If you often chalk up your wife’s mood swings and bizarre cravings to menopause (remember those food runs for chocolate and carbonara you did for her?) as she approaches middle age, you’ve got another thing coming.
Those hormonal changes she’s experiencing are also happening to you.
But wait, you’re a man and your oestrogen level isn’t diving off a cliff, which is what happens in menopausal women, you say. Or perhaps you think you still have many more years to go before you have to worry about hormonal changes.
Consider this a wake-up call: It’s not oestrogen but testosterone that is going to taper off as you get older.
Also known as andropause, it can occur as early as in your 40s, said Dr Ronny Tan, a urologist at Mount Elizabeth Hospital and Parkway East Hospital.
And unlike menopause, which typically condenses its accompanying symptoms into the ages of 45 to 55 in women, andropause can stretch over decades in men.
ERECTILE DYSFUNCTION, MAN BOOBS AND OTHER SIGNS
According to Dr Tan, testosterone levels generally start to drop by one per cent every year after age 40. Most men would show signs in their 50s, he said, which include erectile dysfunction, loss of morning erections, drop in libido, decreased energy levels and loss of muscle mass.
Some men may also develop breasts or what the doctors term gynaecomastia. There are various reasons for this, and one of them is the imbalance of the oestrogen and testosterone ratio in the body (yes, men have oestrogen, too, just in different levels from women), said Dr Chiam Tut Fu, the medical director of Thomson Wellth. As the testosterone level dips, the ratio will favour the development of male breasts.
Individuals who have a high body fat percentage may also develop gynaecomastia. “The enzyme, aromatase, is found in fatty tissue and this enzyme converts testosterone to the oestrogen known as oestradiol,” said Dr Tan. “Increased oestradiol can result in development of breast tissue in men.”
HOW COMMON IS MALE MENOPAUSE?
If you haven't heard about andropause, well, men just aren't the type to discuss such topics over drinks. Furthermore, it is "not as well studied as menopause”, said Dr Kaysar Mamun, a senior consultant at Singapore General Hospital’s Department of Geriatric Medicine on the HealthXchange website.
And if you do hear about it, it’s not uplifting news: According to the same website, 26.4 per cent of men in Singapore suffer from low testosterone levels in clinic-based health screenings conducted on 1,000 men between 2007 and 2009. As for more recent statistics? “There are no real figures on andropause prevalence in Singapore,” said Dr Chiam.
The lack of awareness in men could be attributed to how unspecific testosterone deficiency’s signs are. Take a look at the symptoms: Drops in energy level and muscle mass, sexual dysfunction, mood changes and weight gain – they could just be easily caused by other issues, including stress.
“Testosterone deficiency is also associated with metabolic syndrome (refers to a cluster of conditions that occur together, such as high blood pressure, high cholesterol levels and diabetes), which generally have no specific symptoms,” said Dr Tan.
Of course, there are also men who do not experience any changes at all even as they undergo andropause. “There are always individual differences in the expression or manifestations of any symptoms of any disease, and it is similar for low testosterone,” said Dr Chiam. “This is why not all will experience andropausal symptoms.”
Furthermore, those with a slower decline of testosterone levels are less likely to experience symptoms, he said.
HOW LOW IS LOW TESTOSTERONE?
Your testosterone level varies throughout the day and are affected by your weight, diet, certain medications (eg hormones for prostate cancer) and even the alcohol you drink. But doctors agree that testosterone typically peaks in the morning, near 8am. So if you're going in for a test, this is why doctors prefer to schedule it early in the day.
Testosterone levels generally start to drop by 1 per cent every year after age 40.
The male hormone can exist in your blood in three ways: Moving freely in your blood (less than four per cent) or bound to either of these two proteins, albumin (less than one third) or sex hormone binding globulin (aka SHBG; taking up about two thirds), according to University of Rochester Medical Center’s website. The free testosterone and albumin-bound version are the ones that your body can use readily, or what is known as bioavailable testosterone.
Most tests measure total testosterone in your blood, which already provides your doctor with sufficient information. “Normal blood total testosterone level is between 300 nanograms per deciliter (ng/dL) and 1,000 ng/dL,” said Dr Chiam.
Interestingly, even though we’d earlier established that age does have an effect on testosterone levels, they don’t necessarily work out that way. For instance, Dr Ciril Godec, the chief urologist at Downstate Long Island College Hospital, noted on Healthline that he’d seen a patient in his 80s with a testosterone level of 600 ng/dL, while another in his 30s has just 150 ng/dL.
But on the whole, “men with testosterone levels of 8 nmol/L (or 230 ng/dL) or less would be diagnosed to have testosterone deficiency, provided they have symptoms mentioned earlier,” said Dr Tan.
DO HERBS OR SUPPLEMENTS HELP?
Sex sells and in the world of health supplements, there are plenty targeting men’s sexual performance. Over-the-counter capsules, pills and powders are as commonplace as multivitamins. They are often formulated with herbs and substances that manufacturers call T-boosters to improve your body’s production of testosterone or free up the bound testosterone in your body. But do they work?
Dr Chiam best sums it up when he said: “These supplements are rarely studied with enough scientific rigour to be assessed adequately”. Those that have been researched on, the evidence is limited.
For instance, out of the 11 studies on the popular herb tribulus terrestris – which has been long used to treat impotence and infertility – only three showed increases in testosterone levels. However, these were conducted on non-human subjects.
As for substances such as creatine, DHEA, HMB and L-arginine that some bodybuilders use to add muscle mass, the evidence on boosting testosterone levels is either limited or mixed, according to various studies. They can also come with side effects such as high blood pressure and increased risk of bleeding.
“Men who are concerned about testosterone deficiency should not self-medicate but seek medical attention," said Dr Tan. “Testosterone therapy includes medication that must be prescribed by a trained medical professional."
WHAT SORT OF TREATMENTS ARE THERE?
Much like the gels, pills and injections that menopausal women are offered to help them cope, men are also offered those solutions but for testosterone. “The injections are better because they ensure accurate dosing into the body, which the gels do not ensure,” said Dr Chiam. As for the oral method, he said that after passing through the liver, it has a “lower effective blood testosterone”.
But no matter which method is used, the dosage has to be carefully calibrated “to have the blood testosterone in the normal physiological range and just enough to achieve the desired health and quality of life benefits”, he said.
“If too much testosterone is given over long periods, there is increased risk of high red blood cell count, prostate enlargement and even abnormal blood lipid profiles, and thus, higher risk of ischaemic heart diseases.”
To keep those issues at bay, along with mood swings and oily skin, your doctor would schedule blood tests to monitor your testosterone and keep it at an optimal level.