The Curbsiders Internal Medicine Podcast REBOOT: #462 Male Hypogonadism Pearls with Dr. Bradley Anawalt: Insights on Testosterone Deficiency
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Jan 26, 2026 Bradley D. Anawalt MD, endocrinologist and Chief of Medicine with expertise in male reproductive health. He walks through practical approaches to low testosterone: who to test and how, why lifestyle and weight loss often trump therapy, nuances of lab interpretation, fertility-preserving options, and choosing and monitoring treatment while watching for hematocrit and sleep apnea risks.
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Prioritize Weight Loss For Mild Cases
- Emphasize lifestyle weight loss for sexual function; improvements correlate with amount of weight lost.
- Use waist circumference and belt-loop change as motivating, practical measures.
Check Free T In Obese Or Diabetic Men
- In obese, diabetic, or insulin-resistant men, get a calculated free testosterone (with SHBG) or validated assay.
- Avoid direct-platform free T assays—they are often inaccurate.
Beware Spurious Low Free T Results
- Discordant normal total but low measured free T often reflects an inaccurate direct free assay, not true low free T.
- Confirm with a calculated free T on a validated total assay before diagnosing.