Defense Secretary Pete Hegseth announced the new policy, dubbed ‘The High-T Department of War,’ which will screen every service member over 30 for low testosterone. (Photo by Alex Wong/Getty Images)
Getty Images
Defense Secretary Pete Hegseth’s announcement that the military will screen every service member over age 30 for low testosterone—and offer replacement therapy to those who qualify—under the banner “The High-T Department of War.”
The stated goals of the policy: optimize combat readiness, resilience and the long-term health of troops.
Yet the evidence shows a different story. The issue is who is being tested. The population the military is about to screen looks almost nothing like the men in the studies that made testosterone therapy look safe. And major endocrine societies have warned against this sort of screening approach.
Data From the Largest Testosterone Replacement Trial
The TRAVERSE trial, published in 2023, is the largest study ever conducted on testosterone safety. It randomized 5,246 men to daily transdermal testosterone gel or placebo. The primary result: no increase in major adverse cardiac events: 7.0% in the testosterone group versus 7.3% in the placebo group. That result was strong enough that in early 2025 the FDA removed the decade-old cardiovascular boxed warning from testosterone products.
Yet the population studied in TRAVERSE was different than many of the 30+ year old military population receiving the mandatory annual screening, as well as those less than 30 who may opt into screening. TRAVERSE enrolled men aged 45 to 80, averaging their early 60s. Every participant had two things: diagnosed hypogonadism confirmed on repeat fasting morning testosterone levels below 300 ng/dL, and either established heart disease or a high risk of it. Most were overweight or obese.
The trial was designed to answer the question whether it is safe to treat genuinely testosterone deficient older men who already have heart risk. The answer is yes.
But here’s the issue: it doesn’t say much about a fit 32-year-old in uniform with no symptoms and a testosterone level that happens to land in the lower part of the normal range.
Issues With Mass Screening For Low Testosterone Levels
Screening works well when you look for a common condition in a group likely to have it. It works badly where the opposite is true. The military’s target population is closer to the opposite case.
The crude prevalence of androgen deficiency in the U.S. is approximately 6%. That number is heavily weighted by older, less healthy men. Population studies have been conducted mainly in middle-aged and older men with multiple comorbidities.
Among fit service members in their 30s, the real prevalence of clinically significant low testosterone levels is likely considerably lower. When you screen a population where few people have the condition, most “positive” results are false alarms: healthy men who are caught with a low reading on a bad day.
Low testosterone readings also are common even in normal men. Testosterone swings with sleep, illness, stress, recent exercise, glucose intake and time of day.
The Endocrine Society guideline states: 30% of men with an initial testosterone concentration in the hypogonadal range have a normal concentration on repeat measurement. The AUA guideline adds that intra-individual variability can reach 65–153% between tests depending on the assay used, and that using two or three measurements reduces this variability by 30–43%.
A single annual number, taken as part of a routine health assessment, possibly in the afternoon, possibly after a hard training day, possibly non-fasting, is exactly the kind of measurement most likely to mislead.
That is why the Endocrine Society explicitly recommends against routine screening of men in the general population for hypogonadism. The Society, responding directly to the Pentagon news, reiterated that there is not enough evidence to support screening asymptomatic men at the population level.
Other Issues With Testosterone Treatment To Consider
TRAVERSE’s headline finding was reassuring for cardiac events. But the trial also detected other signals: higher rates of pulmonary embolism, atrial fibrillation, acute kidney injury and broken bones in the testosterone group. Erythrocytosis which is an abnormal rise in red blood cells that can increase clotting risk was the clearest adverse effect. It occurred in 17.0% of the testosterone group versus 3.3% on placebo.
The FDA, while removing the cardiac boxed warning, added a new warning that testosterone can raise systolic blood pressure by 2–4 mm Hg.
Importantly, these risks were observed in older men with comorbidities. Whether they apply equally to younger, healthier troops is unknown—but the absence of evidence in that population is not evidence of absence.
One clear downside is highly relevant to the younger, healthier troops this program targets: fertility. Taking testosterone inhibits the body’s testosterone production, and drastically reduces in the testicles, which is normally about 100 times the concentration in circulation. This can impair sperm production substantially.
Dosages of testosterone 200 mg intramuscularly per week decrease intratesticular testosterone levels by 94% within three weeks.
The AUA guideline states: exogenous testosterone therapy should not be prescribed to men who are currently trying to conceive. Recovery of sperm production after stopping testosterone is highly variable. In some men it requires being off it for six months or more. In rare cases fertility can be permanently impaired.
More Exercise May Be What Some Soldiers Actually Need
A randomized controlled trial in men aged 50–70 with low-normal testosterone found that supervised exercise training significantly improved aerobic capacity and muscular strength and reduced fat mass, while testosterone treatment alone did not improve aerobic capacity or strength.
Adding testosterone to exercise conferred limited additional benefit beyond what exercise alone achieved. The investigators concluded that exercise should be evaluated as an intervention in preference to testosterone treatment.
Importantly, the military already has the most effective testosterone-raising intervention available: physical training. What many also may need is better sleep, nutrition, and stress management, not necessarily a prescription for testosterone.
Here’s What Soldiers and Families Should Do Next
The first thing to know is that testosterone therapy is not actually bad medicine. Used in men who truly have a deficiency, confirmed by proper testing and accompanied by real symptoms, it can restore energy, muscle, libido, mood, and long-term bone and metabolic health. The evidence that it is safe for the heart is reassuring.
However, a single low result is not a diagnosis. Guidelines recommend at least two low fasting morning testosterone measurements, plus consistent symptoms. This includes low libido, fatigue, muscle loss, mood changes, and/or erectile dysfunction before a diagnosis of hypogonadism can be made. Ask for a repeat test before anything else.
Timing also matters. Testosterone peaks between 3 and 8 a.m. and drops after poor sleep, illness, hard training, glucose intake, or stress. A number drawn on a rough week, in the afternoon, or after a meal can look falsely low. Both guidelines specify fasting, early-morning draws.
Third, think about reversible causes first. Excess weight, poor sleep, heavy alcohol use, opioids, steroids, and certain other medications all lower testosterone. Doctors should assess for systemic illness, sleep disorders, excessive exercise, nutritional deficiency and medications that affect testosterone production before attributing low levels to true hypogonadism. For men carrying extra weight, weight loss is the first-line consideration.
Also ask about fertility. If you may want children, raise this before starting therapy. There are ways to protect fertility (e.g. human chorionic gonadotropin, selective estrogen receptor modulators and sperm banking), but they have to be planned for up front.
Additionally, treatment is a commitment. Starting testosterone usually means ongoing therapy and regular monitoring of hematocrit, blood pressure and prostate health. The decision to prescribe testosterone should be guided by how low the testosterone is, the type and severity of symptoms and the patient’s willingness to accept the risks of treatment and monitoring.
Finally, optimization is not medicine. Testosterone has never been approved to enhance performance in men with normal levels. Using it for that purpose carries risk without established benefit.