BY nature, men are less likely to seek help for medical problems, more so if it's one perceived as being linked to their masculinity.
Many men prefer to remain silent about such issues and only when they escalate, do they finally seek help.
By then, the impact on their emotional well-being and physical and mental health can be significant, and this, in turn, affects their relationship with their wives or partners.
Testosterone Deficiency Syndrome (TDS), or male hypogonadism, is one such condition and it affects men in different ways.
The prevalence of the condition in Malaysia and Singapore is 19 per cent and 26 per cent respectively, according to a global Mayo Clinic testosterone study entitled "Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions".
Some studies indicate that testosterone deficiency affects seven per cent of men aged 50 years and above, while The American Journal of Medicine estimates that it affects 30 per cent of men aged 40 to 79.
Many Malaysian men still lack adequate knowledge and awareness of this condition. Testosterone deficiency remains a taboo among men, leading them to suffer in silence because they view it as an embarrassing reflection of lost masculinity.
This results in missed opportunities to detect the condition early and implement medical interventions to address it.
It's important that men be educated on this condition as it may be linked to other serious medical issues like obesity, metabolic syndrome and cardiovascular disease, which affect general health.
Data on testosterone deficiency from the journal indicates that there is an increased risk of the condition among men with common medical problems such as obesity, type 2 diabetes mellitus and hypertension.
Studies have also shown that men who are affected by testosterone deficiency have a higher risk of dementia, irritability and depression.
Prince Court Medical Centre consultant urologist and robotic surgeon Dr Datesh Daneshwar provides answers to this often unaddressed male health issue.
WHAT IS TESTOSTERONE DEFICIENCY?
Testosterone deficiency syndrome or hypogonadism is a condition in which a man's body does not produce sufficient testosterone, the primary male hormone. It is not merely a laboratory reading that determines this, but a combination of a certain lab test level and accompanying symptoms and signs which will allow a clinician to label a patient as someone with TDS.
WHAT CAUSES IT?
It is not attributed to natural ageing like menopause in females. There are some well-known causes, which involve the pituitary gland in the brain, but in most people, no obvious cause is found. There is a link to obesity, a diet rich in estrogenic compounds, and a lack of resistance training.
IS IT LINKED TO OTHER MEDICAL CONDITIONS?
Obesity has a direct link to low testosterone by allowing the conversion of testosterone to estrogen (the female primary hormone). Low testosterone is also linked to a cluster of conditions called metabolic syndrome, which causes you to be at high risk of developing heart disease, stroke and diabetes.
A man under 40 who has low testosterone level has almost a 30 per cent chance of having significant cardiovascular disease.
WHAT IMPACT DOES IT HAVE ON FERTILITY?
It may cause low sperm count, erectile dysfunction and sexual dysfunction.
HOW PREVALENT IS THE PROBLEM IN MALAYSIA?
It is high, but I don't think there is any national data on age and ethnicity. In my experience, patients are generally above 50 years old. There is some local data on its correlation with vitamin D deficiency and this is well established in Western literature too.
WHY DO MEN SHY AWAY FROM SEEKING TREATMENT?
Ego, illiteracy, taboo and the misconception that being sexually active is a "naughty thing".
As a species, we are born to procreate. Culturally, we are expected to get married and produce progeny, yet we do not have the right to talk about sexual dysfunction.
Sexual dysfunction can negatively affect the patient's partner, the patient's life and the lives of everyone around because the patient may not be the same person he was when hormonally sound.
CAN THE CONDITION BE TREATED AND REVERSED?
It can be reversed only in very selected patients, but treatable in almost everyone.
CAN THE CONDITION BE PREVENTED?
The short answer is we don't know. But there are strategies to make it less likely that you will suffer from it, and these include maintenance of an ideal body weight, moderate exercise, especially resistance training, a normal vitamin D level and a healthy intimate lifestyle and relationship.
Male Hypogonadism
Early signs and symptoms:
*Decreased sex drive
*Decreased energy
*Depression
As the condition develops over time, symptoms include:
Erectile dysfunction
Infertility
Decrease in hair growth on the face and body
Decrease in muscle mass
Development of breast tissue (gynecomastia)
Loss of bone mass (osteoporosis)
Source: www.mayoclinic.org
