SINCE the Malaysian Men’s Health Initiative (MMHI) published its latest book, Managing Men’s Health: Improving Men’s Health Through Research, there has been a lot of interest in MMHI’s research on men’s health in Malaysia.

In the previous article for this column, we highlighted some of the findings regarding erectile dysfunction among men in Malaysia.

This week’s article will touch on testosterone deficiency syndrome and some of MMHI’s research findings on this important area of men’s health.

For decades, female menopause got all the attention, and few people talked about the effects, if any, of hormonal changes in ageing men.

However, the concept of “male menopause” is not actually new, as testosterone deficiency was first reported in scientific literature as early as 100 years ago.

There is increasingly more debate and discussion about testosterone deficiency and more research is being carried out on this condition to study how men are profoundly affected by it, and how it can be treated, in order to avert serious complications.

The most common medical terminologies to describe testosterone deficiency are symptomatic late-onset hypogonadism (SLOH, or sometimes, just late-onset hypogonadism, LOH), and Androgen Decline in the Aging Male (ADAM). Currently, the medically accepted term is testosterone deficiency syndrome (TDS).

TDS is characterised by total testosterone levels below 11 nmol/L, as well as symptoms like low sexual desire, lethargy and lack of energy, negative mood changes and irritability, memory loss, and lack of concentration.

This condition of low testosterone is called a “syndrome” because it consists of a group of symptoms or characteristics that usually exist together.

Research on TDS has been relatively recent, carried out mostly in the last 15 years. Most of this research has been done among the Caucasian population. Therefore, little is known about the prevalence and impact of TDS among men in Asia and Malaysia.

MMHI’s research on TDS looked at the prevalence of the condition and its associated co-morbidities, as well as the quality of life among men with TDS.

Two of MMHI’s key studies looked at the prevalence of TDS among an urban population: the 2006 Subang Men’s Health Study and the 2003 Klang Valley Men’s Health Community Study.

In the Subang study, 1,046 men above the age of 40 had their blood tested for glucose, lipid and testosterone levels. MMHI found that 19.1% of the men had total testosterone below 11 nmol/L, which is considered to be low. This prevalence is in line with regional findings of 10-40% among Asian men.

Meanwhile, the Klang Valley study found that the Aging Males Symptoms (AMS) scale correlated with the testosterone levels of 351 men. This shows that the AMS scale may be used to screen for testosterone deficiency and identify men who are at risk, or need further follow-up.

The idea that men, like women, also suffer hormonal changes, especially in the later stage of their lives, is not one that is easily accepted.

For one, it is not easy to identify TDS, because the symptoms can be vague and easily mistaken for other conditions. Men also find it hard to admit that they are vulnerable to hormone changes, as it challenges their notion of masculinity.

Even less is known about how men cope with TDS, and how it affects their lives. That is why MMHI looked at the quality of life of men with TDS in the 2003 Klang Valley study. Not only were men with TDS found to have poor physical, mental and emotional role functioning, many also suffered from some form of depression.

Another interesting study by the MMHI was the Nebido® study, which compared the quality of life between men who received testosterone replacement therapy, and men who were given placebo. You can read about the interesting results in Managing Men’s Health: Improving Men’s Health Through Research.

TDS is not a benign condition to be taken lightly. What is most worrying about testosterone deficiency is that it is closely correlated with other serious medical conditions like obesity, metabolic syndrome and cardiovascular disease.

MMHI’s epidemiological studies in Malaysia confirmed the association between TDS and many conditions that significantly increase the risk of cardiovascular disease and diabetes. These findings are especially important for men and doctors to be aware of, as it suggests that men with low testosterone are at risk of other, life-threatening diseases.

With better scientific understanding of the effects of TDS in the ageing male, interest in diagnosing and treating TDS is gaining enthusiasm.

In the next 50 years, Malaysia is expected to follow the trend of other Asian countries, where the population of those above 65 years is expected to increase four-fold.

Recognising the extent of TDS in Malaysia will have a significant impact on preparing the country for the ageing boom. Our ageing male population will need to be healthy, fit and well in order to remain in the workforce into their 70s, so that they can contribute towards sustaining the country’s economic growth.

More information about local research findings on TDS is available in the book, which is now available from the MMHI.

Apart from TDS, the book also covers three other main themes in men’s health, which are erectile dysfunction, prostate diseases and psychosocial issues among men.

The book draws attention to these key issues, because they urgently require attention among healthcare practitioners, policy makers and those involved in research.

Look out for the next article in this series, which will touch on prostate diseases and lower urinary tract symptoms.

ON average, we spend more than three hours a day staring at the computer screen or some other electronic gadget. I, myself, am guilty of this especially since I bought the latest MacBook Air I am writing this article on. You may well be reading this article on your computer or iPad. This has led to the recognition amongst eye care professionals of a new syndrome called Computer Vision Syndrome (CVS). This is surprisingly common among the working population, but often untreated or mistaken for something else.

CVS is due to the eyes being used to focus on the computer screen for prolonged periods of time. Common symptoms include headaches, red eyes, blurred vision, neck pain, double vision, and dry and irritated eyes.

These symptoms may be aggravated by a smoky environment or air-conditioning vents blowing dry air in the direction of the person.

Most of us blink an average of 18 times per minute. This wipes away debris from the eye surface and keeps the eyes functioning optimally. However, when in front of computer screens, we blink less than six times per minute, which allows for dry, irritated eyes.

Our eyes are naturally developed to focus six metres (20 feet) in front, and if we look at a screen located less than a metre in front of us, we have to use our internal eye muscles to get the screen in focus. This can result in “eye-strain”, which may be very uncomfortable for some people and difficult to resolve.

It is, of course, almost impossible for us to be separated from the computer as we not only need it for our work, but also for social networking.

The American Academy of Ophthalmology has recommended some simple steps to reduce CVS symptoms. These include:

·Pasting a note on your screen to remind yourself to blink often.

·Sitting at a comfortable position from the computer and position the screen so that your eye gaze is slightly downward.

·Every 20 minutes, shift your eyes to look at an object at least 20 feet away, for at least 20 seconds: the “20-20-20” rule.

·Taking regular breaks from computer work and getting enough sleep.

People with dry eyes are more likely to experience CVS. As such, artificial tear drops can help relieve eye discomfort. There are a huge variety of artificial tear drops available, and it would be best to discuss with an eye care professional the most suitable drop for yourself.

Most patients with dry eye also often have meibomian gland dysfunction (MGD) or blepharitis. MGD is very often unrecognised as a cause of eye discomfort.

The meibomian glands are located near our eye lashes and provide some of the lipid secretions that make up part of our tear film. In MGD, the glands are blocked and inflamed. This causes our eyes to feel gritty and sore, especially in the mornings.

A simple measure to treat MGD is to use a warm compress to massage the eyelids for about two minutes twice a day. The heat from the warm compress allows the sticky oily secretions from the glands to melt slightly. This can help relieve the blockage.

After the warm compresses, you can use a wet cotton bud to scrub the eyelashes to remove the oily secretions that have been released from the glands.

I tell my patients to do this whenever they brush their teeth so that they don’t forget. This simple lid hygiene regimen has to be done daily for at least a month before improvement in symptoms can be seen. More severe cases of MGD may require steroid and antibiotic eye drops, and tetracycline antibiotic tablets.

More recently, dietary supplements like omega-3 essential fatty acids (EFA) have been found to be useful for helping dry eye and MGD. Such essential fatty acids may help enhance the lipid layer of the tear film and prevent premature evaporation of the tears from our eyes.

Omega-3 EFAs also have an anti-inflammatory role in the eye. EFAs are called essential because they can’t be produced in the body. There are two main groups: omega-3 and omega-6.

Omega-6 EFA is found in most vegetable oils like rapeseed, sunflower, peanut and corn, poultry, eggs, cereal, and whole grain breads. Omega-3 EFA, on the other hand, is found in oily fish (example: salmon, sardines, catfish, Indian mackerel, kembong or Spanish mackerel,tenggiri, jelawat, and canned tuna), and oils like flaxseed, rapeseed, and walnut.

Our modern diet has led to us taking an excess of omega-6 EFA, which limits the effectiveness of omega-3 EFA in helping dry eye and MGD. The ideal ratio of omega-3 to omega-6 EFA is 1:4, but most people in developed countries are taking a omega-3/omega-6 EFA ratio of up to 1:25!

In other words, we are taking more than 20 times the amount of omega-6 EFA compared with omega-3 EFA. A diet high in processed food and meat, and lacking in omega-3 fish oils causes this imbalanced ratio and can lead to higher incidence of dry eye.

Due to the difficulties at having enough omega-3 EFA in our diet, dietary supplementation of up to 500mg per day of omega-3 EFA is recommended by the American Dietetic Association.

Having said that, females who are pregnant or are breastfeeding should limit their intake of oily fish to two servings a week to avoid overconsumption of potential pollutants that may be found in the fish.

Several studies have found clear benefits of dietary supplements of omega-3 EFA for dry eye. Individuals taking these supplements had a 20% reduction in the likelihood of getting dry eye compared with those with a low intake of omega-3 EFA.

New trials are now testing the use of omega-3 EFA as an eye drop for dry eye. In MGD, omega-3 EFA supplements help clear up and thin meibomian gland secretions which in turn improves dry eye symptoms.

Omega-3 EFAs have also been found to be beneficial for our heart (reduction in myocardial infarction), brain (reduced risk of stroke), and joints (helps reduce joint pain).

In summary, our eyes are not designed to look at the computer screen for hours each day. This can take a toll on our overall health, especially if we have co-existing dry eye and MGD.

The main suggestions that I have to prevent computer vision syndrome is to take regular breaks from your computer work, avoid a dry working environment, lid hygiene for MGD, consider artificial tear supplements, as well as increase omega-3 EFA intake.

Here is a recipe you can try at home – tea smoked salmon.

Salmon is a great source of omega-3. You can substitute with another type of oily fish of your choice. Fish with high oil content are suitable for smoking as they remain moist and absorb more smoky flavour.

Serves four

Preparation & cooking time: 15 minutes

Ingredients:

400g (4 pieces) salmon fillet

2 teaspoons (tsp) dark soya sauce

1 tsp sugar

½ tsp salt

Garnish:

1 tsp sesame seeds, black and white

½ lemon

Smoking:

4 tablespoons (tbsp) tea leaves

4 tbsp uncooked rice

4 tbsp sugar

Method:

Marinate fish in dark soya sauce, 1 tsp sugar, and salt, and leave aside.

Heat a dry pan on medium heat. Toast sesame seeds in the pan until they darken and become fragrant. Leave aside.

Line a wok with a piece of foil. Mix the tea leaves, uncooked rice and sugar together on a piece of foil. Heat up the wok with the foil for about a minute, or until it starts to smoke.

Pat dry salmon fillets with a kitchen towel and place the fish (skin-side down) on a rack in the wok. Smoke the fish for five to 10 minutes (depending on the thickness of the fish fillets).

Remove the fish from the wok and sprinkle with toasted sesame seeds and garnish with a slice of lemon. 

IN the previous article for this column, I talked about several causes of low libido in women. I feel that it is important to give coverage to this issue, as women still find it difficult to openly confront this problem.

The libido is a fragile, fickle thing, and can so easily be lost due to physical and psychological factors in our lives.

If we do not identify the causes of low libido, we will be constantly wondering why we do not enjoy or desire sex, and may even heap blame on ourselves and damage our relationships.

In this article, I will continue with the list of common sex drive killers in women, and ways to address these.

Beauty and attraction are intertwined with feelings of sexuality and desire. Yet, it is often not our looks or body that is the issue, but our perception of them.

It is hard to feel comfortable with your body, or feel sexy when you have poor body image. Some women think that they are too fat, others think that they are not curvy enough. Some want bigger breasts, others want longer legs.

These characteristics don’t really have anything to do with sexual performance, yet some women obsess about it until they lose their desire to have sex because they feel ashamed to bare their bodies.

This problem has to be first resolved within yourself – nobody can make you feel sexy until you feel good about yourself.

You should also talk to your partner and ask him what he finds desirable about you. You might be surprised to learn that he has no issues with the parts of you that you so dislike! Do not let anyone make you feel bad about yourself.

If you feel that you should lose weight, make sure that you do so healthily and properly. Do not crash diet or starve yourself. Follow a suitable exercise programme – working out will give you an energy boost, tones your body, and increases your sex drive. 

Sex after menopause? Why not? But first, women have to overcome the tendencies of menopause to reduce sexual desire.

The hormonal changes brought on by menopause not only affect libido, but also some of the important sexual functions. As testosterone production drops, the sex drive becomes lower, the clitoris becomes less sensitive, and the body is less able to respond sexually.

The low levels of oestrogen, meanwhile, cause vaginal dryness and makes penetration painful.

While menopausal changes are inevitable, there are ways that you can overcome some of the symptoms. If you have vaginal dryness, your doctor can prescribe topical oestrogen therapy, or you can use a water-based lubricant.

Besides these physical factors, menopausal women should also consider the state of their relationship (have they become too comfortable, entered a boring routine?), their body image, and self esteem (are they shy about their ageing bodies?), as well as their state of health (are they taking other medications or suffering from other conditions that could affect libido?).

Complacency can set in to any relationship. Sex is part of a package that includes intimacy, connection, communication and affection. If sex becomes routine in a relationship – on a fixed day, at a fixed time, with fixed moves – the fun and sizzle will quickly dry out.

For women, in particular, intimacy and affection are very important. Your partner needs to understand that talking, snuggling and touching can do a lot to revive your sex drive.

It’s somewhat ironic that birth control pills not only stop you from getting pregnant, but they also stop you from wanting sex.

Oral contraceptives work by stopping your ovaries from producing hormones, which affects your body’s sexual functions. The Pill also causes your body to produce a protein called sex hormone binding globulin (SHBG), which binds itself to testosterone and renders it useless.

If you feel that oral contraceptives are interfering with your sex drive, consider using an alternative form of contraception, with your doctor’s advice.

If you have health problems like thyroid disorders, high blood pressure, high cholesterol, diabetes or autoimmune disorders, you may find yourself losing interest in sex.

This is because these conditions affect your hormone levels, blood flow and nerve signals in the body, all of which play a role in sexual desire.

If these conditions are well-managed and under control, you should find your libido returning to normal. However, be aware that certain medications, such as high blood pressure drugs, can also affect libido, so discuss it with your doctor, if this is a concern.

If you think that one or several of these libido killers relates to you, talk to your doctor about what you can do to change the situation.

Sometimes, you will not even need drastic changes. You’d be surprised at how much good lifestyle changes can do – just exercising regularly, eating a healthy diet and taking time out to relax.

If you take care of yourself, your libido will take care of itself too!

I’M so worried! My weight keeps increasing, moans a female executive to her friend.

For women, any increase in weight is a very sensitive issue. And for men, a “spare tire” around the tummy and a chubby body shape can occasionally be a source of jokes among friends.

How important is controlling your weight? Is it just to look good?

The truth is, being overweight not only affects a person’s self-image, but also affects their health, and exposes them to the risk of diseases like diabetes, hypertension and heart disease.

The question is: is it easy to control your weight?

The truth is, it isn’t that hard to ensure that your weight remains at the ideal level. Follow these tips to ensure that your weight is ideal for your height.

Healthcare professionals use the BMI (Body Mass Index) to measure your ideal body weight. You can calculate your BMI using this formula: BMI = Weight (kg) ÷ [Height (m)]²

The ideal BMI is between 18.5 and 22.9. (See BMI levels)

Firstly, you should know your body’s caloric needs.

Each person’s caloric needs differ according to gender, age and daily activities.

If you are a woman who is not very physically active, and spends most of the day in the office, your daily caloric intake should be around 1,800 kilocalories (kcal). Whereas, on average, an adult male would need around 2,200 kcal.

Secondly, you should practise healthy cooking methods.

While you needn’t limit your methods of cooking or variety of food, the most important thing is that your cooking methods should involve less fat, less salt and less sugar, so that you can enjoy healthy meals. Below are some guidelines for preparing healthy meals:

·Remove the skin from poultry before cooking.

·Remove any visible fat from meats before cooking.

·Avoid refrying fried food.

·Use tissue paper or oil absorbent paper to absorb excess oil on fried foods.

·Use a non-stick pan to decrease the use of oil.

·Ensure that the oil is really hot before frying food, so that less oil is absorbed.

·Use healthier cooking methods like roasting, baking, boiling, braising or using the oven.

·Use diluted santan (coconut milk) or low-fat milk.

·Cool down soups or meat stock, and remove any visible surface fat.

·Remove any visible oily layers from food.

·Use low-fat salad dressings.

·Reduce the use of sugar while cooking.

·Avoid adding sugar while preparing food. Instead, sweeten your meal with fresh or dried fruits.

·Avoid layering your cake with sugar or icing.

·Avoid adding sugar into fruit juices.

·When preparing drinks, provide the sugar or milk separately.

·Replace condensed milk with low-fat or fresh milk.

·Use only a little salt in your cooking, and avoid sprinkling salt onto your food.

·Decrease the use of oyster sauce, chilli sauce and tomato ketchup, as well as flavouring while preparing meals. Replace them with suitable natural spices like black pepper, ginger, etc.

·Reduce consumption of preserved foods like salted fish, salted eggs, preserved vegetables, etc.

Are you a physically active person? For a person working in the office, and spending a lot of time in front of the computer, you may be a less active person.

JULIE Grimm was training for a marathon when she started feeling a twinge in her hip. She assumed that some moments in her training would be painful, so she ignored it and kept running. By the end of that 25km run, she couldn’t even walk. She had to be carried home and stayed in bed all weekend.

Grimm had broken her femur at the hip joint. The break required emergency surgery and a metal plate, bolt and two pins to piece the bone back together.

Grimm was devastated. After all, she had competed in two triathlons and weight-trained for many years. She was thin and in good shape. Her surgeon agreed: “This doesn’t happen to 34-year-old women who are fit,” he said.

Six weeks after the surgery, he sent her for a bone density scan. The scan is a painless type of x-ray that checks a part of the body, such as the hip, for loss of minerals or thinning bones. It turned out Grimm’s bones were weaker than normal. She was diagnosed with osteopenia, a precursor to osteoporosis, if left untreated.

“Osteoporosis never crossed my mind,” Grimm, now 35, said. “I have old-lady insides and young-lady outsides.”

Osteoporosis is a weakening of the bones due to loss of minerals that make up bone mass, or density. The more porous bones become, the more likely they are to fracture.

For years, the face of the disease was considered a hunched-over, tiny old woman. That is no longer the case, according to a expert in the field. While the disease still primarily affects older, post-menopausal women, cases like Grimm’s are becoming increasingly common, according to Dr Kathryn Diemer, director of the Bone Health Program at Washington University’s School of Medicine in St Louis.

“My clinic used to be little old ladies, but now I’m seeing a lot of younger women, men and young men,” she said. In her typical clinic routine, Dr Diemer sees 20 patients a day. Several years ago, a younger person with low bone mass might turn up once in a month. Now, she sees at least one or two young women in each clinic session. She has treated a 21-year-old with multiple fractures due to low bone mass.

There may be several reasons for the increasing diagnosis of osteoporosis, Dr Diemer said.

There is greater awareness of women’s health issues, and people can get their bones scanned at health fairs or at their doctor’s office.

Younger girls are not drinking as much milk as they should and are not as physically active as they should be.

Very athletic girls may stop menstruating, which can also affect bone mass.

Many women do not realise that a prenatal vitamin during pregnancy usually does not provide enough calcium to maintain strong bones.

Grimm, a stay-at-home mother, had nursed each of her three children for a year, which also depletes a woman’s calcium reserves. She had no idea that her prenatal vitamin wasn’t providing enough calcium.

“Because girls are not developing peak bone mass by 30, they hit the fracture threshold sooner,” Dr Diemer said.

In older, post-menopausal women, the controversy surrounding hormone replacement therapy made many discontinue using it. But the lack of oestrogen undermines bone tissue, and the difference needs to be made up with nutrition and exercise, Dr Diemer said.

More than 40% of post-menopausal women are at risk for developing osteoporosis and up to 50% are at risk for a preventable fracture. A recent study found that an average of 24% of hip-fracture patients, age 50 and over, die within a year of the fracture. The disease is a major cause of disability and frailty in older people.

Certain risk factors make a person more susceptible to low bone mass. Those factors include:

·A family history of fractures or osteoporosis.

·A thin frame.

·Smoking.

·Heavy drinking.

·Certain medications, such as steroids.

·Irregular periods, or loss of periods.

·Anorexia.

In Grimm’s case, despite her thin frame and pregnancy and nursing, she had no symptoms before she fractured her hip. Now, she takes extra calcium supplements every day and stays committed to her weight-training programme.

“Everyone sees me as so fit and healthy, but my bones aren’t,” she said. By taking care of the problem now, she says, she will make sure that by the time she’s 50, she doesn’t have the body of an 80-year-old. – St Louis Post-Dispatch/McClatchy Tribune Information Services.

MEN taking daily vitamin E were more likely to get prostate cancer than those not taking the dietary supplement, according to a study of close to 35,000 North Americans.

This means that over a decade, one or two men out of 100 taking vitamin E would be expected to get prostate cancer, said the researchers, whose findings were published in the Journal of the American Medical Association.

"If you have enough of these vitamins in your system...extra doesn't help you any, and too much of something like this can be harmful," said Eric Klein from the Cleveland Clinic, one of the study's authors, to Reuters Health.

The findings come on the heels of a study suggesting that older women who take multivitamins have slightly increased death rates compared to those who don't.

"There's a theme here that taking vitamins is not only not helpful but could be harmful" in people who are not deficient in vitamins, Klein added.

But one researcher who wasn't part of the new study said he doubted it means vitamin E causes prostate cancer.

"It's an interesting finding. I'm not sure I believe it," said Neil Fleshner, from the University of Toronto, adding that the result may have been a chance finding or false positive.

For the study, men in the United States, Canada and Puerto Rico were randomly assigned to one of four groups.

Starting between 2001 and 2004, about 9,000 men in each group took daily supplements of 400 international units (IU) of vitamin E, 200 micrograms of selenium, vitamin E and selenium together or a vitamin-free placebo pill.

The study was halted in late 2008 when the researchers saw a hint of an increased risk of prostate cancer in the men taking vitamin E. But they kept monitoring men for cancer after they stopped taking the supplements. It turned out that the extra risk became clearer over time.

By mid-2011, about seven percent of men who had taken vitamin E only had gotten prostate cancer, compared to six percent of those assigned to placebo pills.

The researchers did not find an extra risk of prostate cancer in men who took only selenium or vitamin E together with selenium.

Klein and his colleagues said it's not clear how vitamin E would increase the risk of prostate cancer, and that not all past studies have shown it does any harm to the prostate. Some have even found a lower prostate-cancer risk with vitamin E.

He added that the new findings aren't definite proof that vitamin E causes extra prostate cancers, but that there wasn't anything else that could explain why men taking the vitamin were more likely to be diagnosed with cancer - for example, they weren't screened more frequently.

The supplement doses, he added, are much higher than what's in most over-the-counter multivitamins, which typically contain 15 to 25 IU of vitamin E.

Fleshner said that either way, vitamin E doesn't seem to be beneficial for prostate health.

"There's certainly no major evidence that vitamin E helps, so why bother?" he said.

While vitamin supplements are known to prevent disease in people who have vitamin deficiencies, so far studies haven't found much extra benefit in people who already get enough vitamins through their diet. Specifically, vitamin E has not been shown to protect against heart disease, colon cancer or lung cancer.

On the other hand, there is a growing body of evidence suggesting supplements may be harmful in high doses.

"Vitamins are not innocuous substances," Klein said