Risks and Benefits of Therapy

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And that's where the Pilot TV Podcast comes in, your essential guide to every show that matters. Each week we sift through the very best in Prestige TV to help you decide what's worth spending your time on and what isn't. So join me, James Dyer, as well as venerable TV critics Boyd Hilton and Kay Rivero, and let us help take the stress out of your downtime, the pilot TV Podcast. Because you can't watch everything. You can't do much in under five minutes. Boil an egg? Sure. Cook a roast dinner? No chance. But comparing car insurance prices with mustard.co.uk? Easy. See what you could save in just a few minutes. Click mustard. co.uk. Authorized and regulated by the Financial Conduct Authority. See website for details. Arrayo Original Podcast . Hi, I'm Catherine Ryan, and welcome to Dr. Nicholas's second Opinion, the bonus podcast, where science gets a front seat and aging gets a reality check. We're taking a deeper dive into the science we talked about on this week's show and giving you more details from our resident scientists' insight into our celebrity sci Plus, we're breaking down what it all means for your biological age. Stick around for your questions and of course Dr. Nick's quick fix to help you age smarter starting today. This week we're talking testosterone , a big topic of conversation when Joe Lyset joined us on the What's My Age Again sofa. Dr. Nicola's second opinion. So yes, in our recent episode with Joe Lyset, he took the opportunity to ask about testosterone. Because I am essentially saying this is a free medical consultation. And it really struck me how often this topic is coming up now. Because testosterone replacement is no longer just something that we're hearing about in specialist clinics. It seems to be all over social media now. There are test and kits being advertised, and you'll hear phrases like low T and testosterone optimization being thrown around everywhere. And most of us are familiar with what testosterone is, but what else do we really need to understand about it? What does it actually do in the body? Does it really decline? Do we really need to be optimizing it? So, in this episode, what I'm gonna do is talk about exactly that. So, let's start with the science. Well, first of all, although we often think about testosterone as the male hormone, I just want to say that that is only part of the story because both men and women have testosterone. And yes, men have much higher levels, but testosterone plays an important role in both sexes. So in men, it's predominantly produced in the testes, and in women it's produced in a much smaller amount by the ovaries and also in our adrenal glands. And in men, it does a lot. So it supports muscle mass, bone density, libido, the production of red blood cells, mood, motivation, and even aspects of cognitive function. And it's deeply involved in how the body repairs, builds, and maintains tissue. In women, even though testosterone levels are much lower, it still contributes to our libido, our energy, our muscle tone, and our bone health. So it's not just about sex drive, it's a part of the broader hormonal network that keeps our metabolism and our musculoskeletal health functioning well. Now naturally testosterone does change as we age in both men and women. So in men, levels tend to decline gradually from around the age 30. So on average, we'll see about a 1% drop per year in total testosterone. Now, that does sound quite dramatic when you say it like that, but it's important to understand that this is a very gradual decline. So it's not like menopause in women , where most of our hormones literally just drop off the end of a cliff, it's very different to that. Whilst menopause is an abrupt and dramatic hormonal shift, testosterone decline in men is much slower and it's also highly variable . So some men in their 60s still have a very healthy levels, whereas in others it may dip a lot earlier. And in women, testosterone levels also decline with age, but again, this tend s to be more gradual than more dramatic hormonal shifts in like our estrogen. So the testosterone tends to just taper off rather than fall sharply. And again, this can vary from person to person . So the next question, of course, is when does this decline become clinically meaningful and whether you should actually do something about it? But before we even get there, I want to first talk about lifestyle. Because testosterone doesn't just fall due to age, there are other lifestyle factors that can influence it, particularly in men. So a big one is chronic stress, and that's because stress increases cortisol, and high cortisol can suppress natural testosterone production. Another is poor sleep, especially getting less than five or six hours consistently, because this has been shown is significantly reduced testosterone levels. Excess alcohol and smoking can also suppress production. And if you overweight, carrying excess fat can lower testosterone because the fat tissue actually converts testosterone into estrogen. So sometimes what might look like age-related low testosterone is actually lifestyle-related suppression. And that's an important distinction. And I'd love to know what it feels like to have some testosterone in my body because I've for thirty-seven years I don't think I've had any. I just don't think as a vibe I'm very testosterone-y. I'd love to just at some point in my life get like really hedge. I'd love to be Tony I think your vibe is very testosterone-y. I think testosterone is misunderstood. Oh. I think you have a great mood all the time. You are horny a lot I uh do you know what? I I do swim a lot and I go to the gym and one of the problems I have with it is everyone's so sexy. Mm-hmm. So then you're like, I'm trying to focus on doing my bench press and every ever you're you're horny. Yep. How do you do these two things at the same time? So what about symptoms? How would you recognize if you have got low testosterone? In men, low testosterone can present in many ways, but the most common are reduced libido, erectile dysfunction, reduced muscle mass, low mood, and reduced motivation. In women, symptoms might include also low libido, fatigue, reduced muscle mass, and also a general drop in fatality. But here's where we have to be careful because these symptoms are pretty non-specific and they could be caused by other things. Fatigue could just be poor sleep, low libido could be stress, for example, which is why guessing isn't helpful. So if someone you know is generally concerned about low testosterone or you're concerned about it yourself, then proper blood testing is essential before you start any sort of testosterone replacement, which is exactly what I said to Joe in the episode. Because there are absolutely cases where testosterone replacement is appropriate, but it is a medical treatment. It will suppress your natural production, so it does require monitoring. It also carries potential risks. So like all hormone therapies, it deserves careful evaluation and ongoing monitoring by a professional. And there are also ways to support testosterone production naturally. Strength training is one of the best ways to stimulate your body's own testosterone production. Sleep, that's also critical because deep sleep in particular helps to support our hormones and also just managing stress to allow testosterone production to normalise. Dr. Nicola's second opinion. Okay, so let's get into the questions from this week's episode and because we're talking about testosterone you might not be surprised to hear that we've got a few more questions from the men this time and Catherine's got the first one. James is 44 and from Manchester. He says, hi do no, I'm not gonna do the accent. And he says, but in a mancunian accent, hi Dr. Nick. I've noticed my energy and gym performance dipping over the last couple of years, and I keep seeing stuff online about low T and longevity. As someone who's trying to play the long game with my health, could you explain how testosterone actually changes as we age? Hi James. So this is a really common question as, there's so much confusion out there when it comes to hormones. So your testosterone does definitely decline gradually from your 30s onwards, but the keyword is gradually. So it's not a dramatic drop for most men, and the drop can vary in levels hugely between individuals. So two men of the same age can have a different numbers and both be completely healthy. Now, from a longevity perspective, what we're aiming for isn't high testosterone. We're aiming for what is physiologically relevant. So levels that sit comfortably within a healthy range. Because more is not always better. And actually, really high levels, meaning high levels above what your body would naturally produce, can actually negatively impact things like cholesterol, your blood pressure, and also increase cardiovascular risk, which is certainly not good for longevity. So that's more like short-term enhancement. So if you personally know it's in symptoms that could be due to low testosterone, the first thing is get some proper blood testing done by a professional who can interpret the results properly alongside your lifestyle. So the next question is from an email. It says Hi Dr. Nick, this is Mark, I'm 52, I strength train, eat pretty well, and I don't drink much, but I still feel more fatigued and sore after workouts than I used to. I'm wondering if my testosterone might be part of the picture. From a recovery and aging perspective, how big a role does testosterone really play compared to things like sleep, nutrition, and stress? Okay , so Mark, testosterone absolutely plays a role in recovery because we know it supports things like muscle synthesis, red blood cell production, and also tissue repair. But recovery encompasses many different things. For example, things like deep sleep can actually cause the release of something called growth hormone. And this is also critical for tissue repair. We also know that adequate protein intake provides the building blocks for muscle recovery. Micronutrients will support your mitochondrial function, whereas things like chronic stress can impair recovery. So, yes, testosterone does matter , but so does everything else when it comes to recovery. And it's also worth saying that aging itself changes recovery capacity. So a fifty two year old unfortunately simply doesn't recover like a 25-year-old anymore. And that doesn't mean something's wrong. It just means that training might need to evolve. You might need to consider slightly more recovery, slightly smarter programming, better nutrition, more sleep. Testosterone is definitely a piece of the puzzle, but it's rarely the only piece. This episode of What's My Age Again is sponsored by MedExpress, the UK online pharmacy. If you've been trying to manage your weight but feel like nothing's really working, MedExpress connects you with UK registered clinicians who assess your situation and create a treatment plan to support your weight management goals. 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