Pentagon's new testosterone tests for troops spark debate over readiness, health risks

The Pentagon’s decision to introduce annual testosterone screening for thousands of US military personnel has triggered a debate among medical experts, with many questioning whether the policy will improve combat readiness or instead expose service members to avoidable health risks.

US Defence Secretary Pete Hegseth has directed that all active-duty and reserve personnel aged 30 and above undergo yearly testing for testosterone deficiency. Announcing the move, Hegseth said the initiative is aimed at improving military performance, resilience and long-term readiness while ensuring troops maintain optimal hormone levels.

The screening, he said, will be accompanied by medical counselling, with any subsequent treatment remaining voluntary.

However, the policy has been met with scepticism from specialists in men's health, endocrinology and urology. According to Reuters, five of the six experts it consulted questioned the scientific justification for routinely testing all service members based solely on age, warning that the move could result in unnecessary treatment rather than better health outcomes.

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Doctors question scientific evidence

Current medical guidelines do not recommend universal testosterone screening. The American Urological Association and the Endocrine Society advise testing and testosterone replacement therapy only for patients who exhibit symptoms of hormone deficiency—such as fatigue, reduced libido, erectile dysfunction, loss of muscle mass or decreased bone density—and whose low testosterone levels have been confirmed through clinical evaluation.

Experts argue that testosterone levels naturally decline with age, typically beginning in a person's thirties, but that age alone is not considered a sufficient reason for screening.

Several doctors also warned that prescribing testosterone without clear medical need could carry significant side effects. These include reduced fertility, shrinking of the testes, blood thickening, acne, hair loss, prostate-related complications, abnormal heart rhythms and mood changes.

Dr Kevin McVary, a urologist quoted by Reuters, noted that while patients diagnosed with testosterone deficiency often report improvements in energy and mental alertness after treatment, there is little evidence that routine screening of healthy military personnel would translate into better combat performance.

Operator Syndrome cited as one reason

Hegseth has linked the initiative to efforts to better address Operator Syndrome, a condition observed among elite special operations personnel that involves low testosterone alongside traumatic brain injury, sleep disruption, hormonal imbalance and other health issues.

But 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 turning to replacement therapy.

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 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 said 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.