The Conversation
Men Keep Avoiding

Rakesh, you run a men's clinic, you are the head of clinic and wellness. Tell us what that actually means — because I think the general misconception whenever you say men's health is that it is all about one thing.

Yes, and I will name that one thing: people immediately think about erectile dysfunction and premature ejaculation. And look, those are very real clinical issues that we deal with. But men's wellness is so much broader than that. It is about how society has shaped the way men relate to their own health — and the very significant consequences of that shaping.

A man who has been consistently conditioned by society to feel strong, to project a certain kind of masculinity, to not show vulnerability — that man will only seek help when his performance is in danger. And even then, he often comes in too late, having dismissed or pushed through a dozen earlier warning signals that his body was sending him.

And as a psychologist, I see the identity dimension of this very clearly. For many men, performance is tied directly to their sense of self. So when that starts to be compromised, it is not just a physical concern — it is an identity crisis.

Exactly. And what is interesting is that in my clinical experience, the cases that present as psychological — men who come in already managing shame, low confidence, a sense that a part of them is lost — when I go through their physiological markers, their blood work, their hormonal levels, I often find significant physical causes. Low testosterone. Undiagnosed diabetes. Hypertension. High uric acid. Elevated inflammatory markers. These are very commonly the root cause driving the emotional presentation.

So when we correct the physiological aspect — alongside lifestyle intervention — we see the emotional dimension improve significantly alongside it. The broken man who came in on the first visit, practically in tears in some cases, with his wife beside him — by the third visit, the sixth visit, he is a different person. Not because we gave him something to suppress the psychological dimension, but because we addressed the underlying physical causes that were driving it.

You mentioned warning signals. For a man in his forties who suddenly experiences performance issues — what is that actually telling us about what else might be happening in the body?

This is a very important question. The research indicates that because the small blood vessels in the penis are affected earlier than the larger vessels, vascular dysfunction in this area can be a precursor signal for what might develop in other systems — particularly the cardiovascular system. This is not universally confirmed, and not everyone who has performance issues will go on to have a cardiac event. But it is a signal. Just as a cough and fever can be the surface symptom of a bacterial infection, performance issues are the surface symptom of something that requires investigation deeper down.

So when a man comes to us with this issue, we go back to square one. Full blood investigations. What are the hormonal levels? Are there signs of undiagnosed diabetes — which is extremely common in the Malaysian context? Undiagnosed hypertension? High uric acid? Elevated inflammatory markers? And very frequently — low testosterone, which is the primary male hormone. Correcting these underlying conditions very often resolves or significantly improves the presenting issue.

So the point is not to just address the surface complaint but to treat the whole system.

That is precisely the philosophy of the clinic. We are not trying to give someone medication to temporarily manage a symptom. We are trying to fix the root cause. Medication for us is supplementary — it is not the endpoint. The endpoint is a man who has genuinely improved his health markers, changed his lifestyle, and addressed the systemic reasons why his body was giving him the warning it was.

And this is why we do not operate as a standalone consultation. We have a partner wellness centre with an onsite fitness trainer and physiotherapist. Because the problem is almost never going to be solved purely medically. It has to be solved through a genuine lifestyle change — sleep, stress levels, diet, exercise, substance use. All of it. That is the complete approach.

There has been increasing discussion in research about testosterone levels declining across populations. What are you actually seeing in your clinical practice?

There are statistics suggesting testosterone levels decline approximately one percent per year after a certain age — and that looks small but over a decade, over two decades, it is very significant. But even beyond the age-related decline, what I see clinically is that baseline testosterone levels in men today appear substantially lower than what was typical in previous generations. Men in their sixties and seventies who come from military backgrounds — men who lived physically demanding, high-stakes lives — often have testosterone levels that are genuinely impressive. Whereas much younger men, living more sedentary, high-stress, sleep-deprived modern lives, have levels that are clinically low.

And low testosterone does not only affect sexual performance. It affects energy, mood, cognitive clarity, physical strength, and motivation. It is a systemic hormone. When it is chronically low, everything suffers — including professional performance, relationship quality, and psychological resilience. This is a men's health issue that extends far beyond the clinic into the boardroom, into families, into communities.

What are the primary lifestyle drivers of this decline?

Poor sleep. Chronic stress. Lack of adequate exercise. Poor diet. Excessive substance use — alcohol, smoking. These are the foundational drivers, and they are almost embarrassingly basic. Basic in the sense that we all know we should be sleeping better, managing stress better, moving our bodies more. But basic does not mean easy — and modern life creates structural conditions that make all of these things harder to maintain than they should be.

The frustrating reality is that if every man in Malaysia got quality sleep, managed stress adequately, ate real food, exercised consistently, and avoided harmful substances — we would see the testosterone picture change significantly. The interventions I do clinically are partly about correcting what has already declined. But the real prevention is the lifestyle — and that is a conversation that needs to happen at a societal level, not just in a men's health clinic.

Let us talk about fertility for a moment. Because the conversation around fertility challenges is almost exclusively focused on women, when in fact male factors are equally significant in a very large proportion of cases.

This is critically important and massively underaddressed. Male fertility factors — sperm count, sperm quality, sperm motility — are implicated in a very significant proportion of couples who are having difficulty conceiving. And the drivers of poor sperm health are almost exactly the same as the drivers of everything else we have discussed: poor sleep, chronic stress, poor diet, lack of exercise, substance use.

When I see men with fertility concerns, very often their follicle-stimulating hormone — the signal from the brain to the testes to produce sperm — is low. Their luteinising hormone is low. Their testosterone is low. And when we address those hormonal and lifestyle factors, we very often see sperm quality improve alongside everything else.

There is also the age question. Research has indicated that advancing paternal age is associated with increased risk of certain conditions in offspring — including autism spectrum conditions in some studies. The emphasis is almost entirely placed on maternal age, but paternal age matters too. This is not to create anxiety but to create awareness: men's reproductive health is time-sensitive in ways that are rarely communicated clearly.

We are coming to the end of our time, but I want to ask you something slightly broader. If you could reframe one thing about how Malaysian men think about health and strength, what would it be?

Strength is not the absence of vulnerability — it is the willingness to address what needs addressing before it becomes a crisis. The men who wait until they are in significant distress before seeking help are not demonstrating strength. They are paying a price for a definition of strength that does not serve them.

The men who come to me — who have overcome the cultural conditioning, who have walked through the door of a men's health clinic with their concerns — those men are demonstrating something that takes genuine courage in our context. And almost without exception, they leave in a better state than they arrived in. Not just physically, but psychologically. Because having named the problem and taken action is itself healing.

That is the shift I would want: from strength as stoic performance to strength as intelligent self-care. One leads to a broken man on my consultation chair. The other leads to a man who is performing at his genuine capacity — in his relationship, in his work, in his life.

That is a profound reframe. One final question — if you had one wish to make the planet a better place, what would it be?

I would love to see more authentic education about health — not the kind driven by fear or shame, but the kind that empowers people to understand their bodies, to seek help without embarrassment, and to make the lifestyle choices that actually serve their wellbeing over the long term. Not just men. Everyone. But if we could start with men, given how thoroughly we have been taught to avoid this — that would be a very good start.

Education without shame. What a gift that would be. Thank you so much, Dr. Rakesh, for being on The Centered Edge today.

Thank you for having me. These conversations matter — and I am glad we are having them.