men's health
∙5 minute read
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Despite growing awareness of men’s health, testosterone deficiency remains under-recognised, underdiagnosed, and often misunderstood, both by men themselves and the clinicians treating them. Dr Zak Zafrani, a GP at Numan and an expert in men's health, is on a mission to change that.
“Testosterone deficiency is a clinical and biochemical syndrome,” explains Dr Zafrani. “You’re not just looking at blood test results, it’s about symptoms and signs too. Both have to be present for it to mean something.”
And while prevalence figures vary depending on the population studied, Dr Zafrani references studies suggesting that between 2% and 12% of men over 40 may be affected. “Some UK data even suggests one in four men over 40 may have low testosterone levels,” he notes, “but that’s likely referring to biochemical deficiency only, as not all of those men will have symptoms.”
The symptoms, says Dr Zafrani, are often subtle and easily dismissed. “Men tend to suppress their symptoms,” he says. “They're told to be stoic, to crack on with life. So they might notice they’re tired, a bit low, maybe struggling with motivation, and just put it down to ageing.”
But the signs are often there. “The more ‘textbook’ symptoms are sexual: erectile dysfunction, reduced libido, and loss of morning erections,” he explains. “Beyond that, it’s things like fatigue, low mood, difficulty concentrating, poor gym recovery, and a general loss of that ‘get-up-and-go’ feeling.”
Masculinity plays a role too, Dr Zafrani notes. “There’s still a stigma around sexual dysfunction, and around saying you don’t feel like yourself. It’s not something men talk about openly, even with their GPs.”
But silence comes at a cost. “Many men suffer unnecessarily for years because they think it’s ‘just life’ or they don’t want to bring it up. The key is awareness - not so they shout about it at the pub, but so they know they don’t have to suffer in silence.”
Shockingly, yes. “I’ve seen lots of men misdiagnosed, treated for anxiety or depression, put on antidepressants, given Viagra for ED, and no one ever checked their testosterone,” Dr Zafrani says.
In fact, he conducted an audit across several NHS practices to assess how testosterone deficiency was being managed. The results were telling:
37% of symptomatic men tested showed testosterone deficiency
Only 10% of those were referred for further evaluation or treatment
“And even that 10% was inflated by the fact I worked at those practices,” he says. “Without that, it would have been even lower.”
The issue, he explains, often lies in how GPs interpret test results. “For example, if a patient has a level of 9 nmol/L and it’s flagged as ‘normal’ by the lab, it might get filed away without further action. But guidelines from the British Society for Sexual Medicine (BSSM) say anything under 12 nmol/L with symptoms should be investigated.”
Dr Zafrani recalls one patient, a successful business owner and avid tennis player, who had spent over a decade on antidepressants. “He’d lost his motivation, his energy, his personality,” he says.
Two testosterone tests confirmed he was deficient. After referral and starting treatment, the change was dramatic. “His wife said, ‘It’s like I’ve got my husband back from when we were in our 20s.’ That’s the impact this can have. It’s not just about libido, it’s about quality of life.”
So how do men know when to get their testosterone levels checked?
“If you’re experiencing symptoms like fatigue, low mood, or poor recovery, don’t ignore them,” Dr Zafrani advises. “But more importantly, if you’ve noticed changes in your sexual function, even small ones, speak up. Loss of morning erections, erectile issues, low libido, these are red flags.”
For GPs, he urges more face-to-face assessments. “You can’t always pick up on these things over the phone. A lot of it is subtle, like tone of voice, energy levels, and body language.”
Not necessarily, says Dr Zafrani. “Testosterone replacement therapy (TRT) can be life-changing for the right patients. But it’s a big commitment. It’s lifelong, because it’s treating a deficiency.”
That’s why he takes a holistic approach. “Lifestyle plays a huge role. Weight loss, improved diet, better sleep, and targeted supplements can all support healthy testosterone levels.”
Some men can restore levels naturally. Others may still benefit from medical therapy, but potentially require lower doses. “It’s not one-size-fits-all. My job is to help patients find what works for them, not just prescribe and forget.”
Testosterone deficiency is far more common than many men (or their doctors) realise. But it’s not something to be feared, and it’s certainly not something to suffer through in silence. “If something doesn’t feel right physically, mentally, or sexually, just get it checked,” says Dr Zafrani. “You might not need treatment. But understanding what’s going on gives you options. And for some men, it can be life-changing.”
Written by Hassan Thwaini
Clinical Pharmacist and Copywriter, Master of Pharmacy (MPharm)
