Dr Andrew Greenland: 0:00

Welcome to Voices in Health and Wellness. This is the show where we explore the changing face of healthcare one conversation at a time. I'm your host, Dr. Andrew Greenland, and today I'm joined by Dr. Zak Zafrani, a general practitioner with a specialist interest in men's health, testosterone deficiency, sports medicine and musculoskeletal care. He's also a 2025 Androgen Society Emerging Scholar Award recipient, recognized for his work in men's hormonal health. Zach is deeply passionate about raising awareness around testosterone deficiency, challenging misconceptions, and promoting evidence-based approaches rooted in lifestyle, sleep, and nutrition before resorting to hormonal therapy. Zak, welcome to the show. Thank you so much for joining us this afternoon.

Dr Zak Zafrani: 0:40

Thank you for having me, Andrew. It's a pleasure, as always. Thank you. Thank you for the introduction. It's uh it sounds it's n it's nice to hear sometimes, but um yeah, it's it's been a great journey to to get to this to this point specifically.

Dr Andrew Greenland: 0:54

Well, actually, speaking of the journey, perhaps you could start with yours and maybe just tell us um how you've ended up focusing so much of your work on men's health and testosterone deficiency.

Dr Zak Zafrani: 1:04

Yeah, I've I I'm I'm a general practitioner by background, so I qualified as a GP five years ago. Um prior to that, I was doing some work within general surgery or in subsection of like sports medicine. Um I worked with MMA promotions uh as a cage side five um cage side doctor. I worked with rugby league teams, so I've done quite a bit of work with sports, and I used to compete in the amateur kind of sector of um powerlifting and strongman. So I had been in and around testosterone for many years, never never utilized it myself. Um, but I saw the challenges a lot of athletes and a lot of men came came to both within sport and also after sport as a retired athlete, or even just general men day to day. So as I got into general practice, um my my interest was always there. I always did reading about it, I signed up to the British Society to gain more gain more knowledge because the training pathway doesn't really it's it's not fantastic for testosterone deficiency itself, so you have to do a lot of work on your own. Um, and then moving forward from there, I I started working as a GP and I saw there was an issue within the NHS, which was that patients were being missed. Um I would I would generally see patients, I would look at society guidelines and say, okay, why is this patient who has block standard symptoms that anybody who would read the guidelines would miss? And it was a lot to do with lab values, and there was a lot of things in the background. So I started auditing data. As I audited data, I noticed that a lot of men were being missed. And when I would contact them again, refer them to endocrinology, some of these men would then be increased in testosterone efficiency, and then case study after case study after case study, um, of men whose lives were completely changed um miraculously, you know. Some definite like people would define it as I felt like my lights were switched off for 10 years and I've suddenly woken up. And and if we if we just go off that, that sounds fantastic, and most men would jump at it. It's obviously not as simple as that in itself, but um that kind of led me down this path. And I do a lot of work privately in the private sector with testosterone replacement because the private sector gives you a lot more leniency in how you treat. Um, a lot more men are now seeking advice, and what you don't want these men to do is go down the black market route and and seek testosterone from you know different different means, which a lot of men can. Uh, it leads to a lot of side effects, a lot of problems that people aren't aware of. And that's that's led me to where I am. I did some research. I've uh I was blessed enough to get to go to San Francisco and get the award from the Android Society, met some fantastic people there, um, some great professors who are doing great work in andrology. So this is what I plan on doing in the future. I I I hope to I hope to help men um not only use hormone replacement but just use the tenets of general kind of lifestyle medicine, longevity medicine to improve their day-to-day.

Dr Andrew Greenland: 4:24

Thank you. Really interesting. Um, what do you what do you think is going wrong in general practice? Why is men's health and especially hormonal health seeming to get overlooked? What is it all about?

Dr Zak Zafrani: 4:33

I think there's two two aspects to it. One aspect is from a patient's perspective, and the other aspect is from general practitioners. Um, if we start with men themselves, uh, there's a big stigma about talking about specific symptoms. If we look at testosterone deficiency, um the main symptom, if you look at again diagnosis, like diagnostic criteria, it is sexual dysfunction, things like lack of libido, erectile dysfunction, loss of morning erections. These are things in general. A lot of men, as as much as society has progressed and people are open, they don't really want to talk about it. They still have a stigma attached to openly mentioning these things. So they tend to keep things quiet. Um, there are also other symptoms like you know, general vague symptoms, fatigue, lethargy, lack of motivation, lack of drive, which creep up slowly. And men generally, when I speak to them day to day, their perspective is I'm just getting older. It's it's okay, you know, these are things that happen as we age. And then so from one side, it's difficulty of patients to interact with their GPs. And and then on the other side, it's the the patients who actually have spoken to their GPs are then shut down, and their GPs will generally say things like our our guidelines are your testosterone needs to be eight and below to be treated. Um, and they just shut down. So the symptoms are all there, but then they're not going to progress any further. So these men are then left feeling okay, they're either in two camps, one is just carry on, live the way I am, or the second camp who are determined and they will find a means of getting onto TRT. And what I do hear of a lot is a lot of men have managed to get onto black market testosterone replacement, um, just buying it from different sources, which obviously, if if we were we were able to if we were able to provide them with a means to be treated, they wouldn't have to do that. They should they should be seen by their GP, um, treated effectively, referred to endochronology as appropriate based on guidelines. Um, and this is where sometimes the private sector is really good because we we have a bit more leniency, not in terms of guidelines. We all all the private practitioners will follow the same guidelines. We just have more time. We have time to listen to them, we will get lab work done, we will follow them up, we will give them it's almost like a hand holding because hormone replacement is a big thing, even for men. A lot of men are very, you know, they have this, they have this thing inside them where it's like I'll just try it, but a lot of men are scared of the side effects that come with it. So um that gives us a bit more time. And as a GP in general practice, you have 10 minutes per patient. It's very difficult to manage these sorts of patients, all their expectations, their concerns within a 10-minute period.

Dr Andrew Greenland: 7:15

I think you mentioned on the pre-podcast call that we did that one in four pre-diabetic or diabetic men are testosterone deficient. Um, that's a pretty staggering figure. Why do you think there's such limited awareness or screening around that?

Dr Zak Zafrani: 7:27

Yeah, that's interesting. I I had a conversation with someone, uh one of the professors, uh, recently in a conference, and his his perspective was interesting. He said he feels all diabetic men should be screened for testosterone deficiency. And that was his blanket idea. And he said if we did that, we'd actually find how because the the link is to do with metabolic syndrome. Um and he and he said if you if you look into it, uh the the treatment of testosterone deficiency in these patients actually improves diabetic outcomes as well. Um, and and just to kind of not to go off onto a tangent, but even recent data with uh GLP1s, what why why are they improving testosterone? It's because the whole process is linked. Your body is a you know singular unit, it utilizes multiple um it utilizes multiple actions to to get an outcome. And sometimes when it comes to things like your HBA1C, which is your sugar control, uh, triglycerides, trunchal obesity, all these things form metabolic syndrome, but we have to look at why they happen. And testosterone plays a massive role in that.

Dr Andrew Greenland: 8:32

Thank you. Um, you've talked about um people getting testosterone on the black market, and there's a lot of um talk about testosterone therapy right now, both in clinics and social media. What do you think are some of the biggest myths or misconceptions that need to be cleared up in this realm?

Dr Zak Zafrani: 8:46

The biggest the yeah, the biggest myth is testomaxing, or that's what they call it. Um, there's a big thing amongst the influencer space, which you hear of a lot, and in consultations, even in men that come in with normal testosterone levels, there is this myth that more is better. So, doctor, my testosterone is over 12, but it's 14. Would it not be better if it was 30? And my answer is no, it's not because if you have no symptoms, that's not how things work in your body. It's the complexity behind why that is, is because different men have different needs in terms of testosterone, their androgen receptors are sensitive to different levels. Um, but a lot of these influences will push this idea of everybody needs to be on TRT. So people have this conception in their mind that if I get more, I will feel better, I will feel stronger, um, I'll feel more manly. And that's the biggest misconception because the side effects that come with testosterone use is it can be quite deadly. Um, you know, things like VT risk, risk of blood clots. Um and this is where a lot of these a lot of these men who will get black market testosterone don't tend to get tested. They they will somebody will tell them a dose, they will take it for years and years. They'll if they're lucky, they'll end up in a clinic, see somebody who who deals with this, they'll will look at the blood work and sometimes be horrified at what's been going on for five five years or so.

Dr Andrew Greenland: 10:13

Got it. Um I know you take a holistic approach, which is um music to my ears because I work in holistic medicine, functional medicine in my spare time. And I know you look at stress, sleep, and diet before prescribing. Can you share a little bit about how these lifestyle factors actually help restore testosterone function without medication?

Dr Zak Zafrani: 10:31

Yeah, definitely. Um that that is that that is the those things that you mentioned are the main things I see. So when I when I do a consultation for testosterone deficiency, once we've looked at symptoms of the patient suffering, I will go into lifestyle. And I usually start off with diet and exercise. I look at sleep, I look at stress levels because I find that in today's society, these are the things that tend not to be looked at as much, and they have a massive impact on testosterone. Um, stress generally is to do with cortisol. So when your cortisol spike when you're cortisol spiking multiple times a day, you're in flight, fight or flight, if you're suffering with anxiety, a lot of these things um suppress your testosterone for multiple reasons. It's it can be quite complex as well. It plays into sleep as well. So if you're not sleeping at the correct depth for the correct amount of time, um overnight your hormones do not stabilize the way they should, and in the morning your testosterone won't spike the way it should. So um it all it all fits in. So you know, a holistic approach is the main thing. If we come back to diet, um diet, um I I always stress the importance of diet and exercise because I think it's it's not cardiovascular exercise, it's more resistance training. Some element, it doesn't have to be excessive amounts, some element of uh resistance training weekly, so two or three times a week, it's shown to improve testosterone levels. So I say to men, the first thing I'll say to them is run me through what your week looks like. How many times do you get exercising? What does that exercise look like? What's your diet like? Have you ever counted your calories? Have you ever counted your have you ever checked your macros? And a lot of men don't have a clue about these things. So it's nice to have these discussions. And I I I the beauty of what I do is I've got time to speak to them. I can spend 40 minutes talking to them about these things, and we'll make a plan. And I never rush to hormone replacement. If if a man comes to me and they have a period of time between their first blood test and the second blood test, I will always say to them, let's make a change. Start off with optimizing your lifestyle. Let's see what your blood work does. If your blood work improves, then my answer is what why would you want to involve hormones? Because generally these hormones tend to be long-term, you're not going to be on them for six months and coming off, which is another common myth. People talk about cycles. How many, you know, can I cycle it? The answer is usually no, because in true deficiency, you need replacement long term.

Dr Andrew Greenland: 12:55

Got it. And do you think that patients are generally receptive to this kind of a multi-factor approach, or are they sometimes looking for a quick fix and they're really kind of edging towards the prescription?

Dr Zak Zafrani: 13:05

I think that there's again there's two there's two big categories here. There's the category of men who as soon as they get on the call uh the card in the console, in the call, in person, wherever they are, they already will have it in their mind that they need TRT. And if that's the case, you can usually tell because as soon as you start discussing the lifestyle, they kind of zone out. And they're harder to treat because they're not willing to look at the underlying cause. You also have the other other side where there's men who have looked into it quite significantly, they'll ask me lots of questions, they will understand the true benefits and the true risks of TRT. And these men usually will say, I'm willing to try anything before testosterone replacement. And if my body tells me that I am truly deficient after everything that I've optimized, then I will utilize testosterone to improve my day-to-day.

Dr Andrew Greenland: 13:56

Got it. And thinking about the um the black market situation, because you've mentioned it a couple of times and and misinformation in general, I mean, what impact do you think that's happening having on both patients and legitimate practitioners?

Dr Zak Zafrani: 14:10

Uh it is difficult because we black market use of testosterone is a lot more significant than we think as doctors or practitioners. If we're in this space, you know, we we would think maybe a few men, I don't know the actual data, it'd be interesting for me to try and find out, but it's a lot higher than we think. In consultations, now I do quite a few consultations daily now. Um, and I'll I'll I'll ask men the standard question any anabolic steroid use anytime in the past. And a lot of men are like, oh yeah, maybe I I did it for a few cycles. Um, and and and the the issue with black market testosterone is it causes problems to your to your hormone profile in general long term, if you use it for a certain period of time. And when it comes to, for example, practitioners trying to manage it, we tend to find it difficult because you've already done some damage, it might impact your fertility. You you come to me asking about fertility issues, etc., and we have to unpack like unpack the whole situation going back historically. So, one issue is use of black market steroids means that you're likely to become testosterone deficient once you come off it and you're going to need TRT in the future. The second thing is people who are actively using it. So we we get a lot where patients will ask, can you help me dose down or dose up? My usual answer is no, I'm I'm not involved in black market testosterone replacement or even anabolic steroid use. These are things that as doctors we can't get involved in, even from a safety perspective. The most I would ever tell someone is your blood work is horrific, you need to get off whatever you are. I will not be giving you any assistance in in reducing it, but I can tell you that you need to taper down. So, very, very kind of blasé answer, and not to kind of get involved medically in their dosages. And then the compounds they're using. Um black market compounds are not pharmaceutical grade. There's a lot of strange compounds that these people use. If they're using it for anabolic steroid use, there's some compounds that doctors don't even work with, you know, we're not aware of. Um, so it becomes it becomes difficult to treat.

Dr Andrew Greenland: 16:19

Interesting. Um do you think the medical the wider medical community underestimates the broader impact of having low testosterone, things like metabolic health, mental well-being, motivation? Um, just thinking obviously you've talked about some of the challenges of doing this work in general practice, but just thinking a little bit wider in terms of the medical community. What's your take on that?

Dr Zak Zafrani: 16:38

Yeah, I think I think the there is there is a stigma around testosterone. And I look I look at TRT as HRT. So HRT went through a boom where it's been you know decades ago where it suddenly became the new in thing. Women found out about it and they were treated correctly on the NHS. And I and I think that's fantastic. I think it did really well for women's health. I think testosterone still has a stigma when you speak to a lot of doctors, they might not know too much about it. Um, they won't know how to manage things. There's also a concern about what if patients take this testosterone and abuse, overdose, etc. I mean, from my perspective, that's not really a big concern for me. I I you can usually tell from their blood work, and you most patients are sensible. If they're going to do things like that, you can you will just stop the medication. You can tell quite quite quickly. Um, in the wider medical community, I think endocrinology is an interesting one as well. And I've met some fantastic endocrinologists who who are really keen on treating not only primary and secondary hypogonidism but also functional testosterone deficiency, which is the realm we're kind of talking about. Um, and there you know, there's this there are some who argue it should be treated, and some argue it shouldn't be treated. Um, and it's a long, long-standing debate. And I think this is where the issue is, and I think if we sit down and look at the impact it actually has on men, and I'm not saying it's for everybody again, I I don't want it to be taken in in that context, but the men who are truly deficient need need testosterone replacement because it improves their quality of life in so many ways. That's untifiable.

Dr Andrew Greenland: 18:20

Thank you. Are there any surprising or any under-discussed factors like environmental toxins or chronic stress that you kind of discover in this world? Um and do you think that deserves any more attention than it gets?

Dr Zak Zafrani: 18:31

With regards to testosterone?

Dr Andrew Greenland: 18:33

Yeah. Yeah.

Dr Zak Zafrani: 18:34

Yeah. Um, I mean, environmental toxins. So I I I've looked a lot into I've looked a lot into why testosterone deficiency is more common these days. And the question always comes up, is it that we are more aware? Why is it that generations ago men ran slightly higher testosterone? And it it comes back to chronic stress, um, it comes back to our ability to cope with certain situations, our lifestyle, but also to do with our diet, and there is a lot of stuff around microplastics within the environment that that has been proven to impact testosterone. So, yeah, that there's a lot of things, and I have these conversations with patients, and they say, How can I eliminate all this? Because I have to live, and and my answer is usually you minimize as best you can because yes, we do live in this world and we've got to do certain things, but you try and minimize your exposure to plastics and uh to microplastics and just live as healthy a life as possible that that you can manage based on your day-to-day.

Dr Andrew Greenland: 19:41

Thank you. How can um primary care practitioners become more confident in identifying and managing testosterone deficiency without overmeticalizing it? And you talked about some of the challenges of doing this work in general practice, but how do we get them to um skill up, find ways to better help the men that they serve in their clinic without necessarily having to resort to the private sector?

Dr Zak Zafrani: 20:06

I think I think not not every man who because of criteria, I don't think I think the private sector will always be there. But I think specifically from the NHS, the thing that they they can do to upskill themselves is to to look into criteria for diagnosis. That's the first thing because an audit I did recently of um multiple practices, we looked at, we didn't look at you know diagnosis and referral, we just looked at the initial criteria from the British Society of Sexual Medicine. So when men had a testosterone level, when it was below 12, were they repeated? Were they discussed? And it was pretty shocking. I think the majority of it was a no, it was over 90% of the patients weren't actually treated as per protocol. So it's kind of shocking. Um, the one thing that would be really good is just a review of the society's guidelines, which I think are actually very simplified. They've they're very nicely written guidelines. There's a flow chart which basically gives you step one, step two, and most GPs can look through that and gain some confidence. Now, they don't need to prescribe testosterone, that's not gonna, I don't think that's gonna happen uh on the NHS, but it should be aware of situations and and comorbidities where you want to flag testosterone deficiency. So, for example, in diabetics, in men who have never been depressed or anxious, who suddenly start to feel anxious and depressed. There's some some uh professors in the states who who were saying you should just test these men, just run a serum testosterone because if it is running low, there's been so many cases where men have been anxious and depressed for many years on SSRIs, and they've actually ended up coming off their SSRIs, not in every case, but they come off them with the use of TRT because the underlying issue wasn't actually mental health, it was that they were just hormone deficient. So there's there's a lot of tenants to, and it is very complex because even even doctors who get into the TRT space, it takes quite a bit of experience and and and seeing patients to get comfortable doing it.

Dr Andrew Greenland: 22:15

So you're obviously running a business because you're seeing people in the private sector. What are the things that are working particularly well for that you just rephrase that? What are the things that are working particularly well for you in this business setting? And um, what are you particularly proud of?

Dr Zak Zafrani: 22:29

I think that the thing that I'm most proud of is the impact that you have. It's it's a really rewarding place to be because when when you see the impact that it has on patients and you speak to their partners, for example, or you'll hear of a man whose business was failing because he wasn't motivated, and you bring him in, you have a chat with him, and he's completely demotivated, and you see him six weeks later, and he's a completely different person. You speak to him on the phone, you have a consult. That that's the beauty of it. There is there is to some extent instant gratification from my side. I get to see it, I get to speak to them. We taper their doses up and down, we manage, we you know, we sit you hold your hold their hand through the process, and it's beautiful to see because you'll hear their partners say, you know, this is I I feel like the man I married or the man I met 20 years ago disappeared for a short period of time, but he's back again, and it's like mental clarity, personality, everything comes back. Um, so yeah, that's that's one of the most beneficial parts of my job and and doing what I do, and I think it's good that I am able to provide that to people.

Dr Andrew Greenland: 23:33

And how do you market this kind of work? Because I guess there's probably some regulatory things that you have to be very careful about what you say and how you do it. But how do you how do you attract new patients? What's your kind of process?

Dr Zak Zafrani: 23:44

So so at the moment, I um I currently work for a big provider in the UK. So their marketing strategy with with testosterone, it is a controlled drug. You have to be very careful, you can't market testosterone itself, but within within that, you can market towards symptoms. So, majority of CRT practitioners, what we would do is we put out uh advertisement and information around symptoms that patients will suffer with, and find a lot of these symptoms can be quite diverse, quite varied. They can also fall into different um different illness patterns, etc. So you would put them out, and it's mainly just to spark someone's interest to say, is this something that possibly could be going on? Because once you draw them in, you can do a questionnaire and it gives them a few different symptoms of things to look out for for testosterone deficiency specifically. And then the the you know what I usually say to my patients is just get a blood test. I think I think all men going forward from the age of 30 every few years, maybe it'd be, you know, it'd be really good if you could get a blood test done so that you know where your testosterone levels are at different stages of your life. Because a lot of these men come in at 50 or 40 and they have no idea what their testosterone levels were in their 30s. And the beauty of it is we are now seeing that. So I do see a lot of men who will just contact the clinic and say, um, I'd like a blood test. Not because I have any specific symptoms, I'd just like to know because I'm I'm really healthy, I'm active, I look after myself, I'm really um trying to improve my sleep quality, I want to see what my numbers are like, and that's great for me because then you know you get to have conversations with these people about how to minimize the minimize the chances of them getting deficiency in the future.

Dr Andrew Greenland: 25:33

You talked about some of the um things going well. Is there any any particular frustrations or challenges you've had to overcome in doing this work?

Dr Zak Zafrani: 25:40

I think some of the frustration is uh uh mainly around patients who are on TRT already, so not from other providers because if you you know, provider to provider, if somebody was having TRT with me and decided they wanted to go somewhere else, it's really simple, it's medic to medic transfer. It's more when patients are buying things. Uh, I find that quite difficult because we the the guidelines usually or or general best practices you need a washout period. So the problem that you you have is somebody may come to me already on testosterone that they've bought from the gym. And when I do their bloods, their testosterone levels, if they're on the testosterone, might be really high. So I have no true means medical legally to define that they they've ever been deficient. So my question to them usually is have you got any blood tests? Their answer is no. So the rule then is they have to have a washout period of around two to three months, retest, and as you can imagine, if you've been taking TRT, you've shut down your testosterone to tell these men you have to stop, it's really difficult. So a lot of these men usually disappear off and carry on on TRT the way they've been doing it. Um, but that that's very hard because these are the men I'd like to help, and I'd say, you know, just try the washout period, you'll feel not very nice for a few months. But once we get this diagnosis in place, you have an option of multiple different methods of either testosterone replacement or hormone optimization through things like HTG and clomophene.

Dr Andrew Greenland: 27:10

And if you um if it was a GP out there who'd be very interested in doing this kind of work, how would you steer them into taking this further? How do they learn the skill, the art of what you do?

Dr Zak Zafrani: 27:20

With with with some difficulty. Actually, I get this question a lot. Um, people contact me to say, How would I train in this? And truthfully, you you need to seek some sort of mentorship. Um, I would say sign up to the British Society, the British Society of Sexual Medicine do a lot of good work in this field um around testosterone deficiency, and they've got some really good people there who can guide you. Um, but with general, general kind of guideline reviews, but you just need to find some sort of mentorship, someone who will let you sit in onto clinics and guide you into how how this is done. There are general methods to treatment, but even within practitioners, you'll have bits of debates about how they manage certain things. Like some testosterone prescribers will prefer a certain form over another. Um, I have my opinions on certain forms, other people might disagree, and it's just based on your own uh experience. So, yeah, it's a hard one because there isn't a formalized training program where you can just go and spend six to twelve weeks and learn everything. You can do the book work, so having a good basis of endocrinology is is fundamental, but the rest of it is clinical experience.

Dr Andrew Greenland: 28:31

Thank you. Um, are there any innovations, technologies, tests, or research developments that you're particularly excited about looking that might be coming online in future months or years in this space?

Dr Zak Zafrani: 28:44

Um I'm I'm generally very interested in I'm I'm I'm always interested in AI. So wherever AI is going, I'm I'm I'm looking into um health tech. So that's there's so many different things that are coming up from that. I'm also very keen on um CGMs, so glucose um continuous glucose monitoring. Uh and the reason I I like it is because I was gifted a CGM a year ago and it was it was uh eye-opening. So I I keep myself quite active, I I exercise and things, and it taught me so much about myself. And I don't think it's for everyone because it drives anxiety in some people because they'll eat something and then get worried. But I think some of these new CGM monitors that come out they just need to become more accessible and they will help a lot of people, um, especially in the sports side of things as well. They've been very beneficial to me. I I've learned a lot about why I feel certain ways throughout throughout the day, even at work. Um certain things to eat, what not to eat. So it's yeah, uh, I mean there's this this a lot of there's a lot of health tech stuff going on at the moment.

Dr Andrew Greenland: 29:50

And do you have any particular plans for the next six to twelve months in your work? Anything, any directions of travel you're looking to go in, or just doing more of this more of the good more of the good work?

Dr Zak Zafrani: 29:59

More all Always more of the good work, but I I I have a I I try and tie into sports again. Um my initial love is sports sports medicine. Um I I look at how I can benefit certain certain people and I will always be there for the mass majority of people. But uh one of the niches that I'm looking at is athletes and retired athletes. So I'm also retired athletes, and there's a bit of work being done in terms of looking at why is it certain men in certain sports come out of the other end with a higher risk of testosterone deficiency? Is it because of you know impact sports where you're getting recurring concussions, they can cause pituitary issues? Um, is it just because you they lose their structure after intense you know endurance training from athletes? So there's there's a lot of there's a lot of work to be done in that space, and that's something I'm really interested in now. I'm looking at kind of developing my own interest within that field to mainly advise athletes. It doesn't have to be professional athletes. These are, you know, there are plenty of men who have played sports to a very good level. They come out of the other end and they just feel deflated. And and these men do really well uh when they are deficient with testosterone replacement.

Dr Andrew Greenland: 31:10

And on that note, Zach, I'd like to thank you very much for your time this afternoon. It's been a really interesting conversation, rich with useful information and advice. Thank you so much, really appreciate it.

Dr Zak Zafrani: 31:19

Thank you for having me. It's been a