What You Need To Know About Andropause

What is Andropause?

Andropause is men’s equivalent of menopause. Like menopause, its onset is usually above the ages of 40 years old. However, it does not happen to all men. It is gradual in onset and it is not associated with infertility.

How common is it?

Various international studies have estimated the prevalence of andropause at up to 30% for men above the age of 60.

A similar survey in Singapore found that of the 1,000 patients (mean age 54) who were screened, more than a quarter had some form of androgen deficiency based on the Aging Male’s Symptoms scale.

What are the symptoms?

Upset businessman

The symptoms of andropause, both physical and psychological are attributed to a decreasing testosterone level.

Physically, a low level of this hormone may lead to impotence and a decreased sexual drive. The man begins to notice a spare tyre, often referred to as the ‘beer belly’, resulting from more fat deposits around the waist. His strength dips with the softening muscles, and his bone mass decreases in a condition termed osteoporosis, which puts him at a higher risk for bone fracture.

Psychologically, the man may experience frequent anxiety and depression. He may also lack the motivation to work and frequently can’t concentrate on things as well as before.

How do we diagnose Andropause?

The diagnostic test for andropause will be the blood level of testosterone.

How do we treat it?

Treatment will be via testosterone replacement therapy. There are various ways of administering this replacement.

The most popular way in the clinic is thru a regular 3 monthly injections of a testosterone preparation. Other routes of replacement will be thru oral capsules and gels applied on the skin.

The length of time required for replacement varies. But generally, medication can be continued as long as the man finds that it improves his symptoms.

What are you thoughts about Andropause?

Andropause is a fairly common occurrence. Yet many sufferers from andropause present themselves late for medical treatment. Frequently, they may just accept it as part of ageing.

It is my experience at the clinic that most men are quite relieved when there is a diagnosis to their frequently vague symptoms.

With treatment, many will experience improvement of symptoms within 6 months. They will perceive a heightened energy level, an improved mood and zest to life. Coupled with a suggested exercise routine and diet regimen, many are delighted with the physical changes that accompany the change in proportion of muscle mass and fat.

With greater awareness and earlier treatment, these sufferers will be able to maintain a better quality of life and thus enjoy their golden years.

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Managing Diabetes

What is diabetes?

Diabetes means having too much sugar in the blood. The food we eat is broken down into glucose. In a normal person, insulin (manufactured by an organ called the pancreas) acts on cells throughout the body to stimulate uptake, utilization and storage of glucose. People who are diabetic do not produce enough insulin (Type 1 Diabetes) or the insulin produced does not work well (Type 2 Diabetes). As a result, sugar builds up in the blood causing diabetes.

In Singapore, statistics show that about 1 in every 10 Singaporeans has diabetes and has almost doubled among those 50 years and above. It is a serious chronic medical condition and is a growing concern in Singapore.

Uncontrolled diabetes can lead to serious complications like kidney disease, heart disease, stroke, blindness, nerve damage, foot ulcers and amputations. Diabetes is  also the most common cause of chronic kidney failure in Singapore, hence early detection and treatment is crucial.

Who are at risk?

These are some risk factors:

  • Family history of diabetes
  • Being overweight (BMI of 23 or higher)
  • Inactive or sedentary lifestyle
  • High blood pressure
  • Raised cholesterol levels
  • Above age 40
  • Past history of diabetes during pregnancy
  • Impaired glucose tolerance or impaired fasting blood glucose (pre-diabetes state)

How do I cope with diabetes?

Although there is presently no known cure for diabetes, it can be controlled and its complications can be prevented. We also know that the risk of developing diabetes can be reduced by leading an active and healthier lifestyle.

Treatment for diabetes includes diet modification, oral treatment and insulin injections.

Here are some steps you can take to manage your diabetes:

  • Have a well balanced diet as advised by your doctor or dietician
  • Exercise regularly and maintain a healthy weight
  • Take your diabetic medication as prescribed and monitor your blood sugar
  • Keep your blood pressure and cholesterol at desirable levels
  • Go for annual eye check up
  • Quit smoking as smoking increases the risk of heart disease, especially in a diabetic
  • Go for your regular follow up with your family doctor or specialist.

Hence if you have any of the risk factors or have symptoms of feeling thirsty or tired all the time or need to urinate a lot at night, I recommend a blood test to exclude diabetes as early detection and management of diabetes can prevent  complications.

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Dear Doctor, I’m Losing Weight, Should I Be Happy or Worried?

Excessive weight loss

Having a healthy weight (of BMI between 18.5- 22.9) and an active lifestyle is something that we are all encouraged to do.

Unintentional weight loss is a decrease in body weight that is not voluntary.

Hence, weight loss without exercising or dieting may be indicative of an underlying medical condition, especially if it is more than 5 percent of your body weight in 6 months. Many patients whom I have seen have said to me that they don’t realise their own excessive loss of weight and is only made aware of it by friends or family members.

Should I be concerned if I have excessive weight loss?

stressed women

Excessive weight loss can come about when one has loss of appetite. This could be due to conditions like painful mouth ulcers, new dentures or orthodontic appliances. Of course, when one undergoes severe stressful life events or is depressed, there will also be loss of appetite and weight.

Losing weight excessively could also be a major symptom in several medical conditions that can be diagnosed from screening tests.

So YES, you should consult a doctor if you have excessive weight loss or unintentional weight loss.

What medical conditions can cause weight loss?

2 common causes are endocrine diseases like hyperthyroidism and diabetes.

Hyperthyroidism is a condition where there is an overactive thyroid gland. This is a fairly common condition and can lead to rapid weight loss, irregular, rapid heart rate, excessive sweating and nervousness.

Diabetes is a metabolic disorder in which a person has high blood sugar level.  The classic symptoms of untreated or undiagnosed diabetes include loss of weight, frequent urination, increased thirst or increased hunger.

Other causes of persistent or excessive weight loss include malignancy (leukemia, carcinoma), malabsorption, (coeliac disease, Crohn’s disease) perisistent vomiting (hiatus hernia), acute or chronic infection (tuberculosis, HIV) or systemic diseases (heart failure, chronic renal failure).

In our fast paced society, many people attribute their weight loss to stress and sometimes do not realise that it could be related to a medical condition. In my experience, I have personally seen several cases of hyperthyroidism and diabetes diagnosed as a result of them coming for a check up as a result of unexplained weight loss.

If you have persistent or unintentional weight loss, do consult your physician for further check up as early detection will lead to early treatment.

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Tips for healthy aging

What do you consider to be healthy aging?

Healthy aging has to include both components. Living longer and staying healthy. Staying healthy involves being free of debilitating diseases and functioning well, both physically and mentally.

Aging is inevitable, but the rate of aging is not.

As we grow older, we become physically less like our peers. This is not obvious in a group of young adults but the differences will be obvious in a group of 60 year old. Some will be energetic, in the epitome of health while others will be managing chronic diseases and frail looking.

We need to start young to ensure that we age well.

Senior mother and adult daughter

Could you elaborate on living longer and staying healthy?

There are conditions that could strike us in our prime. Some of these like cancers, heart attacks and strokes are associated with mortality.

We can avoid untimely death from heart attacks and strokes by minimising our risk factors. We have a higher chance to survive a cancer if we detect it early enough.

Aging involves the decline in the body’s resiliency, in each individual cell’s ability to repair itself and regenerate.

Due to the variety of cells in the body, the aging process will be marked by deterioration in both physical and mental function.

We can stay healthy with certain dos and don’ts.

What are some tips from a medical point of view on healthy aging?

There are a few things we should and should not do to ensure that physically at least, we age well.

  1. Establish a  regular exercise routine.

Exercise is an important cornerstone to healthy ageing.Try to incorporate at least 30 minutes of exercise activity a day. Do it daily if possible. Choose a variety of exercise activities addressing both aerobic fitness and muscle tone. Lastly, choose enjoyable activities so that we are more likely to make it a part of our life.

  1. Eating right is important.

A diet high in vegetables, fruits and fibre is preferable. Food containing cholesterol and saturated fats should be taken in smaller quantities as it contributes to heart diseases and strokes. Take as much salt out of your diet as possible as this often leads to hypertension. We want to live life and eat well. But eat well in moderation.

  1. Don’t smoke, if you do, quit.

Smoking ages physical appearance. Smoking is the primary cause of chronic obstructive lung disease. Living with a chronic cough, in a state of constant breathlessness is not healthy aging. Smoking increases the likelihood of heart diseases, strokes and certain cancers. Any of these will certainly diminish the chance of living an expected life expectancy.

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How could your doctor contribute to your healthy aging process?




Your doctor is a valuable partner in aging well.




As mentioned, developing a condition like heart disease, suffering from a stroke or discovering an advance cancer will certainly ruin the chance of healthy aging!


Regular health screening allows for early detection of illnesses. This allows for early intervention before complication or morbidity occurs.




We want to keep our cells healthy. We want our organs to continue functioning well. Your doctor can discuss with you the preventive measures to take to ensure that this happens.




Andropausal & menopausal symptoms will plaque many when we age.


Studies have shown that up to 30 percent of older individuals experience symptoms associated with decreasing hormones. A hormonal screening could pick up the problem and corrective measures taken.




Healthy aging will allow us to continue living life with zest and joy.



What is hyperlipidemia?

Hyperlipidemia commonly refers to a high cholesterol level. It can also indicate an elevated triglyceride level. Frequently it is a combination of both.

Why is there “good & bad cholesterol”?

The cholesterol that is detrimental to our body is the LDL cholesterol. This refers to the bad cholesterol.

Circulating LDL cholesterol together with triglycerides builds up in the walls of arteries and form plaques. This process known as atherosclerosis contributes to the major risk factor for ischemic heart diseases and strokes.


The HDL cholesterol refers to the good cholesterol because it scavenges & removes the LDL cholesterol to the liver to be reprocessed. It thus lessens the risk posed by the circulating LDL cholesterol.

What causes hyperlipidemia?

Hyperlipdemia is very often genetically based. It can also be contributed by an unhealthy diet laden with saturated oils and cholesterol. Either of which will result in its onset during early adulthood.

It is recommended that our first lipid screening, made thru fasting blood levels start at the age of 20 years old.

Are there any “natural” means to avoid hyperlipidemia?

Although there is a significant genetic predisposition to the development of hyperlipdemia, there are some lifestyle modifications that will improve the condition.

We should be watchful of our intake of cholesterol laden food. This will include all types of meat and animal derived parts & product including eggs and milk. Saturated oils, excessive alcohol and sugar will contribute to an elevated triglyceride level. Intake of such should be moderated.

A regular exercise routine will result in calorie expenditure. This will lower triglyceride level.

Exercise has also been shown to elevate the HDL or good cholesterol level. A high HDL level results in lower atherosclerosis risk.

Supplements containing red yeast are useful in reducing cholesterol levels. Fish oil & Omega 3 can be taken to reduce elevated triglyceride levels.

What are your thoughts regarding hyperlipidemia?

It is common for patients to dismiss hyperlipidemia. It is a myth that just because it is common, it is harmless. It is perhaps an even greater self delusion that just because it has existed the last 10 years that it will not pose a problem in the next 10 years.

Hyperlipidemia is the underlying condition behind atherosclerosis which results in heart attacks and strokes. It should be medically controlled if lifestyle modifications fail to do so.

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Do I Have Hypertension

What is hypertension?

Hypertension, otherwise referred to as high blood pressure is a chronic disease characterised by persistent elevated blood pressure  above 140/90mmhg.


Does it happen only in the elderly?

It can occasionally happen in the young although it tends to affect many as we grow older.

How do we diagnose hypertension?

The only way to diagnose hypertension early is through routine checks. A few elevated readings have to be documented to confirm the presence of the disease. This is because the stress during a medical examination can also result in a spurious elevated reading.

Is there anyway to prevent hypertension?

There are a few risk factors that will increase the likelihood of developing hypertension. They are obesity, a sedentary lifestyle & excessive salt consumption.

To prevent & delay the onset of hypertension, it is important to maintain an ideal weight, to engage in regular exercise and to avoid excessive salt consumption.

Could you elaborate?

1. A sensible diet to maintain an ideal weight would be one rich in whole grains, fruits, vegetables and low fat diary products while skimping on meats with saturated fats.

2. A good exercise routine will comprise 5 sessions a week lasting at least 30mins. It should probably include both cardio and toning sessions.

3. To reduce salt intake, it is important not to add extra salt to your foods. It will be good to minimize intake of processed foods as it is often high in salt content. Positive changes to the blood pressure can be seen within a month of effort.

Group Of Marathon Runners At Start Of Race

When will I need medication?

When lifestyle changes fail to lower the blood pressure, medications should be started early to prevent onset of known complications.

Hypertension is largely asymptomatic. However if left unaddressed; it will lead to heart failure, heart attack, strokes and kidney failure.

The occasional side effects of medications can never outweigh the potential disability from hypertension.


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