Men may not have menstruation, but like women, at some point of time, they also ‘pause’, perhaps somewhat differently. Thus, women’s menopause pronounced as men-no-pause doesn’t really imply that men don’t pause. Known by various terms such as andropause, Testosterone Deficiency Syndrome (TDS), Partial Endocrine Decline in Ageing Males (PADAM), etc., none of these are as popular as the woman’s menopause – ‘The flow that ceased’.
Interestingly, the word ‘PADAM’ in Malay actually means extinguished, or ‘The fire that ceased to burn’. That’s it! ‘The fire that ceased to burn’ in a man who is expected to be macho all the time describes the pause phenomenon of man so well especially in Asian society where the fire element denotes aggressiveness, strength or power. Nonetheless, somehow the usage of this term is fizzling out. Generally, the existence of PADAM is not known to most people. A man’s gradual decline of power and prowess are presumed to be part of the normal process of ageing. Until recently, it was never known that the phenomenon is due to hormonal deficiency that can be biochemically corrected.
Studies have shown that the most important male hormone (androgen), known as testosterone, begins to decline after the age of 30 by about one percent per year. By the age of 50, many men would have lost 20 percent of this ‘macho’ hormone and experience ‘the syndrome of extinguishing fire’. In other words, they are no longer feeling as manly as they used to be.
Andropause together with TDS and PADAM are essentially the same syndrome caused by androgen (especially testosterone) deficiency which may adversely affect multiple organ functions and the quality of life. The clinical manifestations of this syndrome can be nicely summarised by the acronym PADAM itself:
P – Poor performance, Physical deterioration, Pettiness (grumpiness)
A – Anxiety, Anger, Aggression
D – Decreased libido, erection, muscle mass, Depressive mood, Difficulty falling asleep, Declining general well-being, Distribution of fats to the belly and chest.
A – Androgen decline, Arthralgia (joint pain), Anhedonia (inability to feel pleasure in activities)
M – Moodiness, Muscle ache and weakness.
As health is defined as not merely the absence of disease but also a complete state of physical, mental and social well-being, a PADAM man is essentially a man in a POOR state of health. His physical, mental and social well-being are significantly and adversely affected by his declining testosterone hormone. The replacement of such hormone would restore his ‘lost magic’ and make a world of difference in his health, appearance as well as his physical and mental performance including his sexual libido and potency. His personal confidence or self-esteem would improve apart from the following favourable changes: a sharper mind, more muscular body, healthier heart, and stronger bone.
Testosterone is a hormone with many effects. Surely, there will be concern about its potential negative side effects. The main concern is its effect on the prostate. Yet the only definite contraindication is the existence of a prior diagnosis of prostatic cancer or breast cancer. Yes, men also can have cancer of his breast although it is pretty uncommon. Testosterone is not contraindicated in benign prostatic hyperplasia or the prostate enlargement due to ageing that is commonly found in men above 55 of age.
Testosterone hormone is available in different forms: the oral tablets, gels and injectables. The former two are far less effective and less reliable, thus they are naturally falling out of favour. The injectable testosterones are gaining increasing popularity in spite of its high price tag. The most popular one among my patients is the 3-monthly injectable testosterone that proves to be the most effective and reliable. Those who are on it liked it, confirming that they are happy with its great value-for-money benefits.
To be on the safe side, all patients on Testosterone Replacement Therapy should be monitored from time to time to exclude the development of prostate cancer or raised hemoglobin. If cancer or abnormally raised hemoglobin is detected at any time while the patient is on Testosterone Replacement Therapy, it is only appropriate that the treatment be discontinued.
Testosterone does not cause prostate cancer. Studies have shown that there is no increased risk of prostate cancer with testosterone replacement therapy. In reality the reverse is true. To a certain extent testosterone actually prevents men from getting prostate cancer as studies have shown that men with low testosterone levels are noted to have an increased risk of prostate cancer.
Testosterone Replacement Therapy is an appropriate therapy that should be offered to all PADAM men with biochemical evidence of testosterone deficiency provided there is no contraindication. PADAM is a disease that is treatable and should be treated. All men suffering from this ‘pause phenomenon’ should not be left to suffer in silence out of ignorance. It is wrong for anyone to think that those receiving testosterone are ‘dirty old men’ just because it also increases their libido and penile erection.
Such a view is too simplistic, narrow and judgmental. Testosterone confers benefits far beyond the sexual function of men. More often it is the sharper mind, healthier heart, stronger muscles and bones together with the more stable mood and greater efficiency in their work that constitute important reasons for the treatment.
Contrary to popular belief, testosterone deficiency in men is indeed very common. The New England Journal of Medicine reported that about 10 percent of men in their 40s have low testosterone, 25 percent in their 50s, 45 percent in their 60s and 70 percent in their 70s. Those with deficiency of such hormone usually present with a syndrome of signs and symptoms that should be collectively treated with Testosterone Hormone Replacement. Treating each of the signs and symptoms individually instead of their common root-cause is certainly far from adequate. Thus, treating a man presenting with depression secondary to testosterone deficiency with an antidepressant is merely treating one of the symptoms of a PADAM man while missing out on all the other clinical manifestations that result from the same root-cause.
A PADAM man with ‘The fire that ceased to burn’ should be treated appropriately in such a way where ‘The fire shall rekindle and continue to burn’.
My next column will be on ‘Laugh your way to good health’.
Dr. Victor Ti, MD, MFAM (Malaysia), FRACGP (Australia), Dip P Dermatology (UK), Dip STDs/AIDS (Thailand), Dip. AARAM (USA), LCP of Aesthetic Med.(Malaysia) is an experienced expat specialist generalist (Family Physician) of BH Clinic, Phnom Penh. As a specialist generalist, he is skillful at diagnosing all general diseases and excluding the sinister ones. Apart from the general diseases, Dr. Victor is also known for his skill in skin diseases, sexually transmitted diseases, minor surgery and aesthetic medicine. He can be contacted via email [email protected]
Tel: 023900446 or Whatsapp: +60164122977