What Happens When Your Prostate Gland Becomes Enlarged? Find Out from A Consultant Urologist


Consultant Urologist
Prince Court Medical Centre
An overview of benign prostatic hyperplasia. Click on the image for a larger, clearer version.

This condition has become more common due to several factors including:

  • Changes in men’s attitude towards their health and well-being. These changes in attitude led to them seeking medical advice more proactively.
  • Advancements in healthcare have led to a longer lifespan seen among men. Because of this, there is an increase in the number of elderly individuals and consequently has a rise in the incidence of benign prostatic hyperplasia.

By the age of 50, about 50% of men experience prostate enlargement, and this figure rises to about 80% by the age of 80.

This highlights a significant correlation between age and the prevalence of benign prostatic hyperplasia.

Seek medical attention when you experience any of these symptoms over a long period of time or when they interfere with your daily routines.
  • Frequent trips to the restroom
  • A need to wake up from sleep to urinate (nocturia)
  • Weak urine flow
  • Painful urination
  • Blood in the urine
  • A feeling of incomplete bladder emptying
  • Symptoms of more advanced stages of benign prostatic hyperplasia can include high fever and/or an inability to urinate.

This is especially true as individuals age and potentially encounter other health problems that can worsen their prostate issues, such as diabetes and stroke.

However, if one’s underlying health issues are well-managed and infections are treated effectively, there is potential for improvement in the prostate condition.


Treatment involves a comprehensive approach for managing any underlying conditions and considering the extent of the enlargement and its impact on the patient.

If the prostate enlargement is minimal, usually we will monitor for the time being for any further enlargement.

However, if symptoms cause significant discomfort, the doctor will prescribe the appropriate medications to manage these symptoms.

If medications are not effective, we can consider surgery. There are several surgical options to consider, depending on individual circumstances and preferences.

  • Adopt a lifestyle regimen that includes reducing the intake of irritants like caffeinated beverages—these irritants can increase the urge to urinate.
  • Reduce consumption of liquids and foods high in water content during the evenings, to help avoid nighttime bathroom visits.
  • Maintain proper hygiene to prevent infections, especially since prostate enlargement increases one’s risk of infection.

Benign prostatic hyperplasia is associated with ageing. Good habits as above could prevent worsening of the condition.

Additionally, one should seek regular medical check-ups, such as blood and urine tests, to monitor kidney function and identify potential infections early.

How Much Do You Know about Male Breast Cancer? Let’s Find Out!


Clinical Oncologist
Sunway Medical Centre

Breast cancer in both men and women share many similar attributes.

The most common kinds of breast cancer in men are the same kinds that are present in women, namely:

  • Invasive ductal carcinoma
  • Invasive lobular carcinoma
  • Ductal carcinoma in situ (or DCIS)

Dr Nik Muhd Aslan Abdullah says that breast cancer is, however, rare among men.


According to Dr Nik, many of the most pressing early warning signs of breast cancer in men are also similar to those found in women, such as:

  • Lumps in the breast tissue
  • Skin dimpling or puckering
  • Nipple retraction
  • Unusual discharge from the nipple

One reason why breast cancer is rare among men is that the hormone testosterone inhibit the growth of breast tissue, while oestrogen stimulates breast tissue growth.

While men and women have both hormones in their bodies, men have higher levels of testosterone compared to women. On the other hand, women have higher levels of oestrogen.

Some breast cancer cells have special structures at the surface, called hormone receptors. These cells are called hormone-receptor positive (HR positive for short). Oestrogen can bind to these receptors to cause the growth of these cells. Dr Nik explains that men have a higher possibility of developing breast cancer cells that are HR-positive, when compared to their female counterparts.

“Breast cancer cells in men are sensitive to hormonal imbalances,” Dr Nik explains, “so any factors or conditions that can lead to an excess of oestrogen and a lack of testosterone will increase their risk of developing breast cancer.”

What can cause the raise in oestrogen levels in men?
  • Klinefelter syndrome, a rare genetic condition in which a male has an extra X chromosome and produces lower levels of androgens
  • Injury to the testicles
  • Use of androgen inhibitors
  • Liver cirrhosis (scarring of the liver)
  • Obesity 
Family history also plays a factor

About 1 out of 5 men with breast cancer is found to have had a family history of the disease.

This is because men can also inherit a mutation in the BRCA1 or BRCA2 genes or in other genes, such as CHEK2 and PALB2. These mutations will highly increase their risk for breast cancer.

“Unfortunately, we do not have a say in the types of genes we inherit,” Dr Nik says.

He recommends that men with a family history of cancer should consider seeking counsel from their doctors about going for genetic screening tests as soon as they can, especially those over the age of 50.

Genetic screening tests involves taking a blood sample for analysis. A genetic counsellor will then advise the person, based on the results given, on what the next best steps would be for him.

How to conduct self-breast examination for men. Click the image for a larger version.

Dr Nik explains that hormone therapy can be used to help lower the risk of the cancer cells spreading or treat cancer that has come back after treatment.

Why then do men with breast cancer have lower survival rate compared to their female counterpart?

“Through many of the studies that I’ve seen, men who are diagnosed with breast cancer have a 8-9% lower survival rate than women,” Dr Nik says.

He attributes this to the fact that men with breast cancer are often diagnosed late.

“Men will sometimes wait too long to seek out a diagnosis for the symptoms they may be experiencing,” he explains, “or not recognize the warning signs of breast cancer in their bodies.”

As a result, they delay seeking help, and tend to do so only when the cancer has become advanced and spread to other parts of the body.

Dr Nik encourages men to seek a doctor’s opinion if they find themselves experiencing any of the mentioned symptoms related to breast cancer. “Breast cancer can be cured, and it is very treatable if detected early on,” he says.

A Man’s Swimmer Problems

A Man's Swimmer Problems

May 8, 2022   Return


Man’s Health and Fertility with

Dr Agilan Arjunan

Consultant Gynaecologist & Fertility Specialist KL Fertility Centre


According to the Guinness Book of World Records, Moulay Ismail ibn Sharif who ruled Morocco during the 17th century likely fathered 1,042 children during his lifetime. Some historians believed that the number might be as high as 1,171!

These days, it may not be possible to have this many children, even if the man is crazy enough to want to, as there are reports that, overall, the sperm count for men in America, Europe, Australia and New Zealand has dropped by more than 50% in less than 40 years. However, we have yet to find out the exact reason(s) for this fall. It is speculated that perhaps it is due to exposure to chemicals or pollutants, smoking, stress, obesity or maybe even all of them.

This month, we join fertility specialist Dr Agilan Arjunan in looking at what men can do to ensure that their fertility is still up there to create that little bundle of joy with their beloved partner.

Reference: Kelland, K. (2017). Sperm count dropping in Western world. Scientific American. Retrieved from https://www.scientificamerican.com/ article/sperm-count-dropping-in-western-world/


Too much! “The heavier you are, the more fat you will have stored in your body,” says Dr Agilan. As a result, there is more testosterone, the male sex hormone, converted to oestrogen, the female sex hormone in the fat. This will significantly affect sperm production, which is driven by a cascade of hormones that include testosterone.

Too hot! Another issue that comes with having excess weight is that it causes the temperature in the testicles to increase. Optimal sperm production requires a temperature that is slightly lower than that of the rest of the body, which is why nature has designed a man’s testicles to dangle between the legs instead of being an internal organ. The hotter it gets inside the testicles, the lower is the rate of sperm production.


“So … eat less?”

Not just that. To maintain a healthy weight, total energy obtained through food should be equal to total energy used by the body. So, there are two components to consider here: eating healthy, balanced meals and being physically active on a regular basis.


“How can I eat less? I’ll starve!”

We don’t have space in this article to fully dwell on the principles of healthy eating, but you can consult a dietitian for more advice. Basically, you should eat foods from all food groups, according to the recommended portion size based on your age, sex, current body weight, level of physical activity and any existing health condition you may have.

Some hunger is inevitable at the early stages of your new diet, but you will survive and adapt. Hang in there – over time, you will feel healthier, happier, and sexier!


“I’m already hungry and now you want me to exercise? Are you joking?!!”

Daily physical activity is important, as it strengthens the muscles and keeps the body working in good condition (all these are great for many things, including making babies). It also burns away any unused calories from your meals, ensuring that you do not gain weight. Furthermore, exercise is a great stress reliever. The gains far outweigh any momentary discomfort you may experience when you begin your new exercise routine.


If you like your alcohol, brace yourself as there is no way to break it gently: abstaining from alcohol is always better when it comes to trying for a baby. Even moderate consumption of alcohol can affect fertility in a significant manner.

Alcohol affects both sperm count and quality. This is because it can disrupt the ideal conditions in the testicles needed for optimal sperm production. Over time, it can even cause the cells in the testicles responsible for sperm production (Sertoli cells) to deteriorate. Alcohol may also affect the production and regulation of hormones that regulate sperm production.

All in all, drinking is not a good thing when it comes to ensuring that a man’s swimmers are in good condition and numbers!

“Sober up, huh? You think that’s simple? HAH!”

Don’t be so pessimistic! These days there are programmes to help people quit drinking successfully. A psychiatrist specializing in treating addictions will be the best person to turn to, but if one is not available near you, you can try asking a family medicine specialist for help. There are also many support groups available both in real life and online.


“It’s been known for many years that smoking can reduce both sperm count and the quality of the sperm produced by the man,” Dr Agilan points out, adding that the sperm count is especially affected by this habit.

It is found that the tobacco in cigarette contains substances that can negatively affect the ability of a man to produce normal amounts of sperm.

In the sperm cells that are produced, it is found that many have lower motility than sperm cells produced by non-smokers – which is to say, these sperm cells are less capable of traveling along the woman’s womb to successfully reach the egg cell.

“Hmm, so I should quit. That’s hard, right?

These days it’s easier to quit compared to the past, thanks to a combination of nicotine replacement therapy and counselling. You can consult your neighborhood pharmacist for more information.

“Wait … if the problem is nicotine, I can then vape instead, right?”

Dr Agilan points out that research on vaping is still at early stages, and it’s likely that other chemicals present in vape juices may also affect sperm count and quality. Why risk the chance? 


There is evidence that high levels of stress can affect sperm production, according to Dr Agilan. Furthermore, stress also makes it hard for couples to experience the mood to make babies!

When you are stressed, the body reacts as if you were in danger and releases stress hormones, which trigger the fight-or-flight response. You will feel your heart beating faster, your breathing will become shallower and you feel tensed up. The fight-or-flight response also closes off other functions that the body considers to be of lesser importance when dealing with the stress, and one of these functions is reproduction. Therefore, the more stress you experience, the more your sperm count may be affected.

Stress can come from a variety of external sources outside the bedroom – work, family finances, relationship woes, health issues. However, it can also come from the bedroom.

Dr Agilan cautions against what is called “medicalizing” the process of making babies. This occurs when couples are so determined to have a baby that each planned sexual encounter ends up becoming a stressful chore.


Calm down! Challenges and frustrations are inevitable parts and parcels of life. Often, stress relief can be obtained by stepping back for a while to focus on relaxation activities such as exercise, yoga, keeping a journal or anything else that can bring you a sense of peace.

But do reach out for help when you need to!

There are counsellors, hotlines and support groups out there that can help, and some of them offer free support. If trying to have a child is causing you and your partner undue stress, it may be time to seek a fertility specialist for advice.


It’s well known that boxers are supposed to be the underpants of choice as the tighter briefs- style underpants can elevate the temperature around the testicles and affect sperm production. Interestingly, there are studies which conclude there isn’t any significant difference in sperm production and quality among men who wear either type of underpants. However, Dr Agilan believes that there is no harm in choosing to wear boxers over briefs – anything that can increase the odds of success can be a good thing!

What happens if a man is born with low or zero sperm count? Dr Agilan will focus on such a situation in the next column, so don’t miss it! HT

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May 8, 2022   Return







Heart disease is the primary cause of sudden death among men in Malaysia. According to Dr Tee Chee Hian, sudden death can be caused by a variety of heart problems such as arrythmia (having an irregular heartbeat), congenital heart disease, or more commonly, coronary artery disease.


Know the signs and symptoms

Catching heart disease early may help prevent sudden death. Dr Tee says that men experiencing symptoms such as palpitations, fainting episodes, lethargy, shortness of breath on exertion, chest pain, postprandial angina (chest discomfort after meals), or reduced exercise tolerance should see their doctor immediately, as these may be signs of heart issues.

Men should also get screened regularly for the common risk factors of heart disease such as dyslipidaemia (abnormal cholesterol levels), hypertension, and diabetes.


Keep a heart-healthy lifestyle

Lifestyle changes that include quitting smoking, having a balanced diet with more vegetables and fruits, and doing exercises that promote cardiovascular fitness like running, jogging, and cycling can help lower the risk of heart disease.



Dato’ Dr Selvalingam Sothilingam notes that prostate cancer is the 3rd most common cancer in Malaysian men. It is often diagnosed in the late stages, due to the asymptomatic nature of the disease in its early stages.


Get screened

“The most common age for diagnosis of prostate cancer is men in their 60’s and 70’s. However, we have also detected cancer cases in men as early as in their 50’s. Early diagnosis is key as it is potentially treatable if detected at an early stage,” Dr Selvalingam explains.

Men that have a family history of prostate and/or breast cancer should get screened for prostate cancer from the age of 45.


The right diet may lower risk of prostate cancer

Dr Selvalingam shares that frequent consumption of foods such as cooked tomatoes, soya products, green tea, vegetables, and fruits may lower a person’s risk of prostate cancer.

On the other hand, having a diet high in red meats and processed foods as well as low in fibre may increase the risk of prostate cancer.

Just Guy Things

Just Guy Things

April 28, 2022   Return

Ask people what defines a man and, chances are, the first thing that crosses the mind are those body parts down below. There are at least 174 ways to describe the penis using the English language, and at least 100 for the testicles. We said ‘at least’, because there is no doubt that more slangs and creative euphemisms are created for those body parts with each passing year.

We may talk and think quite a lot about those body parts, but just how well do you really know the male reproductive system? Our grandparents often tell us that to truly know something is to love it, so guys, if you really want to love those parts down below, let’s take a while to know them better.

Here are the Guy Bits

Comedians and other people who think they are so funny often describe men as simple, uncomplicated creatures. Well, compared to the fairer sex, there may be some truth to that. For one, biology has decided that the human male reproductive system is less complex than the female reproductive system!

You are no doubt familiar with the penis and scrotum as they are the visible components of the male reproductive system. Hidden from view and less well-known are structures inside the body, such as testes and prostate gland 

The structures of the male reproductive system serve three important functions – to let you look like and function as a man, allow you to make babies and get rid of urine. 

The testicles produce sperm cells, which are then sent to the epididymis to mature. The prostate gland (which technically is part of the exocrine system) produces a fluid that make up a big part of the semen. This fluid serves to nourish sperm cells, so that they function properly to allow the conception of new life.

The testicles also produce and release male sex hormones such as testosterone. These hormones play key roles in the regulation of many important functions to give men their distinctive characteristics (facial hair, huskier voice, etc) and maintain the function of their reproductive system.

The penis also helps to expel urine, which contains excess water and unwanted waste products.

What Can Go Wrong?

Men are naturally concerned about the possibility of things not working properly, especially when it comes to making babies. However, let’s not overlook the dreaded ‘C’ word – cancer. Find out more in the next article.

Reference: WebMD. Available at www.webmd.com

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Grief to the Prostate

Grief to the Prostate

April 28, 2022   Return

E_Dr Sulaiman

Dr Sulaiman Tamanang   Consultant Radiologist and Nuclear Medicine Physician, The National Cancer Society of Malaysia

Prostate cancer may not be the most common cancer among men in Malaysia – that would be lung cancer – but it is nonetheless common in men over 50, according to Dr Sulaiman Tamanang, a consultant radiologist and nuclear medicine physician. To date, we have not identified the actual cause(s) of prostate cancer.

No early symptoms

When it comes to prostate cancer, there are usually no specific symptoms during its early stages. 

Symptoms usually show during advanced stages

Symptoms may occur at later stages, and even then, things are complicated by the fact that these symptoms may be the same as those of other conditions, such as benign prostatic hyperplasia (BPH, swelling of the prostate glands).

Therefore, see a doctor as soon as symptoms occur

Some symptoms to watch out for are:

  • Urinary problems – blood in the urine, difficulty in urinating, weak urine flow, frequent need to urinate (especially at night), pain or burning sensation while urinating.
  • Problems achieving or maintaining an erection.
  • Pain in the hips, back, chest and other areas; this may be a sign that the cancer has spread to the bones.

Even better, go for screenings

Dr Sulaiman recommends every man over 50 to take the prostate-specific antigen (PSA) test once a year. Getting screened is just a matter of having some blood taken to be tested in the laboratory. This test is available at most medical establishments, and can be requested as an add-on to standard health screening packages.

“While this screening is not 100% accurate, it gives us some indication that there may be something wrong,” Dr Sulaiman explains. Therefore, this screening can be a good way to detect prostate cancer at an early stage.


Early is better

Just like with other types of cancer, early detection often means an improved chance of recovery and a lower possibility of the cancer returning (recurrence).

Treatment options

There are usually three options available – surgery, hormone therapy and chemotherapy.

For a patient of advanced age, however, Dr Sulaiman says that a “wait and see” approach is usually adopted. This is because at that age, there are other diseases that will pose a bigger threat to the man’s health. 

Prostate surgery

For early stage prostate cancer, it is usually recommended to have the affected prostate removed via surgery. Parts of the surrounding tissues (including lymph nodes) may also be removed, so that they can be examined to determine whether the cancer cells have spread.

“There may be side effects,” explains Dr Sulaiman, “such as poor urine stream and dry ejaculation (no ejaculate is released during orgasm). However, not everyone will experience them, and we have means (medication, therapy, etc) to address them when they occur.”

Hormone therapy

Hormone therapy is usually offered to patients whose cancer has reached an advanced stage, or if the patient is unable to undergo surgery for medical reasons.

Dr Sulaiman explains that, in a patient with prostate cancer, the testosterone hormone can stimulate cancer cells to grow. Hormone therapy acts to either reduce the amount of testosterone produced in the body, or to stop testosterone from reaching the cancer cells.

As a result, the cancer cells grow slower or, in some cases, the tumour may shrink in size. However, hormone therapy will not cure prostate cancer.

Hormone therapy may cause side effects due to the changes in testosterone level in the body, such as decreased libido, erectile dysfunction and growth of breast tissue (gynaecomastia).


Chemotherapy is usually a “second resort” treatment, given when the patient does not respond favourably to hormone treatment, or when their cancer has spread to other parts of the body.

This therapy involves the use of drugs to kill the cancer cells in the body. Depending on the severity of the cancer, the patient may be offered a combination of different drugs. These drugs will help to slow the growth and spread of the tumour(s), and in the process give the patient more time and improve his quality of life. However, they will not cure the cancer.

Chemotherapy has side effects, caused by the fact that the drugs cannot tell healthy cells apart from cancer cells. Healthy cells will also be affected by the drugs, leading to side effects such as changes in physical appearance (loss of hair, nails, bloating, skin blotching, etc), nausea, fatigue and weakened immune system (which may increase the risk of infections). The good news is that these side effects will eventually go away once treatment is over. 

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A Tumour in the Testicle

A Tumour in the Testicle

April 28, 2022   Return

Assoc Prof Dr Christopher Ho Chee Kong   Consultant Urologist and Sexual Medicine Consultant, Beacon International Specialist Centre

Testicular cancer is not very common, but when it does occur, it commonly occurs among men between their 20s and 40s. It can occur at a later age, but that is even rarer. Usually only one testicle is affected, but the cancer may spread to the other testicle and other parts of the body if left untreated.


Risk factors

Consultant urologist and sexual medicine consultant Assoc Prof Dr Christopher Ho points out that we have yet to discover the exact causes of testicular cancer, but among young men, the risk increases if they have a history of undescended testicle (cryptorchidism).

We can’t rely on symptoms to tell us that something is wrong.

Dr Ho explains that, in many cases, most men with early stage testicular cancer do not experience any pain or discomfort. It is only when the cancer has reached an advanced stage that symptoms may be felt. These symptoms include bone pain and jaundice.

Therefore, self-examination is the best “screening” method.

Dr Ho recommends checking one’s testicles in front of a mirror regularly (at least once a month). Some things to watch out for are:

  • Appearance of mysterious lumps, nodules or other masses
  • Unusual swelling or enlargement of the testicles

It is best to perform this self-examination after having a warm bath, as the heat from the bath would relax the skin of the scrotum, making it easier to detect any signs of abnormalities.

If you detect any abnormalities, see a doctor as soon as possible. If the cancer is diagnosed at an earlier stage, your chances of recovery are significantly higher.

Diagnosing testicular cancer

The doctor will perform some tests to determine whether you have testicular cancer. First, the doctor will physically examine your affected testicle.

Next, an ultrasound test is performed. Dr Ho says that this method allows the doctor to “look” into your testicle to locate and determine the size of the unusual mass. This test is about 90% accurate.

If the presence of a lump is confirmed, the doctor usually recommends the removal of the entire affected testicle. The procedure is called radical inguinal orchiectomy.

According to Dr Ho, this is both a treatment and diagnostic procedure, as the removed testicle will be sent to a laboratory to determine whether the lump is cancerous and, if it is, the type and stage of the cancer.

If you are uncomfortable about your appearance down below after the surgery, Dr Ho mentions that reconstructive surgery is available. This procedure implants a prosthesis into the scrotum, and the prosthesis feels just like a real testicle.

After the surgery

Next, your doctor will determine whether the cancer cells in your testicle have spread to other parts of the body. This is usually done via a computerized tomography (CT) scan. A series of X-ray images of your abdomen, chest and pelvis will be taken. These images will then be analysed for the presence of tumours.

A blood test may also be performed, to check for elevated levels of substances called tumour markers. If the test comes back with abnormally high levels of these substances, there may still be cancer cells in your body.

Follow-up treatments – radiation therapy or chemotherapy, or both – will then be prescribed, based on the stage of your cancer.

Radiation therapy

This is one possible treatment for certain types of testicular cancer (seminoma type). There is a risk of infertility associated with this therapy, so if you wish to have children in the future, you can freeze your sperm first. You can discuss your options with a fertility specialist.


For advanced stage testicular cancer, in which the cancer has spread to other parts of the body, chemotherapy will be prescribed. Just as with the chemotherapy drugs used to treat prostate cancer, the chemotherapy drugs for testicular cancer can cause side effects. You will be monitored closely for these side effects, and dosage would be adjusted to reduce their severity. Once treatment is complete, the side effects will go away.

Recovery rate

Dr Ho delivers the good news: compared to other types of cancer, testicular cancer (even at its advanced stage) has a good recovery rate.

For early stage cancer, the cure rate is more than 90%. Even for advanced stage cancer, the survival rate is still pretty good, about 70%. Of course, this is provided that the patient receives proper treatment.

Therefore, if you suspect that there is something abnormal happening to your testicles, it is definitely a good idea to see a doctor as soon as possible!

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Caffeine for the Hair, Sir?

Caffeine for the Hair, Sir?

April 28, 2022   Return

Hair loss has long been the bane of many men’s existence. Millions of men worldwide are affected by male pattern hair loss, a condition caused by an inherent sensitivity to dihydrotestosterone (DHT), a substance produced in the body from the male sex hormone testosterone. Male pattern hair loss can be passed from father and son – bad news indeed for men whose fathers exhibit this condition.

As much as men may not like to admit it, hair loss can leave a serious dent on one’s self esteem. Various inventive combing techniques (called, imaginatively enough, comb overs) have been invented over the years to hide a bald patch, while those with enough budget blow thousands of Ringgit on hair transplant. All to assure the man that he still looks youthful and attractive!

Interestingly, there may be a solution to hair loss – a solution that is already a big part of our daily lives: caffeine. Yes, the same substance that gives our coffee its ‘kick’.

Hold On to Your Cup of Joe

Don’t go washing your hair with espresso just yet, though, as the amount of caffeine consumed by even the heaviest coffee drinkers is not enough to do the trick.

According to Dr Adolf Klenk, a leading German researcher of caffeine and its effects on hair loss, you will need to consume 40-50 cups of coffee to provide the dose of caffeine needed to make its way up to the hair root. Even if someone is foolhardy enough to drink this much coffee, he will most likely end up with a bigger problem than hair loss. After all, caffeine is a drug-like substance, and it would be extremely toxic when consumed in extremely high amounts.

Fortunately, caffeine can be used as an active ingredient in shampoos, hair gels and other hair care products without causing health problems!


Caffeine Control

Dr Klenk, who was recently in Malaysia, explains that research on caffeine indicates that it can control the effects of DHT and therefore prevent premature hair loss in men. “Caffeine can also protect hair roots against hereditary hair loss in men and support hair for healthy growth,” he adds.

The Center for Cosmetologic Research, Catholic University of Sacred Heart in Rome performed an application test on 30 male subjects, aged from 18 to 55 with male pattern baldness. They found that caffeine shampoo, when used over 6 months, can:

  • Decrease hair pulled out by 7% after 3 months, 14% after 6 months.
  • Significantly improves strength of hair.
  • Reduce intensity of hair loss.
  • Reduce typical scalp problems such as itch, dryness and tension.

The same centre conducted another research, this time using caffeine liquid hair wash, on men with alopecia (a type of hair loss caused by the cells of the immune system attacking one’s own hair follicles) over 2-4 months. They found that the caffeine liquid hair wash brought about the following benefits:

  • Decreases hair loss by 8% after 2 months, 15% after 4 months.
  • Reduces premature hair loss by 43%.
  • Improves hair structure by 53%.
  • Improves scalp condition by 12%.
  • Reduces balding by 43%.

These are just some of the more recent research on the potential benefits of caffeine in controlling and reversing hair loss. Therefore, if you are worried about losing your hair, or if you are already losing your hair, it may be worth discussing with a dermatologist or hair restoration expert about using caffeine hair care products.

Don’t forget the B’s

While good nutrition will not bring back your lost locks, B vitamins can help with the formation and growth of new hair follicles. Therefore, it may be worthwhile to load your daily diet with food rich in these vitamins to complement your efforts to prevent or reduce hair loss. Good options are chicken, fish, eggs and dark leafy vegetables such as spinach. Supplements may also be helpful.

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Too Fast, Too Furious

Too Fast, Too Furious

April 28, 2022   Return



Assoc Prof Dr Christopher Ho Chee Kong   Consultant Urologist & Sexual Medicine Physician, Department of Surgery, Universiti Kebangsaan Malaysia Specialist Centre

How to Make Love All Night: and Drive a Woman Wild! The Way of the Superior Man! Make Her SCREAM: Last Longer, Come Harder and Be the Best She’s Ever Had!

These are just some of the actual book titles found on Amazon should you search for ‘premature ejaculation.’ Regardless of the content between the covers, these titles alone give the impression that a ‘real man’ (or to quote one of the book titles, a ‘superior man’) should be able to please his partner not just sexually, but also all through the night like the Energizer bunny, with the partner screaming and swooning from the ecstasy of it all.

The average man may flinch from the pressure (or try to rise to the challenge), but for someone with the problem of premature ejaculation (PE), the condition can be especially crippling to the self esteem. Furthermore, a lack of sexual fulfilment would eventually threaten the long-term happiness in any relationship.

HealthToday sits down with Assoc Prof Dr Christopher Ho, a consultant urologist and sexual medicine practitioner, to get down to the root of the condition known as PE, and the various treatment options available.

Not So Fast, Man!

Given how closely a man’s sexual performance is linked to his sense of confidence and self-esteem, it is little wonder that many men would prefer not to think about PE. If they do talk about it, it is usually during a ‘men’s only’ moment at the mamak stall, when ‘bros’ share notes and tips on bedroom matters.

Despite many men putting a lid on the problem, PE is actually quite common. While the estimated number of men with this problem can vary from one study to another, Dr Ho states that, generally, about 30% of men around the world have problems that can be defined as premature ejaculation.

How soon is too soon?

A US study found that the average man’s “lasting power” from the start of penetration to ejaculation is 5.4 minutes. If your arrival schedule is around this value, then you are perfectly normal.

“There are two types of PE – lifelong and acquired,” explains Dr Ho. Lifelong PE describes the condition that initially manifested during the man’s first sexual intercourse; the man has never experienced a ‘normal’ intercourse as a result. Acquired PE occurs when a man who has never suffered the condition before starts to show symptoms, often due to psychological factors (stress, anxiety or impatience, especially when the man has a new partner) or organic reasons such as an underlying medical condition.

  • For men with lifelong PE, the average ‘staying power’ is one minute or less.
  • For men with acquired PE, the average ‘staying power’ is three minutes or less.

Dr Ho goes on to explain that there are three typical signs of PE. One, the man experiences PE (1-3 minutes or less) consistently over a period of time. Two, he has problems controlling (or delaying) ejaculation nearly all the time. Three, his condition is causing emotional distress, and the man may even begin to avoid intimacy out of frustration or shame.

The Root of the Problem

There are several possible causes for PE, and it is possible that the causes for PE can be different from one man to another.

  • It’s psychological. Dr Ho says that strong emotions such as anxiety about his performance can cause a man to end things a little too soon in the bedroom. Other forms of stress such as external ones (from work and such) or unresolved interpersonal issues between the man and his partner could also be factors. 
  • It is also possible that early sexual behaviour could contribute to PE. For example, if a man is used to hurrying his climax in the past, he may experience problems slowing down the pace later on.
  • It’s biological. PE can arise when things go awry in the body. Some of the possible biological reasons for PE include:
    • Thyroid problems. There is a study which suggests that PE can be linked to an overactive thyroid (hyperthyroidism).
    • Abnormal levels of certain neurotransmitters (brain chemicals that transmit signals from nerve cells to brain). Unusually high levels of histamine, for example, can cause PE. 
    • Abnormal hormone levels. Like many other processes in our body, sexual arousal, stimulation and ejaculation are all carefully controlled and coordinated by interactions among various hormones. A little too much or too little here and there can cause the entire process to go haywire!


Don’t Suffer in Silence – Get Help!

If you suffer from PE, the great news is that the condition is definitely manageable. There are ways to help you enjoy a healthy sex life with your partner.

Forget the many ‘special foods’ or ‘special exercises’ out there, all promising to improve one’s sexual prowess. The first step to managing PE is actually very simple.

“Talk to your doctor!” says Dr Ho.

“There is nothing to be ashamed of. The doctor will not judge or reveal your problems to other people. Therefore, there is no need to suffer in silence!” he adds. Some men get uncomfortable when the doctor asks probing questions related to intimacy, but this is a necessary step for the doctor to fully understand the extent of the problem. What is a little temporary discomfort or embarrassment, after all, compared to the promise of a healthy, fulfilling sex life?

Furthermore, sometimes PE may be a symptom of an undetected medical condition (such as thyroid condition, prostate disease, high blood pressure and diabetes), and may go away once the medical condition is treated. Getting treatment or management advice for those conditions do not just improve one’s sex life – it improves the overall health and quality of life!

“I know I have PE, so I can buy my own medications without seeing a doctor!”

Are you really sure that you have PE? While erectile dysfunction (ED) and PE are two very different conditions on paper, in reality, there are a number of men who cannot tell apart these two conditions. Dr Ho has encountered men with PE who believe that they have ED, and vice-versa. Since treatment methods for both conditions can be different, a diagnosis by a qualified healthcare professional is important, to ensure that you are getting the right kind of treatment. Another reason to visit your doctor, whether you have ED or PE!

Dr Ho goes on to share some of the most common methods for managing PE.

Hands-on Techniques

There are some techniques that your doctor can advise you to practice in the privacy of your home to help with PE. Dr Ho offers some examples:

  • The stop-and-start method. The man first masturbates on his own, stopping as he comes close to ejaculation. He will then relax until he has calmed down, before repeating this process several times until he cannot hold back any longer. Once he has become used to this, he can bring in his partner and they can initiate sexual activities without involving penetration. Essentially, this method helps the man learn how to control his arousal and delay his ejaculation over time.
  • The squeeze method.  A variation of the stop-and-start method, in which the man masturbates until he is close to achieving an orgasm. At that point, he squeezes the base of his penis to reduce his erection and delay ejaculation. Once the man has the hang of this, his partner can get involved and lend a helping hand, so to speak.
  • Try Kegel exercises. While there is not much evidence to conclusively prove that Kegel and other forms of pelvic floor exercises can help with PE, Dr Ho believes that there is no harm in adding these exercises into the daily routine of a man with PE. By strengthening the muscles in the pelvic region, the man may have better control over the delay of his ejaculation.
  • There are many other options, such as deep breathing techniques to help with focus during sex and the use of condoms to reduce stimulation on the penis. Your doctor would evaluate your case and suggest suitable solutions.
  • Dr Ho adds that these techniques are not “instant cures” – they only show results over time. Some men may get frustrated with  what they perceive to be slow progress and wish for a more “instant” solution, while others may get “distracted” while involving their partners in these techniques. For these men, medications may help tide the frustration.


Medications for PE

Dr Ho explains that medications do not cure PE. Similar to pills for erectile dysfunction, they offer the man an opportunity to participate in sexual intercourse for a certain period of time after taking these medications.

Oral medications.

It may seem odd to many people, but medications normally given to people with depression can also help with PE. These medications can inhibit orgasm and delay ejaculation, usually considered unwanted side effects that, for men with PE, turn out to be favourable outcomes.

Of late, the medication of choice for many specialists is dapoxetine. Dr Ho explains that this is due to the studies that demonstrated its effectiveness on men with PE, as well as having fewer side effects compared to other medications offering similar benefits.

Aside from dapoxetine, other oral medications for PE include tramadol and other medications normally used for treating depression (eg, sertraline, paroxetine). All oral medications require prescriptions from a qualified healthcare professional.

Apply externally.

There are gels, creams, and sprays which work to reduce the sensations experienced in the penis that can bring about ejaculation. They typically contain analgesic or numbing ingredients such as lidocaine and lidocaine-prilocaine, and should be applied on the penis before sex. Because they work less specifically than oral medications, they may not be effective on some men with PE. There are also reports of some men’s partners experiencing discomfort or reduced sensation during sex.

The Lowdown on Dapoxetine

According to Dr Ho, in a normal male, a neurotransmitter called serotonin is involved in passing messages from one nerve cell to another. It is found that high levels of serotonin in the nervous system can lead to delayed ejaculation during sexual intercourse. For men with PE, this is obviously a good thing!

This is where dapoxetine comes in. It is a type of drug that helps to increase the concentration of serotonin at the junctions between nerve endings, hence allowing men with PE to last longer during sex.

It is taken “on demand”, from 1 to 3 hours before an anticipated sexual activity.

Side effects.

These include dizziness, nausea and headache. Fortunately, Dr Ho points out that fewer than 10% of men taking dapoxetine exhibit side effects.

Does it really work?

“Dapoxetine has been tested in robust trials involving thousands of men, and results point to it being effective and safe,” explains Dr Ho. This strong amount of research data is one advantage of dapoxetine over many other PE oral medications in the market.

Can someone with no PE still take dapoxetine to improve their ‘staying power’?

Besides the usual side effects caused by dapoxetine, there is no evidence suggesting that normal men taking this drug will experience health problems. However, Dr Ho also points out that there is no evidence to suggest that usage of dapoxetine can improve a man’s stamina in the bedroom. “Men often have unrealistic expectations when it comes to their stamina anyway,” Dr Ho says with a smile, “thanks to the frequently exaggerated portrayal of sex in popular media.”

Are there certain types of people who should not take dapoxetine?

“Men with severe heart and liver problems should avoid taking this medication,” cautions Dr Ho. Also, certain medications such as other selective serotonin reuptake inhibitors (SSRI, these are drugs that work similarly like dapoxetine to increase serotonin levels in the body), monoamine oxidase inhibitors (MAOIs), anti-fungal and anti-viral medications may cause unwanted side effects when taken along with dapoxetine, so consult your doctor if you are also on these medications.

The best of both worlds

According to Dr Ho, men with PE may be given medications while at the same time they are advised to put into practice the control techniques described earlier.

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Great News from the Man’s Cave!

Great News from the Man’s Cave!

April 28, 2022   Return

Mention “erectile dysfunction” (ED) and most men would blanch at the thought of it affecting them even for a second. Benign prostatic hyperplasia (BPH) may not be as familiar a term as ED, but this condition – in which a man’s prostate glands become enlarged – can cause complications, such as the frequent need to urinate – that can wreak havoc in a man’s efforts to be intimate with his partner.

Yet, many men will not admit that they have these problems if they can help it, several prominent and well-respected medical experts concurred during a very special “man cave” session at the PJ Live Arts Centre on 13 August, 2015.

The “man cave” was actually a stage decorated to resemble a den, representing a safe space in which a man feels confident and secure enough to bare his soul and confront his inner demons. Organized by Lilly Malaysia (Eli Lilly (Malaysia) Sdn Bhd), the “man’s cave” brought together Dr Teh Guan Chou (President of the Malaysian Urological Society and a Senior Consultant Urologist), and Dr George Lee (Clinical Associate Professor and Consultant Urological Surgeon). Joining them was Dr Prabhuram Krishnan, the Medical Director of Eli Lilly Malaysia.

ED is a common problem despite most men preferring to avoid addressing it. Dr Prabhuram pointed to a paper published in 2011 in the Malaysian Journal of Andrology, which stated that 20% of Malaysian men over 50 have ED, while the number doubles among men 40 to 60 years old. Worryingly, we are also seeing an increasing number of younger men with ED now!

ED does not just ruin a man’s effort to be intimate with his partner. Dr Lee pointed out that, among certain patients, ED has been linked to an increased risk of future health problems, including heart problems and strokes. “It can be scary if you don’t get it treated soon,” he said. Dr Teh always said that ED is a sign of a “broken heart”, and this can be true – literally!

Dr Teh, touching on BPH, mentioned that the prostate gland, for reasons yet to be determined, can become bigger with time. Due to its proximity to the bladder, its increased size can obstruct or constrict the bladder, slowing urine flow and increasing the time it takes to empty the bladder. Hence, a man with BPH needs to go to the toilet often. Up to about 60% of men aged 70 and above have BPH, Dr Teh claimed, and 80% of these men experience lower urinary tract symptoms such as the urge to urinate often.

All three speakers stress that seeing a doctor for ED and BPH is a far better course of action than turning to alternative remedies, which may not work and only prolong one’s misery.

The event closed with another excellent reason to see a doctor for ED and BPH woes: the launch of the new Cialis 5 mg Once Daily pill. Cialis is the only drug that is approved to treat both ED and the symptoms of BPH.

For men with ED, now they can take Cialis 5 mg Once Daily just once a day, and can engage in sexual activity any time of the day. Compared to the “on-demand” Cialis, which has to be taken before sexual activity can begin, the Once Daily pill offers spontaneity and convenience that would be welcomed by men who need this medication. 

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