In an obese male with low testosterone, would you initiate testosterone replacement therapy at the initial visit, or start tirzepatide first and monitor for improvement in testosterone levels and erectile function?

Dr. @Dr. First Last has given a thoughtful answer. Assuming no evidence of a structural hypothalamic-pituitary-testicular (HPT) disease (normal prolactin, LH, and FSH in the low-normal to normal range, normal free T4), the best approach is weight loss for these men. Whether to try lifestyle changes ...

Assuming that the patient does not have evidence of pituitary pathology (e.g., other deficiencies such as central hypothyroidism) and that the degree of hypogonadism is not very severe, you could either see if a significant weight loss results in testosterone increase, or use off-label clomiphene. I...