"When you feel like you’ve failed so much physically and mentally, the fear it puts in you is inexplicable really."
Prepare to learn about a condition which affects at least one in five men during their lifetime:
Simon* was 'flying' in his career as a PE teacher to youth offenders, had a long-term partner, two houses and even later went to Abu Dhabi to teach boxing, but gradually 'lost total interest' in everything in his life, before experiencing a 'massive decline' in January 2017.
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With his mental health hitting rock bottom, left unable to get up in the morning, Simon's relationship broke down and he was admitted into a mental health facility, later moving back in with his parents, and was so low his dad had to help feed him coffee through a straw.
Despite taking antidepressants, Simon still 'couldn't hold it together, let alone have any sort of feeling of emotional happiness or expression' and felt like 'a broken down car [that] no one knew how to fix' - until he met Professor Geoffrey Hackett.
Professor Hackett diagnosed Simon with testosterone deficiency.
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Testosterone deficiency - also known as hypogonadism - is a condition which will affect around 20 percent of men in their lifetime and up to 40 percent of over 45s, and yet so few people have heard about it - with 43 percent of over 55's completely unaware it even exists.
Professor Geoffrey Hackett, Senior Medical Advisor at Ted’s Health and Consultant in Urology & Sexual Medicine, tells UNILAD: "Testosterone deficiency is a low level of testosterone. [...] Men tend to lose testosterone gradually as they age by about one to two percent per year from the age of 30.
"Unlike the menopause, where women hit a wall when they're about 50 and lose 100 percent of their hormone production within five to 10 years, [for] men, it's a gradual decline. [...] Most of the guidelines now define testosterone deficiency as a level below 12 nmol/l."
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By the time Simon visited Professor Hackett at Ted's Health, he had a significantly low testosterone level of just seven nmol/ l.
It was Simon's dad who'd found Professor Hackett after stumbling across a paper by the doctor on 'fast onset' testosterone deficiency.
The 37-year-old previously tried to go to the GP when he first noticed he was becoming 'terribly moody, aggressive and short tempered,' however, the GP simply told Simon it was 'probably his line of work'.
Professor Hackett explains while GPs are great, they are 'very variable in how they might respond' and even urologists or endocrinologists who can pick up on testosterone deficiency don't always approach the condition as a 'psychological or mental welfare issue' as well as a physical one.
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Simon attributes both his dad and Professor Hackett to 'saving [his] life'.
"We always laugh about it, because I wish you could watch the CCTV of me walking in [to Professor Hackett's] for the first time," Simon says. "And then when I walk in there now just with my routine checkups, because I'm a totally different person."
The 37-year-old was - and continues to be - treated with testosterone replacement therapy - a series of injections which help restore the levels of testosterone in the body.
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Simon notes: "The medical side is is 20 percent - that is, just what you need for your body to function properly. [...] The actual support along with that, that's what kept it all together [...] so I can just live a normal happy, balanced life."
But why didn't Simon know about testosterone deficiency and its massively damaging effects on one's mental health sooner?
The 37-year-old admits he did hear about the condition while studying sport science at uni, but it was only 'touched upon' and he 'never really knew the link between it and mental health'.
Having been a sixth form tutor for three years prior to teaching sport to youth offenders, Simon believes there's 'no reason' the condition shouldn't be spoken about and taught in more depth in school.
Professor Hackett and his team discovered Simon's low levels could've resulted from treatment he underwent at an earlier point in his life.
The doctor tells UNILAD there are multiple reasons why someone can be affected by testosterone deficiency from 'various congenital problems i.e. losing a testicle through trauma, a torsion or a tumour', to treatments such as chemotherapy.
A lesser known cause - but an 'important one' more people may risk being affected by - is prescription painkillers.
Professor Hackett explains: "If you're on repeat painkillers for about six months, 70 percent of patients have low testosterone levels. And it can be a similar thing with antidepressants, because they're not just blocking depression nerves in the brain, they're blocking all other sets of pathways in the brain.
"And that's before you go into medications that aren't prescribed, that people might dabble in ways we really don't know, because that's all hidden from the medical world. So drugs can be quite important in this."
Professor Hackett also mentions the use of anabolic steroids - misused to bulk out muscle.
"Someone will often think, 'I'll only take this for a month or two, and then I'll stop - just to get me started'. But even that short period of time cuts off their body's own natural production.
"I think that's a very important message because we know that's a big problem not being addressed by the medical profession because nobody wants to go there. [...]
"What I would say is, don't feel any shame. Doctors realise this [happens] we're all in the real world. We know the problems and we'll deal with you if you come forward."
But how do you know if you're one of five who could be suffering from testosterone deficiency?
"The three most common symptoms are, first and foremost, and I cannot overstate this, the loss of morning erections," Professor Hackett says. "Not so much to do with what happens in the bedroom, but loss of morning erections. Then erectile dysfunction. And thirdly, loss of libido."
He also notes that symptoms 'normally pop up when [...] things start going wrong in the bedroom' and so unfortunately, people who aren't in a relationship may just put loss of libido and morning erections down to stress or working too hard.
In order to confirm whether you're suffering from testosterone deficiency, it's fairly simple: you need a blood test.
And it's an important test to take too, as Professor Hackett explains: "If you have a low testosterone, you tend to develop more fat and less muscle. And as we know, obesity leads to type two diabetes.
"If you have type two diabetes, that shortens your life expectancy by about 10 years. That's why it's absolutely crucial."
As well as the physical complications and risks testosterone deficiency can have on you, it's ultimately the strain on one's mental wellbeing which can be the most difficult to overcome and recover from.
Professor Hackett says: "The actual loss of libido, means that you don't have the sexual thoughts, you don't have the urge, the desire to go out there [...] and that tends to cause social isolation from your friends.
"Sometimes even one episode of failure is enough for some guys to give up. I've had numerous patients where they've had their first night with a girl and they thought they might have done quite well. But the girl said, 'Was that it?'
"Now that has been the end of all sex for one or two guys. Those three words. And I've even had guys who weren't sure whether they'd done a particularly good job, and they've actually found the girl texting on the other side of the bed: 'Jason, one minute, what a loser.'
"We underestimate the sort of damage that that could do to people's psyche."
Indeed, as a result of his lack of sex drive and depleted mental wellbeing, Simon's two-year relationship broke down.
"You take away the spark or the sort of the physical side of everything, and then you make yourself paranoid she's gonna fall out of love with you and then you start to push her away," Simon explains. "And then she gets the feeling that you're not interested anymore. So then it's like her whole world's falling apart, because you've had such a fantastic time together for so long."
"I struggled to even be around my partner at the time because I felt embarrassed and worried that I was letting her down. She wanted children and she talks openly about it to everyone. I wasn't honest enough with myself to say I was struggling."
A significant 45 percent of men say they wish it was easier to talk about subjects such as testosterone deficiency.
Professor Hackett and Simon hope that speaking about mental health, and not just physical impact of the condition, can help end the 'silent epidemic of men suffering from the mental and physical health implications of testosterone deficiency' and empower men to improve their health with the support of medical experts.
Since beginning his journey with Ted's Health and receiving testosterone treatment, Simon explains: "I'd go to the extent of saying it's like winning the lottery."
I asked Simon what he'd want those supporting someone with testosterone deficiency to know. He said: "That person, they're still there, they haven't been lost."
He resolved: "You can go on to lead a happy fulfilling life. The way my dad describes it, is he's got his son back."
*Names have been changed for the purpose of the article.
If you've been affected by the contents of this article you can find out more about testosterone deficiency and get support via Ted's Health website, Twitter or Instagram page.
Topics: Health, Mental Health, Science, UK News, UOKM8?, US News, World News, Sex and Relationships
Poppy Bilderbeck