US defense secretary Pete Hegseth has ordered annual testosterone-deficiency screening for active-duty and reserve service members aged 30 and older, claiming it will help maintain military readiness. However, many medical professionals warn the policy could lead to unnecessary or harmful treatment, including infertility risks.
Doctors Express Concern Over Evidence
Five of six men's health experts contacted by Reuters said they were puzzled by the announcement and concerned about potential overtreatment. Hegseth stated testing would be accompanied by advice for voluntary treatment, aiming to ensure troops have optimal testosterone levels for combat readiness. But four of the six doctors said there was no solid evidence that screening all personnel aged 30 and older would improve readiness.
“We hear from patients that when you treat low T, things like cognitive alertness and stamina improve. But the evidence is not concrete, and it comes from patients who were treated because they were symptomatic,” said Dr Kevin McVary, a urologist on the medical advisory board of Rugiet.
Testing Recommended Only for Symptoms
The American Urological Association and the Endocrine Society advise testosterone supplementation only for patients with confirmed deficiency and symptoms such as reduced libido, erectile dysfunction, fatigue, decreased muscle mass, and low bone density. Giving testosterone without medical symptoms leads to overtreatment, McVary said, which can cause adverse effects.
Testosterone levels naturally decline with age, starting around 30, but Dr Haleem Mohammed of Gameday Health noted that patterns vary among individuals. “There is a population-level decline of 1% per year after ages 30-40 that accelerates as you get older, but the patterns are not the same for all,” he said.
FDA Lifted Warning but Risks Remain
Based partly on a study led by Dr Steven Nissen of the Cleveland Clinic involving over 5,200 men aged 45 to 80, the FDA revised testosterone labels to remove a warning of increased heart attack or stroke risks. However, participants showed higher rates of atrial arrhythmia and bone fractures. Nissen said these findings may have implications for the military.
All experts contacted by Reuters highlighted the severe impact of testosterone therapy on male fertility. “Many in our armed forces are young men who are not done having their families,” McVary said. “If you just dole out the testosterone, the testes will shrink. And you can’t reliably count on them coming back.” Other risks include blood thickening, prostate issues, acne, hair loss, breast tissue growth, and mood volatility.
Operator Syndrome vs. General Population
Hegseth said the screening aims to address operator syndrome, which afflicts special forces warriors like Delta Force members and Navy Seals, including low testosterone, traumatic brain injury, and sleep dysregulation. But Dr B Christopher Frueh of the University of Hawaii, who first described the syndrome in 2020, noted that special operators are not representative of all service members. “These operators are at an extreme end of a spectrum,” Frueh said. “They have much higher exposures to blasts, airplane jumps, firing all kinds of different weapons.”
Frueh believes many younger soldiers could regulate hormones through sleep, rest, and diet rather than replacement therapy. However, broader screening could also identify reversible causes like obesity, which contributes to low testosterone.
Potential Benefits and Uncertainties
Dr Mohammed emphasized that testosterone testing is one of the most useful blood tests for gauging men's health. “Broader screening would identify many men with reversible causes and some with true deficiency. Both groups would benefit from clinician-guided care,” he said. The Pentagon has not provided detailed guidance on evaluating abnormal results or whether screenings apply equally to females. Frueh noted that broad screening could reveal new information about female soldiers' hormones, though they are unlikely to need testosterone replacement.
