Relief for male menopause

Men do get it, after all. Menopause, that is. By the time a man hits 40, he starts to experience a phenomenon similar to the female menopause, called andropause.

But unlike women, men do not have any clear-cut signpost such as the end of menstruation to mark this stage of their life. As a result, most of them find themselves left high and dry - literally.

Hypogonadism - or testosterone deficiency syndrome - is a medical term for when the male sex glands, the testes, produce little or no hormones. It is a condition that usually kicks in during or after middle age and progresses as one grows older.

'Menopause in women is well-established, but few are aware that for men, sex hormone levels do drop off, albeit gradually,' says Michael Wong, medical director of the Singapore Urology and Fertility Centre at Mount Elizabeth Hospital. 'Data shows that after the age of 40, many men begin to lose a percentage of their hormones every year.'

By the time men reach 50, about 8 per cent of them have hormone levels that are below normal. This extends to 15 per cent of all men by age 60. And by 70, almost one in every four men will be affected.

'It is an age-related condition, and given our rapidly greying population, hypogonadism will definitely affect our lives,' says Dr Wong.

According to him, a lot of doctors have difficulty with the issue, primarily because the idea of dropping hormones in males raises a red flag where sex is concerned - a taboo topic in relatively conservative Singapore.

'Unfortunately, there is a negative connotation attached to hypogonadism,' says Dr Wong. 'Actually, there really is a lot more science to it than mere hocus pocus, and education on this is much needed.'

It doesn't help that in the past decade or so, treatment for hypogonadism had been less than satisfactory, with gels, patches or fortnightly injections that provide temporary relief at best.

Worse still, the condition was previously been confused with another male disorder, erectile dysfunction, or ED in short.

'Pre-Viagra days, ED was blamed solely on low hormones, so a lot of people were given extra hormones,' says Dr Wong. 'But doctors treating ED later realised that almost 20 per cent of males suffering from ED don't respond well to medication because what they really had wasn't ED, but hypogonadism.'

Thankfully, there is now a new treatment regime for those suffering from testosterone deficiency. Launched in Singapore last week, Nebido is the world's first long-acting testosterone replacement therapy.

Global men's health expert Aksam Yassin, who is a fellow of the European Board of Urology and chairman of the Department of Urology and Andrology at Segeberger Kliniken in Norderstedt-Hamburg, Germany, hails the new treatment as a breakthrough.

'The old delivery systems of hormone therapy were not very reliable because they cause fluctuations in hormonal levels and such inconsistencies often bring undesired side effects like acne,' says Prof Yassin.

Nebido, however, causes no such problems.

'The release for Nebido is much more constant,' he says. 'One injection can last up to three months, compared with the fortnightly injections previously on offer.'

Prof Yassin, who has administered more than 300 injections of Nebido so far, says the optimal length of treatment is six months to a year.

Welcoming the new treatment, Dr Wong says: 'This is a quantum leap, really. If properly administered, Nebido will effectively take care of the embarrassing symptoms without the hormonal highs and lows associated with other forms of therapy.'

Such symptoms may include - apart from the usual complaint of sexual dysfunction - decreased beard and body hair, breast enlargement and muscle loss.

But hypogonadism can cause more than mere embarrassment.

'Lack of hormones can cause more than just loss of sexual function. It can affect the bones, leading to increased risk of fractures and even the onset of type two diabetes and the fatty belly syndrome,' warns Dr Wong.

Explaining the importance of therapy, Prof Yassin says: 'It is like adding oil to a car. When a car gets old, it needs maintenance. So, too, when men lose their hormones, they need refuelling.'

Each Nebido jab costs about $300. To find out if he needs therapy, a man's testosterone level must first be tested - usually through a simple blood test.

As for the mechanics of the injection, Prof Yassin explains: 'It goes into the backside. Each injection contains 1,000 mg of testosterone in castor oil. It is an oily solution, so the injection must be given slowly.'

He adds with a hearty laugh: 'Since it takes about 60 seconds to complete the injection, we usually try to distract the patient by asking about his family, golf games, job, etc.'