Episode 62: Expat Health: The Overlooked Change: Male Hormones and Aging Part II

Rachel: [00:00:00] Welcome back Truly Expat listeners. , we have part two. Of andropause and how men should deal with it by our exciting Singapore doctor, , Dr. Caroline Lowe. She's really fantastic. If you need advice or if you are struggling with things, you can definitely Just,, look her up in the show notes, so we'll have all of her contact details. But let's listen to the rest of the interview. It's been a really good, interesting one. I know most of our listeners are around about our age and just like wondering what the hell's going on in their, in their lives sometimes. With all these hormones bouncing around. So, yeah, it's fantastic.

Rachel: Enjoy the rest of the interview. Thanks. Bye.

Caroline: Get four girls coming together and what do you talk about?

Caroline: You talk about Vaginitis. You talk about low sex drive and you go, Oh God, you know, I hope he doesn't sleeping. You get four guys coming together. You think they're going to say, you know, I think my erection is not [00:01:00] great. I don't even have, and the sexual libido drops. 

Paula: Yeah. They're never going to, that's, I mean, I think from a very early age, they're taught not to talk about things like that.

Paula: So, you know, and it must scare them. That's probably why they get depressed because they'll be feelings and things they've never had before. 

Rachel: Yeah. Okay. How can, how can couples turn it around? Do you think 

Paula: number 

Caroline: one, they have got to understand what is happening to their body. 

Paula: So they 

Caroline: need somebody who is very well versed.

Caroline: in hormonal knowledge, talk to them like they would almost like a 

Paula: counsellor. 

Caroline: Not I doctor, you patient. No. It's to basically let them know what can be expected, why they are undergoing certain, the way they feel. And it is normal. It is normal. There is nothing wrong with that. Eight billion people in the world.

Caroline: Four billion of men, four billion of women. You're going to [00:02:00] get different combinations of symptoms. Everybody's different, but the main thing to recognize is it is a journey that is going to be undertaken by a couple together. And, uh, and, and, and therefore, if they have somebody that will be able to guide them, I, I, I call myself the tour guide of your longevity journey.

Paula: I like that. 

Caroline: Yeah. I'm a tour guide of your longevity journey. The journey is yours, but I can give, you know, and you know, like a tour guide, they give you the best places to go and eat and then you don't get cheated here. You think of that. So, so I'm only, but a guide to tell you what to expect, what can be done, what you can do for both of yourself.

Caroline: And I think the word is, if you know what's happening, you become a bit more tolerant.

Paula: I'm just, I'm also just wondering that the next generation, you know, the [00:03:00] next generation seemed to be a little bit more in tuned with their, um, 

Caroline: themselves, the young, the young population gen Z, A, B, C, they seem to be, um, a lot more vocal about how they feel men and women. 

Paula: Yeah, so I wonder if when they go through it, it won't be such a big hit and that we've paved the way kind of thing for them.

Paula: Correct, 

Caroline: correct. 

Caroline: And especially 

Caroline: now that, you know, hormone seems to be like the hot topic in the last 10, 15 years and moving on. Um, even the Even the mainstream news is talking about menopause now. It was a taboo word to use for many, many years. 

Rachel: Yeah, sure. Yeah. Yeah. And it was, and it was, there was the big thing about taking HRT and how it affected breast cancer and all that sort of thing.

Rachel: Doctors stopped prescribing, but they didn't, um, not you, obviously, but some just didn't get past that. Yeah. 

Caroline: So it's, um, the American journal, uh, the [00:04:00] JAMA, Journal of American Medicine, sorry, Journal of American Medical Association came up with, um, a study. It's the largest study ever done. They did it on a hundred thousand women retrospective study over 20 years.

Caroline: And now they come up with a couple of statements. One is HRT. Or body identical, identical HRT does not cause breast cancer. It does not cause, but if you've got microscopic cancer cells, it will accelerate. You need to know the difference in that statement. 

Rachel: Yeah. 

Caroline: So if you're, 

Rachel: if you're, if you're susceptible to cancer, it will.

Caroline: And that's why you must get your boobies checked before you start an HRT. 

Paula: Is it true, like a friend of mine is going through chemo at the moment and she, she was saying that, um, she's now got symptoms again of, like she had gone through it and now she's going through it again because of [00:05:00] the chemo? 

Caroline: The chemo drugs, yes, like Tamoxifen.

Caroline: It's, it's basically, it's a chemical. menopausal agent. Oh, okay. So your symptoms are doubled usually. 

Paula: How terrible. And it's generally, it's usually people my age that seem to have breast cancer and stuff too, right? Yes. 

Caroline: Can men 

Rachel: get breast cancer? 

Caroline: Yes, 1 in 200 of breast cancer is from a man. 

Rachel: Oh, wow. 

Caroline: Yeah, 

Rachel: it's quite a lot.

Rachel: Well, so, and people like that, it's 

Caroline: very likely, it's very likely they are fairly obese and they have got high genetic aromatization, which means all their testosterone becomes estrogen. Don't forget, breast tissue has got estrogen receptor and that's the one we're talking about. 

Paula: Yeah. 

Caroline: Same as a man. 

Paula: Yeah.

Caroline: He's got breast tissue. I mean, breast tissue, you've got estrogen receptor. Same thing. Hmm. And, um, and, and the thing about, you know, going on testosterone therapy, [00:06:00] um, the funny thing about testosterone therapy is it's difficult to convince a man to start, but once he starts, He will never want to get off it.

Caroline: Oh, really? Because he feels young again. He feels sexual again. He feels like he can play tennis like he could five years ago, eight years ago. 

Paula: Is it instant? No, it takes 

Caroline: up to a year. 

Paula: Oh, wow. Up to a year. 

Caroline: Yes. Up to, up to a year. But most people, a couple of, you know, most people after six weeks to two months, you will have some kind of appreciation.

Caroline: But the appreciation increases as the months go by. 

Paula: Oh, that's good to know. 

Caroline: Yeah, that's really interesting. And, and, um, there are many sort of options for TRT, Testosterone Replacement Therapy. Oral is one of them, which is very unpopular. because oral tablets for [00:07:00] testosterone increases fatty liver, cause the liver to be not great.

Caroline: So we tend not to give oral. We tend to either give injectable where you bypass the gut and therefore bypass the liver, or we give them transdermal, which is cream application. So I noticed from years of practice that different ethnic group has got different culture about different ways of treatment.

Paula: Really? 

Caroline: Yes. I find that Caucasians are not bad with the cream, the daily testosterone cream. They're quite good. You give it to an Asian man, after three days he'll stop applying. So yes, and, and therefore Asian men, I tend to tell them the options. I will put injectables first, followed by cream. 

Rachel: How often do you have to do the injectable?

Caroline: You get the short acting [00:08:00] injectable, you get the long acting injectable, obviously injectable means pain, right? So a lot of men would opt for the long acting injectable, which is four times a year, every every 12 weeks. 

Caroline: Oh, but that seems a lot easier to manage than remembering the cream to be honest, no matter what, what, what ratio.

Caroline: That's very true. 

Caroline: But whatever it is, you know, all replacement therapy needs to have a program. You need to get your baseline done for a man would be the ultrasound of the prostate and a prostate cancer marker for a woman is a mammogram and breast ultrasound. So you, you, you have got to get your base done and then you have to be followed up on an annual basis, repeat the prostate cancer marker once a year, repeat the ultrasound of the prostate once a year.

Caroline: The first year you may need to repeat your prostate cancer marker twice a year. Then you move on to once a year and things like that. 

Paula: At what age? 

Caroline: They need testosterone therapy, [00:09:00] remember, it starts from the age of 42 up to 60, essentially, before you flat out. 

Paula: Okay. 

Caroline: And, uh, and, and also you'll find that when they are on testosterone therapy, their cholesterol, easier to manage, their sugar, insulin, especially the insulin drops.

Caroline: And therefore the, the fat collection drops. So these are the little things, you know, from the medical point of view gets better. 

Paula: It's also a very good marketing tool to tell our husbands. The 

Caroline: only thing I've got to, I do tell all my, my male patients is that the last to come back Erection. Mm-hmm . They can take up to a year for the erection to come back or, or come back satisfactory.

Caroline: Mm-hmm . So usually when we give the injectable or the cream, I will also add the blue pill. 

Paula: Oh, that, that was my next question. Can you take that more add because 

Caroline: it works differently. [00:10:00] The blue pill increases the vascular supply. 

Paula: Okay. 

Caroline: It does not change the musculature of why you get erection from the hormones.

Paula: Got you. 

Caroline: Okay, it just, it just unclog all the traffic jam. Yeah. Yep. So the first year they may need help with the blue pill. Hopefully by the second year when everything, you know, when the levels are all much higher, spontaneous erection comes a bit easier. 

Rachel: So 

Paula: interesting. 

Rachel: That's interesting. And would you recommend doing the testosterone before?

Rachel: I always get my guys 

Caroline: It's always good to do a baseline hormone when you turn 40. 

Paula: Yeah. 

Caroline: It doesn't mean you need to do anything about it. You know, when you're 38, 40 is when you're kind of at your best in terms of energy, career, um, drive, uh, motivation. You are pretty much at your peak because after that it starts to fall.

Caroline: So, so. [00:11:00] Between 38 and 42 is when you should try to get all the hormonal baseline. I'm not just talking about your male or female hormones. I'm talking about your thyroid, your growth hormone, your sleep hormone, everything. All the hormones, the adrenal hormones. Get them all down so you get a baseline. Then you keep that number because you remember that it's at your best, you keep the number so that when I see you two years, four years, six years later, I know that I need to go back to that number in order for you to appreciate what you used to appreciate.

Caroline: Because I treat you, I don't treat numbers, numbers per se. Your number that you like may be very different from your twin brother or sister. 

Paula: And is that something you do? Like if someone, yeah. Okay. Yeah. Mm. Yeah, because I guess I guess men wouldn't know most of the time won't know where to go who to go.

Paula: Yeah, right 

Caroline: Yeah, yeah But the main thing is to treat them like you would any [00:12:00] other patient because a lot of doctors I'm not sure if it's an Asian culture or mainly in the world. They seem to Not want to talk about erection, sexuality, it seems to be almost, and even for the medical profession themselves, it seems to be like, skim it.

Paula: Yeah. Yeah. 

Caroline: You know, we always are, the question that we ask, you have to ask as a matter of factly, and you got to treat the patient as a patient. And you say it as a matter of factly, you know, is the erection 50%, 75%, how long do you last? All that is, this is, this gives me a picture of where your hormones are.

Paula: Yeah. 

Caroline: The funny thing about a guy, a man who comes to see me, usually drag in by the wife, usually, and then, you know, denies everything. Then after the second concert, they start to admit a little bit. And usually six months down the line, they tell me everything and I go, okay, you don't not need to tell me,

Caroline: but [00:13:00] it is, they must not see. the doctor as a man or a woman. They must see the doctor as a profession that is there to give them proper education and knowledge. Then they can then decide. I always tell my patients, I give you all this knowledge. I give you all this education. You decide for yourself which works best for you.

Paula: Yeah. 

Rachel: Yeah. Yeah. Make an educated decision rather than just being told what to do. Correct. Remember, I'm a 

Caroline: tour guide. I can give you three different restaurants. You have to decide which restaurant you want to go to. Is 

Paula: it best for them to come to you on their own or with their partner? 

Caroline: Oh, no. Uh, for things like that, I usually get the wife to sit outside, please.

Caroline: It's, it's, it's, it's bad enough for him to come in to tell me about, you know, the morning erection not happening and, uh, and then get, uh, an erection and they immediately drop. That's the most common complaint. So having a wife behind, sitting behind them, no, no, that's not going to work. 

Paula: Okay. 

Caroline: I like to talk to them on a [00:14:00] one to one basis.

Rachel: Yeah. No, that's, I mean, that's good to know, especially for privacy. 'cause those things can really hurt. Hurt, you know? Yeah. And don't forget, a man is a man, and a man will always be a 

Caroline: man. And, and, and he's the one that's supposedly bringing the bacon home. It's, um, it's, you know, telling, admitting to somebody sensitive, falling, become more of a woman.

Caroline: It's to a lot of men, it's almost like a failure. 

Paula: Yeah. 

Caroline: Oh. But it is not. It is not. It is a reality in life. It's not. It's not. That's why I keep stressing. Yeah. There is nothing wrong. There's nothing wrong with a person. It is a fact in life. 

Paula: Do things trigger it? Like stress? 

Caroline: Well, that's why I said if you are a vegetarian, they were definitely asking for it.

Paula: Yeah. 

Caroline: And if you are a plastic man, you are definitely asking for it. So there's few things that you can do. And of course, stress reduces when you are. very stressed out, especially with work, then you are overusing, you're burning [00:15:00] candles from both ends, which means your hormones is being used up a lot faster than what your organ is prepared to produce.

Caroline: And that's the same from head to toe, growth hormone, sleep hormone, adrenal hormones, thyroid hormones, male hormones, female hormones, 

Paula: and, and lack of sleep, 

Caroline: lack of sleep, sleep is your detoxification part of your 24 hour. If you don't sleep, you do not detoxify, you do not clean. Like I said, it's like, it's like you own a factory that makes food.

Caroline: 12 midnight to 6 o'clock in the morning, you get a third shift that comes in to clean up the factory. Because 6 o'clock in the morning, if that factory is not clean, then the machine is going to be dirty, and you're making food from a last night's machine. 

Paula: Yeah, I like 

Caroline: that. If you don't sleep analogy. 

Paula: Yeah.

Caroline: Yeah. I like that analogy. Yeah. Yeah. So if you don't sleep and if you sleep after 2:00 AM you haven't slept [00:16:00] because between 12 and two is when the growth hormone is produced. Mm-hmm . And growth hormone is your detox. Fire is a cleans. It gets you prepared for the next day. So people who sit up and watch Korean drama up to 2 o'clock in the morning, God save you in the long run.

Rachel: You know, you know what, my, my grandmother used to say that to us, she used to say that any sleep that you got after 12 o'clock doesn't count, is why you need to go to bed early. Yep. It's an old saying. 

Caroline: Yeah, correct. 

Rachel: It's a very old saying. It was born 

Caroline: in the 

Rachel: 30s. So, you 

Caroline: know. Correct. And unfortunately with social media, I know we sleep with our phone next to us.

Caroline: We thought you don't get any sleep. We must put it 10 feet away. Put it next room. 

Paula: Mm. Yeah. I mean, all the, I, I hear so many studies about having phones in the Just sleep. Yeah. 

Caroline: You know, we eat what, what that course We under sleep. [00:17:00] Yeah. We over eat, we undersleep and, um, our social media has taken over our stress level and therefore our longevity is there.

Caroline: But our qualitative span. It's zero. 

Paula: Yeah. It's zero. Because I even know if I'm on social media too much during the week, not only do I get more anxious, but I also, my memory, I can't concentrate. 

Caroline: Yep. You don't have dimensional, there's no conversation. 

Paula: Yeah. It's that doom scrolling, right? That's a whole different ecosystem.

Paula: Oh, that's a different, 

Caroline: totally different. Yeah. Yeah. Yeah. Remember, the, the, the thing with the world today is we overeat. And we eat, we eat genetically modified food, which again is a double whammy. We under sleep or we sleep badly, we sleep wrong timing. And we don't actually get to stop because of social media, because of our phone.

Caroline: We don't get to stop. Even texting your friends, they're not stopping, [00:18:00] we're not stopping. So you have got to take the phone away. And that's the only way you can meditate. You do not need to, you know, meditate like, um. No, you need to meditate by taking everything away. Shutting down, shutting down, shutting down, early to bed, early to rise makes a man healthy, wealthy and wise.

Paula: Oh, I like that. I thought you were going to say 

Caroline: something else. No, it's a very important thing. I started to say that. Early to bed, early to rise makes a man healthy, wealthy and wise. 

Paula: I'm a big believer in early rising. That 

Caroline: is really good. Yeah. Yeah. So at the end of all of this, at the end of all of this, you know, all this education, all this knowledge, but it comes back to basics.

Caroline: Yeah. 

Paula: Yeah. 

Caroline: It's just basics. That's so true. If we under eat, and if we sleep before 12, we're all good to go. 

Rachel: Yeah. Yeah. That's a good idea. That's good [00:19:00] advice. 

Paula: Yeah. Yeah. 

Rachel: Do you have anything else you can add for helping men get through this transitional period?

Caroline: I 

Rachel: think 

Caroline: a man, number one, needs to acknowledge this thing called andropause. or male menopause. Uh, that's the first thing. That's the first step. And then to acknowledge that what he's undergoing is part and parcel of aging. We do not want premature aging, but it is part of aging and there is help. There is help and there are options and there are options.

Caroline: So to acknowledge that, uh, he is male menopausing is the first step because once you acknowledge that. Then everything else that, you know, when the medical profession talks to you, it makes sense and you accept that knowledge. A lot of men who do not accept [00:20:00] that, no matter what you tell them, they're just going to walk out.

Caroline: And all they do is they just want the blue pill. 

Paula: Yeah. 

Caroline: That's in denial. But I think moving on, there are more and more people, there are more and more guys who seem to realize that, um, male menopause is a real thing. 

Rachel: Yeah. And they need to search for a balance. 

Caroline: Yes. So remember, the sleep, the eat, and the obesity, and, and, and your mental health all come together, and that will help you how to control your hormones.

Caroline: And your hormones is not just testosterone alone. 

Paula: Yeah. 

Caroline: Remember there's testosterone, there's the feminine side of you, which is the estrogen, and then there's the masculine side of you, which is the dihydrotestosterone. So it's just understanding that chemistry pathway, then you can help yourself. 

Paula: It's awesome.

Paula: It's good advice. Yeah. Is there anything else you'd like to, um, [00:21:00] leave us with besides, I mean, you've given us so much. I feel like I've gone to school and I've been educated on something I should have known 20 years ago. 

Caroline: No, but I, but I think the three things I said that is very important is number one, you have to acknowledge that it is part and parcel, andropause is real and it is part and parcel of aging.

Caroline: And, um, if you go and see somebody who is able to help you, I think all that is very good. Um, the blue pill is not the answer. I think that's very important to also note. Yeah. Just a quick fix. That's a quick fix. Yeah. Awesome. And, and yes, and, and I think, and I think from the spousal or the partner's point of view, the female partner's point of view to also know that, and of course, it's real.

Caroline: And therefore, Uh, tolerant. 

Paula: Yeah. We need to be more patient, right? Giving them a break. Because 

Caroline: don't forget, our estrogen has fallen. The only thing left is our testosterone. All we want to do, you know, we, we become more mad, we become more aggressive as we get older. [00:22:00] We become more aggressive. We, we, we don't bite our tongue anymore.

Caroline: We, it just comes right out. We, we show our irrit, we show our irritant. You know, you're irritable and you show it. So I think that has got to be pulled back a bit because a man now, as of the same age, will have more estrogen than you. So it's now the opposite. 

Paula: Yeah, all those years he had to put up with me, now I have to put up with him.

Paula: Yeah, 

Rachel: no, that is good advice because I do notice that I'm less patient. I used to let, let things just go and now I just kind of like, 

Paula: I don't 

Rachel: have the patience, which is. Yeah, you lose the empathy as you get older for a woman. 

Caroline: Yeah. 

Rachel: Yeah. 

Caroline: But it is, again, part and parcel of aging. Yeah. Nothing wrong with that.

Caroline: It's just recognizing it. 

Paula: Yeah. 

Rachel: Yeah. That's good advice. Yeah. It's fantastic. Well, [00:23:00] Caroline, we have We have your, uh, details and we will leave them in the show notes so that people can reach out to you directly. Thank you. Um, and yeah, and I love coming to you. You're my favorite, favorite person. No, I call them coffee 

Caroline: chats.

Rachel: Yeah. Like 

Caroline: this, coffee chats. I speak, this podcast is like. me talking to a patient. That's the way I speak. That's, that's, it's just giving you fact of life and facts. Then you, you decide how you want to deal with this. 

Paula: I love that. Yeah. Absolutely. 

Rachel: Yeah. Always a pleasure to talk to you. Okay. Yeah, it is. All right.

Rachel: Awesome. Thank you so much. Bye. I'm going to stop the 

Rachel: recording. [00:24:00]