Testosterone deficiency a concern in Asia

Asian men have similar rates of biochemical andropause comorbidities and associated risk factors as those in the US and other Western countries, says an expert.

“We all know that testosterone falls as we grow older, especially in gentlemen,” said Dr. Caroline Low of Drs Jiten & Caroline Medical Centre + X-ray, Singapore. Low was speaking on the topic of guidelines for testosterone therapy in adult men at the recent Aesthetics Asia Exhibition and Congress 2013 held in Singapore.

In a 2006 US study of 2,162 men over the age of 45 who visited participating doctors for any reason, 38.7 percent had a biochemical diagnosis of andropause defined as total testosterone levels below 300 ng/dL. Odds ratios for testosterone deficiency were significantly higher in men with hypertension (1.84), hyperlipidemia (1.47), diabetes (2.09), obesity (2.38), prostate disease (1.29) and asthma or COPD (1.4) than in men without these conditions. [Int J Clin Pract 2006;60:762-769]

The 2006 Subang Men’s Health Study found 19.1 percent of 4,000 Malaysian men aged between 40 and 80 years had a biochemical diagnosis of andropause. The prevalence of metabolic syndrome among the study population ranged between 29.6 percent and 32.9 percent. [Asian J Androl 2006;8:506]

To diagnose testosterone deficiency, Low recommended identifying compatible symptoms through a medical history and physical examination, excluding diseases with similar symptoms including depression and anemia, and performing a biochemical confirmation.

A 2004 Australian study of androgen-deficient men showed that 69 percent experience a loss of energy, 35 percent have a diminished libido, 38 percent experience lack of motivation, 40 percent have a cantankerous mood, 33 percent are sleepy after lunch, 16 percent have an inability to concentrate, 12 percent experience hot flushes, 40 percent have slow beard growth, and 12 percent suffer from muscular aches. [J Clin Endocrinol Metab 2004;89:3813-3817]

Patients typically come to Low with signs of depression, non-sociable behavior, panic attacks, an inability to put on muscle and a simple complaint of feeling “old.”

Current testosterone therapies range from short-acting (2 to 4 weeks) to long-acting (12 weeks). For Asian men, Low said she prefers oral pills or injectables to prevent intermittent medication use with creams, and to avoid embarrassment from the daily shaving of the scrotum required for patches. Although price is important when selecting a treatment method, Low pointed out that the prices among testosterone replacement therapies are similar when compared on a per week basis.

The first improvement typically seen in Low’s patients is a fall in fatigue levels, followed by a decrease in depression and an increase in sociability after 3 weeks of treatment. Those undergoing testosterone treatments are known to also experience an increase in bone mineral density, lean body mass, erythropoiesis, physical activity, mental activity, mood, cognitive abilities, libido, and quality of life. Aggressiveness generally does not change in Low’s patients.

Those receiving testosterone replacement therapy may initially have a worsening of sleep apnea, especially if the patient is obese, said Low. Other risks include a decrease in fertility, a rare but existing chance of polycythemia and a contraindication for prostate cancer.

Low described a need for competent physicians managing andropause and for well-informed patients committed to follow-up and careful monitoring.

“At the end of the day, testosterone is not a fountain of youth,” said Low. “We want to prevent the preventable and delay the inevitable.”