The U.S. Department of War has directed the Pentagon to implement mandatory testosterone-deficiency screening for active-duty and reserve personnel aged 30 and older as part of their regular health assessments. Younger service members can also request the test. This initiative, spearheaded by Defense Secretary Pete Hegseth, aims to "optimize performance, combat ‘Operator Syndrome' and maximize mission readiness," according to a statement from Hegseth's office.
While TRT (testosterone replacement therapy) will be voluntary when clinically indicated, the screening protocol is a significant step in addressing male health within the military. Dr. Marc Siegel, a senior medical analyst, expressed support for the initiative, noting, "I already screen for it in men over 50, and it makes sense to check for it in men who rely on tip-top physical performance."
Understanding Testosterone Deficiency
Testosterone levels vary, but the Endocrine Society cites a harmonized reference range of 264 to 916 ng/dL for healthy, non-obese men aged 19 to 39. The American Urological Association suggests a level below 300 ng/dL, coupled with symptoms, indicates deficiency. Hypogonadism, the medical term for low testosterone, affects an estimated 2% of men, with rates increasing with age and certain health conditions like obesity and diabetes.
Symptoms can manifest in various ways, including chronic fatigue, weight gain, loss of muscle mass and strength, cognitive difficulties, depressed mood, irritability, and sexual dysfunction such as decreased libido and erectile dysfunction. Over time, untreated deficiency can lead to loss of body hair, decreased bone density, and anemia. While fatigue and concentration issues can have multiple causes, sexual symptoms are often more specific indicators.
Diagnosing low testosterone typically requires symptoms or signs along with low results from at least two separate early-morning blood tests. Additional tests may be conducted to identify underlying causes, such as issues with the testes, pituitary gland, or hypothalamus. Doctors might also measure free testosterone if total levels are borderline.
Treatment Options and Considerations
Before considering TRT, medical professionals often look for reversible factors like obesity, certain medications, sleep apnea, acute illness, or excessive alcohol use. Weight loss is typically the first-line treatment for those whose low testosterone is linked to obesity. For individuals with consistently low levels and significant symptoms, TRT may be an option after a thorough review of potential benefits and risks.
TRT can be administered through various methods, including gels, patches, injections, tablets, nasal gel, and pellets. In June 2026, the U.S. Department of Health and Human Services (HHS) announced it had asked the FDA to update TRT prescribing information based on new clinical data. These proposed changes aim to remove language suggesting TRT's effectiveness is unestablished for age-related hypogonadism and to update information regarding prostate cancer risk.
Risks and Safety Evidence
Certain individuals may not be suitable candidates for TRT, including those with active breast or prostate cancer, elevated hematocrit, untreated severe sleep apnea, recent heart attack or stroke, or thrombophilia. Men trying to conceive should also avoid TRT as it can impair fertility. Regular monitoring by a physician is advised for those undergoing TRT to check hormone levels, blood counts, and potential adverse effects.
The TRAVERSE trial, published in The New England Journal of Medicine in 2023, provided data on TRT's cardiovascular safety. It found no increased rate of heart attack, stroke, or cardiovascular death compared to placebo among middle-aged and older men with confirmed hypogonadism and cardiovascular risk. However, the trial did suggest increased rates of pulmonary embolism, kidney injury, and atrial fibrillation in the testosterone group, underscoring the need for careful monitoring. A subsequent substudy also indicated a higher rate of clinical fractures in men receiving testosterone.
While TRT can improve libido, sexual function, anemia, bone density, and lean body mass in selected individuals, experts emphasize it does not guarantee improvements in energy, cognition, or overall vitality. The findings from the TRAVERSE trial offer reassurance regarding cardiovascular safety when TRT is used appropriately, but experts caution against its widespread prescription for men who are not clearly indicated.