Chris Mikesell, The Honolulu Star-Advertiser
Posted July 18, 2012
Women have long been told to expect hot flashes, osteoporosis, depression, an increase in body fat, difficulty concentrating, fatigue and reduced sex drive as they hit menopause, when their menstrual periods cease and their ovaries stop producing hormones.
But many men are unaware they may be experiencing some of the same symptoms for a similar reason: a natural and continuous decline in levels of the male hormone testosterone starting as early as in their mid-30s.
Low levels of testosterone, a condition known as male hypogonadism, is often overlooked because men ignore their symptoms or shrug them off as just part of the aging process.
"It's a progressive condition; it's not going to rebound on its own. A lot of men chalk it up to just getting old, and some think they can't do something about it," said Dr. Michael Dimitrion of the Hawaii Male Medical Clinic, which specializes in men's sexual health services, offering nonsurgical treatment for hypogonadism and erectile dysfunction.
Patient Mick Ferreira of Makakilo said he blamed his 60-pound weight gain, lack of energy and other ills on a sedentary lifestyle resulting from a back injury. After reconnecting with his former teenage sweetheart Mindy Olvera two years ago, the couple was considering marriage, but "problems in the bedroom" threatened their relationship, he said.
"I saw how it was affecting her as much as me," said Ferreira, 47, a retired real estate broker.
He sought help from Dimitrion's clinic at the Ala Moana Building, where tests revealed low levels of testosterone. Ferreira said his weekly hormone injections and sublingual tablets (placed under the tongue) boosted his confidence and energy levels, allowing him to become more active and more able to address some of his other health problems. In the process, he lost 35 pounds over the past five months.
"I'm physically more active, I'm happy and the sunshine comes up," he said, nodding toward Olvera.
Not all guys are as open about discussing that type of "problem," a reluctance Dimitrion witnessed during his 33 years as a primary-care physician.
"Men don't want to open up. You ask them how they're feeling and they'll say (erectile dysfunction) happens every now and then, but they don't give you the whole story," he said.
To ease the awkwardness, the clinic has an all-male staff, starting at the reception desk, and patients are whisked into private rooms when they arrive to avoid the embarrassment of sitting with other patients in the waiting area.
"This is a one-of-a-kind clinic. Once patients come here they say they should have come earlier," Dimitrion said.
Treatment for low testosterone includes prescription hormone cream, usually applied daily to the upper thighs; patches; injections; and tablets, all approved by the federal Food and Drug Administration.
Dimitrion said the clinic also focuses on restoring normal sexual function for men who are taking multiple medications or suffer from chronic illnesses such as diabetes, men "who may not have had sex for months or years."
His clinic partner is Dr. Charles Arakaki, who is experienced in hormone replacement therapy for women from four years in private practice as an obstetrician/gynecologist. Arakaki said it was an "easy transition" to work with men dealing with some of the same issues as his female patients in his former practice.
Like hormone replacement therapy for women, the same treatment for men generally is not covered by health insurance, meaning patients must pay out of pocket for ongoing treatment. For one of the clinic's patients, who declined to be identified for this article, that amounts to about $175 a month for hormone cream.
Although testosterone supplementation is an effective treatment for hypogonadism, it's not a panacea for all men's sexual problems, according to Dr. Tim Roytman, a urologist with offices at the Queen's and Kuakini medical centers. Urologists specialize in disorders of the urinary and male genital tracts.
Other causes of low testosterone levels include injury to the testicles, cancer treatment, inflammatory diseases, chronic illnesses, kidney failure, cirrhosis of the liver, alcoholism and even stress and lack of exercise and sleep.
Roytman said patients who are diagnosed with hypogonadism should be evaluated by a urologist or an endocrinologist for specific causes such as testicular failure or pituitary gland abnormalities. He also advises a prostate cancer risk assessment by a urologist before starting testosterone supplementation,
"Men who have prostate cancer shouldnot be on testosterone supplementation. Men who are at high risk for prostate cancer or had prostate cancer and are now cancer free should be informedofpotential risks and benefits of testosterone supplementation," he said in an email.
"Additionally, men should be followed closelyby aurologist for changes in the physical exam of their prostate and prostate-related blood work."
The Hawaii Male Medical Clinic is at 1441 Kapiolani Blvd., Suite 1902; call 529-0000 or visit www.hawaiimmc.com.
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