What therapies do you offer to young patients with secondary hypogonadism due to obesity who have lost weight but have ongoing hypogonad symptoms and lower end of normal testosterone levels?

First of all, the symptoms may not be due to low testosterone. Keep in mind that obesity can be associated with low SHBG. Total testosterone may thus be low but free testosterone may be normal. Free testosterone assays are not the most reliable. Therefore, clinical judgment is often needed in border...

A man with a low serum testosterone due to obesity whose testosterone rises to the normal range after weight loss is typically eugonadal. Symptoms of hypogonadism, such as low or decreased libido, are nonspecific and are often due to other causes, including depression.

I would look for other underlying causes such as sleep apnea, depression, etc. TRT is not indicated unless 2 fasting testosterone levels below normal.