Men's Health Services

1. What is Andropause?
After the age of 40, the level of testosterone, the main male hormone, gradually declines in men. Some men may experience physical and psychological changes related to this decline. This is commonly called andropause, or late-onset hypogonadism in medical terms.

Unlike female menopause, which has a clear marker of stopping periods, the decline in men is slow and gradual. The degree of change varies widely, so not all men will experience bothersome symptoms.

2. What Does Testosterone Do and Why Does It Decline?
Testosterone is mainly produced in the testes and in small amounts by the adrenal glands. It plays a key role in:

- Building muscle mass, maintaining bone density, and producing red blood cells
- Regulating fat metabolism, blood sugar, and liver function
- Maintaining libido, erectile function, and energy levels
- Supporting mood, concentration, and cognitive function

After age 30, testosterone levels typically fall by about 10% per decade. This is a normal aging process. Every man experiences a decline, but when levels fall below a certain threshold, symptoms are more likely to appear.

3. Common Symptoms
Because testosterone affects many systems, symptoms are often grouped as:

- General / Physical: Loss of energy, reduced muscle strength, increased body fat, loss of height or back pain related to osteoporosis
- Psychological: Mood swings, irritability, low mood, anxiety, lack of motivation, difficulty concentrating, and sleep disturbance
- Sexual and Urinary: Reduced sex drive, less rigid erections, erectile dysfunction, and urinary symptoms often related to co-existing benign prostatic enlargement

These symptoms are non-specific and can overlap with many other conditions.

4. Can It Be Prevented?
Age-related decline cannot be prevented, but a healthy lifestyle can reduce its impact:

- Quit smoking and manage cholesterol, as studies suggest they are linked to earlier onset
- Engage in regular exercise, including both aerobic and resistance training, to preserve muscle and bone
- Maintain a healthy weight and balanced diet
- Manage stress and ensure adequate sleep

5. Diagnosis and Treatment Options
Do not self-diagnose based on symptoms alone. If you are concerned, consult your family doctor or urologist.

Your doctor will:
1.  Assess your symptoms with a detailed history
2.  Arrange a morning blood test for testosterone, as levels are highest in the morning
3.  Perform a physical examination and exclude other causes such as thyroid disorders, depression, or prostate problems

Management:

- Support and Lifestyle First: For most men, understanding the process, receiving psychological support, and adopting healthy habits are sufficient to manage the transition.
- Testosterone Replacement Therapy (TRT): Considered only when bothersome symptoms are present AND blood tests confirm low testosterone. The goal is to relieve symptoms, not just to raise the number. Benefits may include improved libido, erectile function, body composition, bone density, and cognition. Options include oral capsules, transdermal gels or patches, and long-acting injections. Improvement is usually noted within 3 to 6 weeks.

Important Safety Information:
TRT must only be prescribed and monitored by a doctor. Self-treatment can cause serious side effects, including infertility, testicular shrinkage, and increased red blood cell count.

TRT should never be used in men with prostate cancer or male breast cancer. It may also be unsuitable for men with severe liver disease, uncontrolled heart failure, or other conditions. Regular follow-up with blood tests and prostate assessment is required during treatment.

6. How Can You Help Yourself?
- Talk openly with your doctor about your symptoms
- Whether or not you receive TRT, you will benefit from:
    - A balanced diet rich in calcium and vitamin D
    - Regular exercise
    - Effective stress management
    - Quitting smoking
    - Limiting alcohol consumption

Benign Prostatic Hyperplasia (BPH)

1. What is BPH?
The prostate is a small gland below the bladder that surrounds the urethra and contributes fluid to semen. As men get older, the prostate often becomes larger due to a non-cancerous growth of tissue. This is called Benign Prostatic Hyperplasia. When the enlarged gland squeezes the urethra, it can affect how urine flows.

BPH is not prostate cancer and does not turn into cancer.

2. Why does it happen and how common is it?
BPH is considered a normal part of male aging, linked to long-term hormonal changes.

- More than 50% of men over 60 have some degree of prostate enlargement
- Up to 90% of men over 80 are affected
Only about half of them will experience noticeable urinary symptoms.

3. Common Symptoms
Symptoms can be grouped into storage and voiding problems:

- Storage symptoms: A sudden urge to urinate, needing to urinate frequently, having to get up at night to urinate (nocturia)
- Voiding symptoms: Difficulty starting urination, weak or slow urine stream, stopping and starting, feeling that the bladder has not emptied completely
- Other symptoms: Burning sensation during urination. In severe cases, acute urinary retention can occur, where you cannot pass urine at all, causing lower abdominal pain and swelling. This requires immediate medical attention.

Many symptoms overlap with prostate cancer, but BPH itself does not increase your risk of cancer. A medical evaluation is needed to tell them apart.

4. When to See a Doctor and How It Is Diagnosed
If you notice persistent urinary changes, see your family doctor or a urologist. The doctor may perform:

- Symptom assessment using a standardized questionnaire
- Digital rectal examination to assess prostate size
- Urine test and blood test, including PSA testing
- Uroflowmetry to measure urine flow and ultrasound to check residual urine
These tests help to rule out infection and other conditions.

5. Management Options
Treatment depends on prostate size, symptom severity, and your general health:

- Watchful Waiting: For mild symptoms that do not bother you much, regular monitoring with lifestyle adjustments and annual check-ups may be all that is needed.
- Medications: Two main types are used - alpha-blockers that relax the muscle in the prostate and bladder to improve flow, and 5-alpha reductase inhibitors that can shrink the prostate over time.
- Surgery and Minimally Invasive Procedures: Considered when symptoms are severe, medication is not effective, or complications such as recurrent infections, bladder stones, or kidney problems develop.

6. Self-Care Tips
- Do not drink large amounts of fluid at once; reduce fluid intake in the evening
- Limit alcohol, strong tea, and caffeine, which can irritate the bladder
- Some over-the-counter cold and decongestant medicines can worsen symptoms - check with your pharmacist
- Stay physically active, maintain a healthy weight, and avoid constipation
- Treat urinary tract infections promptly
- Take prescribed medicines as directed and attend regular follow-ups

Testicular Cancer

1. Overview
The testicles are responsible for producing sperm and male hormones. Testicular cancer occurs when cells in the testicle grow uncontrollably. Although uncommon overall, it is one of the more common cancers found in young men.

2. Risk Factors
There is no single known cause, but the following factors are associated with a higher risk:
- A close family member with a history of testicular cancer
- A history of cryptorchidism, where a testicle did not descend into the scrotum before birth
- Abnormal development of the testicles

Having a risk factor does not mean you will develop cancer. The disease is not caused by injury, lifestyle, or infection.

3. Signs and Symptoms to Watch For
Please consult a doctor if you notice any persistent changes, such as:
- A painless lump, nodule, or enlargement in either testicle
- A sensation of heaviness or dragging in the scrotum
- A dull ache or discomfort in the lower abdomen or groin
- A sudden collection of fluid or swelling in the scrotum
- Breast swelling or tenderness related to hormonal changes

4. Early Detection Through Self-Examination
Regular self-examination is the best way to detect changes early. Once a month, after a warm shower, gently roll each testicle between your fingers. Check for any new lumps, changes in size, firmness, or pain. Early-stage cases are often first noticed by the individual during such checks.

5. Diagnosis
If you have concerns, see your family doctor or a urologist promptly. To confirm the diagnosis, the doctor may advise:
- Physical examination and medical history
- Blood tests for tumor markers
- Scrotal ultrasound to assess the abnormality
- Further imaging or surgical evaluation when clinically indicated

6. Treatment and Prognosis
When detected early, testicular cancer has an excellent prognosis, with a cure rate of over 90%. Even in advanced cases, modern treatment is highly effective.

Your medical team will recommend a personalized plan based on the stage and type of cancer:
- Surgery: Removal of the affected testicle is the primary treatment
- Chemotherapy: Medications used to eliminate cancer cells that may have spread
- Radiotherapy: High-energy rays used to destroy cancer cells in specific areas

Regular follow-up after treatment is essential.

Prostate Cancer

What is Prostate Cancer?
The prostate is a small gland that is part of the male reproductive system. Its main role is to produce the fluid that mixes with sperm to create semen. Prostate cancer develops when cells in the prostate grow abnormally and uncontrollably.

What Causes Prostate Cancer?
The precise cause of prostate cancer is still not fully understood. However, studies have shown that certain factors may be linked to a higher risk of the disease.

Major risk factors include:

- Age: The disease is most common in older men, with cases under 50 being uncommon.
- Family History: Having close relatives with prostate cancer can increase your own risk.
- Other Potential Factors: Several other possible risk factors are still under investigation and have not yet been conclusively proven.

Common Signs and Symptoms
Early-stage prostate cancer often causes no obvious symptoms, so many men are unaware they have it. When symptoms do occur, they may include:

- Difficulty starting urination or a delay in urine flow
- Weak or slow urinary stream
- Presence of blood in the urine
- Discomfort or pain in the lower back, pelvic area, or upper thighs

Prevention
Adopting a healthy lifestyle may help lower the risk. A diet rich in fruits, vegetables, and whole grains is recommended, while intake of high-fat foods and red meat should be limited.

If there is a family history of prostate cancer, it is advisable to ask your doctor whether screening is appropriate for you.

What Should You Do If You Suspect Prostate Cancer?
If you experience any of the symptoms listed above, please seek medical advice as soon as possible.
To establish a diagnosis, doctors may use several examinations, such as digital rectal examination (DRE), prostate-specific antigen (PSA) blood test, blood and urine analysis, ultrasound scan, and tissue biopsy.

Should You Consider Screening?
Screening for prostate cancer typically includes two methods:

Digital Rectal Examination (DRE):
The doctor, wearing a glove, gently inserts a finger into the rectum to feel the prostate gland for any irregularities.

Prostate-Specific Antigen (PSA) Test:
A blood sample is taken to measure the level of PSA in the blood. PSA is a protein made by the prostate. Its level can rise due to benign enlargement, inflammation, or cancer of the prostate.

Points to Consider About Screening:

- About DRE:
    The reliability of DRE depends largely on the examiner's skill and experience. Among those with an abnormal result, four out of five are later found not to have cancer. Conversely, around half of men with prostate cancer may have a normal DRE result.
- About PSA Test:
    An elevated PSA does not necessarily mean cancer - about three-quarters of men with high PSA do not have prostate cancer. On the other hand, about one-quarter of men with prostate cancer may have PSA levels within the normal range.

Next Steps After an Abnormal Result
If initial tests show abnormalities, your doctor may arrange further investigations, such as a prostate ultrasound or a biopsy, to confirm the diagnosis.

Treatment Options
Treatment will depend on the size of the tumour, how far it has spread, and the patient's general health. Options include:

- Active Surveillance:
    The condition is closely monitored with regular DRE and PSA tests, and active treatment only begins if there is evidence of progression.
- Surgery:
    Removal of the prostate gland through an operation.
- Hormone Therapy:
    Treatment that aims to shrink the prostate and slow the growth of cancer cells.
- Radiation Therapy:
    Using radiation to control the growth and spread of cancer cells.
    Apart from active surveillance, other treatments can cause side effects, which need to be managed on a case-by-case basis.

Conclusion
It is important to talk to your family doctor about the benefits and risks before deciding on screening. If you have a family history of prostate cancer, you should have a more in-depth discussion with your doctor about appropriate testing to protect your health.

Lower urinary tract symptoms such as slow stream , intermittency, sense of incomplete voiding or nocturia maybe signs of benign prostate hyperplasia, however, it can also be early symptoms of prostate cancer. To detect prostate cancer we could make use of a simple blood test such as prostate-specific antigen or more advance test such as prostate health index to guide us for further for diagnostic investigations. Please contact our urologist to discuss on these investigations for early detection of prostate cancer.

Peyronie’s disease is a condition that affects the curvature of the penis which causes pain and difficulties in sexual intercourse. Repetitive microvascular injury or trauma are the most widely accepted etiology of the disease. Consult our experienced specialist team for the most appropriate treatment modality for you.

Recurrent urinary tract infections are difficult to treat and affect men’s quality of life. One has to investigate if there is underlying causes which may contribute to the infection , such as benign prostate hyperplasia, urinary tract stones or other voiding dysfunction.  The urology specialists of our hospital will offer our expert management for this condition.

Varicocele

1. What is a Varicocele?
A varicocele is an abnormal enlargement of the pampiniform plexus, a network of veins inside the scrotum that drains blood from the testicles. When the one-way valves inside these veins do not work properly, blood pools and the veins become dilated and tortuous.

It is similar to varicose veins in the leg. It can affect one or both sides, but about 90% of cases occur on the left side due to venous anatomy. It is common, affecting about 15% of men, most often detected between puberty and age 35. In many men it causes no health problems, but in some it may be linked to testicular growth or fertility issues.

2. What Causes It?
In most cases there is no single identifiable cause. The main mechanism is valve dysfunction leading to backward flow and pooling of blood, which increases pressure and stretches the vein wall.

Rarely, a varicocele that appears suddenly on the right side or is large and non-reducible may be caused by a mass in the abdomen pressing on the vein. Your doctor will consider this and arrange further assessment if needed. A family tendency has also been reported.

3. Common Signs and Symptoms
Many men have no symptoms. When symptoms occur, they may include:

- A soft, lumpy collection of veins above the testicle that feels like worms
- A dull ache, heaviness, or dragging sensation in the scrotum, worse after prolonged standing, exercise, or at the end of the day
- Symptoms that improve when you lie down
- In some cases, the affected testicle may be slightly smaller

A varicocele does not usually cause severe or sudden pain. Sudden severe pain, swelling, or a hard lump should be assessed urgently to rule out other conditions.

4. Self-Monitoring
Get to know what is normal for you. Perform a monthly self-check of the scrotum for any new swelling, lumps, or changes in testicular size. Because varicocele can have similar features to more serious conditions such as testicular tumors or infection, any new finding should be checked by a doctor.

5. How Is It Diagnosed?
Diagnosis is usually made by physical examination while standing and lying down. The doctor may also recommend:

- Scrotal ultrasound with Doppler to measure vein diameter, blood flow, and testicular volume
- Semen analysis if fertility is a concern
- Additional abdominal imaging in selected cases

6. Management and Treatment
Treatment is not always necessary. The decision depends on the severity of discomfort, impact on daily life, and whether there is evidence of testicular atrophy or subfertility.

- Conservative measures: For mild symptoms, wearing supportive underwear instead of loose boxers, avoiding prolonged standing, and regular follow-up may be enough to control discomfort.
- Interventional treatment: If pain is significant, the testicle is shrinking, or fertility evaluation suggests a link, you may be referred to a urologist. Options include surgical ligation or percutaneous embolization, where the affected veins are sealed off and blood is redirected through healthy veins.

Outcomes are generally very good, and your doctor will discuss the benefits and risks of each option with you.

Aging men experience a gradual decrease of their testosterone production starting at their early forties. Symptoms including lethargy, loss of energy, reduced sexual desire and erectile dysfunction.  Low testosterone has also been associated with various disease such as metabolic syndrome and cardiovascular diseases. If you are experiencing these problems, please consult our urology specialist.