Supermale syndrome

It seems perilous to be male.

Men typically die at a younger age than women, have higher rates of cancer and are more likely to die from accidents.

Yet, many do not place much emphasis on their health.

Studies have shown that twice as many men have no regular medical care compared to women, said Professor Peter Lim, the president of the Society for Men's Health here.

Up to 25 per cent of men would also wait 'as long as possible' to see a doctor, he added.

'The male role is the real culprit of poor health in men. They usually think they're invincible and tend not to ask for help,' said Prof Lim, who is also a urologist.

However, there may be no need to panic - yet.

If men are more open to health screenings and seek medical help at an early stage, their mortality and quality of life would improve, said Dr Tan Kok Kuan, the chief medical officer of The Men's Clinic.

Mind Your Body charts the common health challenges that men may face as they age.

Age: 20s and 30s

Risk-seeking behaviour

Men are prone to risk-seeking behaviour during this period, said Dr Tan Kok Kuan, the chief medical officer of The Men's Clinic.

Aggressive driving, participating in extreme sports, risky sexual behaviour and the over-consumption of alcohol are common among young men, he added.

This desire for thrills and spills has its drawbacks.

Physical injuries like broken bones often occur. Premature death may result.

The leading cause of death of men in their 20s and 30s is motor vehicle accidents, said Professor Kesavan Esuvaranathan, a senior consultant at the department of urology at National University Hospital.

Sexually transmitted diseases are also a common problem, said Prof Kesavan.

The 2008 Communicable Diseases Surveillance in Singapore reported that the number of men who had sexually transmitted infections (STI) edged out women by a ratio of 2:1.

Men aged between 30 and 34 had the highest incidence of infection.



Depression in men is a problem often overlooked.

The average age of onset for depression in men occurs when they are in their 30s, said Dr Thong Jiunn Yew, the medical director and consultant psychiatrist at Nobel Psychological Wellness Clinic.

Said Dr Tan: 'This is the age when there is a lot of flux in their lives.'

Career changes and embarking on new social roles - say, being a first-time father - are some of the new experiences that they face.

Dr Thong said that the most common cause of depression in married men of this age group is family or marital problems.

The second cause is related to unemployment and work-related problems.

Work is often a major source of a man's sense of worth, he said.

Research has shown that one in seven men who become unemployed will develop a depressive illness in six months, he added.

However, depression can go unrecognised in men.

Dr Tan said: 'Men usually won't admit that they are stressed or anxious.'

Dr Thong said that many men may hide their depression symptoms by drinking alcohol or abusing other substances.

Some may throw themselves into work or talk about physical symptoms like pains and aches, rather than their emotional problems.

Sometimes, diagnosis of the problem may not bring relief.

He explained that some men may resist treatment because they are worried that the stigma of having the condition might damage their career or cause them to lose the respect of family and friends.

Thankfully, depression is highly treatable with psychotherapy, medicine or a combination of both.

The condition can be prevented too.

Regular exercise, adequate rest and a balanced diet can help to improve one's well-being.

Dr Marcus Tan, the medical director and consultant psychiatrist at Nobel Psychological Wellness Clinic, said that taking time out for oneself, especially during a heavy work schedule, to do something enjoyable is beneficial.

It can be as simple as reading or taking walks, he said. 'Developing a hobby can be one of the best ways to de-stress, build confidence and expand one's coping abilities,' he added.

Poor food choices

Poor food choices

Since men have more muscles and are typically bigger than women, they require more calories.

Moderately active men in this age group may require up to 2,950 calories a day, said Ms Nehal Kamdar, a senior dietitian at Raffles Hospital.

Compared to older men, they generally burn calories faster because of their active lifestyles and a higher basal metabolic rate, which is the rate at which the body uses energy to perform vital body processes.

For energy, weight management and disease prevention, the American Dietetic Association recommends that men should eat more whole grains, fruit and vegetables. These foods are high in fibre, help manage hunger and fend off certain types of cancer, like prostate and colorectal, which are common in men.

However, The Men's Clinic's Dr Tan said that men tend to make poorer food choices and like to consume those that are high in salt and fat.

Weight gain can be prevented at this stage because a younger man generally has a higher metabolic rate and a more active lifestyle - even if he does consume more fat and calories.

However, as he ages, a man tends to become more sedentary and the rate at which his body uses energy slows down, said Dr Tan.

Excess calories are stored as fat, which might spell trouble for the later years.

Good eating habits have to be cultivated from young. Having a poor diet now might lay the foundation for chronic diseases as a man grows older, he said.


Age: 40s

Chronic diseases

Those who ate poorly and neglected their health during their youth may see chronic diseases like diabetes, hypertension and heart disease creeping in now, said Dr Tan Kok Kuan, the chief medical officer of The Men's Clinic.

As their metabolic rate starts to slow, men who are sedentary may gain weight if they overeat.

What makes it worse is that men tend to gain weight around the waist, which puts them at risk of serious health problems like heart disease and stroke.

If a man's waist measures more than 94cm, it is time to lose weight, said Ms Nehal Kamdar, a senior dietitian at Raffles Hospital.

Testosterone drop

Into their 40s, men start feeling the effects of a decline in testosterone, said Dr Tan Kok Kuan, the chief medical officer of The Men's Clinic.

Testosterone is the male sex hormone produced by the testicles. It promotes the development of the genital glands and male characteristics, as well as influences a man's growth and overall vigour.

Testosterone peaks during adolescence and early adulthood. As a man gets older, its level gradually declines, typically at about 1 per cent yearly after the age of 30.

Symptoms include a loss of sex drive and fewer erections. Various physical changes may happen, like increased body fat, reduced muscle mass and strength and lowered bone density.

If testosterone levels dip below normal, a condition called late-onset hypogonadism results.

Erectile dysfunction

Erectile dysfunction

The prevalence of severe erectile dysfunction (ED) appears to increase with age.

About 9 per cent of men in their 40s are affected by ED. By the time they reach their 60s, about 44 per cent are affected. At age 70 and above, 77 per cent were found to have the problem, reported a 2003 study published in the Singapore Medical Journal.

Men can also face ED in their 20s and 30s, but the most common cause then is stress, said Prof Kesavan Esuvaranathan, the head and senior consultant at the department of urology at the National University Hospital.

However, when men hit their 40s, ED may be due to more serious conditions, like atherosclerosis or metabolic syndrome, he said.

Metabolic syndrome is a cluster of conditions - increased blood pressure, elevated insulin levels, excess body fat around the waist or abnormal cholesterol levels - that occur together, increasing the risk of heart disease, stroke and diabetes.

Explaining how ED is linked to chronic diseases, Dr Tan said an erection is a reflex dependent on blood flow.

Some chronic diseases, like atherosclerosis and hypertension, may cause the clogging of blood vessels in the body, affecting erections.

Prof Kesavan said that men with ED should visit their doctor for a check-up. However, many men may be afraid to do so because they feel embarrassed.

Still, the first step to the clinic must be made.

'It could be the first sign of a more serious disease,' Prof Kesavan cautioned.

Hair loss

While male pattern hair loss - hairline usually recedes at the forehead and temples - may occur anytime after puberty, it typically affects men in their 40s, said Dr Martin Chio, a consultant dermatologist at the National Skin Centre.

About 50 per cent of men may show some signs of male pattern hair loss by age 40, he added.

The condition, also known as androgenetic alopecia, is usually hereditary and hormonal.

It happens when dihydrotestosterone (DHT), a by-product of testosterone, damages hair follicles in men.

Seeking early treatment is important, said Dr Chio.

The earlier one starts, the more hair one may be able to preserve, he said.

Treatment options include minoxidil, a topical application, and finasteride, an oral drug.

Hair loss usually recurs if treatment is stopped, he said.

For more advanced hair loss, hair transplantation may be required, he added.

50s and beyond

Age: 50s & beyond

Testosterone woes

Male testosterone levels continue to drop. By about age 70, the decrease in a man's testosterone level can be as much as 50 per cent.

When testosterone levels drop below normal levels, this condition is called late-onset hypogonadism.

Hypogonadism is a term used to describe a developmental disorder of puberty when boys fail to develop secondary sexual characteristics, such as body hair and the thickening of vocal chords, because of low levels of testosterone.

However, there are also some mature males whose hormone levels fall below the normal range for their age, hence the term late-onset.

A survey published this year, conducted by the Society for Men's Health Singapore, questioned 1,500 men to check for the prevalence of hypogonadism. It found that some 26 per cent of respondents had the condition, up from 9 per cent in 2002. The mean age of those who had hypogonadism was about 55.

Late onset hypogonadism is more than just about sexual problems, said Professor Peter Lim, a urologist and the founding president of the Society for Men's Health Singapore. Left untreated, it can lead to significant consequences on men's health, like hypertension or diabetes, he said.

Diagnosis is usually confirmed through blood tests. Hormone replacement therapy is the standard treatment for late-onset hypogonadism. It can be taken orally or administered through patches or injections.

Testosterone levels can also be boosted through regular exercise like brisk walking, said Professor Kesavan Esuvaranathan, a senior consultant at the department of urology at the National University Hospital.

Prostate problems

Prostate gland enlargement, or benign prostatic hyperplasia (BPH), is the most common prostate problem in Singapore as men grow older.

Up to 50 per cent of screened men aged 50 and above have at least one symptom of difficulty in urinating. It is typically caused by BPH, said Prof Kesavan.

The prostate is a walnut-sized gland found just below the bladder in men. It makes some of the milky fluid, or semen, that carries sperm.

What causes it is unknown, but symptoms include a weak urine stream or the frequent or urgent need to urinate. Treatment includes drugs or surgery.

Prostate enlargement can also be caused by prostate cancer, which is the fifth most common cancer in Singaporean men.

It is usually curable when detected early, but can kill if diagnosed late or not treated effectively.

The cancer is prevalent in men who are in their 70s or 80s, said Prof Kesavan. It is usually treated through surgery and radiation therapy. Hormone therapy may be used as prostate cancer cells rely on testosterone to help them grow.

Chronic diseases

Chronic diseases

Men start to really pay for their health mistakes once they hit their 50s, said

Dr Tan Kok Kuan, the chief medical officer of The Men's Clinic.

For example, a smoker in his 40s with hypertension, who refused to kick the habit then, may end up with heart disease now.

In terms of cancer, colorectal cancer is the most common cancer in men here and the most prevalent one in Singapore. Men aged 50 and above are encouraged to go for colorectal cancer screening, said Dr Tan.


Men over the age of 65 face an increased risk of depression, said Dr Thong Jiunn Yew, the medical director and consultant psychiatrist at Nobel Psychological Wellness Clinic.

This is the age when many would have retired.

As men usually identify with their job and breadwinner role in the family, relinquishing their career may cause them to feel stressed, he said.

Depression may also partly be caused by the new health challenges faced by ageing men, he added.

Certain medical conditions, like heart disease and stroke are associated with the development of depression.

In addition, men may worry about their impending mortality and dependence on others.

Men also have to endure the loss of friends and family over the years. This predisposes them to grief and may lead to depression in some men, he said.

This article was first published in Mind Your Body, The Straits Times.