Career Clarity with Athletes: A 2ndwind Podcast with Ryan Gonsalves

176: Dr Zak Zafrani - Low Testosterone in Athletes: The Hidden Cost

• Ryan Gonsalves • Episode 176

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Dr. Zak Zafrani joins us for a conversation that breaks open a topic rarely discussed in sport: testosterone deficiency in men, especially in aging athletes. If you're feeling tired, low on drive, or like you're losing your edge long before you should, this episode will make you rethink what's “normal.”

Zak is a UK-based doctor with a background in family medicine, sports injuries, and hormone health. He’s one of the few experts bridging the gap between athletes and men’s hormone therapy. 

From elite-level competitors to weekend warriors, too many men suffer in silence. This conversation is about equipping you to ask better questions, get tested early, and understand the difference between clinical testosterone replacement and performance-enhancing drug use. Whether you're still playing or transitioning out of sport, this episode gives you a whole new lens to understand your body and performance.


What You’ll Hear

The difference between testosterone replacement therapy (TRT) and steroid use

Why symptoms like fatigue, low motivation, and brain fog might not be “just getting older”

How concussions, overtraining, and endurance sports can lead to hormone imbalance

- The red tape and stigma that stop many men from getting tested, especially in public health systems

- Why Zak believes athletes should get baseline testosterone tests early in their careers

- Real-life case studies where low testosterone was misdiagnosed as depression

- What makes testosterone deficiency hard to diagnose and easy to dismiss

- How retired athletes struggle to train the same way and why identity plays a role in burnout

- Natural ways to support healthy testosterone levels through sleep, nutrition, and training

- What the “enhanced games” reveal about public perception, performance, and health risks

- The long-term risks of anabolic steroid abuse and why it often leads to lifelong hormone treatment

- Why more doctors are finally taking men’s health seriously and what still needs to change


Golden Nugget

“Retirement starts at 18. That plan starts at 18. You won’t want to hear it at the start of your career, but if you’re not checking your levels, building your network, and looking at the long game, you’ll wake up at 40 wondering what happened.”


Want to go deeper?

If you are navigating what is next in sport or beyond, visit www.2ndwind.io
to learn more or book a consult.

SPEAKER_00:

There's two stigmas here. One is one is on the side of men in general, who true understandably don't really want to kind of talk about these things. They're you know, in a unfortunately, like in a society where you're told not to really talk about certain things, so men will kind of hide things like sexual dysfunction, which is understandable, and we know this. We we know this in medicine. But on the other side of things, there's a stigma around, especially in the NHS in the UK, which is that we're not as forthcoming to treat. And and and I don't know, you know, I look into why that is, and sometimes it is the maybe not knowing as well, you know, is testosterone replacement and deficiency talked about enough amongst doctors. If I kind of give you an oversight of just colleagues of mine, if I was to mention testosterone to them, they just kind of roll their eyes and like, oh, this is just people wanting to take steroids. And I'm like, no, no, it's not, you know, it's the same compounds, but this is not steroid use, it's completely different. This is a medical treatment.

SPEAKER_01:

Hi, I'm Ryan Gonsalves, and welcome to a Second Wind Academy podcast. A show all about career transition through the lens of elite athletes. Each week, I invite a guest to the show who shares their unique sporting story. Please join me to delve into the thoughts and actions of athletes through a series of conversations. Don't worry, there's plenty to learn from those of you that aren't particularly sporty. Elite athletes are still people after all. Let's be inspired by the stories of others. Zach, welcome to the Career Clarity Podcast by Second Wind. Good to have you here. Thank you for having me. Now, Zach, what's going to be fascinating about our conversation? I know typically we we talk through the career clarity from an athlete's perspective. What's great about what you're going to bring to this conversation? And again, uh, I think as I said, just as we were chatting earlier, I'm ready to learn a lot from you. And there's some things that you know. So apologies if I really delve into places where you're like, that wasn't what we were going to be talking about. But uh hopefully we'll have a good chat and everybody will learn a little bit.

SPEAKER_00:

Yeah, definitely. I'll I'll be happy to kind of uh give answers to everything everything I know about and yeah, hopefully helps help some people.

SPEAKER_01:

Yeah, now so Zach, I guess the I'm gonna let you introduce yourself and and talk a little bit more about what your specialty is so that everyone who is listening and watching can, well, basically come along with the journey with us. So please give us that uh quick intro, who you are and what you're up to.

SPEAKER_00:

Yeah, so uh my name's Zach Zafrani. I am a uh UK-based um doctor. My my official kind of um background is in general practice, so family medicine. Um I have a specific interest um that I've developed recently, or not recently, but over many years in in sports, regenerative medicine, and um more so in men's health and testosterone replacement. And I think that there is a there is a very good link between all of that. And and in different parts of my career, I've seen the interplay between all of these um aspects of what I do. Um I've I really enjoy what I do. Um medicine is beautiful, you get to help people, but you also get to tailor it to assist people that you kind of have a link to. I've got a you know a massive love of sports, and I always try to tailor my career to what I like to do.

SPEAKER_01:

Well, that's good, and I think tailoring to what you you like to do and where your passion is is definitely a big theme that that resonates across many of the episodes and guests. Now, uh we'll we'll come a bit more into your background and sort of some of the the story, but um I just want to pick into some of those words or phrases that you said. You talk about testosterone um replacement uh in in men, and what what does that mean, or how might we sort of interpret that or or or come across it in our sporting world?

SPEAKER_00:

So if we if we looked at um so we we we're talking about testosterone deficiency. So testosterone is an androgen, it's a men's hormone, it's also in women as well. I mean, we have we both both genders have it, and it can be impacted by many things. Specifically in sport, um there is there is a lot of data being looked at about endurance athletes, any sports with risk of concussion, head injuries, these are all things that can cause testosterone deficiency later on in life. Also, energy availability, the training for elite-level athletes is is pretty high, so the body has um less likelihood to focus on things like hormonal uh balance rather than just athletic performance. So, this is the issue that we do come across. Also, injuries and and and certain things like that. Now, testosterone itself is a general male problem. So, if we talk about deficiency, to keep an eye out for the symptoms, it's the same for an athlete as it is for just an old member of the public. So, general deficiency syndrome uh symptoms will be things like sexual dysfunction, so erectile dysfunction, lack of mourning erections, and lack of libido. Those are the common ones. And if you think about it, men tend to not really be I mean, it's it's it's getting better, but they tend not to want to talk about these things, and this is where the stigma is. So, sexual dysfunction is a big aspect of it, but also more common symptoms, and this is where people get a bit lost in TD, as we call it. Uh fatigue, lethargy, lack of drive, motivation loss, lack of concentration, you know, like that. They they call it brain fog. So you're just that fog of not being able to think clearly and losing clarity of mind. And unfortunately, men then say, We're getting older, it's alright, you know, I'm in my 40s, and then I look at it and think 40's not old. You can't, you know, this is not normal, and that's where they come to somebody like me.

SPEAKER_01:

Thanks for saying that.

SPEAKER_00:

Yeah.

SPEAKER_01:

And so what you've described there is is you know, for me is quite interesting. Testosterone deficiency, you know, does occur with men. I want to understand then this intersection with sport and how those two pieces align. Because in my mind, I'm thinking, well, this must start to come along a bit of a borderline here between what's competitive and what perhaps starts to uh break certain rules and things like that. And there's a lot of talk about enhancements, and certainly in the sports that I like it enjoying. So I'm interested to understand a bit more about that intersection with sport and and what you're seeing.

SPEAKER_00:

W within sport, so if I if I give you a bit of data just to kind of prevalence, I I like to look at prevalence. So how how frequent is it? And if we look at prevalence data, there was some studies done and they looked at around 180 to 200 athletes, and they found uh 12% had severe deficiency, and up a further 18% had what we call mald deficiency. And if we go off UK guidelines, if you would combine them, because both of those are deficiencies, and that is a marker under 12 nanomoles of testosterone. So, in within sport itself, it is it is quite prevalent. And I came across this across this um in a very interesting way. I my my interest in testosterone peaked because I was doing sports clinics for a treatment, you know, I I see um athletes to do PRP, just platelet-rich plasma for injuries. And some of them were saying, you know, I I can't recover as well as I used to. And these were, you know, kickboxers and other athletes who had officially retired, but they still wanted to continue training because it was part of their life. And it would come up, and and I'd always just say to them, you know, what kind of symptoms are you having? And at that point, I wasn't working in men's health, so I would then ask them to go to their general practitioner, and then they would always come back and be like, 'I got batted away.' Uh, they weren't interested. They just said, you we're not interested in doing the blood test. And this is where then a lot of people went into the private market to get it. Now, the difficulty you do have is that's talking about retired athletes. To get what? To get blood tests. Because initially, symptoms are one kind of part of testosterone deficiency, but also to get the serum testosterone level done because you can't have a day diagnosis without both. This is where, if we look at another pet peep in my which is influencer marketing and stuff from certain certain influencers who talk about um testosterone, and there's a there's a new trend called testomaxing, which is you know, just yeah, your testosterone's normal, maybe you have a bit more, you might feel a bit better. That's that's doping. That that's not that's not replacement, this is not a medical issue. So you need both. Some men do run lower testosterone because their their receptors are more receptive to androgen, so that's normal, you know. For example, me and you could go get testosterone levels done, and the officially UK guidelines 12 and below is normal. You might have a testosterone of 28 and be it might be fantastic. I could have a testosterone of 12 and still have no symptoms and be completely healthy and be able to train and recover. So it's it's dependent on person to person, and symptoms are really important. So, in terms of athletic performance, you've got to be careful because you can't you can't just take testosterone to amplify your level, even if it's at the top level of normal, because you can find out there are means of checking the other hormones to see who's actually doping versus actually being treated.

SPEAKER_01:

Yeah. And so do we see many athletes with a natural deficiency in testosterone whilst competing, or is this something that, you know, you mentioned it it might be more with aging athletes, people who used to whether they were doping or not, but who who are used to having a certain level of testosterone and seeing that dropping. Where where does this lie? Where are you starting? Where where's sort of your your main sort of base case of of individuals that you speak with?

SPEAKER_00:

It's I'll be honest, it's less frequent in younger athletes, and it happens more so towards the latter end of the career. Now, there could be many reasons for that. Again, there's a lot of research and data that needs to be looked at in this in this group of people because we don't a lot of the answers we don't know. So this is all hypotheticals of what I see and what I've kind of dealt with. You do see it happening more often in in aging athletes. The question is, is that because as we get older, um our reserves change, as we know in most sports, as you get towards your 30s and things, depending on what sport it is, you tend not to be able to compete to the same level as you did in your 20s and and earlier. So maybe, you know, injuries, use of painkills, there's so many things that fall into it, and there's too many different causes that we we can look at. And at the moment they're just all there, but it tends to be more towards the latter end of careers and and after generally after retirement or or stepping down.

SPEAKER_01:

Okay, you you you would see athletes getting the injections, PRPs. Yeah. And that that's where they're practicing athletes. Is that is that sort of those examples? So they are individuals who talk about or at least verbalize things that could be linked to uh a reduced um testosterone that that kicks in. Yeah. We're gonna have people coming towards end of their careers, um, men and women, but those who are listening to this, and you mentioned those symptoms before. Uh tell me what those symptoms are again, because I'm then interested in what should they be doing about it, and if if anything at all.

SPEAKER_00:

So the general symptoms of TD, testosterone deficiency. Yeah. Um generally most people will the ones they tend to notice most are lethargy, fatigue, tiredness, you know, um, sleep disturbances, lack of motivation. So that they commonly describe it as I I want to go and train, I want to do things even in business. Some, you know, some athletes post um, you know, competing and retirement, they'll start business benches and they're just like, I have no drive. I want to, but I have no ability to do it, no motivation, can't concentrate for long periods of time. And then if you kind of delve into it, it's a sexual dysfunction, um, which is that that sits in the background, and they'll be like, actually, yeah, that's true, comparatively to maybe three or four years ago, my libido's gone, I don't feel like myself anymore. And and that's where it's about having an open conversation and knowing what to look for.

SPEAKER_01:

You know, you talk there about that former athlete who is a few years out of retirement who is thinking, I don't have the drive, I don't have the passion for this. Isn't that just psychological? Isn't you know, why isn't it just a psychological feeling of, well, I I used to love playing cricket and football, and now I'm not doing that at that level anymore. And you know, running this company is just boring for me.

SPEAKER_00:

Yeah, that's that's definitely a thing. It's like the whole thing about you know, ath athletic identity. When when you have people who train to an extremely high level, they're very well known for certain things, it becomes their whole identity. I I you know this is something you you're fully aware of, and this is where there is life after, you know, there's a career after a career, really. And it does play a massive role because we know that and sorry, one thing I I've completely kind of forgot about, which is mental health issues, which is another thing that is is actually a really big sign of TD to sustain deficiency, is is anxiety and depression in men who have never felt it, they'll just suddenly start developing it and they think that it's normal. So mental health plays into it because we know, for example, that there is a lot of contributing factors. So in an in an athlete, for example, who's retired, you know, loss of that drive to say, you know, I'm not doing this anymore competitively, they'll get stressed. They won't have the uh you know urgency to want to do it, their cortisol levels will spike, their stress response levels that dampens your testosterone production, and then you're not sleeping well, uh again in back to testosterone production. So there's so many lifestyle factors and psychological factors that play into this that it's it's it's why you have to take a very well-rounded look at an individual as themselves, and each patient is kind of catered to based on what they tell you rather than um a one-size fits all and you know that so it's it's what's fascinating listening to this is you know, my focus has pretty much always been on the I'm gonna say psychological and perhaps then the physical, as in be active.

SPEAKER_01:

You know, you're taking this to that um chemical uh level that sort of said, well, there's something else that perhaps you you ought to take a look at, as certainly as you're coming off sports. So then what sort of activities so should they be going and doing, or would you recommend in order well actually before that? Are there ways to maintain a testosterone level? Is it something that individuals can do um, you know, men can be doing either whilst playing or competing or indeed afterwards? What um you know positive or what's the word proactive action can be taken to maintain testosterone or at least slow down the growth uh the decline?

SPEAKER_00:

I think a lot of it is to do with energy energy expenditure. So it depends on it depends, it's sports specific. So it depends on energy expenditure. Sometimes what tends to happen is you find that as you're younger, you tend to push it a lot more and your body's able to recover, but there is only so much reserve before it starts to cause difficulties. So it's I guess it's one of the things that I'm a big advocate of is it's get your testosterone levels checked because unfortunately what we do as men is we'll we'll check it in our 30s and 40s when we start feeling something, and you have no idea what your testosterone level was when you were 22, so because you were fine. So I'm seeing it a lot more in in the work I do, not not even with athletes, just general men in the UK have now started to get this idea. Do you know what? I just want to know because I want to see where I am now. And I I I love that. That's where I think most men should be, just even in athletes, just midway through your career, start of your career, just get your testosterone levels done. And if we look at there was actually uh a study done on like Olympic athletes, I think it was. Um they looked at like 15 sports, and and there's a huge data sample size. I think it was around 700 Olympic athletes, and they looked at during so this is competitive athletes at the time, not retired, and they found that, and they were they found around 25% of them had some element of testosterone deficiency, and this was during competing, so they were you know actively training, etc. So the question really is that's quite high in my mind. Even if you compare that to the general population, that percentage is pretty high. What's the general population? Nowhere near that. No, I mean it wouldn't be anywhere near 25%. I mean in diabetics, it's in diabetics it's around 25%. Uh and in pre-diabetics, but in the general population, it's 25%.

SPEAKER_01:

Okay, without going too crazy and extrapolating across every Olympic um male, but Olympian 25% and I'm just gonna say that at elite sport level, 25% of men um have some form of testosterone deficiency. Given that, what should athletes be doing if they realise, hold on, I I've just gone, I've got tested. It seems as though I've got lower levels. Am I even allowed to do anything about that?

SPEAKER_00:

That's that's difficult because there's a lot of issues with with utilising testosterone. Now, if you if you were an athlete and you were found to be testosterone deficient in some sports, and I know more I know more of as a fan, um, I I follow MMA quite a lot, and I know that it makes martial arts promotions. There were times when they were allowing cage fighters in in big promotions to to utilize testosterone um for deficiency, but it got a bit out of hand. I don't know whether this I don't I don't know what the actual rulings are in the intricacy, I don't think it's allowed anymore because because there's this grey area, you can get a deficiency diagnosis, have it optimise your levels, and then it's class as doping. So there's there's a lot of stuff that goes on in the background. But in terms of what an athlete can do, if you if you're an athlete and you you're looking at your numbers and like, okay, that's pretty low, uh, or it's lower than I'd expect. The question you've got to ask is I'm I'm an athlete and I'm training quite heavily. So that's gonna diminish my reserves anyway. That's something you can't really do anything about. So that so I mean there is you could you could optimize your training to maybe reduce intensity slightly, but again, because you're competing at that level, you can't do that. So if you take that parameter out of the way, you then focus on the other tenants of what improves testosterone. So you've got to focus on things like sleep quality and sleep health. So I'm big on sleep tracking, but I've got to track her, I track my sleep. And initially, when I started looking at it, I thought it was just a new fad. And it actually, I I this was like years ago, and I've been doing this for years. It works really well in terms of sleep depth and quality improves testosterone.

SPEAKER_01:

Okay, all right. That's the link. So getting the sleep in this instance, that can help testosterone levels, can it help them increase? Yes. Yeah, so is that what we're saying? So it can actually increase testosterone levels as well.

SPEAKER_00:

Correct. So there's a few things. The tenets that I look at, because I I approach it in a holistic way. I'm not, you know, there's some some people who work in in testosterone replacement are very heavy-handed with testosterone. But my thing is that testosterone replacement ultimately, when you're deficient, ends up becoming a lifelong thing. And my plan is not to put a man on testosterone replacement until they've done everything. So weight reduction, so reduction in body fat percentage is amazing for increasing testosterone. Doing some form of resistance training, fantastic, three times a week. It doesn't need to be significant amounts, sleeping better, eating better with a high protein diet. These are all things that we is is known to improve testosterone.

SPEAKER_01:

And and these are things that I suspect a lot of athletes are doing, and especially those coming towards the end of their career might be eating better, sleeping better, doing those types of things to try and live that healthier lifestyle to prolong their sporting career. I think what you're adding to me, at least in this conversation, is another angle to look at is well get your testosterone levels um clear. So you have, well, I'll say a base, but it's a base from whenever it is that you took it, be it it's probably towards the end of your career, you know, in in my mind. And then you can start to learn from it. So I guess quite you know, perhaps more bluntly. So do you have people who have come to you asking you to support a sort of a doping plan in some shape or form?

SPEAKER_00:

Not specifically with troll level, because it's very it's a very extricate area to play with. I've I've had I've had retired athletes who I mean I've got I've got case. So my my background is specifically, I I dealt a lot with powerlifters and strongmen because I competed in that area in the amateur like many, many years ago. So I have a lot of links to that uh area of sport, and and I do get like retired or coming to the end of their career masters levels, um, like strongmen who will come in and see me for injuries and also for testosterone replacement. So in that situation, um yeah, I mean when you when you're at a higher level, it's very difficult to get cleared. So that it tends not to happen, it's usually after retirement. And in and in these, yeah, in these athletes generally, they tend to come out of uh competing, for example, they retire and then they try to carry on at the same level because it's built into them. They've been doing it for 10, 20 years, like I need to train like this, and it's that discussion to say, listen, you you know, the identity has changed, you know, for when you're now a former athlete, you need to figure out other things to do, um, change the way you train, reserve energy, um, and and just maintain kind of longevity more than anything else. And that's a difficult conversation. But yeah, we we you know, there's there's been cases of um there were there was a gentleman, and I think anonymized like kind of as a case study just to give the listeners an idea. Um I had like a he was probably a very good level like semi-pro tennis player, he did really well, um, around 38, so not really doing any more like anything competitive, but he was playing four or five times a week. And he came to me, and this was this wasn't in this wasn't in my men's health clinic, this was in the uh in general practice, this was in NHS work. So he came to see me and he was like, Doctor, I want antidepressants. I've never met this guy before. And it's like I'm on antidepressants, I feel like it's doing nothing, my life is terrible, I'm I'm self-employed, I set up a business, it's failing. And he was having a long discussion, and I was listening to him and I was uh looking at his history and I said, you know, did you did you ever supper with depression? And he's like, No, started five years ago. And I was like, fine. I was like, how I was like, how have you been with regards to sports and recovery and things? And he was like, Oh, I can't play tennis, I I'm bored, I just don't have the drive, I can't, he was I'm so tired after I play that I don't play anymore. And he's like, My libido's gone, my energy's completely drained. And then as the more he spoke, I was like, Let's do your blood bubbles. So we checked his testosterone, and lo and behold, he was deficient quite significantly. I referred him on the NHS at that point to a hormone specialist, and he was commenced on to social replacement. Saw him and his wife two months later, and his wife came in and said that for five or six years she felt like his lights were just switched off. It was not the same man she knew throughout her teenage years and like in her twenties and stuff. They've been married for a long time, and she was just like, He's back to himself. She was like, I thought this would, you know, this was just an aging process. And he came back and he told me, I'm back playing tennis. And he's like, I feel fantastic. My libido's back to normal, my business is thriving. He goes, 'Because my motivation and concentration has skyrocketed.' Now, that would be, you know, the poster boy for testosterone replacement. I mean, it's not that same for everybody, and it's not going to do that for every single man, but he was truly deficient and it impacted his life so beautifully. Like to see this, this is what I kind of work for, which is those sorts of conversations with family members and patients. So it works fantastically when it is required. And again, he was already doing all the other tenants, he was eating well, he was sleeping as best as he could. So, yeah, I mean it's it's good to hear these kind of stories.

SPEAKER_01:

There are too many stories of bankruptcies, mental health issues, and unfortunately two is tied. And so I think it's time for to act. Every year, we see thousands of athletes that reach a point where they need to consider their life activity sport. This might be a retirement, injury, or they need to juggle your careers between sport and a job. As a former English professional footballer, I have somehow managed to transition from sport into banking, strategy, innovation, and now life coach, career practitioner and founder of the Second Wind Academy. So I want to help those around me find their career secondwind. Find me on Insta or through my new Facebook group, Second Wind Academy, where I'd love to know your thoughts and suggestions. Yes, yes, it is, and like you say, the poster child of testosterone replacement and that sort of uh therapy or that approach sounds like it can have benefits. And look, it's not something I'm sort of very well versed in, or in you know, m maybe it's my maybe it's my age, or maybe it's the people I'm hanging around with, maybe it's just not spoken about um as yet. Do you find then that it it is perhaps more prevalent than than we realise? And it's more once you do it, once you see your doctor and talk to them, suddenly you realise actually all my more of my friends are probably doing this, more former athletes, certainly in my case, may well be um following this path.

SPEAKER_00:

There there is um there there's two sides to this, and I talk about I I do a lot of work around kind of breaking the stigma. There's two stigmas here. One is one is on the side of men in general who true understandably don't really want to kind of talk about these things. They're you know, in it unfortunately, like in a society where you're told not to really talk about certain things, so men will kind of hide things like sexual dysfunction, which is understandable, and we know this, we we know this in medicine. But on the other side of things, there's a stigma around, especially in the NHS in the UK, which is that we're not as forthcoming to treat. And and and I don't know, you know, I look into why that is, and sometimes it is the maybe not knowing as well, you know, is is testosterone replacement and deficiency talked about enough amongst doctors. If I kind of give you an oversight of just colleagues of mine, if I was to mention testosterone to them, they just kind of roll their eyes and like, oh, this is just people wanting to take steroids, and I'm like, no, no, it's not, you know, it's the same compounds, but this is not steroid use, it's completely different. This is a medical treatment.

SPEAKER_01:

You know, for many athletes, so you know, the the enhanced games are getting more and more um noise, right? And for many, it's been outrage that athletes would take this because it's almost a well, it's not almost, it's a thing you that most don't do, right? I'm not taking drugs, I'm not going to do that. This can happen naturally. I went for a run today. If I do a six minute kilometer, I'm like, yeah, it's because I'm older. I can't go, I can't do four minute kilometres anymore. I could never do three minute some things. So I'm like, I could I can't I can't do that anymore. Isn't it just because I'm 47 and I've just got to live with it?

SPEAKER_00:

Yeah. I mean Yeah, I mean there's a there's a lot, there's a lot to that, there's a lot to unpack within the mindset of of of people. And the enhanced games, yeah. I mean, I find it interesting because uh when I when I you know when I speak to even colleagues within testosterone deficiency and in the field, I have a very different outlook to it. I I come in knowing a lot about testosterone use in sport, and unfortunately there is you know in some in some sports that there is use and I'd come across it many years ago in terms of other people that uh it were competing that used it. So I'm aware of the uses of it, but uh you know the enhanced games are interesting. I find it very interesting to to kind of to kind of look at, both from a medical A medical, okay.

SPEAKER_01:

I do think it's interesting. Tell me that you from a medical perspective, what makes it interesting?

SPEAKER_00:

I just find it amazing because uh the the thing is if you if you look at enhancements, so these men are obviously enhancing their testosterone, etc., and using androgens to to boost their athletic performance, but they're actually already athletes, these are not you know normal members of it's not like me taking steroids and then going and trying to run against runners, these are already good level and elite-level runners who are enhancing what they thought they do, and more from a fan perspective, I'm just like that sounds pretty interesting to me from a medical perspective. Obviously, you've got to be careful. One one thing that comes to my mind is it's just the damage that you do by taking testosterone. There is there are a lot of benefits of testosterone, like I can reel off plenty in terms of body composition, energy levels, metabolism, blood work, all these things. But the downsides are it it can kill your fertility off. So, you know, it it can stop you from being able to have children, can cause blood thickening. So again, these these athletes, and I always tell members of the la, you know, lay lay members of the public who are just wanting to use steroids, I would say to them, these men have teams behind them of doctors who are watching their blood work. Do not try to imitate what they do because you're gonna get in trouble. So there's a lot to this.

SPEAKER_01:

So I'm I'm interested now in a bit of your history and a bit of your sport participation. Tell us again, w when as you were a lad and you were looking at what you want to do, what was your sporting dream?

SPEAKER_00:

I had a few dreams, it's really interesting, because I had a few sports that I really loved. Obviously, in the UK, in the north of the UK, football was massive. I was a Bolton Wanderers fan, so I went and lived through the heyday of Bolton Wanderers um and then the the decline. So uh football was always big for me. Um I was a very, very kind of my parents would say I was pretty hyperactive. I was very energy fueled. And when I was four or five years old, my dad decided, because my dad was very big on in sport himself, he he loved sport, so he put me into kickboxing. So I did Muay Thai for around a decade. I was there, you know, multiple times a week. Never competed in it, but it was more of a learn discipline, behave yourself, you know. Things that I I and I I put that into other aspects and it kind of really mellowed me out. I the dream was obviously football or some sort of kind of kickboxing or something. And then I dabbled in a few other mixed martial arts things, so like Sambo, Jiu-Jitsu. Um, and then somehow I obviously that was throughout my teenage years, and then I started medical school, and I just felt I really kind of fell into strongman and powerlifting. It was really interesting because I was really I I'd been injured when I was younger through a um through a car accident with a lower back injury. And I went to to start developing some sort of like weight training program, and I went to see the strength and conditioning coach, and he's he's like my Mr. Miyagi. He annoyed me for months by telling me not to do anything significant. So I wanted to go and deadlift and squat, and I'd go into the gym and all these guys were getting ready for comps, and I was like, I want to do this, and he was like, No, he was like, Here's a kettlebell. He's like, You do this, very simple things, and I was just getting bored, but I realized all the time he built my core strength up, and then when I started to do this the heavier lifts, my back was in like amazing shape, so I I didn't get any injuries for many years whilst I whilst I competed. Then I went into the amateur stage because I I I seemed to have a knack for it, and and that was it. So I competed in in a very low-level kind of amateur um strong man, and it was fun. Um it was very it was very interesting.

SPEAKER_01:

Yeah, but it I mean to me, you well, competing is competing, so you clearly had uh a gift for it and I guess an enjoyment of doing the sport as well. That competitive edge, now you were doing this sport whilst studying as well. So you were studying medicine, you were starting to learn the I'm guessing this this whole journey around not just general health, but also what performance or how performance might be enhanced by certain drugs as well.

SPEAKER_00:

Correct, yeah. So you you come across this and you come across all like the black market uh use of androgens that aren't even and I'll be honest with you, doctors aren't aware of because even within the within testosterone deficiency, if you if you pulled up some of the doctors and said talk to them about these kind of compounded drugs that people use, I have no idea about them because we they're not medical drugs. These are formulated by labs and they're pretty um complex in the way they work. So I I was coming across certain things within within specifically strongman, and and it was because you got to a point where other people I I remember to be fair, I I look up from an athlete's perspective, and this really this really like um this was like a defining moment for me. I remember I I oh I I competed in an open competition once and I I used to compete around 90 kilos. I wasn't really big. Some of these guys were massive monsters. So I think 90 kilos is quite big. I mean, yeah. I remember had this conversation with my conditioning coach because we went in and I went into an open competition and I was the smallest guy there, and I I didn't fare too badly in the competition. I I I finished not where I wanted to, but nowhere near where I wanted to. And I looked at it and I thought these guys are really big. And I was around other strong men who would then consider using anabolic steroids because they were like, we need to I can't get that big and I can't get to the level that I need to to then perform. So there is this thing within sport as well, which is there's people that are doing something I need to be able to kind of compete. And for me, I knew too much about the damage, and I I never touched any kind of anabolics or anything because I just knew that it was not something I mean, it wasn't my career, it wasn't something I was gonna do long term. I didn't want to ruin my physiology. Um, I knew too much about how bad of an effect it can have.

SPEAKER_01:

And and so you didn't because you knew too much, right? You you'd understood you you've you understood the risks of it. Could you understand the reward incentive for those, I'll say, fellow competitors around you who did take it?

SPEAKER_00:

You'd see them try anything because it was again, it was an identity for them. It was, you know, we're we're doing this, I have plans to be the best in the country. If I want to compete at a certain level, can I do this without uh and that's that's something and a lot of these guys were also working and things, but yeah. I always think and and I reflect on this, if if they were aware of what I was aware of, would they still do it? And possibly they would, because some of these guys were just like, I have to do this, or I have to get to this level. And truthfully, you know, we all know this. If if you're if you're walking around naturally at 90 kilos, you know, the most I ever weighed was 103 kilos in in my time. If I wanted to get to 120, and that's not 20 kilos of fat, this is 20 kilos of muscle mass. It's you know it's it's impossible. You know, anyone who comes to me and and says, Oh, you know, I'll put on 20 kilos of muscle mass in a year or two, uh I just it's not possible. It's I'll be honest with you. I'm I'm an optimist, ever the optimist, well that's uh that's pretty impressive to do that. That's pretty high.

SPEAKER_01:

So it I mean it's interesting. You so you turned you turned your back on taking um drugs in that way, ended up studying it, and if I'm right, become from an androgen perspective, uh winning awards indeed this year, is that right?

SPEAKER_00:

Yeah, so I've been I've been doing I've been doing some data and stuff and collecting. So I received um I I went to the States um just recently, actually a few months ago, and I got the Emerging Scholars Award from the Android Society. And more so than the award, um thank you very much, and more so than the award, I actually really enjoyed the experience. Um I went to um I went to San Francisco for the conference, and it's almost like you know when you know when you meet, you know, you're a child and you have a footballer that you idolise and you meet them in person, I was there and all these papers, and I know I know it sounds really ridiculous, but all these papers written by the top professors, they were all in front of me, and I got to meet them, speak to them, and I was just like, This is a guy who wrote the paper on X and told us that there's no prostate cancer risk. And I was just like, Well, then I'm just sat here having conversations. So, more so than anything else, the experience was fantastic, and I really appreciated all of the advice they gave me, and they're very welcoming, like they were very nice.

SPEAKER_01:

That is a wonderful experience, and you know, the fact you get to meet well, to meet idols at any stage, I think, is is wonderful. And hearing it in your voice, it it does take me back because as I've been doing my studies, must have been a few years ago now. I reached out to um a couple of people who wrote papers that I studied, and I wrote them a note and just said, Hey, thanks, really enjoyed reading uh what you said, and one of them, you know, she got back to me, and I was really chuffed. I was like, Wow, a real person. This is yeah, this is fascinating. So uh yeah, listen, I I'm I can um fellow uh geek out like an academic uh in the same way. So uh yeah, uh I'm I'm with you. Um so I mean with that award, so you have this knowledge. I I'm assuming you you're perhaps to some extent sought out. And I'm I'm interested then for those individuals who made the decision to take some sort of performance-enhancing drugs, do you have any case studies of you come across them who coming out of elite sport or competitive sport, yeah, need your help to reduce it, come off it, normalize in some way? Is is that a thing?

SPEAKER_00:

It's a big grey area. Or or it's it's a very stigmatized thing within medicine. So, for example, y you'll get some athletes, for example, who will have used steroids. So a common one, the common ones are bodybuilders. Um body bodybuilders utilize testosterone, they utilize basically a lot of things, um, some really complex drugs. The problem that they have is they're used for years, they're used for a decade, two decades. And we we touched upon this earlier on, which is you you shut off your own production. So the way testosterone works, and this is really important for people to understand, um testosterone is produced by the testes. I don't want to go into too complicated a pathway, but the stimulate stimulant for it comes from the brain. Keep it simple, keep it simple. But yeah, I'm saying to understand that yeah, the the brain stimulates the testes to produce testosterone. When you take testosterone and put it into your body, there's something called a negative feedback. So the brain looks and says, Oh, well, there's loads of testosterone, I don't need to keep stimulating them. So the testicles shut down. So the longer you do that, the less likely it is that when you come off testosterone, or I'm sorry, not testosterone, but anabolic steroid use, that you can ever live a natural life without them. So you will see most men who have ever abused steroids will end up on testosterone replacement, and that's because their testicles just don't produce testosterone anymore. And as as a doctor, the the the gray area here is a lot of these men come to me and and we, you know, in both in the NHS and and in private, and they will ask the question, you know, uh they'll be very straight. And the people are very honest with me, because I have no kind of judgment on it, you know, I I don't care. If you if you use steroids, it doesn't matter to me. Um and they'll say, This is in doc, I'm on X, Y, and Z. Um, I've I'm done, I want to come off them. Can you help me? And on the NHS the answer is no, because that's drug abuse. I can't help you come off things. So they left to do it on their own. So then they turn to Reddit and then they turn to people that they might know, and then they do things and and it's there's no structure to it. So my perspective on that is my opinion is I think that it should be something that we do because there are a lot of men who are coming off steroid use, and I don't know the actual numbers, but we know specifically in the UK that the number of normal men who have tried anabolic steroids is significantly higher than we actually think. It's not in the 1 or 2%, it's actually very much higher, and this is in general during their lifetime. So these men need some hand holding because they there are some complicated ways of coming off testosterone. So once they're on steroids, you have to slowly reduce the testosterone uh amount that they're using, but then you have to build up another hormone called either HCG or clomephine or N-Clomephene if you're not in the UK. And these are drugs that then stimulate and try its best to start working again. It's really it's for me. I mean, it smells complicated, but it is quite complicated, and then there's risks that come with it. So, you know, you've got to monitor estrogen levels and so many other things that happen.

SPEAKER_01:

Right. And so it's a well, I guess it's a thing, right? I mean, I you know, I said at the start, I'm I'm gonna be learning as we have this conversation, and the the bit in my mind is I'm gonna end this conversation, and then so many more questions are going to come. I'm sure there are there are gonna be many listening, they're gonna want to reach out. We'll we'll definitely come back to if if you know if if they want to get in contact with yourself. But I I'm just I guess I'm amazed actually that it's a thing. I'm amazed as a a specialty. I'm amazed about I guess the awards you won, the conference, the things that have been written about this, because to me as an athlete, it's just been I I guess the whole use of drugs has just been a no, don't even go there. Everything batch tested, move forward, do that type of thing. Here, what we're talking about is well, actually sometimes there's a need, right? There is as not as an athlete, but just as a a man. Yeah, as a man. Yeah. As a as a man, this this is something that I I would need to consider, or at least it should become a normal thing in the vocabulary. Yeah. To say, given these types of symptoms, there's another way of thinking about what's going on or or what might be going on inside you, not just mentally.

SPEAKER_00:

I mean, one of the one of the things that comes to my mind is I think the the health benefits. People people don't realise. So you know, if we go back ten, maybe ten, fifteen years, there was a big push for HRT in women. And I think that's fantastic because HRT, women weren't realizing that it's necessary and the benefits of it, because there was a lot of scaremongering and like, oh, be fearful of this cancer and that cancer. Same thing's happening in men's health. So, you know, if you look at one of the common worries that a lot of men have with regards to um when they talk about TRT, testosterone replacement therapy, is they'll always come to me and say, Doctor, what about cancer? I've heard that prostate cancer is gonna, you know, I'm looking at prostate cancer. And the interesting thing is there was a study done called the Traverse Trial in the States, which is which is basically quashed that. It's complete nonsense. I mean, there is they had to do a huge data set study to follow normal men and TRT like replaced men. And they found that the link there is no difference in the prostate cancer risk. So this is this came from not even data, this idea came from someone's thought process that because prostate cancer can be driven by testosterone, it must cause it. And it's not true. So, you know, if you look at the benefits, the benefits are so much better on like kind of metabolism, insulin resistance, cardiovascular risk, so many things that when you actually get it into an optimized level, it will benefit you later in life. You don't want to be 60 and have a poor bone mass density and then end up on medication trying to retain that. So you want to try and hit it early and retain as much as you can whilst you're still well.

SPEAKER_01:

To bring this to athletes, those who are looking at their retirement perhaps, or again over that few years off, what what advice would you give to them? You know, if they're getting any sense of the symptoms that you've mentioned before?

SPEAKER_00:

The first thing to do is is just get get a blood test done, a full blood panel. Depending on which country you're in. I mean, in most countries, privately you can get whatever panel you want. And that would include a full men's health panel. That includes things like a total and pretestosterone, your sex hormone binding globulin, estrogen, prolactin, and all your stimulation hormones. This gives a doctor the ability to figure out what's going on with your hormone health. And even if you have an inkling or you think, oh, maybe I feel something, just get it tested. Nothing bad comes of it. You you get numbers, you figure out where you're at. And and then if you are deficient, then seek out assistance early because the dreaded thought of you know lifelong therapy, etc. When you wait when you've met someone on TRT who was truly deficient, they would never ever contemplate not having done it because it changes their whole life.

SPEAKER_01:

I feel I feel I've got so many more questions to ask, but I've I listen, Zach, I I've got to say thank you for bringing your perspective um to me. Um definitely teaching me a little bit more about this. And you know, I I suppose listen, I'm I'm hoping through this conversation, those watching and listening are are also going to start to normalise a little bit more about um, I guess, testosterone replacement therapy, but also to bring a different perspective as to what might be happening to their bodies as they come out of elite sport as well.

SPEAKER_00:

Yeah. I mean, you you the the conversation is a starting point. I think it's not enough that's known about this. And it's it's it's an it's a specialty in its infancy. I I still believe. I don't think there's enough in it, and you're gonna see a lot more doctors um delving into the like hormone specialism and andrology, and that's good. I'm I'm happy. I think the more there are, the more options patients have to reach out to people.

SPEAKER_01:

Now I'm thinking about testosterone. We've we focused very much on men in this, and I know that's been your your focus there, and yeah, you've just now got me thinking about women um and all all of those pieces. Perhaps that's a topic for another time.

SPEAKER_00:

I mean, there is there's a lot of um again, a lot of work being done in the utilization of testosterone in women, um, not to the same extent because women don't have as much testosterone-free roaming to to utilize, but um there is a big uh there is a big topic around testosterone in um HRT, which is prescribed um in in the private sector. In the UK it is prescribed, and it works very well. So again, not my subspecialty, you know, a HRT specialist would give you a fantastic conversation about that and the impact it has.

SPEAKER_01:

Yes, yes, indeed. Um well look, Zach, people are gonna have more, people will want to reach out because through this platform, people will hear your name, people are gonna hit listen to this story, they're gonna at least want to delve a little bit. What's the best way to find you and perhaps to get in contact?

SPEAKER_00:

I mean, the best way to get in contact with me currently is probably through LinkedIn. I'm very active. I I I I keep I engage with many people and I'm happy to have the conversation. I'm happy to give time because you know people reach out to me a lot about the unknowns of certain things. My my my answer is always just reach out and I'm happy to get in touch and give advice and offer advice as best I can.

SPEAKER_01:

Zach, thank you very much for joining me on the show today. Really appreciate you sharing candid perspective and facts as well.

SPEAKER_00:

I mean, it's been it's been a great conversation and uh it's been great talking to you.

SPEAKER_01:

Thank you for listening to the Second Win podcast. We hope you enjoyed hearing insights from today's athlete on transitioning out of competitive careers. If you're looking for career clarity for your next step, make sure you check out secondwin.io for more information or to book a consultation with me. I'd like to thank Claire from Betty Book Design, Nancy from Savvy Podcast Solutions, and Cerise from Copying Content by Lola for their help in putting this podcast together. That's all from me. Take it easy until next time.

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Ryan Gonsalves

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