The US defense secretary, Pete Hegseth, this week ordered annual testosterone-deficiency screening for active-duty and reserve service members aged 30 and older, claiming it will maintain military readiness. However, many medical professionals warn the mandate could increase risks of infertility and other consequences if testosterone is prescribed inappropriately.
Medical Experts Express Concern
Five of six men’s health experts contacted by Reuters said they were puzzled by the announcement and concerned it may lead to unnecessary or harmful treatment. Hegseth stated testing would be accompanied by advice for voluntary treatment decisions, aiming to ensure troops have optimal testosterone levels for combat readiness.
Four of the six doctors said there was no solid evidence that screening all military personnel aged 30 and older would optimize US readiness for combat. Dr Kevin McVary, a urologist on the medical advisory board of Rugiet, noted: “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.”
Guidelines Recommend Symptom-Based Testing
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 symptoms leads to overtreatment, McVary said, which can cause adverse consequences.
Testosterone levels naturally decline with age, starting around age 30, but age 30 itself is not an appropriate screening point, said Dr Haleem Mohammed, chief medical officer of Gameday Health. “There is a population-level decline of 1% per year after ages 30-40 that accelerates as you get older,” but patterns vary among individuals.
Potential Risks and Fertility Concerns
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.
The FDA revised testosterone labels to remove a warning of increased heart attack or stroke risk based on a study led by Dr Steven Nissen involving over 5,200 men aged 45 to 80. However, participants showed higher rates of atrial arrhythmia and bone fractures, which may have implications for the military, Nissen said.
Operator Syndrome and Broader Screening
Hegseth cited addressing “operator syndrome” as an objective, which afflicts special forces warriors like Delta Force members and Navy Seals, including low testosterone along with traumatic brain injury and other issues. But Dr B Christopher Frueh of the University of Hawaii, whose team first described the syndrome in 2020, said: “These operators are at an extreme end of a spectrum. They have much higher exposures to blasts, airplane jumps, firing all kinds of different weapons, shoulder-fired rockets, machine guns.” He believes many younger soldiers could regulate hormones through sleep, rest, and diet rather than replacement therapy.
The Pentagon has not provided detailed guidance on evaluating abnormal results or whether screenings will apply equally to males and females. Frueh noted that broad screening could reveal new information about female soldiers’ hormones, though they likely would not need testosterone replacement.
