Defense Secretary Pete Hegseth last week ordered annual testosterone-deficiency screening for active-duty and reserve service members age 30 and older, which he says will help maintain military readiness.
Yet, many medical professionals warn it might do nothing of the sort and instead could increase service members' risk of infertility or other consequences if testosterone is prescribed inappropriately.
The mandate is one of several recent healthcare policy changes implemented by Hegseth and other Trump administration Cabinet officials that sparked debate among experts and raised questions about what scientific basis, if any, supports them.
Hegseth also reversed the military's long-standing flu vaccine mandate, a decision that was walked back after a flu outbreak, while the Department of Health and Human Services removed 17 members from its vaccine advisory panel and altered its vaccine recommendations.
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Five of six men's health experts contacted for this story said they were puzzled by the announcement on testosterone testing and concerned it may lead to unnecessary — or even harmful — treatment.
U.S. Secretary of Defense Pete Hegseth speaks during a March 31 briefing at the Pentagon in Washington.
Hegseth said testing would be accompanied by advice to help soldiers make decisions about treatment, which would be voluntary.
The goals, he added, are to ensure troops have the right testosterone levels to operate at their best and to improve their resilience, longevity and performance, so as to ensure the military's combat readiness.
Four of the six doctors said there was no solid evidence to suggest screening for low testosterone in all military personnel aged 30 and older would optimize U.S. readiness for combat.
“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, a telehealth platform that provides testosterone supplements.
The Pentagon declined to further comment on the matter.
Testing recommended for symptoms
The American Urological Association and the Endocrine Society advise testosterone supplementation only for patients with confirmed testosterone 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 have its own adverse consequences.
Levels naturally decline with age, starting around age 30. But age 30 itself is not an appropriate point for screening, said Dr. Haleem Mohammed, chief medical officer of men's wellness and medical clinic network Gameday Health.
"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, Mohammed said.
Most studies of testosterone replacement were done in older men, noted Dr. Ugis Gruntmanis, an endocrinologist at Dartmouth Hitchcock Medical Center, who said the new mandate provides an opportunity to collect data on younger men.
He added, however, that widespread implementation of screening without preliminary study data would be putting the carriage before the horse.
U.S. Army soldiers take part in a U.S.-South Korea joint river-crossing exercise March 14, part of the annual Freedom Shield joint military training, in Yeoncheon, South Korea.
FDA lifted warning
Based partly on a study led by Dr. Steven Nissen of the Cleveland Clinic, involving more than 5,200 men aged 45 to 80 with low testosterone and high risk of heart disease, the U.S. Food and Drug Administration revised testosterone labels to remove a warning of increased risks of heart attack or stroke. The participants, however, showed higher rates of atrial arrhythmia — an abnormal heart rhythm — and bone fractures, a finding that may have implications for the military, Nissen said.
All of the experts contacted by Reuters also mentioned 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.
Hegseth said one objective for the new screening mandate is to comprehensively address Operator Syndrome, which afflicts special forces warriors such as Delta Force members and Navy SEALs and includes low testosterone along with traumatic brain injury, hormonal and metabolic dysregulation, sleep dysregulation and other maladies.
However, special forces operators are not representative of all active-duty and reserve members, said Dr. B. Christopher Frueh of the University of Hawaii, whose team first described the syndrome in 2020.
“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, shoulder-fired rockets, machine guns.”
Other soldiers might have elements of the syndrome, he said, "but should we be screening 100% of everybody? Maybe. I don't know.”
He believes many younger soldiers could regulate hormones through sleep, rest and diet to bring testosterone levels back up, rather than replacement therapy.
Navy sailors have breakfast July 12 aboard the USS Theodore Roosevelt as the aircraft carrier participates in Rim of the Pacific military exercises in waters south of the Hawaiian Islands.
Weight and low testosterone
Still, medical professionals emphasize potential benefits from appropriate testosterone testing, as with other forms of medical tests.
Gameday Health's Mohammed said military reservists in the general population may be overweight, another correctable factor that can contribute to low testosterone.
"Testosterone is one of the most useful blood tests we have to gauge health in men," Mohammed said. "Broader screening would identify many men with reversible causes and some with true deficiency. Both groups would benefit from clinician-guided care, whether that means correcting reversible causes or starting treatment when it is truly warranted."
The Pentagon did not provide detailed guidance on how abnormal test results will be evaluated or whether screenings will apply equally to males and females.
Frueh of the University of Hawaii said broad screening could also reveal new information about female soldiers' hormones.
“Females aren't going to need testosterone replacement in all likelihood,” he said, “but they may need other hormonal interventions.”
