Through my years in academia and now working in tech-enabled healthcare delivery, I’ve noticed a concerning trend – the UK is steadily losing its ageing medicine specialists to opportunities in the US. Most of the PhDs in this field end up going to America – I’ve seen this within my own alumni group – and with universities facing funding cuts and reduced positions, this brain drain will most likely accelerate.

This actually reflects a fundamental difference in how these countries view and treat ageing – and as retirement age increases and our population ages, the corresponding expertise gap will become a critical issue for UK healthcare. When you look at the numbers, each patient properly treated with ageing medicine can save the NHS thousands of pounds annually – but in the UK, we’re losing the very specialists who can properly deliver this care.

Here is my take on what’s happening and what we can do to fix this situation.

A perception chasm

The UK and US have starkly different approaches to ageing medicine. When UK patients visit their GP with age-related symptoms, they’re often told “it’s just a normal part of ageing” with no treatment offered. In contrast, the US healthcare system increasingly views ageing as a condition that can be actively managed and treated. This growing cultural difference profoundly impacts both medical research and patient care. Here’s an example: while the UK readily provides hormone therapy to 2.6 million women for menopause, we have a major blind spot when it comes to men’s ageing. Research shows nearly 40 per cent of men over 45 would benefit from testosterone therapy based on their blood levels, yet less than 1 per cent receive treatment.

This isn’t because the treatment doesn’t work – rather, it stems partly from cultural stigma. While hormone therapy is widely accepted for women, testosterone treatment for ageing men remains taboo in the UK, despite its proven benefits for man age-related health issues such as muscular dysfunction. In the US, by comparison, these treatments are openly discussed and more readily available.

The real cost to patients and the NHS

Alongside the health implications, the UK’s hesitancy around ageing medicine carries significant economic costs. Research in health economics reveals that each patient receiving appropriate testosterone therapy saves the NHS approximately £3,000 annually. These savings derive from multiple health improvements – reduced obesity rates, lower cardiovascular risk, and better mental health outcomes. The benefits extend far beyond what most people associate with testosterone treatment.

The therapy plays a crucial role in maintaining muscle health through specific biological mechanisms. Research shows that testosterone therapy increases the number of satellite cells in muscles – specialised stem cells that are crucial for muscle regeneration and repair. These satellite cells remain present as people age, enabling better muscle maintenance and regeneration well into later life. Without proper hormone levels, many patients develop sarcopenia – age-related muscle degradation that triggers a downward health spiral. Studies show that up to 28 per cent of elderly males and 12 per cent of women will develop clinical sarcopenia. Once people become sedentary due to muscle loss, their overall health tends to decline rapidly, leading to increased cardiovascular risk and overall mortality. By maintaining healthy testosterone levels, we can help people stay mobile and independent well into their 60s, 70s, and 80s.

The prevention gap

The US healthcare system takes a markedly different approach, emphasising prevention rather than just treatment. This is visible in how they handle metabolic health; American doctors often prescribe metformin early on to prevent diabetes and maintain healthy blood sugar levels. In contrast, the UK system typically waits until a disease is fully developed before intervening.

This delayed intervention is particularly problematic because we know testosterone decline begins much earlier than most realise. Research shows levels start decreasing from age 25, with the steepest decline occurring between ages 30-40. By age 35, men typically have only about 76 per cent of the testosterone they had at 25. Yet our system typically waits until symptoms become severe before considering treatment.

This reactive approach can have cascading negative effects on ageing patients. Weight gain illustrates this perfectly: as someone gains weight, they become less mobile and exercise less, which dramatically increases their cardiovascular risk. For men, this creates an additional problematic cycle – excess fat tissue converts testosterone to oestrogen, leading to even lower testosterone levels. This in turn causes further muscle loss and decreased metabolic rate, often culminating in metabolic syndrome. Instead of preventing this cycle, our current system often waits until these issues become serious health problems before taking action.

Why specialists leave

70 per cent of UK PhDs leave academia and many of our ageing medicine PhDs choose to relocate to the United States. The situation in UK universities continues to deteriorate, with ongoing funding cuts leading to fewer academic positions. A recent report from the Office for Students (OfS) warns that 40 per cent of UK universities will be in financial deficit this year.

Additonally, when specialists leave, their workload is simply redistributed among remaining staff rather than new experts being hired. This creates a self-perpetuating problem; without a robust market for ageing medicine in the UK, specialists are naturally drawn to the US, where there’s both stronger economic opportunity and greater cultural acceptance of their work. Why stay in a system that doesn’t fully recognise your expertise when you can practice in one that does?

Reversing the brain drain: what the UK must do now

To address this growing problem, we need to tackle the cultural stigma around ageing medicine in the UK. By increasing funding and training GPs to better recognise age-related conditions, we can create the market needed to retain expertise here.

We also need to embrace technologies that enable regular health monitoring. New capabilities allow patients to track changes over time, enabling early intervention rather than waiting for conditions to worsen. Better utilisation of this data can help develop personalised treatment plans tailored to individual needs.

Of course I’m not talking about advocating unnecessary treatments, but we have to recognise ageing as a manageable condition and give our retirement the necessary support to maintain quality of life as they age. As retirement ages rise and people work longer, often in sedentary jobs, addressing these issues becomes critical for both individual wellbeing and healthcare system sustainability.

Every year we delay, we lose more specialists to markets that better value their expertise, and our growing ageing UK population suffers. The technology and knowledge exist – what’s missing is the cultural shift to implement them effectively. Addressing these issues becomes increasingly important for both individual wellbeing and our healthcare system’s sustainability.

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About the author: Dr Oskar Wenbar holds a PhD in Ageing Medicine from the University of East Anglia. His unique background spans clinical pharmacy, academic research, and health technology, giving him firsthand insight into both the research and practical aspects of ageing medicine. His published research on hormone treatments and muscle health in ageing populations has appeared in the Journal of Cachexia, Sarcopenia, and Muscle, and he has observed the brain drain phenomenon both through his academic network and as a healthcare technology leader. He is also the COO and co-founder of Evaro, a digital health platform revolutionising access to healthcare.