-testosterone.
Testosterone is
important as it helps to
build protein and is
essential for normal
sexual behavior and for
producing erections.
It also affects many
metabolic activities
such as the production
of blood cells in the
bone marrow, bone
formation, lipid
metabolism, carbohydrate
metabolism, liver
function and prostate
gland growth.
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Are You Andropausal?
Men with low
bioavailable
testosterone levels will
find themselves
experiencing some of the
following:
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Low sex drive |
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Emotional,
psychological and
behavioral changes |
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Decreased muscle
mass |
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Loss of muscle
strength |
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|
Increased upper and
central body fat |
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Osteoporosis or weak
bones and back pain |
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Cardiovascular risk |
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Treatment for Andropause
According to Dr Eng Soo
Kiang, Family Physician,
Raffles HealthScreeners,
some treatment options
that are found to be
effective are:
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Exercise, dietary
changes, stress
reduction |
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Couple counselling,
career refocusing,
spiritual support |
|
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Treatment for
depression |
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Chemical dependency
treatment, sexual
compulsivity
treatment |
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|
Androgen Replacement
Therapy |
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Androgen Replacement
Therapy (ART)
The most important
factor in the evaluation
and treatment of
andropause is the public
awareness of its
frequent occurrence that
will stimulate the use
of appropriate screening
tests, beginning with a
morning testosterone
level.
“ART has been shown to
produce improvements in
many of these areas. ART
can be highly beneficial
in alleviating the
symptoms of andropause
and improving quality of
life,” said Dr Eng.
He added that this
practice is not without
risks, both proven and
theoretic. Additionally,
the diagnosis of
androgen deficiency and
the decision to treat is
not always
straightforward.
It is necessary to have
careful screening and
meticulous follow-ups.
It is essential for
anyone that the
following criteria are
met before using ART:
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The presence of
symptoms and blood
tests supporting the
diagnosis |
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Conditions that make
ART undesirable must
be screened for |
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A doctor familiar
with the diagnosis,
treatment and
monitoring of
andropause |
|
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Patient is
well-informed and is
committed to
diligent and
competent follow-ups
for the duration of
the treatment |
Patients can also
enquire if the doctor is
sited in a
multi-disciplinary
centre where there are
other specialties to
look after the diverse
and complex needs of an
andropausal man.
For example, an
urologist,
endocrinologist,
psychiatrist,
cardiologist, ear, nose
and throat specialist,
dietician, exercise
therapist, clinical
psychologist, sex
therapist and other
complementary health
practitioners.
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Treatment Steps for ART
Dr Eng advises that men
should seek a specialist
doctor in andrology and
men’s health to draw up
a comprehensive care
plan jointly that is
both acceptable and
beneficial to him.
It involves:
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Medical nutrition |
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Precise exercise
prescription |
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Sleep optimisation |
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Smoke cessation |
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|
Cancer screening |
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Liver and bone care |
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Sex therapy, marital
and fertility
assistance |
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Diabetes,
cholesterol and
hypertension
co-management |
|
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Orchestrating
community / social
support system for
patient |
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Attention to the
multifaceted male
gender role |
|
► |
Individualised
androgen replacement
therapy |
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Article contributed by:
Raffles Medical Group
Dated: May 2011
|
Raffles
Medical
Group is
a leading
medical
group and
the largest
private
group
practice in
Singapore.
As a fully
integrated
healthcare
organisation,
the Group
owns and
operates a
network of
family
medicine
clinics, a
tertiary
care private
hospital,
insurance
services and
a consumer
healthcare
division.
Patients of
the Group
enjoy a
continuum of
care, from
having their
most basic
healthcare
needs met
through the
Group’s
islandwide
network of
Raffles
Medical
clinics, to
specialist
and tertiary
care at
Raffles
Hospital. |
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