Does Male Menopause Exist?

Male Menopause – Andropause

In women, menopause is the time in the women’s life that menstruation and ovulation ends as a result of decreased hormone production. It is diagnosed after a lady has not had a menstrual period in 12 months. Menopause usually occurs in a lady when she hits her late 40s or 50s, but can vary from one female to another. However, this occurs for all females eventually.

The term “male menopause” or andropause refers to age-related declining testosterone levels. In contrast with menopause where all females will eventually experience, the drop in testosterone levels may not occur in all men. In fact, a 50 year-old man can have a higher level of testosterone than say a man in his 30s. Menopause also involves a complete shutdown of reproductive capability in females, but a man in his 70s can still father a child. While it is still possible for a female to get pregnant in her 70s, it is exceedingly rare. Because of these facts, some people doubt whether male menopause truly exists. 

However, there are a few things we know. Testosterone levels can vary greatly among men but in general, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. 

Other names for this condition are testosterone deficiency syndrome, androgen deficiency of the aging male and late-onset male hypogonadism.


What are the key signs and symptoms of andropause?

The signs and symptoms of andropause is because of a drop in testosterone levels in an aging male. 

A person with andropause may experience a decline in sexual function. This might include reduced libido or sexual desire, erectile dysfunction, fewer spontaneous erections both during the day and night, and infertility. 

Some physical changes may occur, including reduced muscle bulk and strength, increased body fat, and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Some may experience hot flashes. Others may report decreased energy levels. The testes might become smaller as well. 

Emotional changes may occur. Some examples include a decrease in motivation or self-confidence. Mood issues such as feeling sad or depressed may occur. Some may have cognitive issues such as trouble concentrating or remembering things. Some people may have difficulty sleeping as well. 


What are some of the aging-related hormone changes in men? Does this mean (the person) has andropause?

As mentioned above, the primary hormonal change in men is a decrease in testosterone levels. Other hormones such as growth hormone, prolactin and IGF-1 may decrease. Estradiol levels may decrease as well, but in some older males, due to increased fat mass, they may have increased estradiol levels which offsets the natural decline in estradiol levels. A hormone that tends to increase with age is the thyroid stimulating hormone (TSH). Gonadotrophin levels also tend to increase in response to dropping sex hormone levels. 

For the sake of this article, we would just be focusing on testosterone. As doctors, we do not just look at the testosterone level of the patient. We also take into account what symptoms the patient is presenting with. A gentleman may have a low testosterone level and not be bothered at all about it as it may not present with significant symptoms in him. In another gentleman, with a low-normal testosterone level may present with a whole barrage of symptoms that are affecting his life. In these 2 cases, we are more likely to diagnose and treat the second gentleman. 

It is important to note that decreased levels of testosterone may sometimes be attributed to other causes such as medications such as steroids or psychiatric medications, medical procedures such as chemo or radiotherapy, other medical conditions such as kidney conditions, tumours and hemochromatosis, inflammatory conditions such sarcoidosis, and histiocytosis, and chronic infections such as HIV and tuberculosis. Your doctor will run through your past medical history when evaluating your symptoms as well. 


Do I need treatment for andropause? 

Whether or not you need treatment for andropause depends on your symptoms, and to what degree your symptoms are affecting your work, relationships and life. 

Testosterone levels can be easily measured with a simple blood test. Other hormones and other blood tests are usually conducted at the same time. The best time to come for a blood test is in the morning when the testosterone levels are at its highest. No fasting is necessary for the blood test.

For men with truly low testosterone levels, testosterone replacement therapy (TRT) tends to result in the reversal of the symptoms mentioned above, improved quality of life and has health benefits as well.


What are the treatment options?

Lifestyle changes are always recommended for people presenting with andropause. Exercise and weight loss, stress reduction, adequate sleep and a healthy lifestyle and diet can sometimes raise your testosterone level marginally. 

In conjunction with that, we can do TRT as well, where we can replace testosterone through  pills, injections, patches or gels. The dose and frequency of delivery of testosterone varies from person to person. Doctors will usually do regular blood tests to look out for complications and to tailor the correct dose for you. 


What are the side effects and complications?

While people with true testosterone deficiency report marked improvement in symptoms, TRT is not without risk. TRT can contribute to sleep apnea, stimulate noncancerous growth of the prostate and stimulate growth of existing prostate cancer. Testosterone therapy may also increase the risk of heart attack and stroke and contributes to the formation of blood clots in the veins. It can also cause acne or other skin reactions, limit sperm production, cause testicle shrinkage and enlarge the breasts. It is therefore important to weigh the risks versus the benefits in starting TRT, and monitor for complications should any arise. 

While ageing is inevitable, andropause and its symptoms can be managed with improved quality of life as a result. Speak to your doctor to see if you do have the symptoms mentioned above and if your testosterone levels are truly low, to see if TRT is suitable for you. 


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Why you should not be embarrassed to get tested for HIV

Many people are still not getting regularly tested for HIV.

In my line of work as a Family Physician, I frequently assist patients in performing Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infection (STI) screening. I would like to share a story of a patient I recently treated. 

40-year-old Melvin (not his real name) came by one day for a clinic consultation. His friendly and cheerful demeanour was accompanied with a mild level of anxiety. He shared with me his background: he was a gay man, in a monogamous relationship with a long term partner. Like many people, he had had several previous partners – past relationships, and the occasional casual fling. However, he had never undergone any screening tests to evaluate his sexual health. The last time he had been tested for HIV was over 20 years ago, when he enlisted for National Service.

“The honest truth is I am embarrassed and also fearful of seeing a doctor to do these tests. In fact, it took me a lot of courage to come to visit you today!”, said Melvin rather sheepishly.

“I have always had this avoidance mentality towards HIV. I felt that I would rather not get tested, and just live my life more peacefully. And really, what are the chances? I have always used condoms and compared to other people, I don’t think I have had many sex partners in my life,” he added.

He lets on further that it was after a lot of encouragement from his partner that he decided to bite the bullet and visit a clinic.

The news came as a complete shock to him – he had unfortunately tested positive for HIV. It took some time for him to come to terms with the result, and the fact that his life was never going to be exactly the same again. The silver lining was that Melvin was still in the early stages of the infection. He has since promptly started on treatment and is doing regular follow-up monitoring of his condition. The good news is that by doing so, he will likely be able to keep the virus in check and thus maintain a healthy immune system. 

Melvin’s case highlights a perennial problem in mankind’s fight against HIV. Despite continuous  efforts by health organisations to educate the public on HIV and increase awareness on the importance of regular screening, many people are still not getting regularly tested for HIV. It is estimated that 15% (1 in 7) of people in the United States are presently living with HIV and unaware that they have the infection. In an update on the HIV situation in Singapore earlier this year, the Ministry of Health (MOH) stated that only 14% of newly reported HIV cases in 2018 were detected by self-initiated, or voluntary, screening.


Common reasons that deter people from getting tested for HIV

1. I am scared of getting tested positive for HIV

Fear and anxiety are probably the biggest reasons why people avoid getting tested. The truth is, living in the unknown is worse and often scarier. It is far better to get the testing over and done with. If it is negative, it will bring much relief. If unfortunately the result is positive, all is not lost. Knowing your status early is the first step to getting support and receiving treatment in order to stay healthy. 

2. If I test positive for HIV, people will find out

Medical clinics and testing centres endeavour to keep all patient records strictly confidential. Under the Infectious Diseases Act in Singapore, a positive test for HIV is notifiable to the Ministry of Health (MOH). This is mainly for public health purposes, such as disease surveillance, monitoring the HIV infection situation, conducting contact tracing and assessing disease prevention and management measures. Healthcare professionals and MOH do not inform the patient’s employer, insurance provider and certainly not family and loved ones.

3. I am afraid of being judged or being embarrassed 

Healthcare professionals are trained to provide professional and non-judgmental consultation. If you do not wish to visit your regular doctor, take some time to do a search online as there are plenty of alternative options that you can consider. It is important to find a sexual health clinic or testing centre that you feel comfortable with. 

4. I trust my partner

If two HIV-negative people are in a monogamous relationship, then certainly there is no risk of HIV, but we are all human and no one is perfect. If one member slips up outside of the relationship, then both parties could be at risk of HIV, especially if engaging in unprotected sex. It is important to have open and honest communication with your partner. If you or your partner has had sex with any casual partner, or if there is any doubt about your HIV status, then do get tested.

5. I am not at risk of HIV

Even if you think that there is no chance that you have been exposed to HIV, as long as you are sexually active, it is recommended to do HIV testing at least once a year, or more frequently if your behaviour puts you at higher risk.

6. Who should test for HIV?

It is recommended by the United States Centre for Disease Control and Prevention (CDC) that everyone between the ages of 13 to 64 should undergo HIV testing at least once as part of routine health care. However, if your behaviour still puts you at risk even after getting tested, you should consider getting tested again at some point later on. People who engage in higher risk activity should get tested regularly.

Also read: HIV SYMPTOMS – WHAT YOU NEED TO KNOW


If you answer ‘yes’ to any of the questions below, you should get an HIV test if not done recently:

  • Are you a man who has had sex with another man?
  • Have you had sex – anal or vaginal – with an HIV-positive partner?
  • Have you had more than one sex partner?
  • Have you injected drugs and shared needles or works (for example, water or cotton) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with, or sought treatment for, another sexually transmitted disease?
  • Have you been diagnosed with or treated for hepatitis or tuberculosis?
  • Have you had sex with someone who could answer “yes” to any of the above questions or someone whose sexual history you don’t know?

What are some of the HIV tests available?

There are three types of HIV tests available. 

1. Nucleic Acid Test (NAT) 

Also known as an HIV viral load test, this test looks for the actual virus in the blood. If the result is positive, the test will also show the amount of virus present in the blood. NAT is very expensive and thus not routinely used to screen individuals unless they recently had a high-risk or possible exposure and there are early symptoms of HIV infection. NAT is usually considered accurate during the early stages of infection. However, it is best to get an antibody or antigen/antibody test at the same time to help in the interpretation of a negative NAT result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of NAT. (All our clinics provide HIV PrEP & PEP services.)

A NAT is able to detect HIV in the blood as early as 1 to 4 weeks (7 to 28 days) after infection.

2. Antigen/antibody test

Also known as a fourth-generation or combination test, this test looks for both HIV antibodies and antigens. Antibodies are produced by the immune system when one is exposed to bacteria or viruses like HIV. Antigens are foreign substances that cause the immune system to activate. In early HIV infection, an antigen called p24 is produced even before antibodies develop.

The fourth generation test is able to detect HIV in the blood 2 to 6 weeks (13 to 42 days) after infection, and is most accurate after a 28-day window period.

3. Antibody test

This is also known as a third-generation test. As mentioned before, antibodies are produced by the immune system upon exposure to bacteria or viruses like HIV. 

The antibody test is able to detect HIV in the blood in approximately 97% of people within 3 to 12 weeks (21 to 84 days) of infection. If a positive HIV result is obtained from any type of antibody test, a follow up test is required to confirm the result. 


What does the test involve?

In the clinic setting, all the tests are typically performed using blood samples. Laboratory testing can be performed for all three types of HIV tests, whereby blood is drawn from a vein and collected in a tube. Rapid testing is available for only the fourth-generation test and the antibody test, whereby a few drops of blood are obtained via finger prick, and the results are ready in 20 minutes. 

The rapid HIV antibody test can also be performed using oral fluids collected from the mouth and gums with a swab stick. Similarly, the results are ready in 20 minutes. This option is available in some clinics and community testing programs, such as Action for AIDS (AFA) Singapore. 

HIV Screening Singapore

Regardless of the test you choose, the process is simple and fuss-free, and no prior preparation is required – all you need to do is show up at the clinic. Pre and post-test counselling is always conducted professionally and non-judgmentally. 

Despite all this, there are many who still feel extremely self-cautious about approaching a doctor to discuss HIV testing, for fear of stigma and discrimination. This is where Anonymous HIV Test (AHT) comes in. AHT is offered as a means to encourage more individuals who suspect they might be at higher risk to step forward to do testing. There are only 10 clinics in Singapore that are licensed to offer AHT. AHT does not require any name, contact number or form of identification. Instead, a number is usually assigned to the patient for the purposes of providing the result later on. The patient is then required to fill up an anonymous questionnaire to provide some information on his/her sexual behaviour. When seeing the healthcare provider, he/she may be asked some further questions before undergoing the test. AHT is performed using rapid testing only. The entire process throughout is kept confidential and strictly anonymous, even if the test result is positive.  

Anonymous HIV Testing is available in our Robertson Walk Branch only.


What happens after the test?

If your healthcare provider uses a fourth-generation antigen/antibody test, you should get tested again 45 days after your most recent exposure. For other tests, you should test again at least 90 days after your most recent exposure to tell for sure if you have HIV.

If your last HIV test was negative, you can only be sure you are still negative if you have not had a potential HIV exposure since then. If you are sexually active, continue to take actions to prevent HIV, like using condoms the right way every time you have sex and taking PrEP if you are at high risk.

Please get tested if you have not done so recently!

The worst part about the prospect of HIV and/or AIDS is living in the unknown. Do not avoid getting tested simply out of fear. Understanding your health and having a solid plan to stay on top of it – regardless if you are HIV-positive or negative – is the best way to live a long and healthy life.

Next read: HIV WINDOW PERIOD – TIMELINES FOR ACCURATE HIV TESTING


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Do Men Get Yeast Infections? (Candidiasis)

Yeast infections in men are among the most prevalent medical conditions that we see at DTAP clinic. Also known as Candidiasis, this is a fungal infection caused by the Candida species, most common of which is Candida Albicans

Candida normally lives on the skin and inside the body, such as the mouth, gut, and vagina, without causing any problems. However, it can cause infections if it grows out of control or if it migrates deep within the body, for example the bloodstream or internal organs.

Although vaginal yeast infections are more common, men can get yeast infections too. This is known as Candida Balanitis. Also Read Balanitis.

Balanitis affects as many as 1 in every 25 boys and 1 in every 30 uncircumcised males, and it can happen at any age. According to a report published in the journal Clinical Microbiology Reviews, Candida yeasts are responsible for 30 to 35 percent of all cases of balanitis.


Did You Know Balanitis is Frequently Associated with Men Living with Type 2 Diabetes
Find our more

What are the Symptoms of Yeast Infection in Men?

Symptoms of Candida Balanitis include:

  • Burning and itching around the head of the penis, which worsens after having sex
  • Redness and swelling
  • Tight, shiny skin on the head of the penis
  • Pain during urination or sexual intercourse
  • A thick, lumpy discharge under the foreskin
  • An unpleasant odour 
  • Difficulty retracting the foreskin

More severe symptoms include ulceration of the penis and fissuring or cracking of the foreskin.

Complications are rare, but in the worst cases of recurrent balanitis, on top of all the symptoms mentioned before, individuals may also develop urethral strictures causing difficult urination, and inability to retract the foreskin. This is termed Balanitis Xerotica Obliterans (BXO).


Who is at Risk for Candidiasis?

The risk factors for Candida Balanitis include:

  • Being uncircumcised
  • Phimosis, or tight foreskin
  • Usage or prolonged usage of antibiotics, which eliminate the good bacterial flora that normally exist on the surface of the penis and keeps Candida in check
  • Diabetes
  • Medical conditions that cause impairment of the immune system, particularly Human Immunodeficiency Virus (HIV)
  • Usage or prolonged usage of corticosteroids
  • Obesity
  • Poor hygiene practices

Causes of Yeast Infection in men

In uncircumcised men, the foreskin covers the head of the penis most of the time, creating a warm and moist environment beneath the foreskin. This is an ideal condition for Candida colonisation. 

Furthermore, poor hygiene practices allow a gradual buildup of dead skin cells, remnant urine and soap particles to get trapped beneath the foreskin that will result yeast infection in men.

On the other hand, overzealous washing with perfumed shower gels or soaps may also cause skin irritation. Another potential contributing factor is when a man has sexual intercourse with someone who has a yeast infection in men.

All these could lead to Candida overgrowth resulting in Candida Balanitis.


Is It a Sexually Transmitted Infection (STI)?

Although Candida Balanitis can occur as a result of sexual intercourse, it is not considered as an STI because men can get the infection without having sex.

Prevention of Yeast Infection in Men

Practising good hygiene is essential. The following are some hygiene tips:

  • Fully retract the foreskin if possible, and wash under the foreskin and around the head of the penis daily using warm water
  • It is not advisable to use soap as it may irritate the skin. Instead, a neutral soap-free cleanser can be used
  • Dry the head of the penis gently after washing
  • When passing urine, retract the foreskin so that urine does not get under the foreskin. After passing urine, dry the end of the penis before repositioning the foreskin
  • Wash and dry the penis after sexual intercourse and masturbation

Men with diabetes can reduce their risk of balanitis by carefully controlling their blood sugar.

Treatment Options for Yeast Infection in Men

Candida Balanitis can be easily treated with antifungal drugs called azoles. Your doctor may prescribe you either a course of oral or topical medications or both. If there is marked inflammation or itching, your doctor may prescribe an antifungal ointment that also contains hydrocortisone, which is a mild steroid. If concomitant bacterial infection is present, antibiotics may be prescribed as well.

If an individual and his partner both have symptoms of yeast infection, it is important that both receive treatment in order to avoid reinfection.
The long term solution is to undergo a circumcision. This procedure removes the foreskin completely and exposes the head of the penis, thus eliminating the risk of future Candida overgrowth. Circumcision is especially advised in cases of recurrent balanitis to prevent the development of BXO.

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Diabetes in Men & 5 Associated Men’s Health Conditions

By 2030, the number of Singapore residents above 40 with diabetes is projected to increase by another 200,000 from about 400,000 today. 

The prevalence of diabetes among adults increased from 8.2% in 2004 to 11.3% in 2010. A higher proportion of men were diabetic (12.3%) compared with women (10.4%). We can imagine how the number would have increased even more by today.

For men living with type 2 diabetes, they are also at higher risk for certain conditions as compared to other men. In this article I will share more about unique mens health issues faced by men with type 2 diabetes.


1. Erectile Dysfunction (ED)

According to a study published in Journal of Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, men with diabetes are much more likely to experience Erectile Dysfunction than men who don’t have diabetes. High blood glucose causes damage to small blood vessels and/or  nerves like the ones that supply the penis. Hence poorly controlled diabetes contributes to Erectile Dsyfunction.

Other than sugar control, there are also some diabetic medicines that causes side effects like ED which adds on to the problem.

Other than diabetes, these men are usually also obese and suffering from hypertension, both of which also adds on to the risk for ED.


2. Urinary Tract Infection: 

Urinary Tract Infection (UTI) is usually caused by bacteria. It can affect any part of the urinary tract. Anywhere including the kidneys, bladder, ureters, urethra, and, in men, the prostate gland. Most of the time the infection is in the bladder. Women are 10 times more likely to get a UTI as compared to men. However men with diabetes are at a higher risk of getting UTIs than men without diabetes.

Why are men with diabetes more prone to UTIs? There are a few possible reasons. One, men with diabetes have poor circulation. This reduces the ability of white blood cells to travel in the body and fight off any kind of infection. Two, high glucose levels can also raise the risk of a UTI. Three, some men with diabetes have poor ability to empty their bladders. What happens is, urine stays in the bladder for too long and this becomes conducive for bacteria to grow.


3. Balanitis

Balanitis is an infection of the skin on the head (glans) of the penis. In uncircumcised men, this area is covered by the foreskin, or prepuce. Balanitis can occur in both circumcised and uncircumcised men, however, uncircumcised men are at higher risk for balanitis and also recurrent infections.  

Any man can develop balanitis, but the condition is most likely to occur in men who have phimosis (tight foreskin) or poor hygiene. Other than this group of men, men with diabetes are also at high risk of balanitis especially if they have poor sugar control. When sugar is poorly controlled, excess sugar may be exreted in the urine. This sugar rich urine when trapped underneath the foreskin, will provide a conducive environment for yeast and bacteria. On top of that, men with poorly controlled diabetes is also unable to fight of infections effectively. Read: What are the Causes of Balanitis


4. Posthitis

Posthitis is inflammation of the foreskin It is characterized by swelling or redness of the foreskin. In some cases, it may happen together with tears on the foreskin which may be quite painful. It is usually caused by an infection like fungus or bacteria. In some cases, it might be due to tears in the skin due to abrasion or friction during intercourse. The selling may lead to phimosis and tightness of the foreskin which makes it difficult for the skin to retract. 

Circumcision is usually a definite treatment for men who has recurrent balanitis posthitis or UTI. It is a very effective treatment to reduce the risk of UTIs, balanitis and also there won’t be anymore posthitis when the foreskin is removed.


5. Low Testosterone

 In the past few years, scientists have found some connection between low testosterone and diabetes. One study showed that in 2,100 men over age 45, the odds of having low testosterone were 2.1 times higher in men with diabetes. Low testosterone doesn’t cause diabetes but it might be the other way around. Men with diabetes might develop low testosterone. Read Andropause

A link between diabetes and low testosterone is well established. Men with diabetes are more likely to have low testosterone while men with low testosterone are more likely to develop diabetes as well. Testosterone improves the body’s ability to take up sugae in response to insulin. Men with low testosterone may have insulin resistance. In this condition, their body need to produce more insulin in order to reduce the same amount of sugar in the blood.

Read: Low Testosterne & Low Libido


All in All

So if you happen to be diagnosed with type 2 diabetes, do keep a look out for some of the issues mentioned above. If you happen to have any of the above conditions, do consider health screening as any of the condtions might be an indication of diabetes. Do consult your doctor if you are experiencing any of the above symptoms and conditions.


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Erectile Dysfunction (ED) Singapore – In a Nutshell

In this video, we are going to talk about a topic that some people may find embarrassing – Erectile Dysfunction or ED for short.

ED is a very common condition. In one study, more than 50% of men in Singapore reported some form of ED. The prevalence increased from 43% in their forties s to almost 80% for men in their sixties. 1 

Aside from affecting your quality of life and relationships2, ED is also an important marker for general health. ED could be the first sign of a chronic disease like Diabetes, High Blood Pressure and High Cholesterol.2,3

Not being able to achieve an erection at all is considered severe ED. Milder forms of ED include not being able to sustain an erection and also not being as firm or hard as you used to be. 4

When you see a Doctor for ED, he will first ask you a detailed medical history and conduct a physical examination.5 He may also need to conduct some tests to find out if there is a medical problem causing your ED. 5

Nowadays, there are many effective treatments for ED. Tablets called PDE5Is are safe, convenient, painless and effective for treating ED. 6,7 Other treatment options include low intensity shock wave therapy8, penile injections9 and penile implants.10

Watch How Do You Inject Caverject

If you feel that your erections are not what they used to be, see your GP and tell him you may have ED and get yourself treated. There is no need to be embarrassed and suffer in silence. 

If you have wish to speak to a doctors about Erectile Dysfunction problem or learn more about treatment for Erectile dysfunction, please contact our men’s health clinics.

References:

1. Tan JK et al. (2003). Erectile dysfunction in Singapore: prevalence and its associated factors—a population-based study. Singapore Med J; 44: 20–26.

2. Paraskevas, K.I. et al. (2009) Erectile dysfunction: a warning sign of silent vascular disease Int Urol Nephrol; 41: 909

3. Cappelleri, J., Rosen, R. (2005). The Sexual Health Inventory for Men (SHIM): A 5-year review of research and clinical experience. Int J Impot Res; 17: 307–319

4. Dutta TC, Eid JF. (1999). Vacuum constriction devices for erectile dysfunction: a long-term, prospective study of patients with mild, moderate, and severe dysfunction. Urology; 54(5): 891–89

5. L.A. Levine (2000). Diagnosis and treatment of erectile dysfunction. Am. J. Med; 109: 3-12

6. Gresser U, Gleiter CH. (2002). Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil and tadalafil—review of the literature. Eur J Med Res; 7: 435–46

7. Sheila A Doggrell. (2005) Comparison of clinical trials with sildenafil, vardenafil and tadalafil in erectile dysfunction. Expert Opinion on Pharmacotherapy; 6(1): 75-84

8. Kitrey, N. D., Gruenwald, I., Appel, B., Shechter, A., Massarwa, O., & Vardi, Y. (2016). Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study. Journal of Urology, 195(5), 1550–1555.

9. Heaton, J. et. al (2001). Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. International Journal of Impotence Research, 13(6), 317–321.

10. Montorsi, F.et.al. (2004). Penile implants in the era of oral drug treatment for erectile dysfunction. BJU International, 94(5), 745–751.

Vitiligo Self-Care & Vitiligo Prevention Tips

People with vitiligo can adopt certain measures in their daily lifestyle to help prevent their disease from getting worse.


Sun protection

Skin that has lost its colour tends to sunburn easily. Sunburn can worsen vitiligo. Getting a tan from sun exposure can also increase the contrast between white vitiligo and normal tanned skin, thereby making the vitiligo patches appear more obvious.

Recommended measures:

1. Use sunscreen everyday

  • choose sunscreen lotions that are water resistant, SPF greater than 30 and offer broad spectrum (UVA + UVB) protection. Remember to reapply every 2 hours, after spending time in water or when you sweat
  • apply sunscreen to all skin that is not covered by clothing 

2. Wear clothing that protects you from the sun

  • The ability of clothing to protect your skin against UV radiation from the sun can be measured as a UPF rating
  • Some clothing comes pre-treated with UV absorbers that gives them a high UPF rating.
  • In general, loose fitting, dark or brightly coloured clothing made of densely woven fabric of unbleached cotton, shiny polyester or satiny silk confers the greatest UV protection
  • You can also increase the UPF of your clothing by adding UV blocking additives to the wash cycle.

3. Stay in the shade when possible

4. Do not use tanning beds and sun lamps

Skin protection

Take precautions to minimise skin injury and irritation

A cut, graze, scratch or friction to skin may lead to new patches of vitiligo

Avoid exposure to chemicals

Compounds containing phenols, catechols and sulfhydryls present industrial chemicals, cleaning agents and some hair dyes are known to cause loss of skin colour 

Reduce mental stress

Psychological stress has been known to trigger vitiligo flare-ups perhaps through its effect on immune cells and nervous systems of the skin.

Hence maintaining good mental health is essential to controlling the disease.

Do not get a tattoo

Do not tattoo your skin other than for treatment purpose as the micro-injuries caused by tattoos can lead to new vitiligo patches


Psychological & Social Impact of Vitiligo

People with vitiligo often suffer from low self-esteem, depression and anxiety.  

The appearance of the disease often affects one’s self image, makes one feel self conscious, anxious and embarrassed. It is sometimes made worst by perceived discrimination from others.  Children are especially vulnerable to teasing and bullying from their peers.

The early treatment of vitiligo is always advised.

People with vitiligo are encouraged to learn more about their condition to improve their own understanding and control of the disease.

Talking and sharing experiences with other people in a similar situation via support groups can also be helpful. 

Counselling provided by a psychologist is another option that is especially useful for addressing issues with self image, depression and anxiety.


How To Apply Testosterone Gel (Androgel)?

What is Testosterone Gel (Androgel)?

This medicine contains testosterone, a male hormone produced naturally in the body. This medicine is used in adult men for testosterone replacement to treat various health problems caused by a lack of testosterone such as male hypogonadism. 


What do you need to know before you use Androgel?

Do not use this medication if:

 If you are allergic to testosterone or any of the ingredients of this medicine (listed in section 6),

– If you are suffering from prostate cancer,

– If you are suffering from breast cancer.


How to apply?

The recommended dose is 5g of gel (i.e.50 mg of testosterone) applied once daily at approximately the same time, preferably in the morning.

The daily dose may be adjusted by your doctor, on an individual patient basis, not exceeding 10 g of gel per day.

The gel must be gently spread onto clean, dry, healthy skin as a thin layer on the shoulders, arms or stomach.

After opening the sachet, the entire contents should be taken out of the sachet and applied immediately onto the skin.

Allow the gel to dry for at least 3-5 minutes before dressing.

Wash your hands with soap and water after applying.

Do not apply to the genital areas (penis and testes) as the high alcohol content may cause local irritation.


Possible transfer of testosterone

During close and relatively long periods of skin contact testosterone may be transferred to another person unless you cover the treated area and could result in the other person showing signs of increased testosterone such as more hair on the face and body and a deepened voice.

It may cause changes in the menstrual cycle of women. Wearing clothes covering the application area or washing the application area before contact protects against such transfer.

The following precautions are recommended:

For the patient:

– wash your hands with soap and water after applying the gel,

– cover the application area with clothing once the gel has dried,

– wash the application area before making close contact with another person.

If you believe testosterone has been transferred to another person (man, woman or child), this person should:

– wash the affected area of skin immediately with soap and water,

– report any signs such as acne or changes in the growth or pattern of hair on your body or face to your doctor. You should preferably wait at least 1 hour before showering or bathing after applying this medicine.


How to store Androgel

This medicinal product does not require any special storage conditions. Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the box.

Avanafil For Erectile Dysfunction

Phosphodiesterase 5 Inhibitors (PDE5i) are a class of medications used to treat Erectile Dysfunction. They are the first line of therapy in men who are present with symptoms of having poor quality of erections. As mentioned in our previous articles, a healthy erection is one of the cornerstones of male reproductive health– Men’s Health Clinic Singapore

Not all PDE5i are made the same, understanding how each one works will allow better discussion with your attending physician when deciding which medication will work best for your situation. In general, inhibition of PDE enzymes in the body results in the dilatation of blood vessels throughout the body. Consequently, medications such as PDE5i that enhance erections can lead to unwanted side effects of headaches and back pain. Medical research therefore has been focused on creating ED medications that are more focused on inhibition PDE5 only in order to enhance erections with minimal side effects.

Avanafil is an example of a highly specific PDE5i and has the potential benefits of providing good quality erections with minimal side effects. Studies done on the molecular binding of Avanafil have shown that it is 110-fold more selective to PDE5 than other PDE5 inhibitors. The additional benefit of Avanafil is the faster absorption of the medication compared to the other PDE5i. A faster absorption translates to faster onset of the medication, therefore with an absorption of 30 to 45 min makes it the fastest acting PDE5i at the moment. One of the largest clinical studies for the medication involving 600 patients showed a significant improvement in erection quality at 100mg and 200mg doses.

Although more specific than other PDE5i, Avanafil does still result in the common side effects of the medication class albeit to a lesser extent. These side effects include headache, flushing and nasal congestion. Absorption of Avanafil is affected by fatty food with a 20% decrease in absorption which translates to a 1 hour delay in onset. 

Avanafil is a good addition to the PDE5i class of medications that help men suffering from ED. Avanafil is only available with a Doctor’s prescription. Discussing your concerns with your attending physician can help you create a treatment plan to include Avanafil or the other PDE5i medications can help you achieve better quality erections and enhance your reproductive health.

Speak to our doctor today to find out if Avanafil is suitable for you.

Avanafil is available at our clinics.


References:

  1. Mehrotra N, Gupta M, Kovar A, Meibohm B. The role of pharmacokinetics and pharmacodynamics in phosphodiesterase-5 inhibitor therapy. Int J Impot Res. 2007;19:253-264
  2. Goldstein I, McCullough AR, Jones LA et al. A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction. J Sex Med. 2012;9:1122-1133

DTAP Cares – Here For You, Here With You

The increase in social distancing and progressive lock down measures in Singapore and around the world during this COVID 19 season have prompted a big change in the way we care for our patients here at DTAP clinic.

The numbers around the world have been alarming as Spain and Italy have become the countries worst hit by the virus with over 6,000 deaths. The need to stay home and observe social distancing have slowed down the spread of COVID, not overwhelm the healthcare system and most importantly save lives.

At DTAP Clinic, we’ve made many numerous steady changes to our day to day operations to protect our staff and our patients.


This is what we have done at DTAP clinic 

  1. Screen everyone who makes an appointment or comes through our doors with the Ministry of Health’s criteria
  2. Check everyone’s temperature and symptoms of cough, respiratory illness
  3. See our patients on an appointment basis – this means NO OVERCROWDING, in the clinic and effective social distancing
  4. Increase frequencies of disinfecting the clinic and if a patient who saw us has any symptoms we thoroughly disinfect the clinic after the patient leaves. (Of course with the usual Personal Protective Equipment worn)

Where it is important to stay home, we are also cognizant that one can still get symptoms, need their medication refills and pick up other non covid diseases all the same.

Furthermore, the sellout of condoms around the world tells us that people staying home are resorting to millenial old, tried and tested forms of entertainment.

To further strengthen our support and commitment to our patients in these uncertain times, we have also thus done 3 more things to ensure our patients are fully cared for 


1. DTAP TELECONSULT SERVICE:

In light of the COVID-19 situation, we are offering DTAP Teleconsult. This teleconsult service allows our current patients and new patients to connect with our doctors during clinic operating hours for non-emergency consults. After assesment and consultation, we will also deliver your medications straight to your doorstep. Learn more

That’s right, our very own teleconsult service where our DTAP clinic doctors address your health concerns as much as possible in the comforts of your own home!

If it is deemed that you need a blood, urine, swab test to further confirm your diagnosis, we would then schedule you at the next most convenient time slot, AWAY FROM OTHER PATIENTS.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.


2. DTAP Medication Delivery Service

DTAP DELIVERY
Getting your medication on time is important. As part of our initiative to provide better patient care to our patients, we are now providing delivery service to your doorstep – Anywhere in the Singapore mainland. Learn more

If you need a refill of your medication prescription, or need to get treatment after your tests, or even get new meds after our doctors have diagnosed you,

Have no fear, together with our partners we deliver to your doorstep the very next day. 

And of course all this is within the SS644 Singapore medication delivery guidelines, where the integrity of the medication, your personal data are fully respected and protected 

So from the comfort of your own homes, you can get the essential medications you need, or if you were planning a special night with your loved one, not be caught out without your trusty blue pill even.


3. DTAP Order & Pick Up

Last but not least, for those who live and work nearby our clinics and want to drop in quickly to pickup your repeat meds, or even new medications, getting your payment done online and the items prepared would allow you to skip the queue, skip the wait and in between your busy lunch hour or schedule, you can still get your errands done, all in a heartbeat.

Stay safe amidst the current situation and remember to look out for your family and loved ones!


Sclerosing Lymphangitis

Sclerosing lymphangitis is a skin condition that manifests as a firm cord-like structure encircling the coronal sulcus, which is the circumference of the base of the penile head.

Sclerosing lymphangitis is observed usually in the second or third decade, although cases as young as 18, and as old as 66 years of age have been reported. The condition is thought to be fairly common, but significantly under-reported because it is usually asymptomatic and resolves spontaneously, therefore most patients do not visit a doctor.

Various other terms have been used for this condition, including non-venereal sclerosing lymphangitis of the penis, circular indurated lymphangitis of the penis, lymphangiosclerosis and sclerotic lymphangitis.


Causes

Sclerosing lymphangitis is thought to occur from prolonged or frequent vigorous sexual intercourse or masturbation. The resulting microtrauma leads to obstruction of a large lymphatic vessel. 

Signs and symptoms

Sclerosing lymphangitis presents as a skin coloured, serpiginous cord-like thickening encircling the coronal sulcus of the penis. It can feel like a hardened, almost calcified vein. There are no signs of inflammation, and the lesion is painless. It usually develops within a few days to a week after the sexual activity. 

Treatment

Sclerosing lymphangitis can cause anxiety and embarrassment due to its genital location, alarming appearance and association with sex. However, it is self-limiting and does not require treatment aside from reassurance and advice to restrain from vigorous sexual activity until the condition subsides. In most cases it resolves spontaneously after 2 to 3 weeks, but can last up to 6 weeks or longer. Investigations such as ultrasound scan or biopsy are not necessary. In recurring cases, surgery can be performed to excise the affected vessel.

Although the condition is by definition not associated with sexually transmitted infections (STIs), patients are advised to consider basic STI screening.

Next read: COMMON CAUSES OF BUMPS & WHITE SPOTS ON PENIS & FORESKIN