Is masculinity going through a hormonal crisis in the twenty-first century? My guest is Tomasz Waligóra, an expert in men’s health and Medical Director of Męska Klinika, who has managed modern medical organisations for years and who, as a practitioner, combines TRT therapy with personal experience.
The ELEVATE Speaker argues that the key to longevity is not pharmacology alone but a comprehensive change of lifestyle. In our conversation he explained why men today have less and less testosterone, and how to sensibly regain vital energy by looking after sleep, diet and mental hygiene.
Michał Wieczorek: Tomek, we are meeting because we share a similar mission: we want men to live to a hundred in health and great shape. Why has the subject of men’s health and testosterone become so pressing right now?
Tomasz Waligóra: It has been an important subject for years, but today we are dealing with a genuine problem of civilisation. We are seeing a drastic downward trend in testosterone levels among men in Western societies. What is worse, we are not talking only about the natural age-related decline – around 0.8% a year after the age of 30 – but about a decline independent of age. The data are alarming: the average testosterone level of a 25-year-old today corresponds to the level a 70-year-old had just two decades ago.
Your journey with this subject did not begin with statistics, though, but with a personal collision with a wall. You were 24 and felt something was wrong.
Exactly. For better and for worse. Despite my young age I had symptoms typical of deficiency: trouble building muscle mass, constant injuries, and eventually anxiety and neurotic disorders. In theory everything was fine – I ate well, I trained, I looked after my sleep. When I had my testosterone tested and the result fell within the reference range, the doctor told me: “You are within the norm, goodbye.” That was the first time I collided with a system that looks only at numbers, not at the patient as a whole.
Precisely, those unfortunate “norms”. Many people get a result, see that they fall within the range, and still feel dreadful. How should these results be read?
Laboratory norms are often the social average of the population in which the diagnostic machines are produced – for example the USA, where the problem of obesity is enormous. If a population is unwell, the norms are lowered so as not to send everyone to the doctor. A range of 200–850 ng/dl accommodates both a healthy 20-year-old and an ailing 80-year-old.
What matters most, however, are the individual characteristics of a given body, such as “androgen receptor sensitivity”. One man will feel great at a level of 400 ng/dl because his receptors are very sensitive. Another, at 450 ng/dl, will have a depressed mood and zero libido, because his body cannot use that testosterone effectively. That is why the foundation should always be the medical history and an assessment of symptoms, not just a “dry” number on a sheet of paper.
So when should a man have his first test, even if he has no obvious problems?
Ideally in the so-called “sweet spot”, that is between the ages of 20 and 30. That is the time when biology gives us the highest levels. Such a result becomes our personal reference point for the future. After the age of 35 it is worth repeating the test every year or two, to monitor how quickly this fuel is running out.
Testosterone and Men’s Longevity: Why Longevity Does Not Begin with a Single Hormone
Read moreYou mentioned that before we move into pharmacology we have to take care of the fundamentals. What damages male hormones most?
Number one is excess weight and the so-called “belly”. Testosterone is closely linked to metabolism. Obesity can lead to insulin resistance, which lowers testosterone, and low testosterone makes it harder to burn fat – a vicious circle.
The next killer is chronic stress. A constantly high level of cortisol literally competes with testosterone and neutralises it. On top of that comes poor sleep hygiene. The bedroom should serve only for sleep and sex, not for scrolling through your phone or watching television. Simply airing the room and darkening it can work wonders for hormonal recovery.
And what about supplements? There are plenty of testosterone “boosters” on the market. Do they work at all?
Most of it is a marketing Eldorado. Tribulus does not work. Supplements such as zinc or vitamin D3 can help, but only when we have deficiencies documented by tests. Ashwagandha is interesting, because as an adaptogen it helps manage stress, which can indirectly raise testosterone in people who are heavily overstimulated.
If natural methods fail, however, we enter the territory of TRT and HRT. How do they differ?
TRT (Testosterone Replacement Therapy) is replacement therapy – we supply testosterone from outside because the body (the pituitary gland or the testes) has stopped producing enough of it. HRT (Hormone Replacement Therapy) has a broader spectrum and may involve, for example, stimulating the body’s own production, provided the testes are still functional.
One thing has to be remembered, though: this therapy is not a one-month course. If we decide on TRT, it is usually a decision for life. It is a choice between living with a deficiency and its consequences (such as the risk of metabolic disease or depression, and ultimately premature death) and living with an optimal level under medical supervision. An important side effect of TRT is also a drop in fertility, which every man planning to have children must know about before starting.
Finally, the psychological thread. Men are often ashamed to talk about weakness, about fear, about “not coping”.
That is the biggest barrier. We want to be superheroes for our families, but to be that we have to be healthy. If a man ignores his check-ups, neglects his emotions and accumulates stress, he eventually breaks. The suicide statistics among men are terrifying. We have to demystify taking care of ourselves – it is not weakness, but genuine responsibility for ourselves and for those closest to us.
