Is the man in your life always tired and irritable? Don’t write off these symptoms as an inevitable transformation into middle-aged grump mode. His new persona could be an indication of Testosterone Deficiency Syndrome (TDS). Here’s what to know and how to treat it.
Why is testosterone important?
According to DR JULIAN NG of DTAP Clinic (Dr Tan and Partners), two in every 100 men have testosterone deficiency syndrome (TDS). Also known as hypogonadism, it’s a condition in which a man’s body does not produce sufficient levels of testosterone, the primary male hormone.
Testosterone is important through the life of any male, says Dr Ng. It determines the development of male characteristics while in the womb, it’s required for males to develop secondary sexual characteristic during puberty (facial hair, pubic hair and the deepening of a man’s voice, for example) and it’s responsible for sperm production.
It’s also key to the development of bones and muscles. “Testosterone is needed to maintain good bone health directly and indirectly, as some testosterone is converted into oestrogen, which helps maintain good bone health. Testosterone also helps in maintain muscle mass, which indirectly improves body fat levels.”
Males normally have the highest level of testosterone when they are between age of 20 and 30. By the time they hit the age of 80, testosterone levels can drop by up to 30 percent. Unlike women, who experience a sudden drop in estrogen levels when they hit menopause, men experience a more gradual decrease of testosterone levels over time.
While TDS itself is not a life-threatening condition, it can have a significant impact on the quality of life for the man and his relationship,” says Dr Ng. “Testosterone can also affect mood and sex drive in males, and may also affect erection.”
And, TDS can do more than just threaten your partner’s patience both in and out of the bedroom. There is a growing body of evidence showing an association between low testosterone levels and coronary artery disease. Research has also linked males with low testosterone levels to risk of high-grade prostate cancer, diabetes, high cholesterol levels and obesity.
“It’s found on average that very obese men have testosterone levels 25 percent lower than non-obese men,” says Dr Ng.
What are the signs of testosterone deficiency?
Common symptoms of low testosterone are low energy levels, mood swings or irritability, poor concentration, reduced muscle strength, low libido and erection issues – either difficulty getting an erection or maintaining one.
“As some of the symptoms are non-specific like tiredness or mood swings, or an increase in weight, they can be misdiagnosed as stress-related or simply not doing exercise,” says Dr Ng. “Some may even be told by their doctor that they are depressed.”
DTAP Clinic suggests using the following questionnaire as a tool to assess the possibility of being testosterone deficient:
- Do you have a decrease in libido (sex drive)?
- Do you have a lack of energy?
- Do you have a decrease in strength and/or endurance?
- Have you lost height?
- Have you noticed a decreased “enjoyment of life”?
- Are you sad and/or grumpy?
- Are your erections less strong?
- Have you noted a recent deterioration in your ability to play sports?
- Are you falling asleep after dinner?
- Has there been a recent deterioration in your work performance?
“If you answer ‘yes’ to questions #1 and #7 and any other three questions, then you may want to see your doctor to discuss testosterone deficiency,” says Dr Ng.
He notes that a man can have low testosterone levels but, as long as he has no symptoms attributable to testosterone, he does not have testosterone deficiency syndrome. And, while low testosterone could be the reason behind certain symptoms, there are other medical conditions that could be at play; in fact, there are some conditions (Type 2 Diabetes, metabolic syndrome and osteoporosis, among others) that mimic the symptoms of TDS, so it’s best to speak with your doctor about getting tested.
A blood test called a serum testosterone test is used to determine a man’s level of circulating testosterone. This is used to diagnose TDS and subsequently, determine the most appropriate treatment option for the patient.
How is testosterone deficiency treated?
Testosterone replacement therapy is a widely used treatment for men with symptomatic TDS, and there are various options for testosterone replacement available here in Singapore.
“This is an option for those who do not wish to take medication on a daily basis,” says Dr Ng. The injection is generally given once every eight to 12 weeks depending on the individual. There are also short-term injections but they require the patient to be comfortable with self-injection, he says.
“This is an option for those who do not like needles and prefer the oral route,” says Dr Ng. “Absorption is dependent on diet, and is better with high fat meals.”
“This option provides the best absorption and most stable levels compared to the other two routes of administration,” says Dr Ng. “It’s also the easiest option for most people, as it only requires you to apply the gel on your skin. However, some people find it inconvenient to use, as you need to wait for the gel to dry; there is also the risk of accidental transfer of testosterone to one’s female partner or children.”
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