Testosterone Deficiency Syndrome

Finally, after all the hoo­ha, uproar and commotion, the “biggest show on earth has officially” started in Rio this weekend. The four­-yearly modern Olympic Games, of course is the leading sporting event featuring the summer games where tens of thousands of athletes from more than 200 nations participates in a variety of competitions.

Baron Pierre de Coubertin, who founded the International Olympic Committee (IOC) in 1894, inspired by the games held by the ancient Greeks in Olympia in the 8th century probably did not foresee how the movement shaped to be more than one century later.

The games has become a platform for various nations to provide unknown athletes with opportunity to attain national and international fame, and the host nation to showcase themselves to the world.

The evolution of the Olympic Movements in recent decades had created numerous challenges including boycotts, bribery and even a terrorist attack in 1972. Of course, the “state sponsored” doping controversies is still clouding the Rio Olympics as we speak.

The former American Figure Ice Skater, 1988 Olympic bronze medallist and also a physician, Debi Thomas, well known for The Battle of Carmens at the 1988 Calgary Olympics with Katrina Witts from East Germany once said: “Being an Olympian, I always have the strong belief in Excellence!”

Thomas studied at Stanford University Medical School during her competitive years and resumed her studies by 1989.

She went on to become a practicing orthopedic surgeon specializing in hip and knee replacement.

After two divorces, Thomas was diagnosed with bipolar disorder in 2012 and now broke and living in a bed­bug infested trailer with a partner struggling with anger and alcohol issues.

Thomas once said: “I like it when my patients are impressed not knowing that I was an Olympian”.

This week, we address an issue of a reader who was reminiscence with his past achievement in sexual relationship, sports and career glory, who is now contemplating the idea of “rejuvenation” with the fountain of youth – testosterone.

I would rather be anonymous and therefore I would use my pseudo name as Dave. I am 57 years old and had a healthy life since my youth.

I was a professional athlete, who trained vigorously for swimming competitions since school days.

When I reached the peak of my professional career in my mid and late twenties, I was winning medals for national and International games.

I continue with a healthy lifestyle after I retired with sporting due to joint problems.

I was married with an amazing sex life since my early thirties, and we have two beautiful children.

My problem started when I faced financial challenges in the last economic crisis.

My health deteriorated and the sexual performance also was non-existent.

Sadly, my marriage also never survive the challenge.

I have started a small business since and my life had slowly picked up again. I have started a new relationship and realize nothing is the same anymore.

I don’t have the zest and energy that I used to have in my youth.

Needless to say, my libido is also non-existent.

My fiancé asked me to visit the doctor, who diagnosed me having Testosterone Deficiency Syndrome (TDS), I guess that is a fancy term for male menopause.

He encourages me to start with Testosterone Replacement to rejuvenate me.

I am unsure of the different options of replacement he talked about.

I am also somewhat worried about the risk, and how long the replacement will carry on.

Although I miss my old life, I also would like to be cautious.

Dave.

In recent years, a lot more patients are approaching the health care providers with concerns of low testosterone.

The diagnosis is becoming increasingly more common because older men are more open about discussing their sexual and general health with less stigma.

On the other hand, men are also bombarded by campaign and media movement to quest for that “eternal youth” and blaming many symptoms of aging on low testosterone.

Testosterone is a hormone produced primary by the testicles, with the main functions in maintaining bone density, fat attribution, muscle strength and sex drive.

It is estimated about a quarter or a third of the men presented with general fatigue, lack of energy and sex drive have less than normal level of testosterone.

This is because after the age of 40, most men begin to experience a gradual decline in the male hormone, that can result in generalized fatigue, interrupted sleep, mood swing and lack of interests in sex.

Needless to say, such symptoms can also be attributed by other medical conditions such as diabetes, depression and coronary artery disease.

Although the promise of testosterone replacement may seem enticing and sound like the ultimate “anti­aging” formula, it is crucially important to differentiate the low testosterone in an older man is simply due to decline in the natural progression of natural aging or the pathological process of hypogonadism.

Hypogonadism is a medical condition in which the body cannot produce sufficient amount of testosterone due to the the dysfunction testicles

or pituitary gland.

This can be determined by the blood investigations demonstrating consistently low levels of hormone that will eventually bring harm to the overall testosterone replacement therapy (TRT) can improve the signs and symptoms of men with low testosterone.

This can be delivered in the forms of tablets, pellets, injections, sprays or even gels.

In many studies, TRT is demonstrated to reverse the effects of hypogonadism in men, however the benefit for aging men who are otherwise healthy is unclear.

In many studies, the replacement is shown to result in ageing men feeling younger and more vigorous. But such effects had not been shown to be sustained.

The promises of benefits from the “fountain of youth” also comes with some health warnings.

The TRT may contribute to sleep apnea and the emergence of skin complains such as acne.

The long term uses of testosterone is also well known to shut down the body’s own production in the testicles causing shrinkage and inhibiting sperms production.

Prolonged utilisation of testosterone is also associated with the emergence of gynecomastia (Oops, muscular abds with man­boobs!).

On more serious notes, the prolonged exposure of male hormones may also have the potential in stimulating the benign enlargement of the prostate, however the association of the hormone with prostate cancer is unclear.

In recent years, the testosterone therapy has been linked with the risk of heart disease, however the research results had been conflicting and the exact risk is still unknown.

There is no doubt the benefit of testosterone replacement therapy outweighs the risk in suitable men with Late Onset Hypogonadism (LOH) or Testosterone Deficiency Syndrome (TDS), as such treatment is not completely risk free, the intervention needs to be stringently monitored with a defined program interval and objectives.

The American former number one tennis player, often considered among the greatest in the history of the sports, Jimmy Connors, once said: “Experience is a great advantage. The problem is that when you get the experience, you are too damned old to do anything about it!”

Dr. G’s advice to Dave is:

“Embark on your journey of rejuvenation and let your new lease of life take you back to your former glory, as long as you don’t lose sight of your health with the help of your physician!”