Doctors question evidence behind Pentagon plan for testosterone screening

US Defence Secretary Pete Hegseth this week ordered annual testosterone-deficiency screening for active-duty and reserve service members aged 30 and older, which he says will help to maintain military readiness.

But many medical professionals warn it might do nothing of the sort and instead could increase service members’ risk of infertility or other consequences if testosterone is prescribed inappropriately.

The mandate is one of several recent healthcare policy changes implemented by Hegseth and other Trump administration Cabinet officers that have sparked debate among experts and raised questions about what scientific basis, if any, supports them.

Hegseth has also reversed the military’s longstanding flu vaccine mandate, a decision that was walked back after a flu outbreak, while the Department of Health and Human Services removed 17 members from its vaccine advisory panel and altered its vaccine recommendations.

Five of six men’s health experts contacted by Reuters for this story said they were puzzled by the announcement on testosterone testing and concerned it may lead to unnecessary – or even harmful – treatment.

Hegseth said testing would be accompanied by advice to help soldiers make decisions about treatment, which would be voluntary.

The goals, he added, are to ensure that troops have the right testosterone levels to operate at their absolute best and to improve their resilience, longevity and performance, so as to ensure the military’s combat readiness.

Four of the six doctors said there was no solid evidence suggesting that screening for low testosterone in all military personnel aged 30 and older would optimise US readiness for combat.

“We hear from patients that when you treat low T (testosterone), things like cognitive alertness and stamina improve. But the evidence is not concrete and it comes from patients who were treated because they were symptomatic,” said Kevin McVary, a urologist on the medical advisory board of Rugiet, a telehealth platform that provides testosterone supplements.

The Pentagon declined to comment on the matter beyond its brief official statement.

Testing recommended for symptoms

The American Urological Association and the Endocrine Society advise testosterone supplementation only for patients with confirmed testosterone deficiency and symptoms such as reduced libido, erectile dysfunction, fatigue, decreased muscle mass and low bone density.

Giving testosterone without medical symptoms leads to overtreatment, McVary said, which can have its own adverse consequences.

Levels naturally decline with age, starting around age 30. But age 30 itself is not an appropriate point for screening, said Haleem Mohammed, chief medical officer of men’s wellness and medical clinic network Gameday Health.

“There is a population-level decline of 1 per cent per year after ages 30-40 that accelerates as you get older,” but the patterns are not the same for all, Mohammed said.

Most studies of testosterone replacement have been done in older men, noted Ugis Gruntmanis, an endocrinologist at Dartmouth Hitchcock Medical Center, who said the new mandate provided an opportunity to collect data on younger men.

He added, however, that widespread implementation of screening without preliminary study data would be putting the carriage before the horse.

FDA lifted warning

Based partly on a study led by Steven Nissen of the Cleveland Clinic, involving more than 5,200 men aged 45 to 80 with low testosterone and high risk of heart disease, the US Food and Drug Administration revised testosterone labels to remove a warning of increased risks of heart attack or stroke.

The participants, however, showed higher rates of atrial arrhythmia – an abnormal heart rhythm – and bone fractures, a finding that may have implications for the military, Nissen said.

All of the experts contacted by Reuters also mentioned the severe impact of testosterone therapy on male fertility.

“Many in our armed forces are young men who are not done having their families,” McVary said. “If you just dole out the testosterone, the testes will shrink. And you can’t reliably count on them coming back.”

Other risks include blood thickening, prostate issues, acne, hair loss, breast tissue growth and mood volatility.

In his announcement, Hegseth said one objective for the new screening mandate was to comprehensively address Operator Syndrome, which afflicts special forces soldiers such as Delta Force members and Navy SEALs, and includes low testosterone along with traumatic brain injury, hormonal and metabolic dysregulation, sleep dysregulation and other maladies.

But special forces operators are not representative of all active-duty and reserve members, said 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 per cent 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 emphasise potential benefits from appropriate testosterone testing, as with other forms of medical tests.

Gameday Health’s Mohammed said military reservists in the general population might 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.

The University of Hawaii’s Frueh 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. REUTERS