Dear Dr. G,

In conjunction with the Year of the Tiger, I would like to wish Dr G and The Star Online readers a wonderful CNY.

I read with interests happily married men in their mid-forties facing issues of male menopause and contemplating Testosterone Replacement Therapy.

On the contrary, my husband who is in his late forties have the opposite problem.

My husband and I both have Chinese Zodiac Signs of Tiger, meaning we are both approaching the big 50.

On one hand, my menstrual cycle is changing and libido dwindling possibly due to menopause. On the other hand, my husband is going from strength to strength and possibly more youthful than the early days when I first met him.

Apart from the excessive appetite for sex, I also notice my husband behaving more “aggressive” and adopting risk-taking behaviour.

I also notice my husband getting more acne on his face and the need to shave more.

I wish to put Dr. G on the spot to find out more about men with high testosterone.

Are all the signs and symptoms I described consistent with men with excessive testosterone?

Is that healthy? Is this congenital? Can it be caused by anything serious?

My husband started exercising a lot during the MCO, can this cause excess testosterone production. Or should I worry about his taking some sort of steroid?

Lastly, I am not keeping up with my Tiger Husband’s excessive appetite for sex, is there any treatment to tame this fiery Testosterone Tiger in bed?

Yours truly,

Taming Tammy

Testosterone is the essential sex hormone produced by the testicles and adrenal glands in men. This sex hormone is important during gestation to differentiate male and female sexual characteristics. The second important phase of testosterone surge occur during puberty, when the hormone is crucial for the development of secondary male characteristics and reproductive function. In later years, the hormone is also essential for maintaining the masculinity and sexual libido in older men. Naturally, the decline in this fountain of youth is expected with advancing age, resulting in less aggression both inside and outside the bedroom.

Testosterone levels differ greatly amongst men, however having a balanced testosterone is necessary for the optimal health and ageing process. Apart from sex, testosterone also affect numerous process of a human body including muscular mass, metabolism of bodily fat, blood pressure, mental health, facial and bodily hair. Men with higher levels of testosterone generally exhibit more aggression and risk-taking behaviour. They also have excessive facial and bodily hair, but experience more issues with follicular challenged male pattern baldness (God is fair). Men with higher testosterone may also have issues of acne and excessive sweating from exercise.

Several studies have concluded that high testosterone in both men and women are heritable. Up to 20% of men have congenital causes of higher testosterone influenced by the combined effect of many genetic variants. Other common causes of high testosterone in men include excess dosage of Testosterone Replacement Therapy (TRT) and usage of anabolic steroid. Serious aetiology of excessive testosterone production can also occur in men with hormone producing tumours in the adrenal glands and the Leydig Cells in the testicles. However, the prevalence of such malignancies are exceedingly rare.

Excessive workouts are associated with higher testosterone levels, however, not all form of exercises are equal. A 1983 study of testosterone levels in men lifting weights found that men experience significant natural increase in testosterone while the women have almost no impact. Another study in 2004 demonstrated regular physical activities improved the levels of testosterone and growth hormone, as well as positive effect on the brain function. In addition, a yearlong exercise study in 2008 revealed 102 men who previously didn’t exercise had an increase of the hormone levels by 15%. Lastly, a 2007 study showed that men who did resistance and strength training three days a week for four weeks were likely to have an increase in testosterone levels over time.

The vast majority of men with the natural increase in testosterone will not require any form of treatment. However, eliminating the external sources of high testosterone is crucial as the first line treatment caused by medication or steroid use. On the other hand, taking yoga classes, keeping excessive hair shaved or using facial cleansers for acnes may also control undesirable symptoms of excessive testosterone. Men with male pattern baldness and issues with excessive sexual appetite may also consider taking medicine such as 5-alpha-reductase inhibitors to lower the active components of the testosterone.

The world has clearly moved away from the dark days of castrating men committing crimes such as rape and exhibiting aggressive behaviours believed to be associated with excessive testosterone. On the other hand, partners living with men with heightened sexual libido may often express concerns of the source of this fountain of youth, and even contemplate some form of measures to tame the appetite inside and outside the bedroom. The well-respected American poet and philosopher, Henry David Thoreau believed: “It is not part of a true culture to tame tigers, any more than it is to make sheep ferocious.”

When it comes to couples with disparity in sexual desires in their advancing years, one should not focus on the hormone, but have an open dialogue without any medical intervention.

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