Treating testosterone deficiency is not about improving men's lives at a superficial level, as some people mistakenly believe, but plays a crucial role in the management of chronic diseases.
Many men start experiencing a dip in their testosterone levels when they hit their 50s and 60s. This syndrome manifests as lethargy, moodiness and irritability, weight gain, low libido, abdominal obesity and erectile dysfunction.
Testosterone deficiency may be linked with older age, but it would be wrong to accept it as a harmless "side effect" of aging. In fact, research now shows that testosterone deficiency is linked with the metabolic syndrome, which increases men's risk of developing heart disease and diabetes by three to five times.
Therefore, treating testosterone deficiency is not about improving men's lives at a superficial level, as some people mistakenly believe, but plays a crucial role in the management of chronic diseases.
A new book published by consultant urologist Datuk Dr Tan Hui Meng, Testosterone: Secret to Healthy Aging for Men, looks at the burning question that many men have regarding testosterone deficiency: how can you improve your testosterone levels?
There is a lot of controversy and confusion surrounding the safety and efficacy of testosterone replacement therapy, but Dr Tan sifts through all the latest international research in his book to provide clear answers to some common questions.
Eating animal testicles
In ancient times, early Chinese and Indian civilisations used to eat animal testicles as a practice to improve qi or energy.
Fortunately, as Dr Tan pointed out in his book, science has progressed tremendously since then, so that testosterone levels in the body can be improved through far more acceptable methods.
Modern testosterone replacement therapy (TRT) started with the chemical synthesis of testosterone in 1935 by Adolf Butenandt and Leopold Ruzicka. This was the same year the term "testosterone" was coined by Ernst Laquer.
The various forms of TRT, using different delivery methods, have evolved over the decades. Today, TRT is commonly available as transdermal scrotal patches, gels or injections (both short-acting and long-acting).
TRT seeks to replace the depleted hormone in the body and bring the level back up to normal again. As the normal level of total testosterone in a man ranges between approximately 10.4 nmol/L and 34.7 nmol/L, it may not be easy to determine who needs TRT.
According to the International Society for the Study of the Aging Male, TRT is recommended for men whose total testosterone is below 8nmol/L (230ng/dL); or men whose total testosterone is 8-12nmol/L (230-350ng/dL) and also have symptoms of testosterone deficiency.
Health benefits of TRT
Many of the symptoms and long-term effects of testosterone deficency on health can be reversed through TRT. Most importantly, TRT has a lot of potential in terms of preventing serious cardiometabolic complications and improving men's quality of life.
·More energy and better quality of life
Fatigue, lethargy and lack of motivation are hallmarks of low testosterone, but TRT is effective in addressing these symptoms. One study carried out in Malaysia in 2009 showed that TRT improved quality of life significantly, especially in the aspects of vitality, general health, and their participation in daily life and activities.
·Muscle strength and reduction of fat
As the body needs sufficient testosterone to maintain muscles, TRT can contribute to a healthier body composition by increasing lean muscle and reducing abdominal fat.
At the same time, because TRT increases lean muscle and energy levels, the men feel stronger and have more energy to do regular exercise. With regular moderate exercise, TRT has been reported to reduce waist circumference by eight to 12 cm within six to 12 months.
·Improvement in sexual problems
Studies of TRT consistently show us that sexual problems improve with testosterone treatment. An international analysis in 2005 showed that TRT significantly improves men's libido and erections, while a Malaysian study also concurred (although the improvement among the Malaysian men were not as significant compared to those on placebo).
·Better control of metabolic syndrome
Compared to all the other effects of low testosterone, metabolic syndrome is the most dangerous and insidious one. Unfortunately, men with low testosterone have a strong likelihood of developing the various conditions of metabolic syndrome.
A landmark article published in the Journal of Diabetes in 2010 by Dr T. Hugh Jones found that TRT significantly improves insulin resistance, fasting blood glucose level, HbA1c (measures long-term control of diabetes), waist circumference and lipid profile - in other words, improving the condition of men with diabetes.
Dr Jones noted that TRT was also associated with the lowering of total cholesterol, LDL cholesterol and lipoprotein (a).
Is it safe?
A lot of concerns about TRT revolve around its safety, especially as it is a hormone and has previously been linked to prostate cancer. Dr Tan dedicates a whole chapter in his book to explaining the risks and side effects of TRT.
For a long time, it was thought that increasing testosterone would cause prostate cancer to grow. However, a lot more research has been carried out since then to show that men with low testosterone who receive TRT are at no greater risk of developing prostate cancer, compared to men who do not receive TRT.
Studies also show that TRT does not cause recurrence of prostate cancer.
However, Dr Tan stresses that it is absolutely important that TRT should not be given to men who currently have prostate cancer. Men who have been successfully treated for prostate cancer can be treated with TRT, but their tumour must have completely disappeared, and there should be a suitable interval between cancer treatment and TRT (usually one year).
TRT has also been linked to other side effects, such as breast pain and enlargement, polycythaemia, lower urinary tract symptoms, body swelling, acne and skin problems, mood changes, liver toxicity and heart problems.
Some of these side effects are no longer present in the newer and better formulations of TRT, while others can be dispelled based on updated scientific evidence.
Dr Tan acknowledges that TRT is a challenging area for many men and their doctors to deal with. Barriers like the non-specific nature of the symptoms, the behaviours and attitudes that stand in the way of men seeking help, and the prejudices about hormone treatment, have to be overcome.
The most important message from the book, however, is that the decision to have TRT has to be based on scientific evidence, not myths and misconceptions.