Testosterone Deficiency Syndrome ( Hypogonadism)

Testosterone Deficiency (Hypogonadism) is the silent killer of many a 'manhood' worldwide : find out if you are suffering from it

Feeling constantly tired and lacking in motivation?

Having low sex drive and erectile dysfunction and unable to perform like before?

Gaining large amounts of belly fat which will not go away no matter how much or hard you exercise?

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Read to discover how low testosterone levels can affect your lifestyle, and how easily it can be treated.

It is a well-known fact that Testosterone levels decline with age in men. Studies show that circulating testosterone levels drop 0.4-2.0% per year. This figure is worse in men with obesity and other health problems like hypertension, diabetes, high cholesterol levels.

However, the fact that it is observed to be an ‘expected’ biological change with aging does not mean that it is ‘normal’ to accept a state of low testosterone and its accompanying debilitating symptoms.

To use the fairer sex as an analogy, having wrinkles and sagginess of the face are well-known signs of aging on our faces. Do all women take this fact lying down and accept their fate of looking old every year? The answer is a BIG RESOUNDING NO!!! They seek doctors’ help and get a little non-invasive BTX, Fillers, Thermage, threadlifting to look young again.

If your quality of life had suffered an immense drop with the above described symptoms, you may be suffering from a silent growing epidemic in men all over the world – TESTOSTERONE DEFICIENCY SYNDROME.

How common is Testosterone Deficiency Syndrome ( Hypogonadism)?

In Singapore, it is estimated that about 26%, or one in four men aged 45 years and older, have some degree of testosterone deficiency. It is also known as “Hypogonadism”. When testosterone levels go lower than normal, adverse health consequences can impact your quality of life.

Low testosterone is more common than you think. The signs and symptoms are usually subtle and ignored as part and parcel of aging. (Remember : It is not normal if your daily lifestyle and sexual relationship is AFFECTED!) Read on to know if you have tell-tale signs of low testosterone and the various restoration therapies that can help.

What does Testosterone do?

Testosterone is an important sex hormone for men, as it is needed to maintain the male reproductive organs and manliness, such as deepening of the voice and the growth of facial and body hair. In addition, testosterone improves and maintains:

A. Muscle mass and strength
B. Bone density
C. A man’s overall sense of well-being and energy.
D. Libido and strong erections

Testosterone deficiency can result in the following symptoms. However, not all symptoms are experienced in every individual.

Signs of Testosterone Deficiency


  • Reduced facial and body hair
  • Osteoporosis
  • Increase in waist circumference due to increased visceral fat
  • Decreased lean muscle mass
  • A combination of obesity, hypertension, high cholesterol, and insulin resistance called “metabolic syndrome”

  • Reduced libido (reduced sexual desire)
  • Erectile dysfunction

  • Depressed mood
  • Poor sleep
  • Fatigue

What are the common causes of Testosterone Deficiency (Hypogonadism)?


Testosterone levels peak at 15 to 30 years of age. Then, testosterone production gradually declines usually from the age of 40.

Organ Damage

Low testosterone can also happen when there is disease or damage to organs that secrete and produce the pre-hormone or hormone such as the pituitary gland, testicles, or a hormone producing area of the brain called the hypothalamus.

Certain medications or treatments

Some antidepressants, and chemotherapy or radiation targeting the testicles, have been associated with low testosterone.

Existing medical conditions

Men with type 2 diabetes are more likely to have low testosterone. Studies have also shown that obesity (fat cells contain an enzyme known as aromatase that converts testosterone into oestrogen) and hypertension are linked to low testosterone. It has been found that improving testosterone levels may improve sugar control.

How do we diagnose Testosterone Deficiency Syndrome ( Hypogonadism)?

Laboratory blood tests will be performed by your doctor. Free Testosterone levels is an important factor guiding treatment compared to Total Testosterone levels. However, testing for Free Testosterone levels (done only via equilibrium dialysis) is costly and is not done in commercial laboratories. The numbers doctors use is derived from a formula involving Total Testosterone levels, SHBG, Albumin levels.

  Usual tests done would be :

  Total Testosterone (to be done between 7am – 11am as that is the timing when testosterone levels are highest, patients on Androgel are instructed not to apply it on morning of blood-sampling)

Follicle Stimulating Hormone (FSH) – hormone that stimulates our testes to produce testosterone

Luteinising Hormone (LH) – hormone that stimulates our testes to produce sperm

Prolactin (to rule out a prolactinoma – an abnormal mass of the pituitary gland)

Sex-hormone binding globulin (SHBG) – a percentage of testosterone is bound to this protein. As men age, this levels increase and result in lower levels of circulating free testosterone.

Estradiol – if high levels of estradiol is suspected and to screen for abnormally high levels of aromatisation (Aromatisation is the bio-chemical pathway by which Testosterone is converted into Estrogen by fat cells – Excess fat tissue reduces your manhood!)

Prostate Specific Antigen (PSA) and Full blood count (FBC) – baseline tests needed before testosterone replacement (if indicated)  

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How can testosterone levels be restored?

There are a few options to replace testosterone. Your doctor will use the most suitable method for you based on your lifestyle and personal preferences. Before starting testosterone replacement, Dr Israr Wong will have a detailed discussion regarding the rationale, benefits, risks and the need for monitoring and surveillance.
Androgel satchets containing 50mg of testosterone gel

Androgel Satchet 50mg - once daily usage on hairless parts of body ( chest, back of hands)

Testosterone Gel

How it is used
Applied on the skin (Transdermal)

• Allows you to achieve normal testosterone levels over 24 hours.
• Bypasses the effects of the liver during absorption – more efficient absorption.
• Convenient and can be easily used at home.
• Can be stopped anytime.
• Testosterone gel is rapidly absorbed allowing the benefits of the treatment to be experienced more quickly.
• Your doctor can adjust the dose to achieve the most optimal testosterone level; the treatment and its effects can also be stopped at any time, should you need to discontinue therapy.
• Needs to be applied on hairless parts of the body e.g upper chest, back of hands
• Daily application ( some men may find it troublesome)
• Hands need to be thoroughly washed after application and skin contact of gel application areas with females and children should be avoided 4 hours after the application of the gel.  

Nebido - Testosterone Undecanoate for Intra-muscular injection for testosterone replacement

Nebido - the cost-effective, safe and convenient way of Testosterone Replacement

Testosterone Injections

How it is used
Injected into the muscle ( usually the buttock muscle)

• Patient may experience pain at the injection site.
• Traditional preparations ( that require injections every 2 weeks) cause testosterone to reach very high levels initially, then falls below normal levels at the end of an injection cycle.
• Newer preparations (like 3 monthly Nebido) avoid the highs and the lows of testosterone levels.
• They are unable to be stopped immediately once injected. However, Nebido injections are unlikely to cause major side effects that would warrant immediate cessation of treatment.

Testosterone tablets

How it is used
Oral intake

• While taking pills can be convenient, testosterone pills are associated with inconsistent effectiveness.
• The pills have to be taken multiple times daily, on a regular basis.

I usually prefer Nebido or Androgel

What are the risks of testosterone replacement?

  • In a study of Testosterone Replacement Therapy (TRT) in men with Testosterone Deficiency Syndrome (TDS), Prostate Specific Antigen (PSA) in men on TRT did not differ significantly from that in men treated with placebo. Meta-analysis of 19 controlled TRT studies also revealed no greater proportion of adverse prostate outcomes (such as increased PSA and prostate cancer development). This shows that testosterone replacement does not cause prostate problems. However, Digital Rectal Examination and PSA levels are still performed and monitored periodically to detect any prostate tumors.
  • There is no evidence that TRT will result in enlargement of the prostate gland.
  • Polycythaemia, a thickening of the blood, may occur while on testosterone therapy. This is because testosterone stimulates the formation of red blood cells. Periodic assessment of haematocrit is necessary. It is advisable to keep haematocrit below 52%.

What improvements do I expect from Testosterone Replacement Therapy?

happy handsome mature man full of confidence and smiling

You can smile like him again with Testosterone Replacement Therapy

Studies have shown that boosting testosterone levels can:
  • Enhance libido
  • Improve energy, mood and sense of well-being
  • Increase muscle mass and reduce fat, while improving muscular strength and bone strength
  • May improve blood sugar control in diabetics, and with continued exercise and diet control, weight loss

  The goal of testosterone therapy is to restore your testosterone levels to a normal range, as well as alleviate the symptoms associated with low testosterone, such as reduced sexual desire, mood swings, fatigue, poorer muscle and bone composition.

  While results vary from individual to individual, most likely, you will experience an improvement in your drive and energy levels, enhancing your sense of well-being. You may be cured of Erectile Dysfunction. There could be increased muscle mass and a reduction in body fat. Diabetics may experience better blood sugar control.   With continued exercise and diet control, you can also look forward to more weight loss.

Getting started is easy

It is normal to have decreasing testosterone levels as men age. However, if your lifestyle and sex life are affected due to this hypogonadism, then it's high time to consider Testosterone Replacement Therapy.

Visit Dr Israr Wong today for a detailed consultation and be the happy, virile and strong man that you once were.

To begin your journey to a better and stronger 'manhood', it is as easy as this:
(1) Fill up this contact form
(2) Give us a call at +65 97309399
(3) Send an email to questions@knightsbridgeclinic.sg

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