Dr Andrew Greenland: 0:00

Welcome back to Voices in Health and Wellness. This is the show where we explore the people and ideas pushing health forward in smarter, more human ways. My guest today is Dr. Dan Leach, a doctor, health systems consultant, and the founder of Valence Health, a new platform focused on creating better health experiences for men. Dan's background is wide-ranging. He's worked in general practice, led projects across NHS trusts and private providers, and advised health systems on how to build services that actually reflect human needs, not just clinical protocols. He also brings a very personal perspective to this work, which we'll get into. But today we're focusing on Valence Health, a new initiative which tackles health, the uncomfortable truth that men are still dying earlier, avoiding health care and suffering in silence, often because the current system isn't built for them. So Dan, welcome to the show. Thanks very much for joining us today.

Dr Dan Leach: 0:48

Hi Andrew, yeah, thanks for having me.

Dr Andrew Greenland: 0:50

Wonderful. So maybe we could start with the obvious. Why men's health and why now?

Dr Dan Leach: 0:55

Yeah, so well, that's a really interesting question, isn't it? So for me, uh, well, obviously I'm a middle-aged man, but for me, sort of men's health is something that uh is growing in interest, but historically has been neglected, I think, you know, uh, for a number of reasons. Um, I guess the initial one would be sort of men don't really seek health, you know, their health-seeking behaviours are sort of a little way behind uh women, and that's very well evidenced and documented over the years. Um, but um, you know, it's noticing these changes in my own life, uh, sort of as I as was getting older, and thinking there's got to be something that can be done about it, you know, and there must be more out there. Um, so really uh I've sort of developed this real interest in passion in trying to improve men's quality of life, uh, you know, from sort of 40 plus really. Uh we all experienced that natural decline in performance and hormone levels and and and sort of overall physiology, and it's just about trying to improve life as we move forward.

Dr Andrew Greenland: 1:57

And so with that journey, was there a particular moment that kind of crystallized the need for what you were doing with valence? Or was it just a kind of a very personal perspective on the gap, the gap in the market, as it were?

Dr Dan Leach: 2:08

Well, yeah, I think it was quite personal actually. So um I was sort of in my in my early 40s and uh you know, working as a doctor as I'm sure you're very familiar with. It's quite a high pressure and and high uh high acuity environment, lots of decision making and and and requiring you know high level of focus all the time. Um and I just suddenly thought to myself that um you know I'm not performing at the same standard that I was perhaps five or ten years earlier. And um it seemed to just you know, it almost sort of dawned on me. And I guess in reality it had been quite a gradual change, but um, you know, nothing nothing dangerous and nothing untoward, you know, but just I just didn't feel as sharp as I was before. Um at that time I was working in uh North America in Canada, um, and and obviously they're much more market-driven than a lot of European healthcare services. So um I did a bit of research around it and and started looking into um hormone deficiencies and also other physiological parameters like thyroid and and just general metabolism and and um physiology aspects. Um and you know, the evidence is is there, but it's quite uh, you know, it's quite few and far between. Um, just sort of looking at uh, you know, this this decline in hormone and and uh metabolism levels from sort of 40 onwards, really.

Dr Andrew Greenland: 3:26

So you've worked inside the system, you've worked from outside. Um so how does this project kind of connect the dots in your various aspects of what you've been doing?

Dr Dan Leach: 3:35

Yeah, so um what we're trying to do now in in the UK is uh is valence health that you remembered uh sorry that you mentioned at the beginning there. And um what we want to do is is sort of join the dots between where where the public are, you know, where men between sort of 40 and 65, 70 are, um, and then the gap between what public healthcare can offer, uh, you know, and um we just we're offering a sort of uh not just a pathway to to to better health, but just a better understanding of where they are, you know, on their journey, you know, and their their kind of medical journey and and also their you know their their own lifestyle.

Dr Andrew Greenland: 4:13

And so if a man was coming to see you, can you kind of talk us through what the sort of typical journey might be for a man in that age bracket as to how you would kind of assess and work with them?

Dr Dan Leach: 4:22

Yeah, so they would um well initially we have we'd have a free consultation for them just to sort of talk them through where they are and just see if our service is for them, you know. We're not looking at trying to catch anybody else, you know, it's a real um two-way journey. Um and and just sort of talking them through what their concerns are, you know, and what their expectations are for the future, you know, where where they where they've identified problems and where they would like to address that and and and um improve on who they are, you know, and um we we use the this sort of tagline of hormone intelligence. So uh we're trying to improve the understanding of an individual of where their body is at that time, but then also together working uh working forward with a plan and um helping them realize those expectations, I guess, you know, to bring them back to peak performance of where they can be at that time. Yeah, you know, I'd love to be able to uh guarantee they could feel like they were 20 again, and that you know that would be great. But um, you know, in reality, we do we have quite a few patients sort of coming back to us saying, you know, they feel like they're back in their 30s, and this is you know, men that are in their 50s at the time. So, you know, that's that's quite a nice achievement to do that.

Dr Andrew Greenland: 5:29

What do you think are the biggest failures in our current healthcare service is approaching men's health if we really kind of drill down? What what's what are the issues?

Dr Dan Leach: 5:37

Um, so I think there's a couple of factors. Um that's quite a big question. There's a couple of factors. So um the the first one will just be recognition that men have a decline in hormones. You know, we all we all know about the menopause in women, you know, there's this really sudden decline, usually late 40s, early 50s, over a year or two. Um, you know, and it it it because it's so rapid, you know, symptomatology is great, you know, they get they get really large symptoms of menopause, you know, we all know about those. Um, but in men, that's just not recognized in the health system uh throughout the world, I think. That is growing, but certainly in the NHS, it it's not recognized, it isn't very well published. Um uh, but that body of of thought is growing. Um, the next one would be uh the difference between optimization and uh treating disease. So the NHS focuses uh on disease uh rectifications. So, for example, if your thyroid isn't working very well, you get thyroid supplementation, but you have to meet certain criteria for that. If your testosterone levels are low, but in the normal range, the NHS wouldn't treat you. But if it's if it's you know abnormal and you have something called hypogonadism, then it would treat you. Um and I guess that's kind of public provision, uh, you know, service provision and sort of allocating that fairly. But what we can do at Valence Health is what's called optimization. So your hormone levels drop off, and a lot of your physiological levels drop off, you know, quite gradually from sort of 40-ish plus, and that that demise continues over time. Um so what we look at doing is optimizing. So still using safe parameters and the normal ranges, but our argument would be when you're 40 or 50, why shouldn't your hormone levels be where they were when you were 20? You know, why shouldn't you feel as good as you did then? Why shouldn't your energy levels be that high, your concentration tracing levels be the same or similar to they were? So we look to optimise everything and bring everything right up to the top level of safe. Uh, you know, everything's done safely and with uh GNC registered doctors, but but really just optimizing and pushing things right up to the top, so improving that hormone intelligence with everybody.

Dr Andrew Greenland: 7:50

Thank you. Um I think we were talking before, you mentioned that many men feel um alienated by healthcare. What do you think that's about? Do you think it's some of the issues you've already mentioned, or there are other things behind that?

Dr Dan Leach: 8:01

Um I think it's really interesting, you know. I think um this awareness of of health and longevity, especially for men, has really increased over the last few years. There's always this feeling that, you know, uh us as men are invincible. You know, we can put up with anything, we never have anything wrong with us. Um uh, you know, we're the providers and the hunter-gatherers and all that kind of thing, you know. Um, but in reality, I think men do care a lot about their health. Um, but they're either too busy, uh too career focused, uh, you know, and just distracted from the important things. Um, so you know, we we kind of ride this wave of being uh you know, having high vitality, being able to go to the gym, our bodies are invincible, we can do whatever we want. But then all of a sudden, you know, the the age comes in and we turn a blind eye to it, or men turn a blind eye to it. But I really get the feeling that's changing, you know, um men are wanting to maintain their fitness and health and and try and balance out that life expectation, you know. Um, women do live longer than men, um, and that's almost certainly due to uh how we look after ourselves, you know, and and hopefully we can uh balance that out a little bit. Thank you.

Dr Andrew Greenland: 9:14

I mean, do you think there is some stigma around some of the non-specific things that might be might be a result of you know having abnormal hormone levels, low testosterone, you know, weakness, um just non-specific illness, poor emotions. And does that that's presumably going to affect outcomes if men don't present? But is there some stigma around these kind of low-level things that people are worried about bothering their GPs with?

Dr Dan Leach: 9:38

Yeah, I think I think definitely, and and you know, you know, men are kind of defined by their masculinity. Um so obviously, androgen is that sort of get up and go and that masculine hormone. And to admit that perhaps it's not as good as it used to be, you know, that's admitting eight, uh admitting that we're aging, um it's admitting that we weren't as good as we were 10 years before, and that's really difficult, you know, and I can understand that. Um but to admit it and to face it and then look for a an a solution, uh, you know, and to try and improve it surely makes you a better and a stronger person because you can you can then go back to where you want to be, you know, you can perform how you want to perform. Um uh obviously there's other things in with there, you know, the sort of the classic uh uh concerns that people come to us with, you know, the the obvious ones that you know, sexual performance, libido, um erectile dysfunction, concentration, muscle mass, you know, these are all things that are really hallmarks for what society would define as being uh you know a successful man. And and you know, it's difficult to talk about that. You know, it is really hard. And and we understand that at Valence Health, and and all of our uh all of our doctors are uh sensitive to that, I guess would be the the the kind of the right way to say it.

Dr Andrew Greenland: 10:56

Amazing. Are there any particular groups of men who are most at risk of being overlooked, do you think?

Dr Dan Leach: 11:04

Yeah, so I think it's probably the ones, probably the ones that are too busy, you know, to to um to just take the time out. You know, they're recognizing that their performance is dropping, you know, whatever that might be, um, and their concerns building, but they're just too busy or too distracted. Um and I think I think they're the ones that we can help the most, ironically, but they would um, you know, and they they would definitely see improvements, but they you know, they just sort of bury their head in the sand and carry on, I guess. But it doesn't have to be that way, you know, uh and and that's really what we're hoping to change, you know, in in things like you know, that like your podcast, Andrew, with you know, sort of spreading the word and helping educate people about um what's available, you know, and what what they can do to help uh help improve their quality of life again.

Dr Andrew Greenland: 11:50

Thank you. So, how do you market this with all those things in mind about men and the various issues they're facing? How do you kind of reach them with your marketing message? What's sort of thing, what are the kind of things that work?

Dr Dan Leach: 12:04

Um, so uh we kind of we have three main kind of uh uh branches to our marketing. So uh we've we've sort of tried to break down into the three common things that people uh have concerns about. So um the first one would be kind of mental performance and um uh mental agility, that sort of thing. And you know, that's one of the common common concerns that people come to us with, you know, they just don't feel as sharp, they've got that kind of cloudy uh thinking, and memory is not as sharp as it used to be, not forgetful and things, but just not quite as sharp. Um so we focus marketing on that. Um the next one is sort of physical performance, so uh muscle mass and um sports performance and that that sort of thing. So we angle that largely towards sort of gyms and um you know, cycling clubs, climbing clubs, that sort of thing. Um, and then uh the the other one, the sort of the elephant in the room of the sexual performance as well. So again, that's another another uh large area that men have concern with. Um uh mainly focused around erectile health, to be honest. Um, so um we try to move away from sort of erectile dysfunction, you know, it's a very negative terminology, um, and just focusing on erectile health and how we can improve that. And interestingly, it's actually linked into uh you know a lot of other conditions uh that get overlooked, you know, sort of cardiovascular disease and things like that. So with with um uh erectile health as well. So you know, we can we can focus on marketing in those areas and and hopefully pick up on on uh what people want.

Dr Andrew Greenland: 13:37

Thank you. And with that sensitive area about erectile health, how do you make it feel safe and relevant for men to engage without relying on fear or shame? Because it obviously is a very tricky tricky situation to handle, it's obviously very uncommon, but I just want to how I'm very curious to know how you navigate this.

Dr Dan Leach: 13:52

Yeah. Um so really the the uh what what I've found is the best way to navigate it is just to be honest and to be open. Um so when when patients first come to us, they um they fill in a confidential questionnaire, so they can obviously they can raise the concern then, and that opens the door to the discussion straight away. So um, you know, that that that makes life a lot easier. But other than that, uh it was just part of the kind of initial com consultation that we have, you know, this free uh free kind of chat through concerns and expectations, and and it and really I've I've found anyway that the best approach is just to be open and honest and and sensitive, you know, so just just straightforward questioning about whether that is a concern or not. And I found actually that a lot of men are quite relieved, you know, when you just ask them that question straight out, you know, uh it's it's not in a not in a kind of a playful or a boisterous way or anything like that. It's just a nice straight question about erect uh erection health and frequency. Um, and um, yeah, most people seem to answer it pretty honestly. Well, I assume they answer it honestly, but they certainly seem to. Um and it's really, really common, you know, and that's again, that's part of educating people around this concern, is it's really common, you know, especially when men get to sort of you know 40 plus into their 50s, certainly into their 60s. Um this is really common and it's so easy to fix, uh, you know, in the majority of times. Um and and we can really transform people's quality of life and and uh you know their relationships sometimes are in in danger because they're not where they used to be, you know, and and we can we can help support them through that uh through medication, uh, but also really um really just make a difference to them, you know. Uh we also can quantify um uh erection health as well. Um so we use a um a device made by a company called FermTech, which is uh it actually measures erection frequency and intensity uh at night, uh so noctile uh nocturnal erections. And that's really interesting. So it's uh evidence-based, it's currently being uh reviewed by the NHS as well for urology use. And um the loss of nocturnal erections has a real close correlation with cardiovascular disease as well as things like testosterone. Um, so this device actually you wear it overnight, and it does it measures the number of erections you have and how long they are uh in duration and also how firm they are. So it can it can give a lot of information about your cardiovascular health. So uh we have access to that as a facility as well. Um, and putting all that together and then creating a management plan with kind of measured measured outcomes, you know, and you can see if um actually see it in numbers, you know, everything improving, uh, you know, it makes a huge difference to people.

Dr Andrew Greenland: 16:42

Really interesting. So you mentioned about the the general model being about sort of optimization rather than um just disease management, as it were. Is there any um other things that you do digitally to support patients, or is there anything that you do which is novel to support patients between their appointments?

Dr Dan Leach: 17:00

Yeah, so um so we have like a a kind of a set format of every every quarter, every three months we have a kind of a set review which is looking at um biological markers, so blood tests effectively, uh, to see how they're getting on from a numbers point of view. Uh, but numbers only mean you know half the story. A lot of it's to do with how the patient feels, uh, how their improvements are, and and if there's well, obviously if there's any concerns or if things aren't going as planned. Um we uh depending on what what they want, basically what people want, we can offer them feedback. For example, we talked about the firm tech product. Um, you know, so that can um that gives them feedback the whole way through with uh kind of how they're getting on and and improvements. Um and then also just sort of regular reviews with our team to see uh you know to see how we how we're doing.

Dr Andrew Greenland: 17:54

And is there a kind of a holistic approach to this? So you wouldn't just necessarily be doing a blood test, starting people on treatment, but you'll be looking at their whole dietary and lifestyle perspective, you know, looking at their stress and all the other things that can impact on, for instance, hormone levels and try to address things that way. What's the general um kind of holistic approach to this?

Dr Dan Leach: 18:14

Yeah, absolutely. So um, I mean, uh, we entirely want to be sort of a bespoken, comprehensive men's health clinic, um, with that security and um confidentiality of remote consultations. So um what we found in the past is that people don't necessarily like to come to a clinic, you know, uh unless they have to, uh, because it gives them real security. You know, they we we actually do quite a few consultations with people in their cars in the car park, you know, they they clearly don't want people eavesdropping, even in their own home uh sometimes. Um so you know, you can talk to plenty of the people anywhere, uh, you know, with complete flexibility. And you know, 100% we offer a full uh holistic approach, patient-centered approach to to where they want to be. And we create a bespoke package for for each patient as individual. Um the last thing we want to do is is be one of these sort of more retail type testosterone providers where they just throw it out the door, you know, and and it's not really measured and monitored. And um that's that's not our our approach at all, you know, it's really bespoke to each person. Um, and it's not just hormones, you're absolutely right. You know, we we focus on you know all health parameters, so uh diabetes, cholesterol, uh thyroid, various other markers, things like DHEA, um, you know, we can review um medical aspects of hair loss, um, uh weight loss, you know, whatever it is that people want to focus on, we can do that. Um, and it's um yeah, just that sort of one stop bespoke management uh of your men's health needs, really.

Dr Andrew Greenland: 19:51

Thank you. I guess you've been developing the model over time and kind of seeing what works. Is there anything that you've tried so far that's completely flopped, no pun intended, or worked better than expected? As you've been trying to develop things?

Dr Dan Leach: 20:03

So I think completely flopped. I don't think anything's been a complete failure. The only thing I guess that we reviewed just different products, really, but we that kind of fell through at the sort of research stage, so it never got exposed to the public. And not that there was anything wrong with them, we just didn't think they were suitable. Things that have done better than expected. So the impact it has on people, I guess, would be the big thing. Is I mean, really, I'm really struggling to think of anybody that we've reviewed that hasn't had a significant impact in their quality of life. You know, whether that be depression, uh, erection, health, um, libido, uh, concentration, muscle mass, almost everybody gets an improvement, you know, and that's the really striking thing. This is it's really nice medicine, it's really, really enjoyable to do. You know, the patients come in with quite significant concerns. Invariably they've been bounced around by the NHS and their GP, you know, and that's understandable. It's a busy service, you know, it's not unfortunately, it's not really there anymore for that sort of lifestyle type problem. Uh, you know, and and people are just really frustrated. And then all of a sudden they get a service where, you know, they get nice long half-hour appointments, you can really engage in what's going on. Um, you get a great relationship with your doctor. Um, and you you, you know, they're just different people, you know, almost by three to six months through, you know, let alone a year later or two years later, that you, you know, they're just completely different people. And um, you know, I'm trying to think of some of the um some of the feedback. You know, some people are sort of suggested that they're you know, they're terrified to be without the medication anymore, you know, because the difference is so significant. You know, the idea of going back to where they were is is terrifying, you know. And okay, that you, you know, there's a bit of responsibility there, but also what a great thing, you know, if if we can make that much difference to people, that's fantastic, you know, and um I think that's probably the biggest surprise and impact that there's been to me. Um, and then the other, the I guess the other things in a more kind of product-based field, you know, the the technology coming out for um men's health hormone replacement, and then in particular, the this uh the firm tech product that we use is is really interesting. You know, it's really, really interesting. It's so closely correlated to cardiovascular disease and strokes that I think very quickly this sort of thing will be available in the NHS as well, actually, you know, because it's it's the the numbers are just crazy, you know. It it the the link is the correlation is is really obvious. Um and treatment is so straightforward, you know, and it's real preventative medicine. Uh, you know, it's it's it's stopping people not just having lifestyle problems, but having pathology, you know, having disease. Um, and surely that's what we're all about as doctors.

Dr Andrew Greenland: 22:57

Certainly. Have there been any um surprising objections or resistance from men or from within the system at all with your work?

Dr Dan Leach: 23:06

Um the the only resistance is about optimization, I think that I've come across. Um, so it's a real mindset change, you know, um it's it's drilled into all doctors, well, certainly that I've come across and and from my own education is you know, you treat disease, you know, the numbers have to be outside of the normal range uh before you can give any treatment. And that, you know, for some things that changes a little bit. You know, for example, the first one that pops to head is is sort of symptomatic subclinical hypothyroidism, you know, nice guidance would suggest you can treat that. Um, so you know, there are some elements where there's a bit of movement there, but generally speaking, if things are in the normal range, normal's normal, and you draw a line under it and forget. So the the big challenge for us has been changing doctors' mindsets to, you know, well, normal is normal, but it's not optimal. You know, it's not giving people aren't feeling the way they used to be, you know, and we just don't know what the data is. You know, if someone comes to me in their 40s or 50s and their testosterone is right down in the bottom quarter of the normal range. What was it when they were 20? You know, it was probably right up in the in the top half or the top quarter. There's no way of knowing because you don't measure it because there's no problem. Um, but why, you know, like I said before, why should it stay there? Why should it stay at this level where they feel terrible, you know, where their muscle mass is dropping off, their energy is dropping off. So um it's just changing that mindset. And it's almost like kind of opening the door, you know, you you kind of once you think about optimizing within normal ranges, it's it's like, well, that's kind of makes a lot of sense, really. You know, we should make people feel better about who they are.

Dr Andrew Greenland: 24:43

You don't have any sort of kickback from the patient's GPs when you're doing this stuff. But I mean, at the end of the day, they're not being able to provide the service, but when they sort of see you as a provider doing this, do you do you have any kickback? I mean, I guess you've kind of alluded to it a little bit just just now.

Dr Dan Leach: 24:58

Yeah, so I I don't know if I go as far as sort of full kickback, but just sort of questioning. I think you know, they they they sometimes like rationale around what we're doing. Um, and once we explain that, um, everyone seems quite happy to be honest. Uh yeah, uh most thing most people are quite happy once we once they understand what we're actually trying to achieve, uh, and more importantly, once they see the benefits to the patient, uh, the GP seem quite happy with that. Um but yeah, definitely not as not as completely negative as kickback, just more questions, I would say.

Dr Andrew Greenland: 25:31

So, what's next for violence health? Where do you want to be in the next 12 months of your work?

Dr Dan Leach: 25:36

So, what what we would really like to do is be available to as many men as possible. Um, so it's all about sort of spreading the word and and being being seen as you know the go-to people for men's health. You know, that's where we want to be. Um, and like I say, it's not just hormone intelligence, you know, it it's many, many fields that we cover. And and just being that brand that people recognise as safe and trustworthy, you know, if we were thought of in the same way as you know, the NHS being that kind of flag that can fly and and people can come to us and know that they'll get a good quality service, that would be amazing, you know. And it and it's and it's about changing people's lives, you know, that's ultimately what what we want to do. Uh so if we can have people talking about us in that way, then you know that's fantastic. I feel like my job is done.

Dr Andrew Greenland: 26:27

Amazing. And if you did go viral, um, what would break first?

Dr Dan Leach: 26:31

What would break first?

Dr Andrew Greenland: 26:33

Yeah. Hopefully not you.

Dr Dan Leach: 26:35

Yeah, probably yeah, my hairline at it. Yeah. Um I mean, we the the system's designed to be flexible that we've built, you know, and and that's one of the great advantages of being a an online clinic is we can we really can grow quite quickly to demand. Um we use um every everything's done remotely. So we use um phlebotomy services or sorry, blood taking services so people can um, you know, be in the comfort of their own homes or their workplace, they can meet the nurses anywhere to take their blood. Um, again, our pharmacy services are all remote, so it's all male order, so things get posted to you in discrete packaging and all those kind of things. So um we really can just grow as quickly as people need, you know. I don't think they need to fear uh sort of loss of continuity of service or anything like that.

Dr Andrew Greenland: 27:24

Um if I give you a mad magic wand and you could change uh one thing about how men access care, or maybe one thing about your business, what would it be?

Dr Dan Leach: 27:33

Well, I think it would be about how men access care, actually, you know, and I think it would just be increased awareness of what improvements can be made. You know, you don't need to you don't need to turn into that grumpy old man, you know. Um we sort of joke about um you know the grumpy old man in the corner, and uh some of our consultations are done actually as as uh with a the the partner is there as well, and and they often say that you know Joe blogs uh used to be you know lively and outgoing and and sociable and all these sorts of things, and he got to 40 or 50, and now he's just that that grumpy old man sitting in the corner, and and that's what we want to get rid of, you know. So if I can may wave a magic wand, it would be that men become aware that they don't have to be that, you know, they can still be that person that they want to be and used to be.

Dr Andrew Greenland: 28:23

Brilliant. So you talked about growing, you want to obviously reach more men. Well, what is the hardest part about growing this? Is it funding, trust, access, or something else?

Dr Dan Leach: 28:32

Yes, yeah, all three of those. Yeah, um, it's um uh access, I would say, to to men, uh not to our service, but to to men. Uh so getting in into the right areas, you know, and and that's we've got a fantastic marketing team that are really helping with that push it forward and building this kind of really trustworthy brand that people can engage with and and have ownership with. And um that's the challenge, I think, is just getting people to understand that they can trust it and it is moving forward. It's not this retail testosterone that's just all for people going to the gym, you know. It really is a patient-focused solution to their health concerns.

Dr Andrew Greenland: 29:16

And again, we're about the whole growth thing. I mean, if the NHS came knocking on your door tomorrow and said, let's roll this out nationally, uh, what would you worry about most?

Dr Dan Leach: 29:25

Well, I guess being separate to the NHS is useful because we're flexible. You know, we can change with research, we can change with public demand. Um, so my my fear with being an under a national service would be that you know that flexibility and that movement disappears. Um, you know, so yeah, uh if if if that did happen, if it wanted if the if the health service wanted it to be a national product, it would still have to have that really high-level patient-centered approach, you know, and that would be my fear that it that that would be diluted and lost, you know, and that's kind of my founding principle is that we we are patient focused from the very beginning to the very end, you know, and and that can't be diluted for anything, in my opinion.

Dr Andrew Greenland: 30:14

Um on that note, Dan, thank you so much for your time today. This has been such an incredibly thoughtful conversation. So thank you so for um for speaking so openly about what's often a very private and under discussed matter. Um, and it's been great to hear about you, your work, and what Valence Health is doing for men's health more generally. So, thank you very much. Really good to speak to you.

Dr Dan Leach: 30:33

Yeah, thanks for having me, Andrew.