Some men presenting with diffuse musculoskeletal pain have testosterone values below the normal range for their age. While scant evidence suggests that functional status in such men may improve with testosterone replacement therapy, there are currently no published studies evaluating a potential correlation between diffuse musculoskeletal pain and male hypogonadism. In a cohort of 45 hypogonadal men with diffuse musculoskeletal pain we found a negative correlation between the duration of pain in years and baseline total testosterone values. Although advancing age would theoretically predispose individuals to lower testosterone concentrations, age was not independently associated with baseline testosterone values, nor were any other variables we examined. At this time generalised screening of gonadal function for such men is not indicated. A prospective study would more clearly evaluate a potential relationship between diffuse musculoskeletal pain and testosterone values in men and might determine if testosterone replacement leads to any measurable improvement.