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Debate About the Free Testosterone Hypothesis: Useful Tool or Misguided Mirage?
Bradley D Anawalt1, David J Handelsman2
1Medicine, University of Washington School of Medicine, Box 356420, Seattle, WA 98195, USA.
The Journal of Clinical Endocrinology and Metabolism
|June 28, 2025
Summary
This debate explores the free testosterone hypothesis in male hypogonadism. While some support its measurement, others question its validity and accurate clinical assessment.
Area of Science:
- Endocrinology
- Andrology
- Clinical Medicine
Background:
- The free testosterone hypothesis suggests free testosterone levels significantly contribute to androgenic effects.
- Clinical guidelines often recommend free testosterone measurement for male hypogonadism, particularly with low sex hormone-binding globulin.
- However, the hypothesis's validity and the accuracy of its assessment remain debated.
Purpose of the Study:
- To present a debate on the merits and demerits of the free testosterone hypothesis.
- To discuss the clinical utility of free testosterone assessment in male hypogonadism.
Main Methods:
- This study is a debate between two clinicians with opposing viewpoints.
- Evidence supporting and refuting the free testosterone hypothesis is presented.
Main Results:
- Dr. Anawalt supports the free testosterone hypothesis, advocating for its accurate assessment in clinical practice.
- Dr. Handelsman argues the hypothesis is flawed, biologically invalid, and free testosterone cannot be accurately assessed.
Conclusions:
- The debate highlights ongoing controversy regarding the free testosterone hypothesis in male hypogonadism.
- Further research and discussion are needed to clarify the role and assessment of free testosterone in clinical practice.
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