Higher testosterone has been associated with higher levels of aggression and power, thought to be positive attributes of active duty soldiers.
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Secretary of Defense Pete Hegseth has recently announced that active duty male military personnel over age 30 will be screened annually for testosterone levels. As most men’s testosterone levels peak sometime in their 20’s, with a steady but slow decline in the decades that follow, having a so-called testosterone “deficiency” after age 30 can be addressed with testosterone supplementation. While this option will be wholly voluntary, the testing will be incorporated into routine annual physicals of all active military personnel born as male.
Testosterone is a hormone present in both males and females, produced by the male testes and the female ovaries and adrenal glands. In males, it is responsible for testicular growth, sperm production and libido, facial hair, deeper vocal pitch and body hair. It also works to promote bone and muscle strength and density. If testosterone levels are too low, at any age, this can lead to muscle and bone weakness, fatigue, and decline in libido. Testosterone in females is important for ovarian function, libido and bone and muscle health as well.
There are medical conditions in both males and females that occur if testosterone levels are either too high or too low, leading to sexual dysfunction, bone and muscle weakness, and generalized fatigue. In women, high testosterone levels can lead to the condition PMOS, or polyendocrine metabolic ovarian syndrome, previously referred to as PCOS, or polycystic ovary syndrome. This condition, present in up to one in eight premenopausal women, is associated multiple systemic issues, including irregular periods, ovarian cysts and infertility.
PMOS, associated with high testosterone levels in women, is remarkably common and often underrecognized.
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While testosterone supplements for males are not new, the Defense Department is now describing the testosterone testing and treatment initiative as a component of the “High T Department of War” as Hegseth described in a video on July 15, 2026. The concept of “High T” is that higher testosterone levels are associated with strength, virility and ability to be better fighters. Testosterone replacement therapy, or TRT, is a popular medication for men with both normal and low testosterone levels, as it has been linked to longevity, better libido, and better musculoskeletal health. Women also use TRT as a component of perimenopausal and menopausal therapy.
But while TRT can be obtained easily, even without a prescription as “off-label” over-the-counter medications, it is otherwise considered to be a controlled substance, requiring a physician to prescribe it. Doctors have a range of views regarding issues of both testosterone level monitoring as well as administration of TRT for low testosterone levels. For men with lower levels but no symptoms, it’s important to provide counseling regarding potential risks and side effects, such as minor nuisances including acne and breast tenderness to more severe risks such as blood clots, fertility changes and mental status changes. There are currently no specific medical guidelines when it comes to routine testosterone level testing in asymptomatic men as young as age 30.
Symptoms of low testosterone in men, including fatigue, erectile dysfunction, lowered libido and bone and muscle issues can be addressed and treated quite successfully with TRT. An FDA expert panel on testosterone replacement therapy for men met in December 2025 to better delineate protocols for monitoring and treating men with low testosterone levels, with or without symptoms. The US Department of Health and Human Services requested revising treatment guidelines as well as updating data regarding cardiovascular and prostate cancer risks of TRT, stating that several studies have recently demonstrated that these risks are actually lower than had been previously reported.
Counseling is critical in deciding to initiate TRT.
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When it comes to young men, especially in their 30’s, when the natural decline of testosterone levels begins, it is unclear what will be offered to them as enlisted military personnel. TRT is a lifelong treatment, for one, and even if some of the risks, particularly cardiovascular disease and prostate cancer, are lower than had been previously thought, part of the treatment must include monitoring for any side effects as well as continuing to measure testosterone levels. Issues of potential fertility decline in this male population also need to be addressed, as well as signs of high testosterone including sleep issues, excess body hair, liver disease, weight gain and mood disorders.
As with consideration of any new medication, understanding implications, both good and bad, short-term and long-term, need to be fully discussed with any patient and treating physician.