Professor Peter Lim on Treatments for Hypogonadism

Professor Peter Lim, Medical Director of Andrology, Urology & Continence Centre at Gleneagles Hospital, speaks about the various treatment options for Testosterone Deficiency available in Singapore.

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Full Transcript:
Well today we have this new method. It’s a gel not a cream. This gel when applied to any skin surface will disappear in about a minute. Therefore you don’t feel it after that. Also it had totally no odour of any kind. It was easy to carry about because it came in little packages like a chewing gum stick. That’s what it looks like.

You tear it, you put it on your body, it dries up, and that’s it. The convenience of this new modality, the ease of administration and the attractiveness was that we now have something that the patient can carry in his pocket.

The skin is absolutely a very good medium to absorb medications. So when you absorb it, it appeared in the blood stream in a constant level there was no fluctuation. Another good advantage of the skin as a way of administrating the hormone was that if you felt that it was inappropriate to give it because the patient showed some changes in his biochemistry, you can stop it the following day. If you give the 3 monthly injections, you will have to wait 3 months for the drug to disappear. And if there was any potential problem you could not get rid of it.

The first one that we used from time immemorial was the 2 or 3 weekly injections. But the trouble with this method was that it caused a rapid rise in the level and a very precipitous fall which caused the temperament of the male to be sometimes unstable. They lose their temper; they get irritable and so forth. And it also called for a need to appear at the doctor’s clinic every 3 weekly. So it wasn’t very successful. Many took on the treatment and they defaulted.

The next era was the era of the tablet. The tablet was a very quick fix to the problem; very attractive. People though they could take 2 in the morning, 2 at night and it’s wonderful. The problem was that it had to be taken with a fatty meal. And certainly you wouldn’t want to get more fat. so it wasn’t easy for compliance for the patients. Furthermore, even with the fat intake for it to be absorbed, the absorption was unpredictable. Not only that, it never really reached very high levels in the blood.

Someone thought why not a cream. The first cream that appeared was a sticky cream. And the sticky cream had to be applied on the body. It had an odour. It created skin allergy it also required you to be living in temperate climate to have it. Otherwise in a humid climate like Singapore it created a lot of problems. Very uncomfortable feeling. It was supplied in a jar and you had to take a carefully measured amount everyday and you couldn’t be sure you got the right amount every day. And this jar was difficult to carry along when you were on a trip.

The intramuscular 3 monthly injection. When this came about it then became clear that people were prepared to have a single injection every three monthly and if the injection did not cause transient rises and fall of the hormone, which the 3 monthly injections was capable of doing. So it was pretty successful when it was launched. People thought that it was the ideal because you appeared at the clinic once every 3 monthly to get your injection. The problem was that it was a painful injection. It had to be given carefully and if the doctor was a bit impatient, it would cause a lot of pain.

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