Testosterone deficiency in Malaysia

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.

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