Medical experts are divided on Secretary of Defense Pete Hegseth’s announcement that U.S. military personnel will be tested for testosterone deficiency during their annual physicals.
“Combatants over the age of 30 will be tested annually as part of their routine medical examination,” Hegseth said in a video posted with the caption “Chief Officer of the Department of the Army.” Selective testosterone testing will be made available to young military personnel, and if recommended, testosterone replacement therapy will be administered at the discretion of the individual.
Testosterone replacement therapy has become big business in recent years. Health influencers and online clinics are touting its benefits far beyond what current evidence suggests, touting it as a miracle substance akin to a happiness elixir. However, testosterone therapy has been proven to be effective for men who have a hormone deficiency and experience fatigue, low sex drive, and mood disorders, even though experts disagree on the best way to diagnose low testosterone (commonly known as low T).
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Hegseth’s announcement is the latest example of the Trump administration’s support for testosterone replacement therapy for men, and the broader acceptance of the hormone as a sign of masculinity and health. Secretary of Health Robert F. Kennedy Jr. declared that he takes testosterone and cited President Trump’s reportedly high testosterone levels for his age as a proxy for his overall health. The Food and Drug Administration also recently revised the labeling of testosterone products to remove false warnings about the risk of prostate cancer and statements that their effectiveness in older men is unproven.
“A lot of people’s knee-jerk reaction to this announcement is that this will lead to overtreatment and abuse,” said Abraham Morgenthaler, a Blavatnik faculty fellow specializing in health and longevity at Harvard Medical School. “However, it is important not to lose sight of what we know medically. Low T levels are correlated with many important medical conditions, some of which may not be known medically until testing is performed.”
“Testosterone levels are without a doubt the single best indicator of a man’s health, and my hope is that one day this will become a routine medical test for men,” says Morgenthaler. all “Blood tests vary, but they are as valuable as the standard annual tests: TSH test for thyroid disease, liver tests, and kidney tests,” he said.
Other experts aren’t so sure. “I think this is crazy,” said Adrian Dobbs, an endocrinologist and professor of medicine and oncology at Johns Hopkins University. She identified several problems with the implementation of routine testosterone testing. First, test variability makes it difficult to obtain accurate values, and the wide range of normal levels makes it difficult to pinpoint who needs replacement therapy, she said.
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She pointed to the fact that it would take a lot of effort and cost to conduct such tests for all military personnel, and that it would be difficult to determine the optimal level for an individual without specific symptoms. “Most men are within the normal range, but what does it mean if their values are slightly lower? Does it mean they need to be treated? Does it mean they have an actual medical problem?” she said. Testosterone levels decline with age, but this does not automatically indicate the need for replacement therapy.
Hegseth claims that testosterone testing can “enhance natural performance” and keep service members on the “cutting edge of lethality,” but the fear is that higher testosterone levels will be assumed to mean better performance, leading to overtreatment in the absence of obvious symptoms.
“The biggest problem is the fact that when men take testosterone, their bodies no longer make it, which is especially problematic when it comes to sperm production,” Dobbs said.
However, Professor Morgentaler believes that screening can provide important insight into a man’s health even in the absence of specific symptoms, and that with proper medical surveillance, overtreatment can be avoided. However, current guidelines from major U.S. medical organizations do not recommend routine screening of testosterone levels and advise that the diagnosis of low testosterone should not be based on laboratory tests alone.
“There’s a unique population in the military,” said Helen Barney, professor of urology and director of men’s reproductive health at Indiana University. “Military members are often exposed to intense physical training, chronic stress, and periods of sleep deprivation, all of which can contribute to low testosterone levels. Because of these unique occupational demands, it may be worthwhile to conduct a screening test rather than waiting for individuals to seek medical attention.”
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Still, she says screening shouldn’t automatically lead to treatment. “Diagnosis of testosterone deficiency requires both consistent symptoms and repeated declines in morning testosterone levels, as well as evaluation of reversible causes,” she said, adding that any treatment should be tailored to the patient and be accompanied by a clear discussion of risks and side effects and ongoing monitoring.
Hegseth speaks of “combatants” and “soldiers” in the video, but appears to equate them with men, since testosterone deficiency is usually a diagnosis for men. Women also have low testosterone levels, but their assessment is more complex than in men, and the benefits of testosterone therapy for women remain controversial.
The Department of Defense told STAT it had no further details to share about the program. Admiral Brian Christine, assistant secretary for health at the Department of Health and Human Services, shared Hegseth’s video on social media, adding that he supports determining whether men have healthy testosterone levels. He said optimizing testosterone levels has many beneficial effects on health and ensures that “America’s fighting force is ready to perform at the highest level.”
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