Mid - Life Man

Ezy Health @ GS Tamilan

Dan, who used to get his kick out of blasting the stereo set, turned noise averse and the slightest squeak from his three children would send him into a rage.

Said the design consultant in his early 50s: “I felt down for no reason and wanted to be on my own. I wasn’t a pleasant person to be around at all.''

He would step out of a cold shower and immediately break into rivulets of sweat. Even sex, the sacred stronghold of his manliness, was collapsing on him. "My libido ebbed and sex became extremely tiring,'' he said.

Dan was frazzled by the changes in his body and behavior. “It was a very odd feeling – like I no longer knew myself.''

He looked to his family doctor for answers, but he was just as confused as Dan and no prescriptions, including anti-depressants, worked.

Things only clicked when Dan caught a health programme on male menopause. The symptoms of the condition – heavy sweating, insomnia, and lack of energy and muscle aches –were all too familiar.

“At first, I assumed that I was going through a mid-life crisis and the physical deterioration was because of ageing. It didn't occur to me that my problems were due to menopause, a condition I used to associate only with women,'' he said.

Like Dan, there are many Singaporean men who suffer from male menopause but are not aware of it. This is expected to become a growing problem in the years ahead as the aged population in Singapore increases.

According to the Department of Statistics, the number of Singaporean men above the age of 55 is projected to reach 1.12 million by 2020.

  Male menopause: the work of hormonal imbalances

During male menopause, the patient's vitality and virility decline as a result of falling hormone levels, especially those of testosterone – the male hormone responsible for good health, sex drive, and fertility.

But it is not easy to spot the warning signs of this downhill journey, which starts at around 45 years old.

Dr Christopher Chen, the principal director of Christopher Chen Centre for Reproductive Medicine, explained: “It is difficult for a man to figure out that he has male menopause as the symptoms vary from  patient to patient.

"In a woman, the condition is more discernible as that is when she stops menstruating. Most men just take menopausal symptoms as a sign of ageing.”

Male menopause, also known as andropause, is an inevitable part of ageing, he stressed. "The severity and symptoms would vary but the condition itself is unavoidable,” he said.

  What are the symptoms of andropause?

The first signs that all's not well are usually waning libido and impotency. Said Dr Chen: “A man going through andropause finds it difficult to obtain and sustain an erection. He is also likely to have a less active sex life as his wife may also be going through menopause.''

The andropausal man may also develop enlarged prostate glands and be more susceptible to diseases like heart problems, diabetes and osteoporosis.

Said urologist Peter Lim: “He may feel a lack of purpose in life, get easily depressed and tired,  and develop insomnia and a paunch.”

  Is hormone replacement therapy (HRT) the answer?

Andropause can be diagnosed through a full-body check-up and treated with a natural hormone replacement of testosterone.

Said Dr Lim: “Testosterone replacement therapy provides relief for all the symptoms of andropause. Similar treatment involving other hormones is still being studied.”

Apart from testosterone, the other male hormones that may be deficient include dopamine, oxytocin, vasopressin, growth hormone, melatonin, DHEA, pregnenolone, and thyroid hormone.

HRT involves more than just pumping testosterone into the patient's body, Dr Lim stressed. “It is a comprehensive programme which requires the patient to exercise regularly and adopt a healthy diet,'' he added.

The aim, he said, is to make the man’s body function as it did 10 years earlier.

But HRT is not for everyone. Said urologist Dr Marie Carmela Lapitan: “You need to have low levels of testosterone. People with prostate cancers, severe liver problems and sleep disturbances cannot have the therapy.”

To ensure its safety and effectiveness, a full assessment of each patient is carried out before hormone replacement starts, and the results of treatment are carefully monitored.

The tests include biochemical measurements of the sex hormones and the complex range of factors regulating their action, together with tests of blood fat, liver, kidney, and prostate function.

In the long run, the way to stay ahead of andropause is to implement lifestyle changes, said Dr Chen. "By keeping fit, having a balanced diet and avoiding abuses like excessive alcohol intake, you can slow the onset of andropause.''

Are you andropausal? Try our checklist: Physical signs Fatigue Taking longer to recover from injuries and illnesses Less endurance for physical activities Feeling fat and gaining weight Difficulty reading small print Thinning hair Sleep disturbances Cold hands and feet Backaches, joint pains, or stiffness        Psychological signs Excessive anxiety or nervousness     Bad temper and easily irritable Indecisiveness     Depression and low self-esteem Loss of purpose and direction in life     Loss of self-confidence and joy Forgetfulness and difficulty in concentrating     Feeling lonely, unattractive and unloved   Sexual signs   Loss of sex drive, libido, and problems obtaining or sustaining an erection Increased fantasies about sleeping with new and younger women Anxious and fearful about losing sexual prowess Erections may not be as hard and easily attainable as before. Testicles shrink and the scrotal sack droops Conflicts with partner about sex and love issues Force of ejaculation will wane and semen amount decreases.