Episode Highlights

00:01:45 Guest Background
00:04:20 What happens when you have an erection
00:07:31 Symptoms of having low testosterone
00:12:30 When do you need to see a GP?
00:17:54 Factors that causes low testosterone
00:22:07 Why antidepressant syndrome is worse
00:31:13 Sexual incompatibility sometimes the cause for break up
00:32:53 Importance of treating erectile dysfunction
00:36:22 Side effects of taking Tadalafil drug
00:46:26 5 tips for erectile dysfunction and general health

Links

 

Transcript

Welcome to the Fitter Healthier Dad Podcast, where you can learn how to improve your diet, lose fat and get fitter in a sustainable and fun way without spending hours in the gym. Here is your host Darren Kirby.

Darren: Welcome back to the podcast, guys. This is the number one podcast for men in their forties who want to improve their health through nutrition and fitness. This is episode 112, and on today’s episode we are speaking with Dr. Geoffrey Hackett about the topic of testosterone and specifically low testosterone in men. Geof Hackett is a past professor of men’s health and diabetes at the University of Bedfordshire and a consultant in urology and sexual medicine at Good Hope Hospital in Birmingham. Professor Hackett has a major research interest in the role of testosterone in metabolic syndrome and type two diabetes. He’s the author of over 130 publications in sexual medicine and has two original books on male sexual health and neurology.

Hi Professor Geoffrey, how are you?

Geoffrey: I’m good today. Yes?

Darren: Excellent. Well, thank you very much for giving me the time today to appear on the podcast. I think the topics that we’re going to be talking about today about sexual health and physical health in men is one which we’ve already discussed is hugely under discussed and depreciated. So I’m really keen to kind of get your insights today, but for people that haven’t come across Professor Geoffrey and your work. Can you give us a bit of insight into kind of your background and how you’ve come to where you’re at today?

Geoffrey: Yeah. Well, I trained and went into general practice as doctors do early on and then discovered that I wanted a bit more and I had done high level academic jobs in my training. And I really had a bit of a eureka moment when I went to a local hospital and met a urologist. This was in the 80s. And I saw him give an injection to a man and saw him get a prompt erection within a couple of minutes. And I thought, this is what I was destined to do. And then I got involved in research and the early development of Viagra, which is probably the most famous drug of the last hundred years and did all the trials for that and soon realized that this was the gateway into men’s health. This was the best predictor of men who were going to get heart and metabolic disease, and that sort of changed my entire approach. So I then went half time and got a hospital post running a clinic as a consultant in a Good Hope hospital in Sutton Coldfield. And then eventually the work became full time such that I was offered a chair initially at Keele University and now I’m at Birmingham and entirely in men’s health. And I do all men’s health now.

Darren: Yeah, it’s interesting, isn’t it? Because when we talk about the topic of men’s health, instantly, the image that comes to mind is this, you know, Men’s Health magazine. But I think if we really are honest, that is the scrape in the surface of men’s health. And you know, you mention their erectile dysfunction is often not a taboo subject, but something that’s taken in jest when you’re talking about it in a group of men. Or, you know, it’s seen as a stress related illness. But as you alluded to before we started recording, it’s far from that. So I’m really keen to kind of dig into that today. Obviously, we’re going to talk about low testosterone, but I really want to highlight the issues that erectile dysfunction can mean that you potentially are facing.

Geoffrey: Absolutely, because it’s the best marker that there is, because when you have an erection, you get a huge increase about six times the blood flow into your penis that you have at rest. And whereas the average guy in his 40s and 50s has given up testing himself by running or going to the gym, this is the one thing that’s a test that he might conduct two or three times a week of his cardiovascular system. And if that blood is not getting into the penis, that’s telling you that you’re going to have problems with other blood vessels around the body, right? And a long term friend of mine, a cardiologist called Graham Jackson, was the first to point out that erectile dysfunction was a strong predictor of a heart attack within the next five years. Wow. It was the best, best predictor that there was. But the average man waited at least three years before we ever saw a doctor about the problem, and he was then likely to be dismissed by the doctor because it was stressful and he should just chill out. So we missed so many opportunities.

Darren: So why is that though? I mean, as doctors and with a lot of the training that’s done, why is it then that if a man goes to a doctor for that condition, is it just deemed that they either need to get less stressed or they need to take Viagra? It’s not seen as a hold on a minute. This is a red light or a red flag to potential other issues. Is this more focused on the resources of the NHS, or is it just a lack of understanding?

Geoffrey: I think it’s the resources of the NHS because of this because, you know, even in the work that I do, the structure of medical specialties, you can’t be a men’s health specialist. You have to be put in a box as a urologist because that’s the tradition as to where they go. But you’re not dealing with bladders and prostates. You’re dealing with really cardiovascular medicine, but you’re not a cardiologist. So a lot of it is classification and a lot of the structure as to what GP’s do and what they get paid for is related to the way work was 30-40 years ago, right? It has. It hasn’t moved up. Yeah. And one of the conditions is that one of the problems is that GP’s get everything dumped on them. Yeah. And as we were saying earlier, there’s quite a lot of incentives for them to look after women’s health because women’s health involves pregnancy, it involves cervical smears and preventing cervical cancer and breast cancer and whatever. There hasn’t been that sort of link with men’s health that luckily we know there is now. Mm-hmm.

Darren: Yeah. Yeah, no, I mean, yeah, it’s interesting. But again, you know, as we’ve already spoken about, whilst you know it’s an important topic that we’re talking about, it’s still way under-appreciated and way under-discussed. And often, you know, a lot of this comes back to like low testosterone. But where would you say or is there a link? You know, if somebody feels like they’ve got low testosterone, you know, outside of erectile dysfunction, what are the common symptoms around that? Because a lot of the guys that I come across, generally one of their biggest or two of their biggest problems are weight gain and low energy. So how does that correlate to low testosterone? Or is that the start of something when you can understand that you’ve got low testosterone?

Geoffrey: Absolutely. The link between obesity and low testosterone is because of what we call visceral obesity. It’s the fat around the tummy. Women put fat around the bottom. Yeah, and they find that embarrassing because of wearing nice clothes and whatever. Yeah, but for men, sometimes a nice big belly is a sign of good living. Yeah, but it’s that visceral fat there that’s highly metabolically active and dangerous because it produces some pretty bad chemicals, one of which is aromatase, which is a hormone that converts testosterone to estrogen. Right? So that man is actually becoming feminized. And if you look at some of the television matches where the guys love to get their shirts off at the match. And you see them there often they’ve got man boobs. Yeah. Which is because of the effect of the estrogen levels and that estrogen is fighting against their testosterone. And in terms of their body shape. Right. And if you could see more detail, you’d actually see that their testicles and their penis was was beginning to shrink from what it had been in early days. So these aren’t good body changes to get. These are something that every man would like to change if he could. Mm hmm. And the other important thing is that as the testosterone level falls, it’s a vicious circle because you produce more fat and you increase your chances of becoming type two diabetic. So there’s a strong link between low testosterone. You have a three times greater risk of developing type two diabetes. Wow. And a major study just published a few months ago from Australia, where they looked at over a thousand men with low testosterone and they treated some and they gave the others placebo and both got intensive lifestyle intervention with gym memberships, regular phone calls from dieticians over two years. And there was a 40 percent reduction in progression to diabetes in the men who had testosterone, and they lost twice as much weight. They lost twice as much visceral fat and their quality of life scores improved significantly over just diet and exercise alone.

Darren: Yeah, that’s fascinating, really, because I think again, you know, it’s often seen as it’s also it’s almost socially accepted, isn’t it in some ways is that you get to, you know, you get over to the forties, forties, fifties and sixties. And like you said, you know, it’s a sign of good living. If a man of that age has, you know, big lower belly fat. But in terms of the kind of, I guess, prevention around that, you know, again, you often see a lot of guys thinking, Well, I’ve got this weight or I’m carrying this fat and I want to get rid of it. So in a typical kind of sledgehammer to crack a nut whilst men tend to go out and either smash an exercise hard or go to a class, do an endurance event. But from what I’ve learned over the years, that is actually not the way to do it. And I’m really focusing on nutrition. And I don’t want to say diet because I have a big issue with dieting in general, because I don’t think that’s the answer. But, you know, you hear guys saying, Well, I’ve eaten the same way that I’ve always eaten over the years and I don’t understand what’s happening. The reality is they are probably not eating as they used to. They’re eating a lot more. But what would you say are simple steps for guys listening to this that are now looking down at their bellies as they listen to this podcast thinking, Wow, yeah, maybe I need to pay more attention to this.

Geoffrey: Well, I think they need to consider going to see their GP to have their testosterone level measured. And certainly they should do that if they’ve got erectile dysfunction. Now I routinely ask every man who comes to see me about erectile dysfunction. In fact, the reputation soon got around that I was I was sex mad in some way, but I took this as a compliment. Yeah, so even if you came in with a bunion, You were likely, particularly if you were overweight, you were likely to get a question about your erections and a short five question questionnaire. And the message there is that that should be investigated in every patient. So if you have an erection problem, you should have your blood pressure down, your cholesterol, your liver function, a diabetes check and testosterone, plus a couple of other measurements like SHBG. Perhaps the level of female hormones in your PSA. Right. So it’s the perfect way into a men’s health check and the blood tests are needed. You should always give nutritional and dietary advice, but a lot of men glaze over. When you begin to talk about this, they’ve heard it all before. They’ve seen some goader nurses who wanted to change them and you can almost see the glaze come out of their face. But by actually bringing them thinking that they might be better in the bedroom within a few weeks, that’s a big motivator for them to take on what you’re saying. But you’ve got to sell it as a package.

Darren: Yeah, yeah. No, I completely agree with that. I think it is, you know, if it’s just general or what they consider to be general advice, unless there’s an issue, we tend to kind of ignore it. And like I said before, you know, I come across and work with a lot of guys where, you know, they have had a health scare and now they’re paying attention. And like you say, you know, to try and just give them general advice. They tend to glaze over. But, you know, hopefully from obviously doing this podcast, people can start to get an understanding that whilst you know daily, you might be Okay-ish. You know, I would argue you don’t know what it’s like to feel good until you feel good. And therefore, you know this kind of general kind of, I guess, lack of energy, lack of libido, stuff like that. You may well accept that as that’s life, but it’s not. That’s not life, is it? And I think that’s the point we want to emphasize today is that that’s not normal.

Geoffrey: Yeah. Those are the sorts of things that also point to a diagnosis of testosterone deficiency. Mm-hmm. And those are the things that can improve quite early in the process. Once you start treating, I see some men who come into my clinic whereby when you start talking to them, they’re almost dozing off in the consultation, whether that’s the monotony of my voice. But I think it’s actually the fact that that’s the level that they’re functioning. You find guys who are falling asleep at work in the afternoon. They’re having to find a quiet room where they can have a nap for an hour and hope that nobody sees them and perish the thought. Those who are out doing driving jobs. Yeah, pull into a lay body and have a kip for a while now. Just think about if they don’t. Yeah, you know how dangerous that can be. So, these are things that I turn up all the time. And when you actually treat them, sometimes they come back a couple of months later and you see them and you have to do a double take because it’s as if a light switch has been thrown on the back of this guy and you’ve you’ve switched him on because his whole façade is different. It’s like a different person’s coming back to see you. I’ve not seen anything like that with any other medication that I’ve used over the years.

Darren: No, I mean, I can speak from personal experience. About eight years ago, I was four stone heavier than what I am now. And yeah, when I got my nutrition in check and I started to exercise the right way, it was exactly as you describe it, is almost like you’ve you’ve given that person a Duracell battery, you’ve switched them on and the mental clarity you get, the energy you get, the zest for life you get is incredible. And you know, until you experience it, you don’t know what it’s like. So, you know, but you know, there’s kind of two kinds of camps, isn’t there from what I understand. And there’s there’s there’s guys that genuinely have a testosterone deficiency, not through lifestyle choices, but then there are a large majority that have the deficiency through lifestyle choices, so you know where, obviously we can go and see a GP to get tested. But are there some areas where we could maybe sit down and reflect on what we’re doing in our lifestyle and think actually a lot of these factors are pointing towards low testosterone?

Geoffrey: Yeah. Well, apart from just lifestyle, there are a few medical things that need to be considered. You know, for example, you find I find some people turn up in adulthood who’ve had childhood problems where they might have had a childhood cancer treatment or they were much younger. They might have had surgery on a test, on an undescended testicle or something like that. And nobody thinks that when that person gets to 17, 18, 20, that one testicle is going to be nonfunctional or it’s been hit by some radiotherapy when they were younger and those specialists have saved their life. So but what could that? It’s unreasonable for that man to expect a normal sex life when he reaches adulthood? Because you’ve done your bit, you’ve saved his life, so they present sometimes very late. The other things are some medications are painkillers. What painkillers do? They don’t just affect the brain in terms of suppressing pain. Those chemicals that are suppressed in the pain pathways are also the same chemicals neurotransmitters that are involved in the feedback processes for testosterone production. So roundabout 50 percent of men on repeat prescriptions for painkillers, which may have been given for prolonged back pain, a back pain injury at work or something like that.

The other one is antidepressants. I know you don’t have to be on antidepressants for much longer than three to six months. For those again to switch off those pathways. And obviously, you I turn up some people who might have gone to the gym at some stage and been induced to get a quick fix by having some anabolic steroids. And the problem with those men is that they often deny that because of shame and fear that they might be categorized. And so they don’t admit to it. And it’s only when you present them with a set of blood tests. And you say the only explanation for these tests would be that a person’s likely to have had some anabolic steroids in the past, and only that time do they come clean. So those are probably the major ones along with, of course, the obese patients that you’ve talked about.

Darren: Yeah. So with those pathways that are switched off from taking that medication, then presumably if you stop taking that medication, those pathways will reopen up. But is there, you know or well, I guess there’s two questions, really, and that is one, can those pathways be damaged by that medication and to what is the kind of general time that those pathways, if they can reopen once you stop taking that medication,

Geoffrey: That’s variable according to how much you took and for how long? Right. So if you were somebody who was swallowing 12 high strength painkillers a day and you can get into the habit of, for example, coming down for breakfast in the morning and before you’ve even looked at the crunchy nuts you’ve taken, you know it’s happening by Reflex. You don’t actually know that you’re taking painkillers. They’ve become a way of life. You know, I’m going to take the dog for a walk to painkillers, go down before you even set out. So when you’re taking that sort of dose, in a few cases, you wait a year, 18 months, it’s still not reversed. Right? So in those cases, you can’t see that man can’t go on like that. So you have to bite the bullet and treat him and then reassess later as to whether it’s improved spontaneously.

Darren: Yeah, OK, that’s fascinating. I mean, that’s a long time period for that to recover, isn’t it?

Geoffrey: And the antidepressant syndrome can be even worse. That can be even longer because if you think about it, what we take for granted is that despite how bad life is, if we get depressed, we take an antidepressant for three or six months and then miraculously, in our body, in our brain, we’ve got some reboot button that will take us back to normal. Yeah, that’s not the case for some, that their life situation is exactly the same. There are problems they can’t deal with that are still there. And so therefore, when they stop the antidepressants, they would rebound. So therefore, somebody puts them back on the antidepressants again.

Darren: Well, so it’s a vicious circle, isn’t it? Really? Yeah. So why would you like to go back to some of the ones you mentioned earlier and it’s around visceral fat because obviously there’s the abdominal fat, visceral fat that you can see around the belly that most men display. But you know, there’s often cases where you get hurt. You hear of this phrase like skinny fat. So the person might be skinny, but they might have a lot of brown fat, a lot of visceral fat around their organs. So in that instance, you know, around the testosterone estrogen scenario, does that and can that still apply?

Geoffrey: Oh, definitely. But there are the problem cases. Right? Because unless you do a CT scan, yeah, you don’t see that internal fat and it can be, of course, in the liver. One of the clues for those is if you do a liver function test and you find abnormal tests. And yet the patient’s not a heavy drinker. They’ve got no other reason for metabolic disease. They can be the idiopathic fatty liver. So. And that, as you say, goes with fat around the other visceral organs. They’re trickier. They’re more demanding.

Darren: And that the same still applies. Then I’m assuming from a testosterone estrogen level when you have that visceral fat that is going to bring down your testosterone and raise your estrogen?

Geoffrey: Absolutely. Absolutely. And the estrogen, of course, can switch off libido on its own. Yeah, it’s bad for libido in men, and it’s also often bad for libido in women. And we could have another talk on a time that women are now benefiting from tiny amounts of testosterone to improve their libido.

Darren: Yeah, yeah, OK. I hear a lot now because obviously there’s a lot of focus around veganism and plant based diets. There are cases where a lot of people are switching to that kind of modality of eating and therefore are raising their estrogen levels because of the foods that they’re eating. What’s your views and thoughts on that?

Geoffrey: Yeah. There’s clearly, if you look at over the decades, a fall in men’s testosterone levels, and the theories are that it’s due to crop sprays and whatever used around the world that they’re toxic and affecting the pituitary function. Hmm. In addition to that, there’s some cases of estrogens being used to prepare nice quality meats that men eat more than women. So. So these are these problems that are difficult to change because they’ve become ingrained in the way farming is done and we’re not going to be able to change those overnight. No. And unless we seek to find sources that don’t use them.

Darren: Yeah. So what what when when someone comes to see you and I would imagine I’m making an assumption here that many men who come to see you with either erectile dysfunction or their belief that they have low testosterone, they come to you not with an idea of what the the the cause is, but they come to you with a symptom. So what would you do? How would you first start to approach it now? I just want to make a disclaimer. This is not medical advice. It’s just me asking Professor Jeff, he’s kind of the way that he approaches things. But it’s, you know, where do you start? Because I’m making an assumption you won’t just automatically prescribe testosterone replacement and all the rest of it. Why would you start with situations like that?

Geoffrey: Well, as I’ve said, erectile dysfunction would be a trigger for me to always measure the testosterone level in that patient. Yeah, and depending upon the level, because we know that low levels below, say, eight nanomoles per liter, that person’s going to be pretty symptomatic. So it’s a combination of low testosterone levels and distressing symptoms. If you’ve got if the person hasn’t got particularly distressing symptoms, then you may well collect a second reading because you need. The treat anybody on one isolated reading again. And if those levels are lower than eight, then there’s good evidence that you should tell that patient that they are at increased cardiovascular risk. Right. And just as if you treat somebody’s cholesterol or blood pressure, if they were at the levels that showed a cardiac risk, then you should treat these men. But at the same time, give them the advice to get those risk factors down. So to be able to lose weight, exercise more to preserve muscle function. You’ll always do that at the same time, and that’s always news to them. But if the man has borderline testosterone levels and his major problem is erectile dysfunction, you may well try a PDE5 inhibitor, which is a Viagra Lite drug. But I’d like to get away from Viagra because I think that came along. It was the first drug in its class, and it should have been superseded by a much better drug in the class, which is a drug called tadalafil, which was originally Cialis. And if I’ve got somebody with reduced libido, if you think about it, if you give somebody a tablet to take an hour before they have sex and they have no interest in sex.

That’s a total waste of time. It’s like buying somebody a £2000 set of golf clubs, and they have no remote interest in golf. Yeah, the finest clubs in the world will not take them onto a golf course to become a golfer. They will stay in the cupboard. So therefore, the advantage of giving them the daily tadalafil is that that begins to work and restore morning erections. And once you begin to see your body restoring those morning erections that you had when you were younger, that erection feeds back to the brain and begins to make you have sexual thoughts that you’ve lost for some time. Yeah. And then the sex will return in a healthy, normal fashion. Mm hmm. Not that. Not as it has been for so long where you say to your wife. Saturday night, 10:00 o’clock. But not not if the Baggies are on you. Forget it. Yeah, I’m not sure about that day. That’s hardly the most romantic thing for a woman to hear. Yeah, and you can only have it once a week because that’s all the doctor will give me. Right? So, that’s largely become my practice. And then when you follow the patient up, if that’s dealt with his symptoms and the testosterone level hasn’t fallen anymore, then he’s far more likely to take the whole package of lifestyle because he feels this doctor knows what he’s talking about. I’ve seen the immediate benefits or buy into everything he’s saying. And you might not need to give testosterone therapy for that man.

Darren: Right, OK. So again, it’s almost like a bit of a domino effect, isn’t it? Once those levels are up and it’s restored, they then, you know, instinctively want to, you know, go further. They want to explore more, they want to understand more, they want to get better at their health. And that’s definitely something that I see with the guys that I work with. You know, once it’s almost like they get their vitality back and they kind of return to their early years, you know, 20s and 30s in terms of their desire and appetite for life in general, really. So, yeah, I mean,

Geoffrey: There’s no doubt that the major cause for cause for relationship break up in this country, which you know, divorce rates as we know, run it over 40 percent. Getting nearer 50 is sexual incompatibility. It may then translate into arguing a lot. But there’s very few relationships that do break up. If the sex life is very strong, yeah, yeah, yeah. We also know that there are huge benefits of sex. You know, several trials have shown that sex three times a week significantly reduces your risk of heart attack.

Darren: Yeah, it’s amazing.

Geoffrey: That was the Caerphilly cohort study. Yeah. And you know, but it seldom washes for a guy to say love. We’ve only had sex twice this week. The third time will prevent my heart attack. Yeah, I’ve tried it. I tried it for a couple of years. But the novelty wore off.

Darren: Yeah, I can imagine. I can imagine. Yeah, it’s an interesting thing to try and use, I guess. So obviously, we mentioned erectile dysfunction, but I really want to just highlight the potential areas and diseases which can come as a result of having erectile dysfunction. Because I really want to be clear in today’s episode of, you know, just how serious this can be if guys are experiencing this and what the potential ramifications are if they don’t treat it. So can we just go over a few of those again, please?

Geoffrey: Well, of course, that the major one is cardiovascular disease because they’ve said if the blood vessels to your penis aren’t working properly, the blood vessels elsewhere aren’t working properly. Right? Then of course, there’s depression because there’s nothing that hits a man’s self-esteem more than failure in the bedroom. Yeah. And for many men, it’s a failure. Once or twice means that you seek avoidance. That avoidance may turn into drinking more heavily. Mm hmm. So your wife goes to bed, you stay down, have a few more drinks. And if that’s happening every night, that only leads to one way. Yeah. And therefore, of course, we’re then slipping into the higher risk of all the diseases liver disease, diabetes that drinking more heavily can cause. Yeah. Is it likely to cause the man to withdraw from lots of other activities and become a little bit of a couch potato and sit at home and feel sorry for himself? Yeah. So no, those are the major problems. Of course, the low testosterone we’ve talked about can be associated with other conditions. Yeah.

Darren: But when we talk about cardiovascular disease, you know, that’s quite a big topic in and of itself. So specific. I mean, are we talking about potential heart attacks and things like that, you know, the real kind of common words that people would understand?

Geoffrey: Yeah, yeah. The couple of famous trials where they looked at men who were admitted with heart attacks and then gone back, looked at their testosterone level, looked at their erectile function, and those are the ones that showed how good a predictor it was. Yeah, but you know, on top of that, you’ve also got high blood pressure, you’ve got heart failure, which, of course, means that it just doesn’t pump as well, which means that when you try to exercise, you’ll get out of breath earlier. Mm hmm. And there’s actually I’ve written a couple of papers suggesting really that we need to think about the benefits of the drugs like the PDE5 inhibitors, the tadalafil that they if you have a drug that is improving blood flow through the vessels of your body as you age, yeah, there’s going to be huge potential benefits. We’ve all searched for years for the polypill. This thing that a doctor could give a man as they age or even women as they age to add years to their life and life to their years, ideally. And I believe that tadalafil is the closest we’ve got to a polypill, right? Because if it improves blood flow, if you take one and then go on a treadmill, you will produce about 10 percent better exercise test. Wow. After a PDE5 inhibitor, it improves blood flow to the kidneys, and kidney failure is often progressive as we age. Right? And that’s largely due to repeated vascular damage.

It improves circulation to the legs and feet, which is important, particularly in diabetes, because as we know, people end up losing toes and. Having done so, they can’t feel any sensation because it’s the blood supply to those nerves that is lost in diabetes, once it’s lost, you can’t get it back. Those nerves are dead. Yeah. There are also improvements in cognitive function. People have had memory tests and whatever, and it’s shown that if you’re taking one of these drugs, the blood flow improves and your mental capacity also improves. Yeah. So there’s quite a lot of benefits. And believe it or not, you might think you’d heard everything, but there’s also good evidence that they protect against COVID. Wow. Because one of the things that kills you with COVID is this intense inflammatory storm that they keep talking about, which usually manifests itself in the lungs. Mm hmm. And you normally die of respiratory complications? Well, PDE5 inhibitors, particularly tadalafil, is licensed to treat various severe lung conditions because it reduces inflammation and improves the function of blood flow to the lungs. Okay, so people are beginning to point out now if we want something that we can take that can protect us against COVID. And by the way, they might improve your erections. So I don’t think I’m going to get many men who say, Well, I don’t don’t think I want something with those side effects doctors.

Darren: No, Absolutely. Yeah, absolutely. That’s super interesting. That’s really fascinating. I think that’s definitely something that people should be aware of and consider, you know, if they’re facing issues. But before we started to record Professor Jeff, we were talking about obviously men’s health in general. And, you know, I really like to take this opportunity on today’s episode to really highlight men’s health in general and other areas that really, you know, as men, we should be we should be aware of or at least consider because as we said, you know, the NHS is a fantastic institution, but unfortunately, we can’t or we shouldn’t be putting the responsibility of our health just in their hands. We have to take responsibility for it ourselves. And so what other areas would you say for you as you have obviously been in the industry for so many years? Would you say that as men, we need to really, really consider?

Geoffrey: Well, well, as we were saying earlier, men have poor attendance at general practitioners, and I was telling you about a study that I did some years ago of a 360 GPS in my area and 55 percent of them were women doctors, even at that stage. And of those doctors, 62 percent of the women doctors stated that their interest was women’s health. Mm-hmm. And out of the 360 doctors, only one stated that he had an interest in men’s health and he was. He was working for me in the clinic, so his and his interest had really come from my inspiration now. How can that be? Yeah, how can the doctors of this country not be interested in 50 percent of their patients? Yeah. And when you go into general practice as a man, you often feel that you’re going into a female environment. Mm-hmm. It’ll be 100 percent female staff. The nurses will be 100 percent female. Yeah, the doctors are more than half female now. So where the male doctors are almost becoming an endangered species, right? And I’ve seen a number of female doctors have said that for me as a male doctor, I couldn’t possibly understand how a woman feels about things. Yeah. Then I also hear from them that they know better about how men feel about things than I do. So even from my experience of being many years in a man’s body, they still know what I think they know more about men than I do. So I’m beginning to feel pretty obsolete and useless.

So, we’ve got this fact that men don’t complain as much and they just get on with it. And then the society doesn’t help them when they do run into trouble. And you can almost see this man up approach, as you said, when you go and see a doctor, if you start to cry. Whereas if it was a female patient, not that they would do at the moment, you feel like putting your arm around them. Yeah, and cuddling them better. But you know, you can get into trouble if you do that too much as a doctor. Yeah, but your instinct with the man is, Oh, pull yourself together. Yeah, man up. Get on with life, that sort of thing. And that doesn’t help. And also, there’s no men’s health specialist. The woman you can refer to a gynecologist and they’ll be Birmingham Women’s Hospital, Manchester Women’s Hospital, if anyone knows a men’s hospital in the country, then please let me know because I’ve driven around most cities and never found one. Yeah, as we were saying, even the payments for doctors, they get paid a lot better for looking after women’s problems. They get no payment for looking after men’s health problems. And so the guy who wants to have a 20 minute chat about his erections, the doctor will be looking at his watch fairly quickly and not seeing this as a useful consultation in terms of his priorities.

Darren: Yeah, which absolutely astonishes me what you just said there around, and I’d never even considered that before, you know, because you have women’s specialist, women’s hospitals, children, specialist children’s units and things like that. I never, ever considered the fact that I’ve not heard of a specialist men’s hospital. You know, you hear these specializations in different hospitals for different medical conditions, but not gender related. And yeah, and I just kind of we’re in twenty twenty one. You know, why is that? And I really definitely was in the camp probably ten years ago of the man up scenario. Unfortunately, I’ve not had a health scare that I’ve needed to not do that, but I generally am in the position now where I don’t man up. We need to talk up, we need to speak up, we need to have these conversations. And because it is life threatening, you know, the stuff that we’re talking about is generally life changing, life threatening. And you know, if we boil it down to families, you know, if the male or the man of the house, you know, has a massive life issue, it has life changing circumstances for not just them, but their families as well, because the majority are the breadwinners. And so we really need to raise this conversation. I feel we really need to talk about this more, and I know there’s a lot being spoken around mental health, men’s mental health right now, and that’s valid and that’s justified. But how about men’s health just in general? You know, I think. And like I spoke to you before we started to record, I don’t know how we’re going to do this, but I definitely feel compelled that I want to be part of something that really raises this. Whether that’s a charity, whether that’s a movement, I don’t know, but it definitely feels like we have to start talking about this more.

Geoffrey: Yeah, and it frustrates me because, you know, I talked about the lack of specialists and a colleague of mine, Professor Kirby, when he started writing a men’s health book, his wife, who was a nurse, said a book on men’s health. The pamphlet would do yeah. And if you go into something like five times as many books on women’s health as there are on men’s health. So and yet the perception out there is that women are fighting for equality. But in terms of health, I think they have long since overtaken men, yeah, in terms of equality, there are obviously problems still in the workplace that everybody’s trying their best to rectify. But in terms of health care, I think they long since overtook men in terms of what they get from the health service. Yeah, but the bottom line is, though, that that system isn’t going to change overnight. No. And in the meantime, if the man’s got to pay for something or take control of himself or her, then that’s the way it’s going to have to be, unfortunately, until we can get this sort of change.

Darren: Yeah, definitely. I think it will be. But I also think there’s there’s people like you and I who have an opportunity to raise awareness and have a voice and use various different platforms to do that. And yeah, I mean, this is a super interesting conversation, but obviously we can’t talk about this forever and all day as much as I’d like to. But before I let you go, professor, what would you say to five top tips that you would give men? Listen to this. Who either potentially think they’ve got low testosterone or, you know, erectile dysfunction or just general health? What would be the five top tips you would give them to kind of become more aware and do something about it?

Geoffrey: Yeah. Well, the five top tips that I would give would be to don’t. Don’t ignore erectile dysfunction, get an assessment early and get blood tests because it is the best predictor of impending critical disease. If you’re excessively tired or have lost libido, low energy levels don’t put it down to the seasons, the weather, the fact that your football team is doing badly covid etc. Go and get a testosterone level check because the statistics are that if you’re age 50, then around 40 percent of men will have low testosterone levels and particularly if you’re overweight. So you have to do that, have as much sex as possible because they use it or lose it is very true. Yeah. And if you can convince your partner that this is an essential part of your workout regime, then that’s even if you have a laugh about it. Yeah, that’s a great thing. And the sex tends to be very good if both of you are actually involved physically rather than one of you having fallen asleep during the act. You know, don’t comfort eat, after your problems, so don’t fall into the traps of it’s easier to get takeaways. It’s easier to just, you know, break open a bottle of lager when you come home. We’re also likely to go mad now that we’re allowed to go to the pubs again, and you can see that people or the there’s going to be some alarming figures. Yeah. For the increase in drinking that will have occurred because we couldn’t do anything else. And am I allowed to say buy yourself a copy of my book?

Darren: 100%, 100%

Geoffrey: It’s all in there. There’s some very funny stories in there, I must confess. Pathetic as I am, I still laugh at some of my own jokes in there, but I mean a lot of very serious messages in there. And I think it’s a best seller in my house anyway. So. So I think that’s five that yeah,

Darren: That’s perfect and I think the title of your book, if you can just show that again, I think it’s I mean, that is enough to grab anyone’s attention. You know, just a tiny prick as the name of a book on a bookshelf. Any man will pick that up and start flicking through that. So yeah, I highly encourage everybody listening to go and grab a copy. I’m assuming that’s on platforms like Amazon and..

Geoffrey: Yeah. And there’s a lot of cartoons in there as well, right? Very lively.

Darren: Awesome. That is fantastic. Yeah, no. Thank you very much. I really sincerely appreciate you. You are coming on to the podcast today, and I hope we can continue this conversation. But for people that want to connect with you, find out a little bit more about you. Obviously, we’ve got the book that you can go and get off Amazon, which is just a little prick and then…

Geoffrey: Just a tiny prick,

Darren: Just a tiny prick. Sorry I Apologize.

Geoffrey: They might get sort of not located if they do. Yeah, yeah.

Darren: And then how can people connect you if you’ve got a website or any social media or anything

Geoffrey: That’s just. Well, the trouble with the website and I’ve put this in at the last moment is that. Unfortunately, in January, I contracted COVID 19, and was hospitalized for over three months. And three weeks in intensive care. And during that time, I defaulted on my payment to my website provider because I was in a coma and had just picked up over the last month or so. You know, perhaps we could have another meeting on the disastrous effects of COVID 19 on so many aspects of life. Then I’ve got to renew the domain, something I’ve got to do this week, but I’ll do that today so that they allow a week. GeoffreyHackett.com Will be up and running with all the tips they need.

Darren: Perfect. Well, we’ll link to all of that in the show notes. And yeah. Thanks very much for coming on to the podcast today. And yeah, I look forward to continuing the conversation.

Geoffrey: Great pleasure. Thank you very much.

Darren: Thanks for listening to the Fitter Healthier Dad Podcast. If you enjoyed today’s episode, please hit subscribe. And I would really appreciate it if you could leave a review on iTunes. All the things mentioned in the episode will be in the show notes, and a full transcription is over at fitterhealthierdad.com