U.S. Defense Secretary Pete Hegseth issued an order this week requiring annual testosterone-deficiency screening for active-duty and reserve military personnel who are 30 years of age or older. Hegseth says the program is designed to strengthen military readiness.
Despite that stated goal, a large number of medical professionals are skeptical. Many warn the screening could actually put service members at risk of infertility and other health complications if testosterone therapy is handed out when it isn’t truly needed.
This mandate is part of a broader wave of healthcare policy shifts coming from Hegseth and other members of the Trump administration’s cabinet — changes that have drawn pushback from medical experts who question whether solid scientific evidence supports them.
Hegseth previously reversed the military’s longstanding flu vaccine requirement, a decision that was later reversed again following a flu outbreak. Separately, the Department of Health and Human Services removed 17 members from its vaccine advisory panel and made changes to vaccine recommendations.
Reuters reached out to six men’s health specialists about the testosterone screening announcement. Five of the six said they were baffled by the move and worried it could result in unnecessary — or even dangerous — medical treatment.
Hegseth has said that any treatment following the screening would be voluntary and that soldiers would receive guidance to help them make informed decisions. His stated goals include ensuring troops have optimal testosterone levels to perform at their best and to strengthen their resilience, endurance and overall performance in support of combat readiness.
Despite those goals, four of the six physicians told Reuters there is no strong evidence that screening all military personnel aged 30 and older for low testosterone would actually improve combat 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 who serves on the medical advisory board of Rugiet, a telehealth platform that provides testosterone supplements.
The Pentagon declined to offer any additional comment beyond its brief official statement on the matter.
Screening Guidelines Call for Symptoms First
Both the American Urological Association and the Endocrine Society recommend testosterone supplementation only when a patient has a confirmed deficiency along with symptoms — things like reduced libido, erectile dysfunction, fatigue, decreased muscle mass, or low bone density.
McVary said prescribing testosterone in the absence of those symptoms leads to overtreatment, which carries its own set of health risks.
Testosterone levels do naturally begin to decline around age 30, but that doesn’t make 30 the right age to start screening, according to 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,” Mohammed said, adding that the pattern varies from person to person.
Dr. Ugis Gruntmanis, an endocrinologist at Dartmouth Hitchcock Medical Center, pointed out that most testosterone replacement research has focused on older men. He acknowledged the new mandate could create an opportunity to gather data on younger men — but cautioned that rolling out widespread screening before any preliminary study data exists is putting the cart before the horse.
FDA Label Change and Heart Concerns
The U.S. Food and Drug Administration recently updated testosterone drug labels to remove a previous warning about increased risks of heart attack or stroke. That decision was based in part on a study led by Dr. Steven Nissen of the Cleveland Clinic, which followed more than 5,200 men between the ages of 45 and 80 who had low testosterone and a high risk of heart disease.
However, participants in that study showed elevated rates of atrial arrhythmia — an irregular heart rhythm — as well as bone fractures. Nissen said those findings could have particular significance when it comes to military personnel.
Every expert Reuters spoke with also raised concerns about the 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.”
Additional risks associated with testosterone therapy include blood thickening, prostate problems, acne, hair loss, breast tissue growth and mood swings.
Operator Syndrome vs. the Broader Military Population
In announcing the screening mandate, Hegseth cited a condition known as Operator Syndrome, which affects special forces personnel such as Delta Force members and Navy SEALs. The syndrome encompasses low testosterone along with traumatic brain injury, hormonal and metabolic dysregulation, sleep disruption and other serious health problems.
But Dr. B. Christopher Frueh of the University of Hawaii — whose research team first identified the syndrome in 2020 — cautioned that special forces operators are not a good stand-in for the military as a whole.
“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 acknowledged other soldiers might show elements of the syndrome, but questioned whether universal screening makes sense. “Should we be screening 100% of everybody? Maybe. I don’t know,” he said.
Frueh also suggested that many younger service members might be able to bring their testosterone levels back up naturally — through improved sleep, rest and diet — rather than resorting to hormone replacement therapy.
Potential Benefits of Broader Testing
Despite widespread skepticism, some medical professionals did acknowledge potential benefits to broader testosterone testing when done appropriately.
Mohammed of Gameday Health noted that military reservists in the general population may struggle with being overweight — a correctable condition that can contribute to low testosterone levels.
“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 yet released detailed guidance on how abnormal test results will be evaluated or whether the screenings will apply equally to male and female service members.
Frueh suggested that widespread screening could also yield new insights into female soldiers’ hormone levels. “Females aren’t going to need testosterone replacement in all likelihood, but they may need other hormonal interventions,” he said.
