Testosterone Deficiency Syndrome

Testosterone Deficiency Syndrome

Testosterone Deficiency Syndrome

In male humans, testosterone plays a key role in the development of male reproductive tissues such as testes and prostate.

It also promotes secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair. In addition, testosterone is involved in health and well-being such as concentration and energy and the prevention of osteoporosis.

Testosterone Deficiency Syndrome (TDS)

Testosterone Deficiency Syndrome (TDS) or Late Onset Hypogonadism (LOH) refers to the age-related decline in testosterone levels in adult men, resulting in various symptoms. TDS may adversely affect the function of multiple organ systems and result in significant decline in the quality of life.

What causes low testosterone?

You may be born with low testosterone, or it can develop later in life, often due to age, injury or infection.

Testosterone Deficiency Syndrome (TDS) is usually due to age. As men age, the testes decline in function and testosterone secreted by them decreases, by about 0.4-2.0% every year. This is due to a reduction in the function and size of the Leydig cells of the testes.

This decline is exacerbated in men with obesity and men with poor health status such as high blood pressure, diabetes and high cholesterol.

Reduce in testosterone production can also be due to previous testicular infection, trauma, heat, hernia or surgery.

Sign and symptoms

Low testosterone may alter certain masculine physical characteristics and impair normal reproductive function. As testosterone decreases, some men may experience symptoms similar to those of menopause in women.

Signs and symptoms may include:

  • Erectile dysfunction
  • Fatigue
  • Decreased sex drive
  • Difficulty concentrating
  • Decrease in muscle mass
  • Decrease in beard and body hair growth
  • Development of breast tissue (gynecomastia)
  • Loss of bone mass (osteoporosis)
  • Hot flashes

You can use a scoring scale to determine how likely your symptoms is related to Testosterone Deficiency Syndrome. Just follow the link below:


If your score is:

  • 50 – symptoms likely due to low testosterone
  • 37-49 – symptoms possible due to low testosterone
  • 27-36 – symptoms unlikely due to low testosterone
  • 17-26 – no symptoms of low testosterone

How do we diagnose?

If you have symptoms of low testosterone, your doctor will likely do a blood test for total testosterone. We may also do albumin and sex-hormone binding globulin level to more accurately calculate the active testosterone level.

We also may offer to screen you for chronic diseases such as high blood pressure, diabetes, cholesterol and obesity.

What is the treatment?

  1. Weight loss and management of chronic disease. – If men succeed in losing weight, their testosterone levels may recover.
  2. Hormonal replacement – to replace testosterone:
    1. Pills – painless but not suitable for long term as it can cuase liver problem. Have to take with fatty meal for better absorption.
    2. Gels – painless but a potential side effect of the gel is the possibility of transferring the medication to another person
    3. Injection – Most convenient. It can be given every 3-4 weeks or every 3 months depend of the preparation.

Side effects

Testosterone therapy carries various risks, including stimulating noncancerous growth of the prostate, enlarging breasts, limiting sperm production, stimulating growth of existing prostate cancer and blood clots forming in the veins.

There is no evidence that testosterone replacement causes prostate cancer in contrary to many belief it does so. The PSA may go up slight when one starts testosterone replacement but the level would stabilize after few months. Doctors do however continue to monitor PSA as part of routine test just to be sure.

As with all medicine, there is potential side effects but mostly it is safe if given correctly. Your doctor will counsel you about the side effects and what to look out for. It is also important to attend your doctor follow up appointment. Physical examination and blood test would be done at a regular interval to monitor the testosterone level and also for any side effects.

What to do and not to do during dengue fever

Dengue Fever

What to do and not to do during dengue fever

To Do:

Not to Do:


Rest in bed



Avoid any sports/physical activities until you have recovered



Hydrate your self



Avoid brushing your teeth to prevent gum bleeding, instead use gargle



Take simple pain/fever medicine such as paracetamol



Avoid medication such as ibuprofen, aspirin, ponstan, arcoxia as they may increase risk of bleeding



Go for your doctor appointment even if you feel better as they may need to monitor your platelet until you recover.



Do not cancel your doctor appointment even if you feel better or fever has stop. This is because the platelets usually start to drop when the fever lysed.



See your doctor if you are bleeding or bruising (bleeding from your gum, nose, urine)




Protect your from being bitten by mosquito to prevent it from infecting others.




Family members/housemates to check and remove stagnant water in your premises to prevent Aedes mosquito from breeding




Discuss with your doctor about dengue vaccine when you are well



Dengue Fever is caused by infection with a dengue virus. There are four serotypes of dengue virus (DENV1-4) circulating in the world.

Dengue is transmitted to humans by the bite of an infected Aedes mosquito. Dengue fever is not contagious and does not spread directly from person to person. A mosquito is infected when it takes a blood meal from a dengue-infected person and later transmits the virus to other people they bite.

Dengue Fever usually develops within 4 to 7 days after being bitten by an infected mosquito.

Symptoms can include:

  1. Sudden onset of fever for 2 to 7 days (usually high fever > 38.5C)  
  2. Severe headache with retro-orbital (behind the eye) pain
  3. Joint and muscle pain
  4. Skin rashes (usually after 4-5 days) which often itch.
  5. Nausea and vomiting
  6. Bleeding from the nose or gums or easy bruising in the skin

Treatment for Dengue:

There is no specific treatment for dengue or dengue haemorrhagic fever.

Treatment for dengue is usually supportive such as simple pain/fever medicine (paracetamol), nausea/vomiting medicine and hydration. Some may need itch medicine when the rash start to appear. Your doctor may need to regularly check your blood for the platelet count until you recover.

Only in few cases where dengue patient need to be admitted for fluid and electrolyte replacement or blood (platelet) transfusions. This is when a patient is dehydrated, has very low blood pressure due to the infection or when the platelet is extremely low.  

Dengue Haemorrhagic Fever/Dengue Shock Syndrome is a severe form of dengue fever that could result in death.

Precautions You Can Take:

To prevent the spread of dengue fever, you must first prevent the breeding of its vector, the Aedes mosquito. It prefers to breed in clean, stagnant water easily found in our homes. You can get rid of the Aedes mosquito by frequently checking and removing stagnant water in your premises.

Learn more ways to prevent Aedes mosquito breeding on NEA’s dengue website

A dengue vaccine has been approved for individuals aged 12 to 45 years and had dengue infection before. Individuals should consult their doctor if they wish to find out more about their suitability for the dengue vaccine.