The Curbsiders Internal Medicine Podcast #394 Recap, Top Pearls from ACP #IM2023
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May 8, 2023 
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Test Testosterone Thoughtfully
- Do not shotgun-screen for hypogonadism; ask about decreased libido and confirm low testosterone with a morning fasting sample.
- Use CDC-validated testosterone assays and confirm marginal lows with a repeat fasting morning test before diagnosing.
Obesity Ages Male Hormones
- Obesity (BMI >30) accelerates age-related testosterone loss, roughly equivalent to 10–15 years of aging.
- Weight loss, exercise, and reducing waist circumference can raise testosterone without starting replacement.
Safety Checks For Testosterone Rx
- Before starting testosterone, check hematocrit and recheck at 3–6 months then annually to monitor for erythrocytosis.
- PSA testing and sleep apnea screening are not mandatory prior to starting therapy unless clinically indicated.