The US Department of Defense has recently mandated annual testosterone-deficiency screening for active-duty and reserve service members aged 30 and older. Defense Secretary Pete Hegseth asserts that this measure will enhance military readiness. However, many medical professionals express skepticism, warning that the policy could lead to unnecessary treatments and potential health risks if testosterone is prescribed inappropriately.
This mandate is part of a series of healthcare policy changes implemented by Hegseth and other Trump administration officials, which have ignited debate among experts regarding their scientific basis. The policy change follows the reversal of the military’s longstanding flu vaccine mandate, a decision that was later retracted after a flu outbreak. Additionally, the Department of Health and Human Services removed 17 members from its vaccine advisory panel and altered its vaccine recommendations.
Medical experts raise concerns
Five of six men’s health experts contacted by Reuters expressed puzzlement over the announcement and concern that it may lead to unnecessary or even harmful treatment. Hegseth stated that the testing would be accompanied by advice to help soldiers make informed decisions about treatment, which would be voluntary. The goals, he added, are to ensure troops have optimal testosterone levels to operate at their best and to improve their resilience, longevity, and performance, thereby ensuring the military’s combat readiness.
However, four of the six doctors stated that there is no solid evidence suggesting that screening for low testosterone in 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 for testosterone supplementation
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. Dr. McVary emphasized that giving testosterone without medical symptoms leads to overtreatment, which can have adverse consequences.
Dr. Haleem Mohammed chief medical officer of men’s wellness and medical clinic network Gameday Health, pointed out that testosterone levels naturally decline with age, starting around age 30. However, he argued that age 30 itself is not an appropriate point for screening. “There is a population-level decline of 1% per year after ages 30-40 that accelerates as you get older,” Mohammed said, noting that the patterns are not the same for all individuals.
Potential risks and benefits
Most studies of testosterone replacement have been done in older men, noted Dr. Ugis Gruntmanis an endocrinologist at Dartmouth Hitchcock Medical Center. He suggested that the new mandate provides an opportunity to collect data on younger men but cautioned that widespread implementation of screening without preliminary study data would be premature.
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 US Food and Drug Administration (FDA) revised testosterone labels to remove a warning of increased risks of heart attack or stroke. However, the participants showed higher rates of atrial arrhythmia and bone fractures, findings 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 stated that one objective for the new screening mandate is to comprehensively address operator syndrome which affects special forces warriors such as Delta Force members and Navy Seals. This syndrome includes low testosterone along with traumatic brain injury, hormonal and metabolic dysregulation, sleep dysregulation, and other maladies.
However, Dr. B Christopher Frueh of the University of Hawaii, whose team first described the syndrome in 2026, argued that special forces operators are not representative of all active-duty and reserve 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, shoulder-fired rockets, machine guns.” He questioned whether broad screening is necessary for all military personnel.
Frueh believes that many younger soldiers could regulate hormones through sleep, rest, and diet to bring testosterone levels back up, rather than turning to replacement therapy. Medical professionals emphasize potential benefits from appropriate testosterone testing, as with other forms of medical tests.
Gameday Health’s Mohammed noted that 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 has not provided 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 suggested that broad screening could also reveal new information about female soldiers’ hormones. “Females aren’t going to need testosterone replacement in all likelihood, but they may need other hormonal interventions,” he said.
