How to Avoid a Mad "T" Party: Evaluation and Management of Male Hypogonadism

madman · Nov 2, 2025

One of the big boys in the field!

Dr. Anawalt!

Pay attention to the Q&A (43:20-56:30) especially when it comes to testing free testosterone!

43:20-46:27 - How do we assess for free testosterone?

* There's a direct antibody assay (IA) that measures free testosterone it is notoriously inaccurate and notoriously underestimates the true free testosterone as much as 30% so you should never use that but it is cheap, its easy, its quick so all labs offer it

madman · Nov 2, 2025

T prescriptions ↑ in US

madman · Nov 2, 2025

Update: T prescriptions↑in Texas & US

madman · Nov 2, 2025

Dr. Bradley Anawalt

This may be the most important slide I have here today!

Testosterone continuum

madman · Nov 2, 2025

Classic Klinefelter Syndrome

Klinefelter Syndrome

This is some of the best data we have on men with Klinefelter's Syndrome.

↑↑ FSH & LH in Klinefelter syndrome

madman · Nov 2, 2025

Hypogonadism algorithm

madman · Nov 2, 2025

Older men lose circadian T rhythm

madman · Nov 2, 2025

When should we measure [T]?

Effects of fasting on [T]

* Fasting [TT] significantly > non-fasting (10-15%, ∼ 40-50 ng/dL)

madman · Nov 2, 2025

Common causes of altered SHBG

madman · Nov 2, 2025

Free Testosterone

Should we order an assessment of free testosterone? YES

Thread 'Debate about the Free Testosterone Hypothesis: Useful Tool or Misguided Mirage?'

Jun 28, 2025

Dr. Handlesman and Dr. Anawalt two highlly respected and well known endos in the field!

https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgaf370/8171633?redirectedFrom=fulltext

Abstract:

In this debate, two clinicians discuss the merits and demerits of the free testosterone hypothesis. Although most clinical guidelines recommend the measurement of free testosterone in the evaluation for male hypogonadism (at least in men with suspected low serum sex hormone binding globulin), there remains controversy about underlying hypothesis that serum...

madman · Nov 2, 2025

Common causes of hypogonadism

Dr. Bradley Anawalt

This is a different way of thinking about hypogonadism and I think this is the way we should think about it in 2025, REVERSIBLE vs IRREVERSIBLE.

Reversible vs. irreversible hypogonadism

madman · Nov 2, 2025

Management of reversible 2° hypogonadism due to obesity and aging

Significant weight loss ↑ serum T

Obesity & aging synergistically ↓ [T]

madman · Nov 2, 2025

Dr. Bradley Anawalt

This is a picture of Hershey kisses drawn by me and this is the kisspeptin neurons that regulate the hypothalamus to make GnRH to and create the onset of puberty

Kisspeptin neurons

madman · Nov 2, 2025

Dr. Bradley Anawalt

For the first time in a 100 years we have data from randomized controlled trials placebo controlled

4 major clinical testosterone outcomes trials since 2016

Dr. Bradley Anawalt

This is the summary and Im going to circle the major outcome points here

In terms of adverse events.

madman · Nov 7, 2025

Bradley D Anawalt
University of Washington School of Medicine, Seattle, WA 98195, USA.

Thread 'Aging and androgens'

Dec 25, 2022

Aging and androgens: Physiology and clinical implications (2022)
Bradley D. Anawalt · Alvin M. Matsumoto

Abstract

In men> ~35 years, aging is associated with perturbations in the hypothalamus-pituitary–testicular axis and declining serum testosterone concentrations. The major changes are decreased gonadotropin-releasing hormone (GnRH) outflow and decreased Leydig cell responsivity to stimulation by luteinizing hormone (LH). These physiologic changes increase the prevalence of biochemical secondary hypogonadism—a low serum testosterone concentration without an...

Thread 'Relationships between endogenous and exogenous T and CVD in men'

Nov 4, 2022

Relationships between endogenous and exogenous testosterone and cardiovascular disease in men (2022)
Arthi Thirumalai · Bradley D. Anawalt

Abstract

In this narrative review, we discuss the evidence about the controversy about the cardiovascular effects of endogenous and exogenous testosterone in men. Prospective cohort studies with follow-ups of~5–15 years generally indicate no association or a possible inverse relationship between serum endogenous testosterone concentrations and composite major cardiovascular events, cardiovascular deaths, and overall...

Thread 'The Truth About Performance Enhancing Drugs'

May 1, 2021

Bradley D. Anawalt

Professor and Vice-Chair of Medicine

Department of Medicine

School of Medicine

University of Washington

Disclosure Summary: Consultant for the United States Anti-Doping Agency