Medical experts are divided on Defense Secretary Pete Hegseth’s announcement that U.S. service members will undergo testosterone deficiency screenings with their annual physical exams.
“War fighters aged 30 and older are going to be tested annually as part of their periodic health assessment,” said Hegseth in a video, posted with the caption “The High-T Department of War.” Elective testosterone testing will be available to younger service members, too, and if recommended, testosterone replacement therapy would be at the individual’s discretion.
Testosterone replacement therapy has become big business in recent years. Health influencers and online clinics have been touting its benefits well beyond what current evidence suggests, promoting it as a miracle substance akin to an elixir of well-being. But testosterone therapy does have proven benefits in men who are deficient in the hormone and experience fatigue, low libido, and mood disorders, even as experts disagree on the best ways to diagnose low testosterone — widely known as low T.
Hegseth’s announcement is the latest example of the Trump administration showing support for testosterone replacement therapy for men and embracing the hormone more broadly as a mark of masculinity and health. Health secretary Robert F. Kennedy Jr. has declared that he takes testosterone, and he referred to President Trump’s reported high-for-his-age testosterone levels as a proxy for his overall good health. The Food and Drug Administration also recently revised testosterone product labels to remove a disproven warning about prostate cancer risk, and a statement about lack of proven efficacy for older men.
“The reflex reaction for many to this announcement is this will lead to overtreatment and abuse,” said Abraham Morgentaler, a Blavatnik faculty fellow in health and longevity at Harvard Medical School. “But it’s important we don’t lose sight of what we know medically — low T has many correlates with important medical conditions, some of which will not be picked up medically unless testing is performed.”
Morgentaler argues that “testosterone level is easily the best single indicator of a man’s health status. My hope is that this will one day be a routine medical test for all men over 30 years,” he said. “There’s variability with any blood test, but it’s just as valuable as a TSH for thyroid disease, or liver tests, or kidney tests, which are all standard annual labs.”
Other specialists are not so sure. “I think it is crazy,” said Adrian Dobs, an endocrinologist and professor of medicine and oncology at Johns Hopkins University. She identified several problems in the introduction of routine testosterone screenings. First, she said, the variability of assays makes it hard to get accurate values, and the range of normal levels is broad, making it difficult to pinpoint exactly who needs replacement therapy.
She pointed to the fact that logistics and costs of performing such testing on every service member would be significant, and in the absence of specific symptoms it would be hard to determine what constitutes an optimal level for an individual. “Most men will be within normal range, and if they’re just slightly low, what does that mean? Does it mean that they should be treated, does it mean that they have a real medical problem?” she said. Even as testosterone levels decline with age, this doesn’t automatically indicate a need for replacement therapy.
With Hegseth’s framing that testosterone screening would “enhance natural capabilities” and keep service people “on the leading edge of lethality,” the worry is that higher testosterone levels would be equated with better performance, which would lead to overtreatment, in absence of clear symptoms.
“The biggest problem is the fact that … if a man is taking testosterone, his own body will stop making it, and this is particularly a problem when it comes to sperm production,” Dobs said.
Morgentaler, on the other hand, thinks screening even without specific symptoms can provide important insight into a man’s health, and with the right medical oversight, overtreatment can be avoided. Current guidelines from major American medical organizations recommend against routine screening for testosterone levels, however, and advise that diagnosis of low testosterone should not be done based on just a lab test.
“The military presents a unique population,” said Helen Bernie, the director of men’s sexual and reproductive health at Indiana University and a professor of urology. “Service members often undergo intense physical training, chronic stress, and periods of sleep deprivation, all of which can contribute to lower testosterone levels. Because of these unique occupational demands, there may be value in screening rather than waiting for individuals to seek medical attention.”
Still, she said screening should not automatically lead to treatment. “The diagnosis of testosterone deficiency requires both consistent symptoms and repeatedly low morning testosterone levels, along with an evaluation for reversible causes,” she said, adding that any treatment should be tailored to the patient and accompanied by clear discussions about risks and side effects, as well as continued monitoring.
In his video, Hegseth talks about “war fighters” and “service members,” though he seems to equate those with men, as testosterone deficiency is typically a male diagnosis. Women, too, have declining levels of testosterone, but assessment is even more complex than for men, and benefits of testosterone therapy for women are under debate.
The Defense Department told STAT it had no further details to share about the program. Admiral Brian Christine, Health and Human Services assistant secretary for health, shared Hegseth’s video on social media, adding that he supports checking that men have healthy testosterone levels. Optimizing testosterone levels, he said, would have many beneficial health consequences and ensure “America’s fighting force is prepared to perform at its highest level.”
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