By Dhany Osman

If you are a male from the baby boomer generation - that is, aged between 45 and 62 - you should be taking better care of your health.

After all, a Straits Times report, 'Men losing sex drive at younger age', on Nov 7 noted that one in five Singaporean men aged 45 and above experiences low testosterone levels for their age.

The condition, known as hypogonadism, can lead to falling libido, male osteoporosis (brittle bones) and fatigue in older men.

Hypogonadism will be among men's health issues to be raised at the three-day Third Japan-Asean Men's Health Conference to be held here from Dec 1 to 3.

Medical experts from around the world will also speak on topics like prostate cancer and andropause (also known as male menopause).

The conference, jointly organised by the Society for Men's Health (Singapore) and the Singapore Urological Association, will focus mainly on age-related conditions affecting men.

Mind Your Body spoke to doctors from different fields for their views on men's health issues and on some of these conditions.

Falling testosterone levels

Testosterone, also known as the principal male hormone, plays a crucial role in the overall well-being and sexual functioning of both men and women.

Produced by the testes in males, testosterone contributes to the growth of muscle mass, increase in bone density and the maturation of sex organs at puberty.

In adult men, testosterone helps to regulate libido along with their levels of physical and mental energy.

While it is generally acknowledged that testosterone levels decrease with age, the Nov 7 report suggests that a significant number of Singaporean men are experiencing unusually low levels of the hormone for their age.

Previously associated primarily with sexual problems, hypogonadism has now been found to also affect other areas, like the immune system.

'Treating hypogonadism has shifted from sexual reasons to treating it for other bodily complaints,' said Professor Peter Lim, a urologist in private practice and president of the Society for Men's Health (Singapore).

'Low testosterone levels can affect your mind as well. It can make you moody and grumpy,' he added.

Symptoms of the condition include joint and muscular aches, excessive sweating, sleep problems, physical exhaustion, decrease in muscular strength as well as the inability to perform sexually.

Men who suspect they are suffering from hypogonadism can fill up a health questionnaire that surveys their physical, psychological and sexual symptoms. The form is available at some general practitioner and specialist clinics.

For those whose answers are positive, a blood test for the amount of bio-available testosterone in their system can then be conducted to confirm the condition.

Hormone replacement therapy like patches, creams, oral medications or injections can then be started.

Injections cost $150 a month while oral medication for three months costs about $530, Prof Lim said.

As hypogonadism is related to many other physiological symptoms, treating it can improve a patient's overall health.

'You'll feel leaner and meaner with treatment,' he said.

Urological problems

In addition to erectile dysfunction (ED), common urological problems affecting middle-aged men include BPH or benign prostate hyperplasia (prostate enlargement) and prostate cancer.

Dr Chin Chong Min, a senior consultant urologist and vice-president of the Singapore Urological Association, said BPH - which can cause severe urinary infections and kidney obstruction - will affect about 50 per cent of men by the time they are 60.

(Page 1 of 2)In BPH cases, the prostate gland, which is located below the bladder and surrounding the urethra, becomes enlarged due to hormonal imbalances in men aged 50 and above.

Usually the size of a walnut, its growth can cause the obstruction and irritation of the bladder, leading to symptoms like frequent urination or the disruption of urine flow.

Dr Chin added that prostate cancer is now the third most common cancer in men here (after colon and lung cancer), with some 1,773 new cases diagnosed between 2001 and 2005.

Prostate cancer is classified into four stages and usually produces no symptoms in its first stage, when the cancer is detectable only through a blood test for the patient's prostate specific antigen (PSA) levels. From stage two onwards, the tumour is usually large enough for the doctor to detect and a biopsy can be done to determine if it is cancerous.

The growing tumour may compress the urethra, blocking the flow of urine. It can cause blood in the urine or semen as well.

In the later stages, prostate cancer can spread to the pelvic lymph nodes and bones and also affect the kidneys.

Prostate cancer is commonly treated through surgery (to remove the affected area), radiation therapy and hormone treatment (to manage the level of testosterone that fuels the cancer).

Emphasising the need for early detection, Dr Chin said that prostate cancer is one of the most treatable forms of cancer, with a cure rate of about 90 per cent if it is detected in its first stage.

He advised men aged 50 and above to ask for a PSA level test at their regular health screenings.

Despite the facts and figures, Dr Chin said some men still hesitate to seek treatment for their urological problems.

'Men by nature do not open up or go to the doctor early. So, they tend to seek treatment only when they have advanced symptoms,' he said. Such attitudes make the treatment process more difficult.

Sexual problems

Dr Li Man Kay, a urologist and transplant surgeon, said that middle-aged and even elderly men can and do lead active sex lives.

In a recent study he was involved in, 61 per cent of 204 Singaporean men aged 50 to 80 polled reported having sex every month.

That said, Dr Li still treats many men who come in complaining of sexual 'performance' problems, namely erectile dysfunction (ED).

ED refers to the inability to achieve or sustain an erection for sexual intercourse. Currently, ED is estimated to affect around 30 per cent of men above the age of 50.

Dr Li said ED is usually caused by a mix of 'physical and psychological' factors. These can include poor blood flow to the penis, stress (both work- or home-related), depression or anxiety about sexual performance.

Besides age, conditions like diabetes and hypertension - which affect the blood vessels - can cause ED. Smoking, too, is a prime cause of ED as it promotes the hardening of the arteries and disrupts blood circulation.

As part of the treatment for ED, Dr Li provides sexual counselling to help couples work out their sexual problems.

Dr Li said he encourages wives to participate in their husbands' treatment so that they can better understand what their husbands are going through and support them.

Treatment for ED often involves lifestyle changes such as exercising more, quitting smoking and taking vitamin supplements.

Drugs like Viagra and Cialis may also be prescribed. They improve blood flow to the penis when it is stimulated, resulting in a more sustained erection.

Such drugs, Dr Li estimated, have proven to be effective in about 85 per cent of cases treated.

Mental health concerns

Psychiatrist Adrian Wang said depression is the most common psychological problem men aged from 40 to 60 face.

'It affects on average 5 to 10 per cent of men during their lifetimes, yet many men do not seek treatment. They either feel ashamed to seek help or they don't realise it's depression,' he said.

He added that many of his patients worry about being past their prime and feel pessimistic about the future.

Depression can stem from declining health, job stress, marital strain and loneliness. In most cases, it is a confluence of multiple factors that can send a man into a downward spiral.

Given that men often identify with their jobs, retirement can bring about its own worries.

'Work gives a sense of purpose and satisfaction. Take that away and you take away part of their identity and sense of self-worth,' he said.

Depression can be expressed in the form of physical complaints like constant lethargy or backaches.

One reason for this, Dr Wang explained, is due to the men's reluctance to open up about their troubles, hence they fall back on bodily symptoms as seemingly more legitimate complaints.

'It's not like the patients are lying. They may actually feel these physical symptoms,' he said.

It is usually only after a full physical check-up has failed to turn up results that some men start considering other possible conditions.

Treatment for depression usually follows two paths: counselling and medication.

For milder cases, counselling itself may be enough to help a patient. In more severe instances, various medications can be prescribed to correct the chemical imbalances in a patient's brain.

Even with medication, counselling is still neccessary to help a patient learn how to better manage the condition.

Dr Wang advised men above 40 to seek help when they feel stressed. Bottling up their feelings may only worsen the situation.

A stable home environment is important too. He said there are studies which showed that married men, or those in meaningful relationships, tend to suffer less from depression.

A supportive social network is crucial in troubled times.

'That's why it's important to balance your life. One needs to have equal parts of friend, family and work time,' he said.

dhano@sph.com.sg

This story was first published in Mind Your Body, The Straits Times, on Nov 20, 2008.

For more The Straits Times stories, click here.

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