Pentagon’s annual testosterone screening draws skepticism from medical professionals

WASHINGTON — The medical community is expressing skepticism of the Pentagon’s plan to annually screen service members 30 and older for testosterone deficiency.

“There is insufficient evidence to support a general recommendation to perform population-level screening,” the Endocrine Society said in a statement.

Screenings for all active-duty and reserve personnel are effective immediately, according to a memorandum signed by Defense Secretary Pete Hegseth on Wednesday. The screening will be added to the periodic health assessment for troops over 30. Those under 30 can voluntarily choose to be screened.

If treatment is recommended following the test, service members can choose to receive testosterone replacement therapy, or TRT.

Hegseth, who announced the initiative in a video posted to X on Wednesday, described the move as a readiness measure. The secretary said in the video, posted under a caption reading “The High-T Department of War,” that maintaining proper testosterone levels was a way to keep troops “on the leading edge of lethality.”

Testosterone deficiency, or hypogonadism, commonly known as “low T,” is a condition in which the body does not produce enough of the hormone that is key to the development and maintenance of typical male physical characteristics such as muscle mass and growth of facial hair. Testosterone levels in men naturally decline by about 1% to 2% a year after age 30, according to the Cleveland Clinic. Low T can cause physical, mental and sexual changes such as fatigue, decreased libido, erectile dysfunction, muscle loss, mood fluctuations and weight gain.

The condition affects about two in 100 men overall, according to the American Urological Association, but the rate increases with age.

Hegseth’s video and memo do not stipulate how testosterone deficiency will be defined for women, who produce the hormone at significantly lower levels than men.

Despite some men having testosterone deficiency, medical organizations generally advise against universal testosterone screening.

“A universal screening program would inevitably generate a large number of false-positive results, triggering unnecessary confirmatory testing, specialist referrals, anxiety, and potential inappropriate treatment,” Karl Nadolsky, a former active-duty endocrinologist, posted on Facebook.

Adrian Dobs, a professor of medicine at Johns Hopkins University who specializes in endocrinology, said there are several reasons why this is a problem.

It is not easy to measure testosterone levels, and a person’s biological variables are factors. The time of day also matters.

“The level is higher in the morning, so the levels need to be drawn in the morning,” Dobs said. “It also depends on the age. There’s a lot of variability, and it’s difficult to interpret whether or not a man really has low testosterone levels.”

Dobs also added that in order to conduct a large number of screenings, provide evaluations for why a service member has low testosterone and treat them requires a lot of money.

The new Pentagon policy comes amid a wider push within President Donald Trump’s administration to make testosterone replacement therapy for men more widely available. Proponents tout the hormone as a way to boost muscle, energy and sex drive. Hegseth, in his video, says that it is a way to help troops operate at their “absolute best.”

Testosterone replacement therapy has long been associated with health risks. Recent studies have addressed some concerns, but the Endocrine Society said more research is needed to fully understand TRT risks.

The TRAVERSE trials in 2023, conducted with more than 5,200, found no meaningful increase in heart attack and stroke over a one- to four-year period. However, the trials showed roughly a 50% relative increase in pulmonary embolism and an increased incidence of bone fractures among testosterone-treated men.

Dobs added that if a man is given testosterone, it decreases his natural production of testosterone as well as his production of sperm.

“I’m trying to make the point here … it really is not a good idea to do this,” Dobs said.

The Defense Health Agency referred all questions about the new policy to the Pentagon, which on Thursday did not have more information to provide outside of Hegseth’s video and the memo.

A 2020 study on more than 50 special operation forces operators conducted by the Defense Department and other institutions linked low testosterone levels to deployments during which poor sleep, high-stress environments and poor nutrition can take a toll.

The condition is referred to as “Operator Syndrome.”

“Operator Syndrome represents a unique convergence of health challenges that require proactive clinical intervention,” Hegseth wrote in his memo. “Additionally, applying lessons learned from treating Operator Syndrome across the total force including targeted testosterone therapy directly optimizes warfighter readiness.”

Chris Frueh, one of the authors on the 2020 study, is a psychologist. He understands from endocrinologists that annual screenings are “not typical” and only conducted when there are “signs and symptoms.”

“I think this will be about identifying and treating hypogonadism and not giving out TRT to people who do not medically need it,” Frueh said.

He was encouraged, though, by Hegseth writing in his Wednesday memo that an advisory council would be created.

“My optimistic read of the memo is that Operator Syndrome is now going to be kind of brought into military doctrine,” Frueh said.