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MEN’S HEALTH
265
June15
The Right Test
The only test that’s required is a simple
blood test done in the morning on an
empty stomach. But Dr Ben Ng stresses
the importance of testing the level of
what’s called “free” (or bio-available)
testosterone; “total” testosterone is a
poor indicator of actual levels.
One example is an Indonesian
patient of his who recently came in for
testing. Though previous tests (done
elsewhere) had showed a normal level,
both the patient and his wife believed
his testosterone was low: over the past
year, he’d lost muscle bulk, gained
midsection weight, suffered from hot
flushes and even developed diabetes,
despite his exercise regimen.
“Our questionnaire already showed
him to be at high risk: he drank rather a
lot, which made his liver a bit inflamed,
resulting in the excretion of huge
amounts of protein that attached to
his testosterone, making much of it
unavailable. So – although his total
testosterone tested normal, his free
testosterone was very low indeed.”
After a shot of testosterone, says Dr
Ng, the patient did extremely well: his
blood sugars soon came down, the fat
came off, the muscle built up and his
wife was delighted.
The Right Stuff
DR FOO JOO P I N i s ano t he r
endocrinologist who sees a lot of
male patients, many of them expats,
for various hormonal and endocrine
conditions, including testosterone
deficiency and replacement therapy,
osteoporosis (yes, it’s common in men,
too), obesity, metabolic syndrome and
more.
“Withsome, it’sclear-cut:theycomplain
of fatigue, inability to concentrate,
erectile dysfunction, fatigue, grumpiness
and feeling generally lousy. This group is
usually very worried about their loss of
libido – worried that they’ve lost interest,
and maybe about performance issues.”
Another category of men don’t initially
complain of these symptoms, he says;
they come to him with diabetes and
obesity, and on further probing, they
admit to the other problems.
Testosterone, says Dr Foo, is the
hallmark of being a man. It gives you
a healthy libido and plenty of energy,
ensures emotional health and good
mood and guards against metabolic
syndrome – powerful stuff!
Believing that almost all endocrine
conditions can be treated and managed
with good results, he is quick to stress
the importance of a considered and
holistic approach that includes proper
monitoring by a skilled professional. He
warns that neither testosterone nor any
other hormone should be administered
lightly or indiscriminately; and that to do
so can lead to a host of adverse effects.
It needs to be administered not
only carefully, but only for the right
reasons. To illustrate his point, Dr Foo
tells me about a 30-year-old Australian
bodybuilder who’d been injecting
himself with testosterone for many years.
“All this exogenous testosterone
had caused my patient’s body to
suppress its own production of the
hormone,” he explains, “so he’d become
very dependent on the stuff and was
feeling very unwell.” What was Dr Foo’s
treatment? “After I’d gradually weaned
him off the injections, I reassessed his
needs and we took it from there.” That’s
all he’ll reveal; every doctor needs to
retain at least a little mystery!
Apart from cases of abuse such as
this one, how common, I wonder, is
low testosterone in younger men? Dr
Foo acknowledges that he does see
it in twenty- and thirty-something men,
but only rarely. Usually, it’s due to an
operation or injury to the testes; or it’s a
problem with the pituitary gland, where
testosterone is produced.
Dr Ben Ng agrees that there’s a
lack of data on the prevalence of
low testosterone in younger, non-
andropausal men. Nevertheless, he
personally believes that it’s higher than
generally thought. “Some studies show
rates of 30 to 34 percent in men over
45, which is very high; but as this is not
something we generally screen for, it’s
hard to know for sure.”
As you’d expect, testosterone is
affected by stress and exercise levels;
obese and unfit individuals tend to have
lower levels. “When the body is under
stress,” he explains, “the reproduction of
the species is low on its list of priorities.”
Testosterone Treatment
Dr Foo describes a number of options
for improving testosterone levels. First
of all, though, for a patient who is
obese or diabetic, these conditions
need to be treated with the necessary
medications, together with lifestyle and
dietary changes.
Replacement testosterone comes
in the form of an oral tablet, gels or
injections. Gels are preferred to tablets,
but the injection at three- or four-weekly
intervals seems the most popular choice
Before deciding on a treatment
plan, it’s necessary to make a detailed
assessment of the person’s needs,
wants and so on. Though testosterone
replacement has been shown to have
some health benefits, they’re not all well
established; so the main purpose is to
improve quality of life, says Dr Ben Ng.
“Giving you more when you already
have enough can be dangerous,” he
stresses. “The challenge is to know at
what level to intervene. For an older
man, the idea would not necessarily be
to restore the levels he had in his youth;
but we could bring them up to the level
that’s appropriate for his age group, in
order to promote his health, strength
and happiness.”