BY AGE WELL
BY TEE SHIAO EEK
The male hormone, testosterone, is essential for healthy ageing in men.
DATUK Prof Dr Tan Hui Meng recalls the day that 58-year-old Mr L sat in his clinic and told him about his “old man sickness”.
“L used to be a very active and vibrant man,” says Prof Tan. “He would go mountain biking and scuba-diving regularly, and played golf every day.”
However, something changed when L hit 55. He began to feel tired and sleepy every afternoon. Instead of exercising for an hour-and-a-half every day, he cut it down to 45 minutes. He also felt that he was generally less focused.
Prof Tan says that he has seen many men in their 50s and 60s complaining of the same “old man sickness”, where they start to feel lethargic, moody and irritable, gain weight around their tummy, and suffer from low libido.
Many of these patients seemed resigned to the fact that their condition is part and parcel of ageing.
However, Prof Tan believes that there is more to it than just getting old. Blaming these symptoms on age, he says, leads to the assumption that they are inevitable. But what if these so-called ageing symptoms could be prevented or better managed to help men maintain their quality of life?
Prof Tan has been privy to a lot of exciting international and local research, which increasingly confirms that low testosterone levels are linked to many physical and psychological symptoms and conditions usually associated with ageing.
A lot of this research also suggests that treating testosterone deficiency could be the key, not only to improve these symptoms, but also to reduce the risk of metabolic syndrome, which is linked to diabetes, cardiovascular disease and early death.
All this knowledge motivated Prof Tan to write a book about testosterone deficiency syndrome, to help men in Malaysia identify if they have low testosterone, and what they can do to bring their levels back to normal.
Testosterone: Secret to Healthy Aging for Men is based on the latest international research, and answers many important questions about testosterone replacement therapy, including its efficacy, safety, and link with prostate cancer.
What is low testosterone?
Testosterone is a male hormone (also known as androgens) produced by the Leydig cells in the testicles of the male body and in the adrenal cortex. Although it is called a male hormone, testosterone is also produced in women’s ovaries, though in small amounts.
According to Prof Tan, the primary responsibility of testosterone is ensuring the proper development of male sexual characteristics. However, testosterone is also important for maintaining muscle bulk, adequate levels of red blood cells, bone density, cognitive function, sense of well-being, sexual and reproductive functions, and many metabolic processes, including those occurring in the fat cells (especially abdominal fats).
Each of these functions of testosterone is explained in more detail in Prof Tan’s book.
“Since testosterone acts on many cells, tissues and organs in the body, we know that the hormone is directly connected to organ systems, body functions and whole body health,” he says. Therefore, it makes sense that once the testosterone level drops, it would lead to a myriad of problems.
Testosterone levels tend to decline as men get older. Generally, even in normal healthy men, there is a decline of total testosterone by 1% to 1.5% per year after these men reach the age of 40. Certain medical conditions like obesity, diabetes mellitus, metabolic syndrome and alcoholism further accelerate the decrease of testosterone.
In Malaysia, two studies found that an average 20% of men above age 40 have testosterone deficiency (total testosterone level lower than 11 nmol/L or 350 ng/dL).
“This is no small number, and furthermore, we are beginning to realise that the problems faced by these men are not as harmless as we previously thought,” Prof Tan warns.
More than just a hormone
His cautionary words will come as a surprise to those who think that testosterone deficiency is just a harmless side effect of ageing. In fact, Dr Tan is concerned that many doctors and men still fail to recognise low testosterone as a serious condition.
“Testosterone deficiency is worrying because it is closely related to the metabolic syndrome. This is a group of conditions – namely, high blood pressure, high blood sugar levels, high triglycerides, low HDL or ‘good’ cholesterol levels and abdominal fat – that increases men’s risk of developing heart disease and diabetes by three to five times,” he says.
More studies now confirm that having low testosterone is a predictor for developing the deadly metabolic syndrome.
This relationship with metabolic syndrome points to an urgent need to manage low testosterone by providing testosterone replacement therapy. Men who have their testosterone levels returned to normal will find that their insulin sensitivity improves, their body fat goes down, and their lipid levels and blood pressure may also improve.
Recognising signs
Unfortunately, testosterone deficiency is not easy to pin down. You may not recognise the condition immediately, as it is a slow process and it comes on gradually.
There are a few common symptoms that are usually most suggestive of low testosterone: decreased sexual desire, erectile dysfunction, lethargy and lack of energy, negative mood changes and irritability, memory loss and lack of concentration.
However, Prof Tan points out that these symptoms are very general, and your doctor is hardly likely to jump to the conclusion that you have low testosterone if you are simply experiencing some tiredness, mood swings and weight gain. They could have been caused by many other conditions or changes in life.
But as he explains in his book, you can look for other clues to piece together the bigger picture – namely, some of the disabilities or conditions that are commonly associated with testosterone deficiency. These signs include frailty, accumulation of fat around the waist, impaired or high blood glucose, cardiovascular disease and sexual dysfunction.
“If you have these co-existing conditions, your doctor should immediately screen you for low testosterone using standard screening questionnaires, such as the St Louis University ADAM Questionnaire and the Aging Male Symptoms (AMS) Questionnaire,” he says.
Finally, a blood test looking at total testosterone level can be taken to confirm whether you have low testosterone. There is no fixed level that is defined as low testosterone, but if it is lower than 11 nmol/L – combined with symptoms that are causing discomfort or distress – then there is a high probability that you have testosterone deficiency.
