Rudy, 65, had not been well for the past year. He felt tired and sleepy every afternoon. He was also experiencing some pain in his left knee, which he attributed to an old injury, that caused him to walk with a limp. Because of these problems, he was no longer able to exercise.

He could not sleep well at night and sometimes he would experience bouts of sweating and a vague sensation of warmth that he could not explain.

He had put on more weight around the waist. In addition, he had lost interest in sex, leading his wife to accuse him of infidelity. All along, Rudy had thought these problems were part and parcel of ageing and that nothing could be done.

Rudy was not entirely wrong. Indeed, ageing does cause a man to lose some of his vigor and strength.

However, part of the reason is also because ageing causes testosterone, the essential male sex hormone, to decline significantly, so much so that testosterone levels in middle-aged men are low compared to healthy young men.

 This phenomenon is popularly known as andropause.

It is caused by fewer numbers of functioning cells in the testes that produce testosterone, or due to reduced signaling from the brain to the testes, or both.

When Rudy sought my help for his symptoms, I recognized right away that he might be experiencing the effects of andropause. An early-morning blood sample was drawn.

 Although his total testosterone was not clearly low, I knew this was misleading. Testosterone is mostly attached to sex-hormone binding globulin (SHBG). As this protein will be high because of ageing, Rudy'€™s testosterone might not appear low.

Many doctors are unaware of this and simply take the testosterone reading at face value, causing them to miss the diagnosis.

Instead, what needed to be done was to calculate Rudy'€™s free testosterone level using a formula utilizing the SHBG. From this, it became clear that Rudy'€™s free testosterone was truly low. Other blood tests revealed the cause to be because his testicular function has declined.

In short, Rudy is a classic example of a middle-aged man suffering from andropause. He is not alone, though, as this condition affects as many as 30 to 40 percent of men above the age of 60 '€” although few people realize that help is easily available.

Rudy was offered testosterone treatment. This could be administered in the form of tablets, gel or injections. Rudy decided to try the gel first, which comes in small packets that are convenient and easy to use.

He only needed to peel open one packet daily and spread the gel over his chest, upper arms and stomach after showering. It dries very quickly, does not cause any stickiness, and Rudy is able to put on his clothes and carry on with his usual daily activities while the testosterone is absorbed through the skin.

Within a week, Rudy was able to appreciate the difference. He felt more energetic and no longer felt sleepy in the afternoons. He could focus better at work and his heavy sweating had disappeared.

His interest in sex had returned and he felt more confident in engaging his wife. Blood tests showed his testosterone level improved significantly.

After three months, Rudy wanted to try a different testosterone preparation. While the gel had worked very well, he wanted to switch to an injectable form that can last 3 months, which is more convenient compared with having to apply the gel daily.

Such an injection contains 1000 milligrams of testosterone that is slowly released from the buttock. After 6 months of treatment, not only did Rudy continue to feel well, his discovered that his knee pain had disappeared. His legs feel stronger now and he is able to walk without limping.

Till this day, Rudy is still continuing on his testosterone treatment and he enjoys an excellent quality of life. As part of his treatment, blood tests are done every 6 months to ensure that the dosing is appropriate and that his prostate remains healthy.

Testosterone treatment is safe and convenient if your testosterone is low, like Rudy, and no man should deprive himself of the chance to attain a better quality of life.

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The writer, a physician, was chief of endocrinology at Changi General Hospital and the president of the Endocrine & Metabolic Society of Singapore

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