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?

So do many men approach you, come into your surgery and say, look, I'm suffering from this. Is this normal? 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?

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. 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 were not a concern. are 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.