Dr Maroof Harghandiwal — On Testosterone, Erections, Getting Ripped after 40!

Our healthy ageing and hormone specialist Dr Maroof in “Keeping Busy People Healthy” podcast. Click link below to hear all about testosterone, erections and getting ripped after 40!

“As men get older, their testosterone levels may decline about 1 percent per year after age 30. In premenopausal women, testosterone is made mainly in the ovaries. Levels will decline after menopause, which usually begins between ages 45 and 55.”

To help us understand our hormones better, today on the show we have the honour of having Dr Maroof Harghandiwal on the show! Dr Maroof specialises in HORMONE Optimisation Therapy. “I have qualified as a doctor over 20 years ago; I have been a NHS GP for nearly 15 years and practicing Bio-identical hormone optimization for over 5 year. Currently I am doing a fellowship in metabolic, hormone and nutrition with A4M (American Academy of Anti Ageing Medicine) and this program is approved by the Royal college of GPs in London.”

Why do you also love working with entrepreneurs and executives?

I love working with CEOs and Executives. They tend to have a very busy working schedule, unhealthy schedule and lack of time to exercise. So, majority of them suffer from Testosterone deficiency symptoms.
I have seen numbers of males and female clients for hormones optimisation over the years.
I strongly believe that Hormone optimisation does miracle, by restoring your hormone to optimal level (youth level), you will feel significant improvement in physical, psychological and sexual well-being.

Whys is it important to look after our hormones?

As we age some of our vital hormones in our body start to decline. Let me give you an example of testosterone in men: testosterone decline starts as early as 30s and the rate of decline is about 1-2% per year. So once we reach the age of 45-50 we have significantly lower testosterone level. This is actually the same age when female go through menopause.
The rate of decline obviously fluctuates according to individual’s diet, nutritional deficiencies, lifestyle, stress, medications and illness like diabetes, obesity, metabolic syndrome
Optimal level of hormones not only help us physically, psychologically, and sexually to be at our best, but MOST IMPORTANTLY – prevent us from getting chronic diseases as we age.

Tell us about your hormone optimisation therapy. Some people believe this sounds scary.. Explain the process, the blood test, the prescribed doses and so on..

Hormones in general have a bad perception among the public and the medical profession and this is due lack of knowledge and the stigma around hormones. Even when I talk to my medical colleagues about testosterone for example, they imagine those body builders who use super-physiological doses that obviously cause significant risk to their health.
It is all about the balance and to have optimal level. By optimal level I mean upper limit of normal where you get all the health benefit. In the clinic we mainly use physiology dose of hormones. For example, testosterone 5-10mg daily for men and 0.5-1mg daily for for women.

Let me briefly explain patient’s journey at ZEN Healthcare:

1. Initial consultation
• General medical history
• Discussion regarding Testosterone Optimisation
• Symptoms and signs (men complete ADAM, AMS, TD questionnaires; and women complete menopause questionnaire)
• Discuss the importance of regular monitoring
• Physical examination (height, weight, BMI, BP, HR, Prostate Examination on the follow up visit)
• Discuss consent form and copy given to patient to read and sign at the follow up visit
• Blood test (kidney function, liver function, thyroid function, lipids, glucose, male hormones plus PSA). Females’ do same blood test, but they will have saliva test for hormones.
• Follow up is usually after a week

2. Follow up consultation
• We discuss blood test
• For men, we explain whether they require testosterone optimisation. • About 20% of our male patients do not need testosterone optimisation as their level is on the higher normal and most importantly they do not have testosterone deficiency symptoms. So, in that case we target other aspect of healthy ageing like nutritional balancing and lifestyle changes.
• If they qualify for testosterone optimisation, then we discuss options (gel, injections – can be every 3 weeks of every 3 months)
• Discuss the importance of diet and lifestyle
• Discuss nutrition and supplementation
• Consent form signed

3. Follow up
0-3-6-12 monthly and then yearly or sooner if patient develops any problems

For women is pretty much the same process apart from we check saliva for hormones and follow up after 2-3 weeks and women get mainly hormone gel or lozenges

What is the range of testosterone in both?

In men the normal range from 8-32nm/L and in women is much lower 0.7-2.8nm/L
Optimal range means higher normal which is ideal, this is where you get maximum health benefit. Testosterone is the first hormone, which decline in pre-menopausal women before oestrogen and this results in lack of libido, mental irritability and affects muscles and bones. Women obviously need significantly lower dose of testosterone than men do.

What are the symptoms of low testosterone?

Testosterone deficiency can cause variety of symptoms: the most important symptoms are lack of libido and erectile dysfunction. It also causes many other symptoms like brain fog, lack of stamina, lack of concentration and focus, central obesity (fat around the abdomen and waist), reduced muscle mass and floppy muscles, anxiety, irritability, depression.

How does testosterone affect body composition?

Low testosterone usually causes central obesity and metabolic syndrome. So you have an increase in subcutaneous fat (under the skin) and visceral fat (inside and around the organs) and less lean mass. So the muscle become less stronger and floppy.

What are the basic habits we must develop to maintain a low body fat?

There are numbers of options: diet has vital role, also exercise and nutrition play a major part. I usually tell the patient that when you try to lose weight and low body fat – diet has 70-80% role and exercise 20%.

Tell us how stressful lifestyle affects our hormones

Stress is the major cause of majority of illness. When we are stressed, cortisol, which is the stress hormone, goes up. This in turn affects other hormones in our body. Cortisol has negative effect on testosterone. It causes direct inflammation in our body that can affect our immune system, causes immunological and cardiovascular diseases.

What can we do to support testosterone naturally?

There are numbers of steps that can optimise testosterone naturally, for example:
1. Exercise, especially the bigger muscles in our body, so thigh muscle (squats) and the back muscles.
2. Stay lean (keep your BMI in the normal range).
3. Diet (high in protein)
4. Minimise cortisol level in our body (stress reduction)
5. Supplementation – zinc, Vitamin D, ginger, ashwaganda, dhea and etc.

And if we want supplementation, how do we get in touch? Where do you work?

I have been working at ZEN Healthcare in the last 3 years, which is a state of art, modern and holistic clinic where we offer hormonal optimisation, intravenous nutritional infusions, ozone therapy, aesthetic treatments and many more.
ZEN has two branches: one at Knightsbridge (53 Beauchamp Place, SW3 1NY) and the second branch is in Baker Street (3D Baker Street, W1u 8ED)

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