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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Ask About Sex Drive Directly
- Ask about sex drive in plain language and compare to the patient's recent baseline, not to being 18.
- Use decreased libido as the most specific clinical clue for hypogonadism.
Optimize Timing And Assay For Testing
- Draw morning testosterone between 7–10 AM and have patients fast ≥6 hours to avoid falsely low results.
- Use a CDC-validated assay and know your lab's normal range when interpreting totals.
Initial Labs To Differentiate Cause
- Order hematocrit, total testosterone, and consider FSH/LH at initial evaluation to save visits.
- Use FSH/LH to distinguish primary (high) from secondary (low/normal) hypogonadism.