Saturday, December 24, 2016

Fat - Is it good or bad for you?

I decided to talk on something different than beauty today, since many have been asking me about this question. Its all about fats and cholesterol and the controversial studies that came out this year about the use of statins and whether they are actually beneficial or not and that fats are not the main culprit of disease, rather it is sugar.

So this is my personal opinion based on the observations and studies I have read.


Is fat good or bad?

In the past, we were lead to believe that by taking fat you will become fatter as it only made sense that what we ate, stores in our body. However, over time, with advancement of technology, we have started to understand how our body processes really work and we discovered that this is actually not true.We discovered that sugar is the real culprit in glucose, galactose, sucrose and fructose forms -i.e. refined sugars especially. When we take refined carbohydrates or any form of sugar, it causes our blood glucose level to spike, and thus increases the amount of insulin produced to reduce the blood sugar level and keep it within acceptable range. This causes a contraction of the pancreas, that may lead to damage of pancreatic cells.When we lose the capability to normalise our blood sugar level, it means we have diabetes. So what happens to the sugar that is being taken by the insulin out of the bloodstream, it is sent to the liver and then later stored as fat. You read me correctly, the sugar gets transformed into fats. 

Fats are an essential part of our body as it is involved in the formation of hormones, regulating body temperature, as an energy store for the body, and important in the absorption of certain vitamins and minerals required to make your body function properly. In fact, most of the brain matter is built from fat, and fat also helps with the formation and growth of hair, nails,, skin and other organs.


So does it means we should eat fat?

Fats also come in different forms. You have the unsaturated fats and the saturated fats. And nowadays there are newer fat types called trans fats. What are unsaturated fats? Basically, they are fats that remain liquid in room temperature, i.e. your oils. Mostly are from vegetable oils, nuts and seeds. They are divided into monounsaturated fats like olive, peanut, almonds, avocado, almond nuts, hazelnut, sesame seeds and pumpkin seeds, or polyunsaturated fats such as canola oil, soy,flaxseed, and fish oils. Saturated fats are mainly animal fats and those from coconut and palm products. Although recent studies have shown that there is not enough evidence to associated consumption of saturated fats to increased risk of cardiovascular disease, there are studies that show switching saturated to unsaturated fats are beneficial to increase the HDL levels in the body, reduce LDL and reduce insulin resistance.


What about trans-fat? What are they really?

Trans fatty acids are fats which has been hydrolysed into a more stable form i.e. from heating up of vegetable oils or hydrogenation process that causes them to harden into margarine or shortening. Some trans fats are naturally found in beef and some dairy products. Because of its stable nature, partially hydrogenated oils are frequently used in fast food restaurants and bakeries, as it can withstand frequent frying without breaking down. However, trans fat has proved harmful to our body, and contributes to the rise of LDLs, and increases inflammation. It reduces HDLs, and contributes to insulin resistance. There was a statistics that shows for every 2 spoons of trans fat, you increase your chances of cardiovascular disease by 23%. 

My take on it?

Personally, I have started to switch all my fats to mainly natural fats i.e. unsaturated or saturated fats only. Margarine is completely banned from my fridge, but I do keep butter and occasional sour cream. I use olive oil for light cooking, and palm oil for frying (scarcely). I have reduced my intake of animal fats and I focus more on healthier fats from vegetable sources. I have at least 5 different types of oils in my house namely olive, virgin coconut, flaxseed, hemp seed and palm. I avoid eating fast foods or preserved foods and I avoid all forms of trans fat as much as possible except from beef and dairies like cheese. On top of all this, I've also restricted my refine carbohydrate intake. Sugar is banned from the house and thus honey is usually used as a sweetener instead. I drink my teas and coffee sugarless, and fruit juices are banned unless freshly squeezed. There is the occasional commercial ice lemon tea for my kids but sodas are a complete no no. 

Between sugar and fat, my concern is more on the sugar, as the usage is much more rampant and it is much easily absorbed by our gastrointestinal system. Fat on the other hand, requires a longer time for absorption and most of the saturated ones just past through. Sugar seem to have a more drastic effect on our metabolism compared to fats, 

The key is moderation, and also avoiding all the processed forms of foods and you would definitely feel a lot healthier.

So how to reduce sugar and fats? Talk to use today and we'll give you a run through of our weight loss, fat loss program.

For more information or to book an appointment, please contact us at or send a message to 012-9660852 or PM us through FB or Instagram. 

Monday, December 12, 2016

Medium Face Peels - TCA Peel

In my previous entry I talked about how chemical peeling has been one of the oldest but most effective (and economical) ways to keep skin looking healthy and tackle some of the superficial signs of ageing. Being in Malaysia, where there is 12 hours of sunlight daily, and constant heat of 27-35 degrees year round, a lot of the deeper peels like Phenol peels and Obagi Blue Peels are banned from being used here. The weather and skin type of most asians do not allow the usage of these medium to deep peels. But they really do wonders.

So we are stuck with the light peels and some light to medium peels that doesn't really give much difference, especially if you are a hard core peeler like me. Ironically, the medium depth peels get banned, but the rampant use of Lasers do not. But then again, my country is pretty funny when it comes to policies. And then there are TCA peels. TCA peels in Malaysia are strictly in clinic procedures and must only be done by the doctor and not a nurse. 

So what are TCA peels?

TCA stands for trichloroacetic acid. When we talk about TCA peeling, it is meant for superficial-medium peeling of the skin. Unlike the AHA peels, it goes beyond the epidermis,and thus encroaching the upper dermis which allows a much more skin peeling to occur. Because of this, it has a downtime of between 5-14 days depending on the strength of the TCA used and the method and duration applied on to your skin. Usually it is more painful than your standard glycolic peel, and water is enough to neutralise the peel.

What are the benefits?

It peels deeper than the conventional superficial peels. So it does help to reduce fine lines, pigmentation and other epidermal issues. It lightens up melasma and previous hyperpigmentation due to various reasons and may remove some of your age spots.

What's the catch?

The main catch is the down time. It will be pretty obvious if you peel, and usually would last a couple of days. The dead skin will appear darker and thus it is difficult to hide. In my case, I did the peel on Monday and although it has been a week, I still see some peeling areas especially laterally. I suffered during the second to the fifth day, as it was obvious I was peeling, but I had to go out and see patients and attend social events. I did try covering it with make up, but it became more obvious, so lastly yesterday, I did not wear any foundation, but rather enhanced the eye make up around my eyes instead. What would you feel? The first day, the skin would feel super tight. By day 2 and 3, the peeling would start and it usually starts from the midline. The skin that is going to peel would be scaly and turn darker and sometimes it looks like you have more pigments on your face. However, once it falls off by itself, you get pink fresh skin from below with less pigmentation seen. 

It doesn't look too bad on the photographs especially with all these new phone apps that make you look flawless, but it took a lot of confidence to just act normally although I know my face was peeling away.Plus, I had a tendency for post-inflammatory hyperpigmentation, so I had to be very careful not to accidentally peel off any of my skin by force that would cause PIH instead. 


TCA-LP is a product from enerpeel, that is used in the clinic for TCA peeling. I've tried a few TCA peels in the market from Skintech, Obagi and others and I find that TCA-LP has some good points.

For starters, true to its name, it is less painful than your usual TCA (LP means Less painful). During this experiment stage, I was applying the TCA to my own face since my nurse and supplier was too afraid to do it. It came in single vials with a brush tip, and was for single use. I applied few layers on until frosting, and was left for 2 minutes before neutralizing.

The only thing I was a bit sad was that the suppliers cannot bring the 40% TCA-LP in as that would do wonders for more aged skin. Another thing is, you will need around 3-4 sessions to be done monthly to achieve the best results that can last for a year depending on your expectations. The good thing is, you can use superficial peels to maintain the results, although it may be every 2-3 months.

Suitable candidates

Since it is a medium peel, only for skin types I-IV . On a general rule, I try not to do medium peels on anyone darker than me, and for those with PIH tendencies like me unless they are a seasoned face peeler who really understands the complications and limitations. SO in English, it means caucasian skin, fair chinese and some other fair races. If you are chocolate milk come in for a consult. If you are darker than that, stick to superficial peels only and preferably by an experienced dermatologist or aesthetic doctor. Also if you are the type of person who cannot afford any social downtime, better stick to the superficial peels. 


Still think that this is a home based procedure? The complications of a TCA peel may not be as bad as the deep peels but can cause a lot of distress to the patient. 

1. Even though it removes hyperpigmentation, there are chances it can cause hyperpigmentation. Especially if the dead skin is forcibly removed and you have a PIH tendency. 

2. Hypopigmentation - sometimes it can cause hypopigmentation especially if the TCA concentration is too deep and it was not neutralized properly or the person has skin types IV-VI. This is why we err on side of caution in darker skins. HYpopigmentation is harder to treat than hyperpigmentation.

3. Infection - sometimes you may get infection of the skin as it peels off but this is rare. Maybe in some cases of severe acne where the source of infection is already there or in immunocompromised people.

4. Scarring - scarring is always a risk especially if the procedure was not done properly or neutralisation part was not complete. 

Doing this procedure in a proper medical doctors office can help reduce chances of complications. If your doctor does not know how to handle the complications, better find a more experienced one.

So in summary, the TCA peel is a very good skin rejuvenation method that is fast but requires downtime. The cost for a session of TCA-LP is RM 350 and you will need 3-4 sessions every 3-4 weeks for the best results.

For more information or appointments do contact us at or text us at +60129660852. Or you can send us a message through our FB page under DR MM Clinic.

Weight Loss with HCG - New things we discovered along the way.

Weight loss has always been a major concern for me as I remembered a time when I was more than overweight. The best weight I was ever in my life was when I was 18, at the weight of 52, I was as lean as ever. But looking back, at that time my assets were not fully blown and perhaps the best I could be now is perhaps 62 kilos. (I did this once last year and everyone was worried and thought I was sick because I looked too skinny, thank you for your concern, I was just experimenting on best weight).

If I told people that I was a heavy 89 kilos, most of them would react by saying when? But yes, this was a reality to me in the years 2006 after the delivery of Bella to around circa 2009. I was struggling with weight loss. Until I stumbled across the hcg diet which was introduced to me by one of my sifus. I believed him because the first time I met him he was twice my size (and I was fat then) and now he is smaller than me.  I owe a lot of my knowledge to his mentoring. He could explain to me things that other doctors would not even bother to understand. And I needed to know, not just because I am curious, evidence-based and critical, but also for my patients. The worst thing to be as a doctor is ignorant to all the effects and complications of the treatment that you warrant to your patient.

Well, back to HCG. In the past, we use to just explain the role of the HCG hormone that acts like a catabolic hormone in the absence of insulin. What it means is that, when there is no insulin spike in the body, the HCG at 125-250mg level acts on the fat cells facilitating transport and metabolising fats into energy. This is why it is strictly prohibited to take any form of sugar or carbohydrate during the diet phase 2 and 3a as it would cause the opposite effect. Many can argue that if they go on 500 calories of protein and fibre they definitely will lose weight but how do you explain the fat percentage loss? Starvation leads to protein breakdown and usually the fats are the last ones to go. (We've measured our patient using a complete body scan and in 1 week, she lost 3kg of fat, her protein mass remained the same). 

It sounds simple, but I believe that as patients you require guidance especially in the first attempt and going through maintenance. There is a lot of explaining to do that some clinics do not bother doing, hence you will get a more yo-yo effect on weight loss which in the long run is not good for you as it can cause more harm to your metabolism. We are playing with hormones people.... Make sure your doctor knows what they are doing. It is not a quick weight loss program.

Along the line, we've learnt a few things. We can use HCG to increase testosterone levels in men who are young and suffers from hypogonadism. It is safer than giving testosterone directly since once you introduce external testosterone, the natural factories will decide to stop production (like 91% based on latest studies done in China). It helps reverse the conversion of testosterone into oestrogen by the aromatase enzyme. The easiest clinical signs are the formation of man boobs and the pot belly hard tummy. So if you are a guy below 60, who is overweight and have gynaecomastia and an increasing pot belly, most likely you have reduced levels of testosterone. Some guys will say, so what? But in the long run it will effect your daily performance (not to mention the performance in bed). I envy my male patients on HCG, as they seem to loose weight faster than us ladies. They kill two birds with 1 stone, lose fat and increase testosterone levels.

I've also realised after being on the program for a few years, the best  is to slowly drop your weight, year by year, and then it would last longer. So usually after new year I would be on the program again, just to lose a few more kilos and maintain it. Since last year, I've succeeded in keeping my weight less than 70kg, and my silhouette has maintained. I've also discovered that muscle building during the second phase of maintenance helps to improve body tone and sustain weight loss results. I took a new liking to pilates, and I find that despite being off for awhile my weight easily jumps back to what it is usually.

Other things we've discovered also is that the protein intake is super important. If you are a strict vegetarian, forget it. The most you are able to lose is 4kg in 23 days. Some vegans who wanted to try, had to be on egg whites daily that it caused them to be bored. Without the protein, the weight loss was reduced.

Other benefits of the HCG diet as observed is a better glycemic control for diabetics, reduced cravings for sugar and junk food in most people, sustained silhouette despite some weight gain, and change of dietary habits. But the set back is the strict regime during the diet and the maintenance phase. So at the end of the day, it is all about will power and determination. Like I always tell my patients, the diet is a detox sacrifice for 3 months. If you do it well, it may be the first and the last time you ever have to do it. It is a personal choice. If you are willing to commit and want to change, we will be here to help guide you throughout the process.

For more information or to book appointments do contact us at or send a message to +60129660852.

Chemical Peeling - Old technique, new advances, economical and still good results.

Recently, I have been asked what would be my favourite method of maintaining skin health and youth. To their surprise, laser was perhaps last on my list. Living in a super hot tropical country with high humidity, perhaps doing laser on your face is maybe a bad idea. Especially if you are not particular enough to consistently wear sunblock (even in the house) and keep yourself protected from direct rays. Unfortunately, so many clinics, medispas and beauty salons are promoting laser as if its just a simple facial, that they forget the complications that entails when not advised properly.

Perhaps, this is why I decided to come back to work and start reeducating the public about medical aesthetic treatments and procedures. The science of beauty is real, not just some money making scheme.

Well, anyway, enough rambling. Back to the facts. Let's talk about chemical peels. This is perhaps the oldest method of beautification brining us back to the Egyptian reign where Queen Cleopatra was well known for her milk yogurt baths to exfoliate her skin and leave it smooth and flawless. Nowadays, we have more specified chemicals to give us the controlled exfoliation that we need to achieve the result we want.

So why all this exfoliation business? Our skin consists of multiple layers of epidermis with the outer most layer being the one most exposed to the environment called the keratin layer or the stratum corneum which is mainly made out of keratocytes which are completely devoid of nucleus. This is also referred to as the outer skin or the dead skin layer. Most of the superficial peels and microdermabrasion take off this layer of the skin, thus revealing a much more fresher newer skin. However, some medium strength peels tend to peel deeper into the stratum lucidum and some into the stratum spinasum. No matter the strength of the peel, the doctor doing the procedure must be aware of the level of peel he or she is doing for the patient and how to monitor for side effects. Many times over the years, my suppliers come to me with a picture of a patient burned from chemical peels done by other doctors and asking how to resolve the problem.

So why do burns occur? The most common reason is bad technique during the procedure where either the application was too thick, the time was too long or neutralization was not done when it was warranted. The problem with chemical peel burns, sometimes it takes up to 2 weeks to heal and you may leave the patient with an unsightly scar. Whatever it is, if you have trained yourself well, you will be able to handle peelings easy since it is perhaps the simplest thing, that a lot of people take for granted.

Why do I love chemical peels? Because it is one of the simplest things you can do for the patient to remove all excess dead skin and make the patient's skin look brighter and cleaner. The procedure usually takes anywhere between 1 to 30 minutes depending on the type of peel and how it is applied and how many layers. A study published in medscape in the year 2006, caught my attention on regular chemical peelings and how it affects the skin. They wanted to see whether regular skin peeling would cause patient's skin to be thinner but on contrary, there is a few millimeters improved thickness instead. This was due to the increase skin turnover due to the feedback that the stratum corneum is thinner, thus increases cells production. However, bear in mind, the procedure has to be done correctly at the right intervals in order to have this effect. Over peeling, or complications due to peels can also cause worsening of skin texture which is what we see with certain local cosmetic products which are too aggressive and uncontrolled. 

So recently, my clinic has been trying out new types of peels since our older ones are being phased out and I am forever in the quest of looking for super no-downtime treatments for my patients. Among all, we found some that we like. One of the newer chemical peeling treatment that we would be bringing in is called the Elsa Peel. It consists of 3 layers of peelings followed by a clay mask. The good thing about this peel is that there is no downtime after the procedure, and yet it gives you a good clean peel and helps lighten up pigmentation. So far I did once on my face and the results was satisfying. I have been peeling my face for years, and even with 1 treatment I noticed at least 2 tones lighter skin compared to before. During the peel I had an acne pop and even afterwards, the post-inflammatory pigmentation was much lighter compared to the rest. 

The Elsa peel is suitable for most skin types. The recommended is to do a peel once every 7-14 days up to 4 times to achieve a much better skin tone with reduced pigmentation. Subsequently, you can maintain by doing it once every 1-2 months. Coupled with serum vitamin C or any other dermal replenishment creams, it would be superb for people with skin that is prone to pigmentation or for those who want a more even and brighter skin tone.

The usual price for this treatment is RM 450 / session and takes approximately 30 minutes to complete. Since we are launching this new product, we are giving a special introductory offer of RM 350 / session. Take up a package and get more discounts but this you have to ask my nurse.

For more info, or to book appointments, please email us at or drop us a message at 0129660852. Or you can like us on FB and pm us from there. 

November Rain

I have just realised its been almost a month since I had time to sit and update my blog. October was such a whirlwind month that I had to remind myself to breathe in between. And now it is November. Wow. Times flies so fast these past couple of months it is scary. Come November, it is more of the rainy season and we will start seeing heavy downpours.

Yesterday I took a day to recuperate and be a mum which I rarely get to do these days. I cooked dinner, sent my girls to school, discussed their social lives and after lunch I was sitting in front of the telly (a real luxury for me since I barely have time to even sleep) and watch the US electoral race. Congratulations to Mr Trump for winning the President vote and I was quite surprised to hear his winning speech which was very diplomatic and thanking Hillary Clinton for her service to the US in the past. The thing I admire most about the Donald, is that he understands that you need to hire the right people to do the job, to get things done, and despite having no political background, I am sure he would have his team of advisers to help him achieve the goal of making America great again. And I wish him all the best and good luck to all Americans. 

Mr Trump is one of the people on my list that I wish to meet in this lifetime. He maybe ruthless, sexist and harsh, but for one, he proved that if you believe you can achieve something with all your heart, you will. I may not be the person he would be nice to, being a Muslim woman who looks pretty much Hispanic since Asians and Hispanics do share some similar ancestry ages ago. I kinda have all the big no nos in his campaign. (Just kidding).
If Mr Donald Trump can become the president of the United States, then I can certainly achieve my target to become a lifestyle ambassador, and advocate for health, beauty and lifestyle. Lots of work, but hard work never really killed anyone. The main key is to get my mind organized enough to work it through and find the right people to make it happen. Yes, Mr Trump taught a good lesson.

Looking back at our local scenario, there are many issues that Mr Trump brought up that is also an issue in this country. The immigrants for one. It is okay to accept legal migrates because we have all their documentation, they are also taxed and they have different rights than the locals. The problem with immigrants is that they enter the country illegally, we do not have proper documentation of them, they may harbour disease since they are not screened, they do not pay tax or even register their salaries, and the best part, they use up our resources in healthcare and other facilities and stay for a couple of years, nearing election, they will suddenly get resident status. And then their children becomes citizens, and are entitled to all the benefits that you and I get. Funnily, the expatriates who marry working citizens takes up to 10 years to get their resident status, and yet these people contribute to the economy and the taxes. Pretty funny yes? I am not the expert in sociology, nor politics so perhaps the best is not to comment too much.

My expertise is more of medical aesthetics, technology and lifestyle. I have this endless need to find the best solutions to treat problems related to beauty and ageing and being a vain pot that I am, it is also driven by the family history that makes me more convinced that lifestyle plays a more important role than genes. In fact, many patients have asked me about the new DNA testing that allows the person to find out their associated disease risks in the future. Although it may be a cool technology, that comes with a hefty price tag, it is a two edged sword that may not give you the outcome you want. 

The problem in this country is that a lot of doctors promote tests but do not counsel the patient on the real benefit of doing one. Doing a complete DNA test to show your future risk sounds cool, but if you were counselled wrongly by your doctor, you may have the wrong impression or you may even go into depression thinking about diseases that might occur to you based on your genes. The good news is, genes only play a 10% role in the risk of getting a disease. The remainder 90% actually comes from the lifestyle. So, at the end of the day, you still require to change the lifestyle. Thus, would doing an expensive gene test actually have much benefit except for adding to your paranoia?

I am not against any form of DNA testing but I would just like to tickle your mind a bit more. My patients are very curious and sharp minded people who would scrutinise every single detail given to them, and they are not afraid to ask questions. I like them this way. In order to achieve optimum health both parties must be active participants, to create a better understanding of the patient's needs and requirements. If they want to do the DNA testing, I can order the test for them. Whether it will give an additional benefit to what we already know, well, maybe.

If you are interested in knowing more on how to optimise your health to look and feel good, and you happen to be in my vicinity, do make a point to make an appointment for consultation. My nurse Mia is superb in keeping up with my crazy schedule. Its November already. It reminds me of of autumn and November rain.

For more questions or appointments do contact us at or send a msg to 0129660852. 

Sunday, November 27, 2016

October is Pink Month

I think most of us would agree that this year is indeed a very fast year for most of us. Its already October. OMG, when did that happen? With the current political and economical issues surrounding our country, it has been a pretty tough year for a lot of us, including myself.

After closing down the Starhill Clinic (Faceworks Clinic) in March 2014, I decided to take a break from my crazy hectic practice that demanded 12 hours daily 7 days a week with only 1 day holiday for important days like New Year or Eid. Yes, having a clinic in a mall is challenging and needed a lot of patience and perseverance. So in a way, I was welcoming the 2 year break I decided to take to rediscover myself.

It was a well worth time taken off. Despite the obstacles and the hurdles, it taught me a lot about how my life use to be and how the now choices I make have totally changed it. I felt that I have morphed from my cocoon of that shy girl who had an idea of what she wanted, to a full bloom woman who commands what she wants. Although I lost a few friends along the way, but I made new better ones, whom I admire and adore so much that when I grow up I want to be just like them. These are women who drive their own industries, whilst giving back to the society and inspiring others to become better people without any insecurities of jealousy or negative competition. I feel so blessed that I am surrounded by these titans (Yes, I am taking notes on their steps towards success). One of the tips of being successful yourself, is to surround yourself with people who have the success that you desire, and it will motivate you to work harder.

And my patients, whom I feel so blessed to manage and care for, kept me going, even when I felt like my life was so bleak. The trust and loyalty they have for me is so heart felt that although at one point I felt like having a complete career change (I have many talents than being a good doctor), I could never abandon their needs. My patients need me, and more patients would benefit from my skill and talents in not just medical aesthetics but also consulting on lifestyle modifications, and other anti-ageing therapies that are the in thing nowadays. 

After pondering for months, I've decided to announce my return from semi-retirement. Yes, people, I'm back and I am working on my new project that will benefit my patients and my readers. I'm working on my new site, which will have multiple blog topics, not just on medical aesthetics but also focusing on lifestyle and nutrition, with some stories for motivation related to some of my past experiences and others whom I've met along the way. The whole idea is to inspire others, the way others have inspired me. How fast will it come on live...? Depends on how good I am at handling wordpress (Or if I get the intern i requested asap). I would just like to request to all my patients and friends, to help Like my clinic page on Facebook (, follow me on Instagram ( @dr.marr), and if you are happy with my service and my care to tell 5 friends about me and get them to Like my social medias. If you are not happy, please let me know so that I can improve myself and the clinic. 

October is Pink month. It is breast cancer awareness month. Despite all the awareness campaigns, it is still the leading cause of deaths due to cancer for a woman. Latest studies have shown Vitamin D can help reduce risk for cancer. So perhaps its time to spend more time in the sun to gain this benefit, or you can just supplement daily. If you are out in the sun, don't forget to wear good sunblock with UVA and UVB protection. Unsure of a good one? Buzz us, and we can recommend the ones we carry which are clinical sunblock products.

Have a good week ahead peeps, the October parties are just starting.

For more information and appointments, do contact us at or contact us at 0129660852.

Testosterone Therapy - Men Need Help Too .....

When I first started my private practice, my focus was mainly on medical aesthetics and external beauty, skincare and products to enhance beauty.  After 8 years, now it have evolved more into lifestyle, where I also delve into optimizing my patient's systems so that the body functions the best. Because what is the point of looking beautiful, if you feel like crap and you gain weight excessively for no reason? I myself face similar dilemma trying to keep my weight checked, to the point that I start studying more on hormones and internal body processes and metabolic pathways. And after awhile, everything seems to make sense.

A very interesting problem nowadays is how a lot of men in their prime are not in optimum health that you find young men having testosterone deficiency symptoms. The factors contributing to this dilemma is mainly stress levels, diet and lack of physical exercise that causes the testosterone levels to decline and slowly leads to weight gain, low mood, low energy and depression. Another issue that a lot of men have is the aromatization of testosterone into oestrogen by an enzyme called Aromatase. This then leads to the formation of gynaecomastia or also dubbed man-boobs and the collection of fats around the stomach pot belly area. This conversion leads to a reduced amount of available testosterone in the body leading to symptoms of deficiency. So basically that growing tummy is not a good thing boys, you better start thinking of losing it. Recent studies have also shown that men with reduced testosterone levels have higher mortality risk. So its not just about getting that 6 packs, but it is also to ensure then men live longer.

Last July I attended a conference on men focusing on hypogonadism or low testosterone and erectile dysfunction. It was a real eye opener. Thank you Bayer for the kind invitation. Our speakers were well experienced andrologist from Malaysia and Singapore who were very informative and entertaining. Andrologist are doctors who specialize in male sexual and urinary problems. I learnt so much on testosterone in that two days that a lot of the things I was studying made more sense.

Most doctors believe that as long as the testosterone levels are within range, it is normal. However, more and more studies have shown that there is an age relation to the level, where it peaks highest in the adolescent stage up to 1200ng/dl at 18 years old and slowly declines over the years with an average of 1.6% decline per year. The range given by the labs is so huge i.e. from 270ng/dl - 1070ng/dl. A few community studies have shown the averages based on age groups which can also be used as a rough guide. The best way is to look at the symptoms and signs and correlate clinically. 

Possible symptoms of Testosterone deficiency:

1. Psychological symptoms
     - Irritability
     - Nervousness
     - Anxiety
     - Depressive Disorders
     - Memory Disturbances
     - Lack of Concentration
     - Mood changes

2. Somatic Symptoms
     - Muscle Pain
     - Joint Pain
     - Excessive sweating
     - Sleep disturbance
     - Muscle strength and muscle mass decline
     - Hot flushes
     - Cardiovascular disease
     - Increase body weight
     - Increased visceral body fat
     - Testicular atrophy
     - Osteopenia
     - Chronic fatigue
     - Anaemia

3. Sexual Symptoms
     - Low libido or sexual interest
     - Reduced number of morning erections
     - Delayed ejaculations
     - Impotency

These symptoms can be reduced by increasing testosterone levels in men to what they require. You see, not everyone function well on the same level. It really depends on the individual. Just like how our body built are not the same. In the past, the testosterone range was determined by subjects between the ages of 20-80 years old. Nowadays, there is a more age specific range based on the general well being of the man, whether or not they have metabolic issues like diabetes or cardiovascular problems.

But it is not as easy as just supplementing testosterone as what most men believe. There are many factors to consider such as age, and cause of low testosterone and whether future offsprings are considered. Long-term testosterone therapy causes the Leydig cells to stop producing sperm in 91% of cases. Hence, we should weigh the pros and cons of treatment. The best is always to consult your anti-ageing or lifestyle practitioner properly to give you the best options based on your age, and future expectations. Furthermore, too much testosterone has been proven to increase aggression in men, with a higher tendency for them to drink, smoke and engage in high risk sexual behaviours. Therefore, careful planning  and monitoring is required to ensure optimized treatment. I'll explain more about treatment options in another blog entry.

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