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As men age, they can
experience depression, mood
swings, decreased energy levels,
and even low sex drive. Known
as andropause, or late-onset
hypogonadism, this medical
condition is essentially triggered
by an age-related decline in
testosterone, a hormone produced
in the testes.
Testosterone stimulates sperm
production as well as a man’s sex
drive, and is responsible for male
physical characteristics, such as
muscle strength, body and facial
hair, and deep voice.
“As men age, their testosterone
levels will go down, but not all
men will suffer from the signs
and symptoms,” said Dr Jonathan
Teo, Consultant, Department
of Urology, Singapore General
Even if they do, they may
not seek treatment. “Some men
may decide to just live with it.
For example, for an old man who
does not have sex anymore, the
lowered sex drive does not affect
him in any way,” added Dr Teo.
Some men may feel
embarrassed, preferring to
suffer in silence. Still, Dr Teo
has noted an increase in the
number of men seeking help for
“I think it is partly because
our society is opening up to such
patients wanting some help.
Increasingly, we are also seeing
women dragging these men into
the clinic, bringing their husbands
in for check-ups,” he said.
Some 26 per cent of men
in Singapore suffer from low
testosterone levels, according to
a clinic-based health screening
conducted on 1,000 men between
2007 and 2009. Andropause
typically affects older men aged above 50 years, and the symptoms
include erectile dysfunction, low
energy levels, changes in attitude,
Having a blood test is
often among the first steps in
diagnosing low testosterone,
coupled with a physical
examination and whether a
patient is experiencing any
of the symptoms associated
Andropause can affect those
aged below 50 years if they have
undergone surgery to remove
testicular cancer or if the patient
is under medication that lowers
the testosterone in his body,
said Dr Teo.
Once diagnosed, andropause
can be treated with testosterone
replacement therapy in the form
of pills, an injection every three
months, or the application of
testosterone gel on the shoulders
or upper arms of the patient.
Those undergoing testosterone
replacement therapy are closely
monitored for side effects. This
therapy can bring on blood
thickening, which increases
the risk of a heart attack or
stroke, and also a drop in
“When you give a patient
testosterone, it tricks the body
into producing less sperm, so such
therapy will not be possible for
those trying to have a family,”
said Dr Teo. Once the testosterone
replacement therapy stops, the
sperm count will recover.
Therapy can alleviate, and
in some cases, reverse many
of the symptoms associated
with andropause. Healthier
lifestyle choices, such as diet
changes, more sleep, exercise,
and treatment for depression or
anxiety, are also important in
Andropause and low
testosterone levels are just one
of a range of andrology issues.
Other men-related issues
include erectile dysfunction and
ejaculatory disorders, said
Dr Teo, who also runs a clinic for
men’s health at SGH’s Diabetes
and Metabolism Centre. It aims
to address the gaps in men’s
health screening, which contrasts
with the wide range of screening
initiatives for women, such as
breast screening and cervical
cancer screening programmes.
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