On today's episode, we're delighted to welcome on Dr. Jeff Foster, a men's health specialist and testosterone deficiency expert, and also the author of the book, Man Alive. So welcome, Jeff.

Very kind. Thank you for having me.

And it's a pleasure to have you on because I enjoyed your book so much and I said, what we need to do is we need to get this person on.

Very kind.

Hence, here we are. Yeah. So to give a little bit of context, listeners might remember that when we did an episode back in the summer with Kate Muir about the men in force, that Kate mentioned yourself. And she mentioned your book and the work that you do around testosterone deficiency and so that's why we wanted to invite you on as well as Kev reading the book.

Kate's lovely, and I think perhaps one of the reasons she asked me on is because there aren't many people that do what I do. So, you might notice there's kind of an abundance of menopause experts out there at the minute, which is a great thing. It's really had a really good highlight in the, in the public eye now in the case that menopause never was 10 years ago. But there aren't many male health doctors out there. And I think there's a handful of us only. So it's a challenge to get, get the message out there a bit.

Well I think that's the the real challenge here isn't it? It's getting because menopause now is is probably on the tips of our tongues when we talk about it but we don't really think about the male version. I'm going to phrase it that way. I'm going to ask you, I mean, what is testosterone deficiency? How do we know? What is it? It

is, it's a really good way of thinking about it actually, because not many people actually understand what testosterone does. And I'd say a lot of doctors aren't very good with testosterone either, which is part of the problem. So, from a basic level, you need your testosterone as a guy, and I'm only referring to men at the minute. Obviously there are important roles for testosterone, but just going from the male side for a. you obviously need your testosterone pre birth to determine your sexual characteristics and it's the thing that makes you come out as a guy. And you also need it in puberty because it takes you from child to man as they say. But, a lot of people kind of forget about it after that and it's kind of just, well, you're done. You don't need, you've done all your bits now. So, but testosterone has a lifelong effect on men and women and it affects things like, your bone density, your muscle mass. your, fat deposition. It affects the way you think it affects the way you focus and concentrate. It's the thing that each day gives you that kind of drive to get up and do things. It's that motivational hormone. And obviously we all need it for sexual activity, sex drive, erection function, lots of stuff. And we know it does that, but it's the fact that there's lots of really positive data around. Testosterone doing an awful lot more and I think for many, many years, it's kind of been trivialized as well. Once you've gone through puberty, you probably don't need it very much anymore. But the evidence really is contraindicatory to that now. And in fact, it seems more so that as we get on later in life, you need to make sure your testosterone levels are where they should be. So testosterone deficiency, leading on for a very long winded answer to your question, is when that level runs out or goes low, and it has remarkable comparisons with menopause. It is not as prevalent because not every man will get low testosterone, and it's really important to remember that not every guy has it, but It's similar in the sense that you lose your primary sex hormone and as those levels drop, you start to gain all the symptoms that menopause have in women, but in men, but perhaps in slightly different ways. Does that answer the question?

I've got so many questions, obviously, from the man perspective. so do many men approach you, come into your surgery and say, look, I'm suffering from this. Is this normal? Um, and I suppose from a, from a driving perspective as well to people come in and say, look, my driving has been affected. Is there anything I can do? Have you noticed that?

Okay, so from an NHS perspective, in a general practice sense, you're going to see everything that will come through the door and then it's often hard to pick out. Obviously, I also have a private men's health clinic, and we have about a thousand patients there, and around three quarters to four fifths will have an inclination that maybe their testosterone is dropping. Well, a lot of guys will know that something's not right. but don't know what it is. So it might be, for example, that you just feel a bit less energetic than you used to. You might feel a bit down, might feel a bit like you've lost your get up and go. You might have a loss of libido or, or some sort of sexual dysfunction, but it doesn't have to be that, and you can have low testosterone without having. any sort of sexual problems, just like we go through early menopause and not have any change in libido there. It can be any of those symptoms. If you think about the population as a whole, 25 percent of all men at some point will have low testosterone. Now, it doesn't mean they all need treatment, but a quarter of the male population is quite large. And the latest statistics suggested around sort of, 11 to 12 percent of men over 40. Which again is actually still a pretty decent number. The key to all of this I guess to really stress is that we're not trying to compete with menopause and it's not trying to take a dig at a woman's condition and say well we can do that too as men. If anything it should be seen as a positive thing because you can actually understand better about what your partner might be going through if you understand what's happening to your own body as well. Specifically relating to driving, well, the way to think about driving is it's, it's another symptom of an underlying problem. So obviously I'm not going to patronize you on this, but when you're driving, you obviously need to be alert and concentrating and making sure that you can be aware of your surroundings and you have to have enough insight to be able to say that if I'm emotionally unstable or unhappy or something else is going on, I may not be able to give that. impartial and fair attention to the writing that I should be doing. And unfortunately, if your hormones are all over the place, then that makes it very difficult to do. So in men, it's not quite the same presenting symptoms as you might find in true menopause. Because of course, if you think about menopause, it's, it's normal level of hormone, and it goes to effectively zero over a matter of years or months, whatever it might be. For men, it's a much more insidious and gradual process. So insidious and gradual process. So it tends to be over many, many years. And if you imagine for most guys, you lose about 1 percent of your testosterone a year, but it takes a little bit of time and sometimes it can occur a bit more quickly. Hence why the average age is sort of in forties and fifties and sixties. But if maybe you were finding that you were far more confident making longer drives in the past, one of the earliest signs of noticing patients who say that They are longer distance drivers often for work, they find that the concept of driving those further distance becomes more daunting, and it's a really early sign so they haven't got full blown low T symptoms and they may not be getting hot flushes at night, but they might find that just little things that We're not a concern. I'm now starting to promote mild anxiety. So distance is one or complex driving situations like this. I've got one guy who says he can't drive in London anymore because he finds it too stressful. And I guess, you know, being in Warwick, it's easy compared with London. So he finds that particularly challenging. And that was one of the early things. And again, there was no insight. I didn't know why he just felt that it was too difficult thing to address.

And it, it, it must be quite confusing, isn't it? It's that thing where this is something I always used to be able to do. and I've done it so many times. So why am I now feeling, it comes back to that mystery driving anxiety that we've explored in the past. And it's, it's just trying to help people being able to recognize that it's not always completely down to the driving. Often it is those other underlying factors. And in this case, our biology that's coming into play and having an impact.

I completely agree. I mean, I don't think I've ever had a patient who's come in and said, my only symptom is I hate driving in London, because that could be most of my patients. But on the other hand, you use that as a, as a, an illustration of just one of those other symptoms that are coming through. the anxiety element. It's really unusual in testosterone because people always imagine that when you have too much testosterone, you get angry and aggressive and you have this idea that it's sort of the steroid rage of men who take too much testosterone, they're always angry and punchy. And even men with maybe higher levels of normal tend to be that stereotypical alpha male character who's more forceful and aggressive. The evidence seems to be the opposite to that really. Or nearly opposite in the sense that it's men with low testosterone that start to become more irritable, more, unhappy, anxious, and angry. And it's the difference between anger of being directed towards something and anger due to frustration or anxiety and concern. So you're just not happy with things and you don't really know why. And we do know that if you give men with low testosterone, testosterone treatment and put it back to normal levels, a lot of those anxieties disappear. If you then push it the other way and keep giving him too much testosterone, and then that's where you are into that steroid rage group, and that's where you see the guys who are typically, I'm just giving an example, but might be at a local recreational gym, and might have decided to take a larger than his, Recommended amount of a supplemental drug like a, a hormone and taking a steroid. And for those guys, they can get more angry. So the whole key to healthy hormone levels and in relation to anxiety and therefore driving is that you want it to be in that middle zone, not too little and not too much. And if you get it just right, everyone's, capacity to drive with a safe limit gets better.

And I think the other thing that was really interesting when reading the book, there was some mention there about concentration levels and decision making as well. So that that's another is not just the anxiety that can be impacted, is it?

We had a really interesting chap who was in his late 70s and had been diagnosed with dementia. and yet all his scans were effectively normal, which was pretty weird. You know, you get slight age related shrinkage of his brain, but other than that, nothing that really should promote a dementia picture. And it turns out in the end, this guy had a crushingly low level of testosterone, which no one had thought to test at this point. And I, to be honest, I think we only saw him because he'd run out of ideas and asked if I could try something. So we tried the test that it turns out it was incredibly low. And obviously, All of his symptoms disappeared once we started his treatment and his dementia symptoms completely resolved. The ability to maintain concentration and drive and focus is one of the key elements of testosterone in men and women. And you'll find that For both sexes, not having enough testosterone stops you being able to concentrate on what you're doing properly. Again, it's, it's often easier to pick these up in menopause cases because of the stark drop and women do notice it a lot worse than men. For guys, it's much harder to pick out this group because they're so subtle as they start to kick in. And the other thing is many men, of course, don't want to talk about it. don't want to go to their doctor about it, and certainly wouldn't want to admit that they didn't have as much testosterone as they should do, because of course we're all manly men, and we don't have issues about our hormones as we get older. We're tough guys, and we don't talk about that sort of stuff. so you often find that most blokes will confabulate, or they will, look for reasons to justify why their concentration isn't as good as it used to be, and it might be, again, that comes back to that long driving scenario, well, you know, I, I don't need to go up north anymore for this sort of thing, or I'll, I'll, I'll put it off for another day and I'll find a reason to do it virtually, et cetera, et cetera, and they reason, and they find excuses that they don't have to do these difficult challenges, which previously would have been far more effortless. But they don't know why. They don't know why it's happening.

So, reading your book, I'll relate to your book again, there was a simple questionnaire in there that I thought, ah, this is so easy, and I'm hopefully we'll be able to mention it. It's the, it's the Adam questionnaire, and it was just 10 questions, wasn't it? And I thought that was just so simple for people to look at and say, yes or no.

The ADAMS tool, which is the Androgen Deficiency in the Aging Male Questionnaire, was basically a 10 point scoring system that had been put in place to try and work out which people may or may not need blood testing for testosterone. The problem with the test, well the good thing about the test, is that it's a very easy scoring system to do. And you can ask most people to answer 10 questions on things like, how much do you like your work? And do you have any erectile dysfunction, or do you find that you haven't got as much energy as you used to? And that's great because they're very easy answers that don't involve too much intellectual effort. You can say yes or no, it's quite good. The downside of the test, of course, is if you get any bloke, It is. I mean, I'm mid forties now. And if you ask me most of those questions on that score, you know, do I get tired at the end of the day? Do I find less enjoyment of work? Most of the time? I mean, God, yeah, no, I could, I can take most of the, you questions is like, would you have a nap in the day? Yeah, God, yeah. If I could get a chance, man, I'd be out. Crikey. I mean, I remember, certainly remember my, Kids were really young. I'm talking about in the first couple of months of life, you know, he's helping out on night feeds. I remember pulling over a service station on the way to work tonight for 20 minutes and being, God, this is the best thing ever. It's just normal stuff. But then, um, so the point being is that you can, you can, culturally normalize a lot of these questionnaires because it's what a lot of folks would do in their 40s and 50s. And it's even younger than I was in my 30s, but that's, that's a normal thing. And the key is trying to differentiate what is normal as you get older and what is a medical problem. And that's where it's really hard. We do have a, Sorry for withering on about it, but we have a bit of a cultural, normalization and a narrative that says, as a guy, as you get older, well, you should be more tired than you used to, you should be more grumpy than you used to. You don't have as much time to yourself. Men in their 40s and 50s often do longer time commuting than they would have earlier in their life. And they tend to take more senior roles as soon as their time in their car driving to different points is longer. So because of that. You're concentrating more during that period, so you should be more tired and all this sort of stuff gets pushed into there. Well, it's normal because of the situations you put yourself into as you get older. And of course, for 25 percent of the population, it's not normal. I'm doing wrong. 75 percent of guys, you are just doing too much and you need to calm down and relax and take a job closer to home. and get a better card, stop worrying about it and get some back support. It's really annoying. There are back pain patients we see with it, but all that sort of stuff. But then for a quarter of patients, this is a hormonal problem. And for these guys, it's, it's a life changing treatment and we should be doing something to help.

So as you've mentioned that, what sort of things can we do that's going to help us?

Okay. Well, from a lifestyle perspective, if it's truly hormone deficiency. If I'm honest, not a lot, because you'd love to think, well, if I just ate better and I lost a bit of weight and I could do a bit more at the gym or something, my testosterone levels would go back to normal. But the evidence seems to be that actually it's incredibly hard to exercise or lifestyle your way out of a hormone problem. You can do things to help. And there are lots of things, of course, uh, again, from a, even from a driving perspective that you can do around anxiety in terms of minimizing the impact of low testosterone. So for example, you're making sure you have shorter trips, making sure you're having appropriate breaks, making sure you're not challenging, driving at challenging times of days, et cetera, but this is all common sense stuff. And you'd want to do that at any age with any sort of. Not all medical condition existing just because we don't want to make you're driving to taxi if you don't have to, but the evidence seems to be now, actually, that if you have a truly low testosterone, the only way really to get out of it to treat the problem and again, you would never say to menopausal woman. Well, looks like you're going through menopause. Well, if you just go to the gym a bit. Everything will be fine because, crikey, you get a punch and rightly so, because you can't lifestyle your way out of menopause. Things will help. And everything we suggest to patients, you know, like being physically fit and like not eating at service stations all the time and having pies as your break and not having 17 coffees just to manage your day. All of that is good stuff, but it isn't going to treat the underlying problem. And the only way really to treat that is to not see a men's health doc and get your hormones levels resolved, really.

Yeah, and I think that's where it sort of like comes back to the menopause again, isn't it? It's those similarities and it's trying to raise that awareness. Like you say, menopause, there's been an increase in awareness of it over the last few years and it's trying to, trying to catch up in the men's health. side of things as well, to say, actually, it's everybody. We all have hormones, you know, human beings are hormonal beings And so it's an issue for all of us regardless.

I think that the, um, increase in menopause awareness has been brilliant for me as a male health specialist, we get about 40 percent of our patients are female partners who have brought their husbands or whoever else in to say, look, I think, My partner's got what I have, or something's not right with him. And often they've started an HRT and they feel the difference and they feel so much better that the disparity between the two of them is so much more obvious. The way I always try and say this to patients is it's a bit like being on the journey together. If you both feel crap, then actually it's a bit better. And a lot of men will hide. their low testosterone symptoms behind the fact their partner has menopause and it's worse for them. So, you know, if you've lost your libido and you don't want to have sex much anymore, or if your partner is going through full blown menopause, or they certainly don't want to have sex, in which case you can say, well, you know, I'm fine, but they don't want to do it. So I can hide behind that. And that's okay. The next thing, you know, suddenly your partner starts on HRT and out there and happy and wants to have sex and is more confident and do all those sort of things you hopefully gain from decent HRT treatment. And then it becomes very much clear that the guy actually really is struggling with symptoms and that's when we get pushed through the door. So, um, the fact that so many of our patients are sent in by women clearly shows that having that journey together is the key to making it work.

That suddenly made me think about, the fact that actually if you've, if your partners is reducing confidence in her driving as her hormones decline, the men can't necessarily hide behind that in the same way. Because actually one of you needs to drive somewhere. So with libido, One person can hide behind the other, but with driving, somebody needs to perform. Somebody needs to get in the car and drive. So you, there's nowhere to hide there, is there?

That's a really good way of thinking about it. I never really approached it that way. And I guess you're right. Cause it's a fixed environment where no one can defer responsibility. So you have to be on it, and I guess it probably does stand out even more so. I think with all the sort of hormone things, you often don't really notice how it's affecting you until you either sit back and have insight and reflect and think, wow, what happened in that process? Why? And that's quite hard, especially when we ask patients. about, I keep going back to this, but this is the commuter drivers who refuse to do it anymore. And they can't rationalize why it's only when you start to pick out the other symptoms as well. Actually, are you also very tired and are you struggling with other elements of low mood? Except then you realize there's probably the testosterone that's doing it. Or the fact it comes to a head and neither of you will drive or one of you is the only one that can drive because they're on their HRC or something, and then I guess that's a much more forced and in your face way of saying, look, something's definitely not right. But I guess driving's a very good and very, openly abrasive way. of showing that this is a problem. It's a bit almost, and I'm not directly comparing this, but you could almost argue the driving effect with your partner is similar to sex, because you're both in this very intimate situation where you both have to be on it, and if one person can't perform, for example, it becomes so much more obvious to the other that something isn't right. Um, there is no escape in your car, I guess,

No.

I'm not advocating that you should be having sex in the car, by the way, whilst driving, that's not

Yes. We don't advocate that. But particularly past a certain age.

Yeah, good, good. I mean, it's how you want to take it, but I just want to make sure I wasn't making a recommendation.

our podcast rating has now just risen. Yes,

That's a separate podcast will be on that one. It's amazing because sometimes I have these ideas and they are, this is a really clever thing to talk about. And then as I start to get through, I think, no, this was a really bad idea, one of the problems with working in the sexual health sort of world, sometimes you do often become slightly desensitized to how your conversations might present.

No it's great, it's staying in, so when we invited you on, was there anything that you thought, ooh, yes, I hope that they ask me about this, or, I'd like to talk about this, was there anything that you thought, ah, yes, drive in testosterone deficiency, I really want to get this across, that we haven't spoken about.

For me, it was more understanding what the, listener's perspective is around testosterone, because I would imagine That most people associate testosterone problems with the, either the excess, the concept of road rage, or being angry behind the wheel, as opposed to the deficiency, which is the thing that we really focus on. There is an assumption, and for the vast majority, I guess, a false assumption, that road rage is associated with people that have too much of the stuff. And it's actually really a minority, you know, you've got to have absolutely buckets of the stuff in excess to cause real, irritability and sort of anger issues around your hormones. From your side, I guess it was. Do you know what the perception was around testosterone at all?

I suppose the more we talk about it, the more we realize we don't really understand it.

Well,

where we are at the moment.

yeah, no, I agree. Not just in terms of driving, but I think in terms of testosterone in general, I think the general public awareness and awareness around a lot of medics, as I've said, is actually really bad. So it's not that surprising. I was going to ask, how did the response to menopause go?

There was a little flurry of people, it was mainly women who responded to that particular episode. Interestingly, there was a female lorry driver who said, yes, I've been a lorry driver for years, and I had to give up driving because of menopause. so that sort of acknowledgement. There was a lot of comments come through about apparently for women, it's one of the earliest signs of menopause is giving up driving or giving up driving on the motorway. Apparently, that was very well known, which we hadn't realized. But in menopause groups, it is. Something that's quite well known is, oh yes, that was the first time for me that I was in perimenopause was when I could no longer drive on the motorway. So we definitely had a flurry of comments and information come our way. So we're hoping that this might do the same actually, but from the male perspective that people will have a listen and think, Oh, I didn't know about that.

I don't think that you would rarely, extremely rare to see men would give up driving or motor age, whatever, because of a low testosterone picture, as I say, it's just too gradual and men are too likely to simply. bury the emotional trauma of what is happening if they truly have low testosterone, they will look for reasons to get out of things and they will falsely justify their own rationale for doing that. There must be a reason that I can't, you know, maybe it's my eyes are gone or whatever else, but they won't necessarily put it down to testosterone. But the other issue that a lot of men will find, of course, is. you wouldn't necessarily think it was testosterone. How do you know? If you don't know about a condition, then how do you know it's something you could be struggling with? And to make it worse, then if you did say, well, it may be in the last year or two, it's often very slow symptoms, you might say I've slowed down a little bit. Um, I don't really have as much confidence as I did. I'm finding that the, the, the element of having to travel to my place of work, whatever, which is so far away is now daunting. Did I look for reasons not to do that? And you go to a doctor about this. They may say, well, either you've got an anxiety problem and give you an antidepressant, or you might get a title, the time screen, which is a blood test that we do on patients. And it's quite common in primary care. So your GP will do that, but they won't include testosterone. So the doctor doesn't know to look for it, the patient doesn't know to ask for it, and of course you get this thing called unconscious incompetence, whereby neither side knows what to look for, and you end up with a very dissatisfied and unhappy patient, who puts it down to the fact, well, it must just be because I'm getting older, and that's just what it is. And of course it doesn't have to be. Yeah.

I'm just hoping that we can, something I said right at the beginning is just that raise awareness. I mean, it may not be a testosterone deficiency in people, but if we can talk about it, it might be just at the tip of people's tongue to say, is it this? Isn't it that? I'm probably the typical male where it would go, well, I'm just old, and do you know what, I just like me afternoon naps now, you know, and it's this sort of thing that happens, but to actually put something to it and go, well, maybe it is that.

Yeah, I think the key with all these things is it's the maybe. It doesn't mean it has to be, and it could be just, yeah, you'd like an afternoon nap, but it could also be that it's an underlying medical issue. And that's always the key. And if you don't think about it, you'll never consider it. I don't know how many, Men would necessarily ever sit and self analyse their driving on how they feel about driving in the sense of distance or stress or anxiety of the process because it's not often a common masculine thing that we would do. Um, and a lot of blokes often, use distraction techniques when they're driving and they're stressed anyway. So you might listen to something on the radio or, you know, You might ring people and phone them on the way and use that as a way to not focus on the fact that there are other stressful environments that you're going through. There is the thing, obviously, you would say that if you want to concentrate more, you would turn off everything that you listen to. They always say that if you turn off the radio, you can reverse better, don't they? even though there's clearly no reason that makes sense because you're not listening, you're watching, but it's the distraction technique and that's why it's important. So the argument is the same thing. If you don't ever stop and analyze how you're driving is and how you're concerned or may not be concerned, whatever's going on, because you're distracted, you're never going to think about, is there something wrong? And then it may never lead you to that point.

And it's being honest with yourself, isn't it? And it's having that self awareness, isn't it? And like you say, it's, it's not something that we've been brought up with that checking in with ourselves and making sure that we're okay. We're, we're far more used to distraction techniques and just getting on with it and manning up, so to speak.

that's exactly the phrase. I'm not supposed to use that phrase, but it really is that. But again, you know, even within my own. Field and cohort as guys, and you still don't want to admit that that's a problem. And that's normal. So it is quite hard to challenge that stigma. And I think, hopefully, it's things like this that make the difference. You make small little indents on aspects of your life that may not be absolutely life ending, but may just give you enough of a kick to go, Actually, maybe I need to do something. Maybe I need to speak to somebody. Maybe I need to start looking into this a bit more. And that's what you need.

Lovely. Oh, well, hopefully that's helped to give our listeners just another option, just something else to think about, something else to bear in mind that, if they're struggling, it's and just like Kev says, just that raising a bit more awareness of the subject. But before we say goodbye, I'm going to ask a question, Geoff, cast your mind back. To when you first learned to drive. I haven't asked this question to anybody for ages, so if you cast your mind back to when you first learned to drive, was there anything that you found challenging about learning to drive

Uh, driving. No. I, started to drive when I was 17, which is now, oh my word, uh, yeah, nearly 20 years ago now. So that's a long time. and I, Learned on my mother's Citroen Visa, and it was a Clio, it was a Clio actually, we did move on to a Clio, it was pretty decent stuff, and it was nearly a one litre engine, but not quite, so it meant that going up hills, we used to have, I grew up in Stoke on Trent, and going up the hill, there's a massive A34 hill going up there, and it used to find unless you got some pretty decent momentum, you may not make it to the top, which obviously as a learner, you is absolutely terrifying because you have in your head, and this never happened, but you have in your head that you might get three quarters of the way up and suddenly just stop. And I imagine myself careering backwards down as cars were plummeting into me, but that was pretty terrifying. and I had a particularly unpleasant driving, assessor, I remember once who hailed me for not doing very well at 3. 10 or Parallel Park. So that obviously then promotes further anxiety moving forward, but I think it's really hard. I think the problem is so much of what we do is based around experience. And if you just do it enough times, Almost everything becomes easier. I do wonder sometimes, are we so desperate in our teens to have the independence of driving that perhaps you jump towards the assessment before you even actually think, am I really ready to do this? And I know they always say that actually once you've got your license, that's when you really learn, et cetera, et cetera. But, but I think part of that is probably true because you're so desperate to get your license that I don't think I was ready. And then it took a long time to really build up those skills and confidence on the road afterwards. Which I'll probably then lose again once the testosterone drops.

I love it. Brilliant. So, Geoff, people can find the book on Amazon? Absolutely.

yes, it's on Amazon and, uh, you can get it on Audible as well actually now, there's an audio version. Um, they did ask me who I wanted for the voice over and they gave me like a couple of choices, it was really cool. And I punted for Stephen Fry, and they said you can't afford him. So I've got another very nice chap, he's equally good, but it doesn't sound like it's Harry Potter now, which is a shame. So I've got that, and then the other thing is, you can get it on, Waterstones, a couple of them still have it in house as well, and probably it'll be in the works next month, so, you know, stay tuned.

Brilliant. And where can people find you are you on social media?

Uh, yeah, so it's just down as Dr. Jeff Foster, pretty easy to find due to my massive cheesy grin. and our website is again, Dr. Jeff Foster, it's very simple. Luckily there are many of us around. So, if you usually Google men's health, my name comes up pretty quickly now, which is great.

Perfect. Lovely. Thank you so much for giving up your time this afternoon. Yes, thank you.

Thank you for having me on. It's been really kind. Thanks.