First of all it is important to make clear that andropause isn't the male version of menopause, says consultant urologist Dr Datesh Daneshwal.
Andropause is a condition where men experience a decrease in their testosterone levels that is not normal. While all men do start losing testosterone after the age of 30, the decrease isn't very significant (about 1% a year) and should not affect their well-being. Very different from menopause which signifies a sudden decrease in a woman’s hormone levels that causes ovulation to cease.
But sometimes, when a man's biochemical dip is more drastic, it can cause a broad range of symptoms that affect their overall health and temperament.
These symptoms include a decline in muscle mass and strength, a buildup of body fat, a loss of bone density, flagging energy, emotional instability, deranged sugar and cholesterol levels, lowered fertility and fading virility.
"A drop in testosterone coupled with these symptoms is what is classified as andropause. When it interferes with your well-being and health," explains Dr Datesh. "Many people have a misconception that testosterone is purely for sexual function which it is not. It is the elixir that keeps the brain sharp, affects one's mood, muscle bulk and weight management and also collesterol and sugar levels. Low testosterone can cause insomnia and depression and, of course, sexual dysfunction too. Men need a certain level of testosterone to function well – in all aspects of their life – and if it dips too low, their health is at risk," says Dr Datesh
David was 38 when he started noticing the symptoms.
"I was experiencing a gradual but progressive decline of erectile function, decreased libido, frequent and more prolonged periods of low moods, decreased energy levels and frustration, sadness and despair that my interest in the opposite gender was not what it once was," says David who is now 61.
Although he initially started taking Viagra to help with his sexual dysfunction, David decided to consult a doctor when the symptoms persisted.
"For many years, l absorbed myself in my work and largely shrugged off and just accepted my symptoms without question. ince retiring a few years ago, l have had the time to become more aware of the physical and psychological fallout these symptoms have been having on me. The biggest psychological symptom was the diminishing confidence that l keenly felt in pursuing new relationships with women (l am, and always have been, a single guy) not least because l was conscious of the increasing difficulty of consummating such relationships.
"On a physical level, l felt myself becoming more anxious and subject to low moods as well as experiencing decreasing energy levels. I felt that l owed it to myself to get my symptoms properly evaluated by qualified professionals in this area," he said.
David was diagnosed with hypogonadism, a condition where the body doesn't produce enough testosterone which can occur from birth or later in life, often from injury or infection. He is currently on testosterone replacement treatment as well as medicine for erectile dysfunction which he says has helped him tremendously.
"Physically, l feel more energised, l have a stronger libido and my erectile functioning difficulties have been greatly improved, with further improvements anticipated after further testosterone injections. Psychologically, my confidence in interacting with women has been greatly boosted – l think this is the most dramatic change l have notice.
"My advise to other men who are going through this is to not ignore the symptoms but to take action! Go and get specialist advice initially from your doctor and better still from a Urologist who has special expertise in this area. Please do not be embarrassed about talking through your symptoms with a doctor or urologist, particularly around erectile dysfunction. Remember that these medical people have seen and heard it all before many, many times. ln most cases your symptoms are likely to be physiological rather than psychological and can be resolved with treatment," says David.
The stigma is real
Although there is a lot of literature available or andropause, men rarely seek medical help even when the symptoms can be affecting their life significantly, notes Dr Datesh.
"There is a stigma associated with this, unfortunately. And that's because we immediately associate testosterone with sexual function. That's why we need to raise awareness about how men need healthy levels of testosterone to lead a healthy life all around. If you are over 40 and are not feeling yourself – notice that you put on weight, lose muscle bulk, emotional instability, find you are no longer attracted to your partner anymore, come and get tested. All it takes is a simple blood test and if it is because of low levels of testosterone, there is a solution now. You can get treated and change your life not just for yourself but for your family too," says the urologist from Prince Court Medical Centre.
Hormone replacement therapies for men come in the forms of pills, injections and gels although the most effective and popular option in Malaysia are thelong-term injections that are adinistered every three months.
"Hormone replacement is a science though and cannot be administered simply without ruling out a few things. First and most importantly, we have to make sure that the patient has no signs of prostate cancer because testosterone is fuel for prostate cancer cells. Second, while testosterone administered externally may help with a man's virility, it may affect his fertility. These things have to be discussed with the patient before he starts on treatment," says Dr Datesh.
How long a patient has to be on them really depends on the individual, he says.
I have had patients who, after a couple of doses, were feeling better and able to resume an active lifestyle which can stimulate the body's ability to produce it's own testosterone," he explains.
Men experiencing the symptoms of andropause are advised to make healthier lifestyle choices. Aerobic exercise to release endorphins that improve mood, strength training to increase blood flow and strengthen the hear as well a healthy diet and a decrease in alcohol and tobacco intake.
Muscle-building exercises, he says, can encourage the body's own production of testosterone.
"But a person experiencing andropause will not have the energy to do weight training - they'd need a boost of hormones get they them feeling energised enough to start exercising and building their body up," he says.
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