Why Men's Testosterone Drops After 40 (And What You Can Actually Do About It)

Hi, this is Suzanne Noble, and you are listening to Sex Advice for Seniors. And I know that a lot of my listeners are men, and recently I've been speaking with several of them to understand more about some of the challenges that they have around erections, around their libido, around desire, around arousal, around all sorts of things having to do with sex, really. And my guest today is a guy that is really curious and interested in that topic as well, and has taken it one step further by actually setting up a business based around hormone intelligence. Dan, I'd like to welcome you to Sex Advice for Seniors. Dan is from Venn Health. You're still called Venn Health, aren't you?

Valens Health. Yeah, Valens Health. Yeah. Hi, thank you very much for having me.

Yeah. And so hormones, tell me, what's— how did that get started? How, how did your interest in that come about?

Yeah, so that's a, it's a really interesting question actually. So part of it was through my sort of personal experiences of sort of transitioning into my forties, I guess. So what we know from a medical point of view is that most men, once they get to sort of 40 plus, start experiencing a kind of gradual decline in many of their hormone levels and, and obviously in particular testosterone, but lots of other factors as well, sort of, and biomarkers like thyroid levels and DHEA and those sorts of things. And they're all, all linked together to give this kind of overall vitality and metabolism that we're used to in youth. And then you get to sort of 40, 40 plus, and that just gradually starts to drop off by kind of 5 to 10% a year. And, you know, myself, I really noticed that mainly in kind of work and activity levels, but also in, in sort of interests and libido and kind of general lifestyle factors. And I just really developed a personal and professional interest in that. And thought, you know, there's gotta be, there's got to be a better way. You know, we have to, you know, we have to look at trying to improve that for people. Yeah.

I think when people hear the word testosterone, and I can just speak from having spoken to a guy recently and he said he started going on testosterone and he felt that he became somewhat aggressive, but I've heard that that's not, that testosterone doesn't lead to that. But I think there is a stigma around testosterone being associated firstly only with men. And I've been taking testosterone, you know, prescription testosterone, male testosterone, because that's all we've got available in this country for a few months now. And I can certainly notice the difference, not in my, in my emotional state, although I can say that I feel a lot more focused. I feel like just stronger in my body. It's definitely increased my interest in sex. But I think that for a lot of people, testosterone is like this kind of hormone that they think of as, well, when men take too much testosterone, they just become quite angry and things. What is that stigma about? And what is the truth behind what is testosterone? What can it do for you?

Yeah, well, I think that's probably really true, actually, you know, that it definitely has that stigma to it. And I guess from my own kind of professional experiences, I think it's You know, testosterone is an androgen, you know, it's associated with masculinity in the male form. And I think it's probably just that sort of urban legend from there really. The way I, the way I talk to our patients and customers about testosterone is it kind of makes you more of who you already are. So you mentioned sort of the aggression and things there. I think if, if somebody's unfortunate enough to have an aggressive predisposition, I think it perhaps might amplify that a little bit. But I think that's a tiny minority of the people we're talking about. And generally it just seems to amplify who the people were before. So for example, if their libido's dropped off or their kind of vitality or just general energy levels have dropped off, it just seems to amplify those elements. And I think it's really interesting what you said, Suzanne, about you know, just your general kind of get up and go and your kind of interest in things improves. And it really does. It just sort of, it almost like turns the dimmer switch up, you know, it kind of makes the lights in the room brighter.

Yeah. Yeah, completely. I mean, I've certainly noticed that. I mean, the one, like I said, the one area where I've noticed it aside from libido is in my overall focus. I have definitely noticed that, for instance, when I do physical activity where normally I would get tired and I would just be like, oh, screw this. I can't, I can't lift this weight. I'm not going to be able to lift this weight. I'm not going to be able to do this. And I just sort of wanted to give up. Since I've been on testosterone, I definitely haven't had that attitude. Like, I'm like, oh, I could do this. And I feel quite strong. And I know that, you know, for a lot of men, when that testosterone does decline, it, it often leads, you know, to problems with having erections, for example, right? And how does it, does taking testosterone improve that?

Yeah, so, well, I mean, erections are a really good marker for hormone health, actually, and hormone optimization. And there's a little bit of stigma around, well, traditionally erectile dysfunction, we like to call it erection health, you know, and how we can improve that. But erections are really important. And especially sort of early morning Erections. So when people notice that they're, they're not waking up regularly with an early morning erection, that can be a really good marker or reliable marker is probably a better term that their testosterone levels are dropping off. Yeah. We at Valens Health, we use something called hormone optimization. So everyone's, you know, everyone's unique, everyone's different. And, and a relative drop for one person may have a totally different meaning for another. So we do use normal ranges and we like to., you know, work safely in those. But especially for testosterone, a tiny, you know, maybe a 5 or 10% drop for person A might affect person B totally differently. So we optimize them symptomatically. And naturally for men, you know, losing, losing erections is, is quite a significant thing. You know, it's, it's kind of, it's a really defining thing for men, you know, part of their identity and vitality. And I would kind of encourage people if they are noticing that loss of morning erections, you know, to. To, to take it seriously, you know, and also, I know we've talked about this, you know, at previous meetings, Suzanne Noble, but also kind of nocturnal erections are really important as well. And there's a big association with other health factors without, you know, ignoring the kind of sex and lifestyle side of it, you know, it can be linked in with lots of other health concerns as well. So, you know, it's really important, you know, from, from a quality of life and a sex point of view, but also, you know, a health point of view as well.

Yeah. Yeah. I mean, the statistics around men who start struggling with erectile unreliable erections is what I them, unreliable erections.

They always—

is that I think it's something like 80% of men who start struggling with unreliable erections will within 5 years go on to have some sort of significant cardiovascular event, like a stroke or heart attack. So it is a massive indicator of, you know, cardiovascular health especially, but also, as we know, like prostate and possibly diabetes and things. So it is, it is huge. And you mentioned that you're, you're not just looking at testosterone, but DHEA, which I've sort of heard about, but I don't really know that much about. I know that sometimes it gets referred to also for menopausal women as part of their HRT. I don't, I wasn't really clear and I'm still not clear about where it falls, you know, how it impacts on men's health. Can you talk a bit more about that?

Yeah, of course. Yeah. So, so DHEA is a, is a, it's a really interesting protein and it's basically you could have good levels of hormones. So in this case we're talking about testosterone and they, and they could be, you know, at a really normal level or, or even a normal level for that individual or even high. But what DHEA does is, is activate or, or helps your body activate that hormone. So what we've seen in, in, in our clinic is that a lot of men have reasonable testosterone levels actually, and, and you can replace that all day long. You know, you can give them as much testosterone you want, they'll probably get some improvement, but actually they're not activating that testosterone properly. Um, and it's a bit like putting a key in a lock, you know, your testosterone activates different cells in your body and it's kind of that get up and go hormone. And if you haven't got the right key or the key's not working properly, the cells can't use it, you know, and that's In layman's terms, pretty much what DHEA does. So, um, we found that having this more holistic approach to the whole pathway of testosterone really boosts people's performance and benefit from the testosterone that they're taking. As with all medications, you want to minimize how much you're having, uh, because, you know, it's all about homeostasis and kind of really balancing who we are as organic machines, if you like, you know, as, as humans. And if we can do that through really correcting the actual problem rather than just pouring more and more testosterone in. That seems to work really well. And also I think makes a lot of scientific sense as well.

And so when people come to see you, what is their, is the outcome that they're looking for generally?

So I would say our typical patient is kind of mid to late forties up to kind of late fifties. That's the sort of the, the, the bulk of who we come to. And most of them, they usually have like a collection of vague symptoms. So erectile health or unreliable erections, I think you called it, didn't you? I quite like that. Yes. Yeah. Um, they, that, that can be a presenting problem, but usually it's a bit more subtle. They usually come in with, just mentioning that their vitality's dropped off, that they're exercising as much as they always have, but they're losing muscle mass and things. Their interest in life has gone. And then when we question them and, you know, kind of get a bit more into it and get to know them a bit more, then the kind of erectile dysfunction element comes in as well. People are usually happy to talk about it, but only when asked, you know, it's not a kind of a volunteered information. And I guess I can understand that. And hopefully over time that stigma will drop a little bit. And that's part of what I'm hoping to do with people like yourself, Suzanne, is just kind of get this information out there that this is really quite common and it doesn't need to be stigmatized. And more importantly, there's quite a lot you can do about it. And those people come to us and they just sort of, they just want all of those things to be improved. And interestingly, that's pretty much what hormone optimization and improving hormone intelligence does really.

Yeah. So what do, what do you do to work out what exact formula formulation these people need? How do you, how do you optimize their health?

Yeah. So we try to be as patient-centered as we, as we can. So it, we, we aim to be sort of a, a, like a one-stop kind of health clinic. So we can do everything from hormone optimization to weight loss medications, cholesterol management, and lipid management. Even things like medical aspects of hair loss, you know, with kind of male pattern baldness, androgenic alopecia, you know, and we can, we can deal with that as well. So we, we always have a free consultation initially with people just to get to know them. And we don't want to catch anybody out or, you know, we're not one of these sort of retail providers that all we're interested in is selling. We really want people to get the value from what we are and want them to feel comfortable with who we are. So we have, we always have a free chat with them initially. No, no obligation whatsoever. And it's just to see whether we can provide what their expectations are and, and vice versa really. Then we do a comprehensive set of bloods looking at multiple different factors. You know, of course, testosterone, DHEA, thyroid, even things like vitamin D, you know, especially in this part of the world, it's really important, you know, and, and linked into kind of the things we all know about, like bone health, but also mood and energy levels as well. You know, and, and then once we've had those results, we then kind of sit down, we have nice long half-hour appointments with people and We just build a program over the next 12 months that's gonna hopefully get them to where they want to be. And in all honesty, we, you know, most people get a pretty significant improvement. I don't think we've had anybody yet where there hasn't been something that's suboptimal, you know, that we can't improve. And, and people, it's really nice medicine actually, to be honest. You know, people get really significant improvements and, and, you know, most notably with things like energy levels, libido, erection health, you know, and, I, I wouldn't say, I would love to say we return people to feeling as vigorous and as they were in their twenties, but you know, we get plenty of people in their mid to late fifties who say they feel 30 again. And that's just amazing. You know, that's just a great feeling. And you know, what a fantastic thing to be able to do.

Yeah. And I think, you know, one of the things that strikes me always when we talk about hormones is a, how little, how rare it is to have conversations about them. It's almost, it's only quite recently that women have started talking about HRT and menopause and working out that actually they don't have to suffer in silence. And I think for a lot of men, they just accept the consequence of aging is going to be reduced testosterone, it's going to be lack of energy, it's going to be lack of muscle tone, you know, and they just think, well, you know, I'm an older guy, and that is the consequence of that. And I, and I suspect that healthcare, a lot of just, you know, our, our GPs and things are not looking to optimize their hormone levels because it's not really something that they've been taught to do. Is that accurate?

I think so. Yeah. I mean, the NHS is, is a wonderful thing. You know, we're, we're very lucky in the UK to have it, but public health of any description does have limitations. You know, GPs in particular, you know, they're really busy. Dealing with, you know, day-to-day diseases and things. And the traditional teaching in medicine is always about disease, you know, pathology and reversing that. And a lot of menopause in women and andropause in men, you know, it, it, it's really kind of symptom-based. It often, it often doesn't become pathology or, or a disease, you know, and, and I think in medicine that it's still lagging behind a little bit globally, really. I don't think just in the UK. Of this thought about optimizing things. You know, why, why should you have hormone levels in your fifties and sixties or forties, fifties, and sixties that are no way, you know, that are declining? Why, why shouldn't they be where they were when you were 20 and 30? You know, and as long as things are within safe ranges, then why is that not okay? You know, and, and, and that's really how the shift is changing and there's growing evidence for that. And, and there's also, you know, growing evidence to show that does a lot of good. You know, it improves your sensitivity to insulin, reducing diabetes risks, you know, cholesterol lowers, overall body fat lowers, muscle mass increases, you know, libido increases, energy levels increase. You know, it just, it just seems silly to fight against it. And just to talk about, to digress a little bit, we often have consultations with partners as well, you know, at the same time. And they always describe this grumpy old man in the corner, you know, and, you know, they say, you know, when I met, you know, whoever it was, Joe Bloggs, when I met Joe Bloggs, you know, he would sit in the, you know, he would be the life and soul of the party, you know. And then he got to 40, 45, and now he just sits in the corner and he's not that interested and he doesn't want to go out anymore. And, you know, and their partner's really frustrated, you know, they're kind of, where's, where's my, you know, where's my husband gone or my partner gone? And, um, you know, we can change that. You don't have to be that grumpy old man anymore, you know. We can, we can reverse that, uh, well, you know, reverse it as best we can. And, you know, and, and But like you said, we don't need to be that way anymore. And women's health is definitely further forward, but there's still a lot of work to do there. You know, even as you mentioned at the beginning with testosterone for women, that's really quite new thinking, but again, makes a lot of sense. And it, and the impact it has on women's quality of life is huge. You know, your story is far from unique. You know, a lot of people get massive benefits from it and, and it really works, you know, it, and it's, especially if you look at bioidentical hormones, you know, the risks seem to be very, very low or, or nil virtually.

Yeah. I mean, honestly, same. You know, it's just a couple of things that I take and the difference to how I feel is so significant. It's not even funny. And, but I also know that there's only so much that hormones and anything can do, you know, for me, and I'm sure it's true. And I know that you're a very physically active person that all of this stuff has to be alongside just a lot of other things that have to do with better health, whether it's changing your diet, you know, and making sure that you're not eating crap, and also physical activity, exercise, all of that. Do you look at the whole person in terms of, you know, how often are you exercising to the point where you're raising your heart to, you know, a significant level? What's your average diet over a day look like? Is it, or is it mainly focused just on the hormones?

No, 100%. Yeah. We, we go for that sort of full, whole person holistic approach. So, you know, you're absolutely right. Just any medication isn't going to be a magic fix. You know, it has to be, it has to be a whole package, you know, but it's definitely a brilliant foundation to start from, you know, and, and, you know, and, and if people are needing to have kind of conversations about lifestyle and things as well, you know, we're absolutely the place to come for that. And, and our doctors all have a different field of interest, you know, specialist interests. So they can really— people can essentially select who they have as their doctor, you know, so they can select who they think would be the best fit for them, you know, to, to kind of really, really pin down exactly what it is that they want to improve and optimize and move forward, you know, for whatever lifestyle aspect that is. And And, you know, with that boost of improved energy and kind of mental alertness and that dimmer switch being turned right the way up, you know, to full brightness, kind of really, I find anyway, really gives people that motivation to return to how they want to be.

Yeah. I mean, the, the other thing I'm curious about, and I know that we've spoken about it before, is the fact that there are, if you've got a problem with your heart, you can see a cardiologist and, you know, you get, you get hooked up to machines and they can see what's going on there. How much of this stuff that, that people report back to you is based on actual data and how much of it is just, I just feel great, you know, which is fine. Like if you feel great, that's great. But how much data can you collect in relation to making sure that you are absolutely optimizing? Because even for me, the word optimization implies that there's a bunch of collection of data that goes on, which then, and a bunch of markers that indicate where you should be, where you are, where you want to be. And all of that combined creates the better version of you, right? Are you able to collect data or is it just repeat blood tests? Like, how does it work with actually, you know, making sure that they are the best version of themselves in a, in a healthy state?

Yeah, absolutely. Yeah. So, yeah, so I'll try and break that down into different, different aspects. So the, the blood tests, absolutely. We repeat that every 3 months as a, as a, as a minimum. So we, we get to see improvement there, you know, that kind of quantitative, you know, like we are in the zone we want to be now.

Yeah.

You know, and, and that kind of gets rid of that immediate reversible cause for why they might be feeling that way. There's a few additional things we can do. So we can, we have the ability to monitor nocturnal erections. And that can be, as we were talking about before, can be linked in directly to hormone levels and cardiovascular health and things like that. So in monitoring those over a 12-month period, we can also see an improvement in their frequency and duration and that sort of thing. And that, that's something that's available to us as well. And then also every time we have an interaction with the patient, you know, they're nice half-hour appointments. So there's no, you know, there's no hurry, we can take plenty of time. And we go through essentially a kind of lifestyle marking guide, I guess, you know, marking criteria. It makes it sound a bit arduous, but, you know, so we can get to the end of the year and say, you know, this is how you reported feeling in these different parameters at the beginning of the year, and this is how you're feeling now, you know. And then people get to really see that difference, you know. And obviously we do that every 3 months. So Typically talking about timeframes, typically people get some improvement pretty quickly, but usually they're optimized and kind of at the top of the, of the medical biomarkers level by about 6 months. So there's usually a little bit of tweaking and some people, you know, need a bit more fine tuning and that can take a bit longer. But as a general rule, kind of 6 months or so to, to get that, that maximum benefit. But, but people certainly feel things within, you know, some people are instant, you know, when they first start taking it that day, they, they just feel like a new person, especially if there's a big deficit, you know, um, And in particular, DHEA seems to really have a very, uh, it's more like flicking a switch rather than a dimmer switch. It seems to have a very dramatic effect. And I think it's because it is, is part of the activating pathway, you know? So yeah, they had plenty of the hormone, but they weren't using it. And then all of a sudden you, you put that protein in there and, you know, and it works.

Yeah. Because I've certainly noticed that for me, it's taken quite a while for the testosterone to for me to feel like it's actually doing something. I know at the beginning I was like, you know, but people did say there was a cumulative effect. I don't know if that— obviously where women are on much, much smaller dosages than men are. So I suspect there's just this accumulation over time of the, you know, taking it every day and then eventually it starts to, you know, work its way through your system in, in a significant way. But it did take, it certainly did take a while. Um, I wouldn't say that certainly for me the effect of it is huge, but it's positive. It's definitely positive. And it's, it's in a, it's in a way that I'm feeling the benefit, you know, just the focus, even just the focus itself has given me more confidence because I know I can just spend longer on something without being distracted or without getting bored or, or being tired or whatever it happens to be. So I think, you know, there are multiple benefits beyond the sexual ones for using it. And are there any other, you know, hormones that you're working with at the moment that you want to give a big shout out to?

So the other one I think would be thyroid is the other kind of elephant in the room. So there's a, the, the clinical name for it's a bit long-winded, but it's subclinical hypothyroidism. And it's really, again, really, really common. And all that means is that, that, that your numbers when you do a blood test are within the normal ranges, but the ranges are enormous. You know, so again, why should you have a range? Why should your numbers be not where they were when you were in your prime, you know, in your 20s and 30s? And we know again that this drops off over time. So this is another area that we look at to, to optimize. And I guess the big question is, what does your thyroid do? And it's like, it's like your, your the metronome for your metabolism. You know, it kind of sets the pace that your body's working at. And again, we use very strict criteria to make sure that's safe. And, and just sort of really, well, optimize it, you know, bring that right up to the top end of safe levels, you know, or where people want to be. And, and again, that, that just, you know, the, the accumulative effect usually of all three for, for the majority of people really just really gives them a boost of everything we've been talking about, you know, energy, libido, vitality, concentration. You know, 'cause certainly testosterone and thyroid, they control everything. You know, they're like the get up and go hormones. And if they've gone, then you get up and go's gone. You know, it, it's kind of, it's left the room. And, and I think it's interesting what you were saying about the accumulative effect as well. And, and I think that's really worth mentioning. My feeling, I'm not aware of any evidence for this, but my, my feeling is that that's because people leave it so late, you know, so when the symptoms, yeah, there's so much catch-up to do, you know, I think it just takes a little bit longer. I think we can still get there, but it just takes longer to do.

Yeah. And the question I'm sure that's on everyone's mind is how much does all of this cost?

Isn't that always the question? Yeah. So, it depends, I guess, would be the answer. So, because everyone's medications would be different, uh, we'd leave the cost of the medications to one of our partner pharmacies. They're not, they're not part of our clinic, but we, they're just a great pharmacy that we really like the service they do. So we leave the cost of the medications to the pharmacy because everyone's different and we don't want to be a retail off-the-shelf thing.

Yeah.

So if, if people want the kind of the, the premium package, you know, where you get like the dedicated doctor for a full year, um, it's £1,800 for the year, but you can do that in installments if you need to.

Okay. I mean, that's like a gym membership into a nice gym, isn't it? It's not, yeah, like, it's not like stupid money. And yeah, it's what, it's what I'm paying for my exercise training here in Thailand.

Well, and this will make you feel fantastic rather than kind of dragging you out in the dark and the cold.

Yeah, no, fantastic. I mean, it's, it's, it's such an interesting area and I think it's constantly evolving. And certainly since I've started getting involved with more with men's health, I've seen an increase in men that are interested not just in using hormones to increase their libido or their energy levels, but just, you know, for longevity, for overall physical— they're just overall health. And as you said, just getting back to that vitality and that feeling that they had when they were a younger person and they just felt like just more on it, I would say.

Invincible, weren't they?

Yeah. Yeah. And, and, and I think that there's less stigma attached to it than there used to be and more curiosity from people about, okay, well, what is out there? What, what can I be doing to improve my health? What's safe for me to use and what's not safe for me to use? And how does all of it contribute to, you know, living longer, living healthier, feeling better. And all of these things are all part and parcel of, as you say, just optimizing your hormones and other aspects of your life to make sure that, you know, you're living your best life. Because I think, you know, one of the things about Sex Advice for Seniors that I've known for ages is that it's not only just about better communication overall, better communication with your partner, listening to your own body, but it's also just about really about remaining healthy. Because longer that we remain healthy, the more likely we are to be able to continue to have an active and enjoyable sex life. And when our health starts becoming affected, that's often when we stop feeling like having sex and we stop having that desire. And then you're on a slippery slope, really. So all of this really is about just about feeling good, isn't it?

Yeah, isn't, isn't life just about feeling as good as we can? I think, isn't it? Yeah.

Yeah. Anyway, Dan, it's been a pleasure to speak to the, to you and from Balance Health, and I will put all the links in the bio so that, and I'm assuming that you will treat people remotely. Remotely, that they don't have to be in—

Yeah, absolutely.

Yeah.

So, uh, we, we, we try to focus mostly on remote care, uh, partly because it gives us, gives us range, but also, uh, we found people actually prefer that, you know, because they can kind of, um, yeah, you know, they can be wherever they want to be and, you know, privacy of their car or their own home or whatever. Yeah.

Yeah. That's great. Thank you and have a lovely evening.

Yeah. Lovely. Thank you very much for having me.