Defense Secretary Pete Hegseth announced that the U.S. military will begin annual screening for testosterone deficiency in service members aged 30 and older as part of their periodic health assessments. Hegseth described the move as an effort to “optimize” health and sustain combat readiness, saying testing will occur under military medical supervision. Testing will be optional for service members under 30, and individuals confirmed to have testosterone deficiency could choose to receive testosterone replacement therapy (TRT).
What the policy means in practice
The new policy places testosterone evaluation into the routine yearly medical visit known as a periodic health assessment for personnel 30 and up. Details on the exact screening protocol were not released with the announcement — a point experts say matters greatly. A single blood test is not a reliable way to diagnose hypogonadism (clinically low testosterone); current best practice is to combine symptom assessment, a physical exam, and repeat laboratory testing before making a diagnosis or starting long-term treatment.
Why some experts are skeptical
Several urologists and men’s health specialists told Healthline that routine universal screening beginning at age 30 is not clearly supported by current evidence. They argued that testing asymptomatic people, especially younger service members, may yield little useful information and risks creating false positives or unnecessary treatment.
Key clinical concerns include:
– A single low blood level is insufficient. Testosterone fluctuates daily and is affected by sleep, recent illness, food intake, medications, body weight, and physical activity. Diagnosis is generally based on consistent low levels plus symptoms, usually confirmed by repeat testing.
– Military life can temporarily suppress testosterone. Intense training, sleep deprivation, and deployment stress may lower hormone levels transiently; abnormal results in those contexts should prompt repeat testing after reversible factors are addressed, not immediate lifelong therapy.
What qualifies as a meaningful screening
Some clinicians said screening could be reasonable if it goes beyond a single laboratory value to include symptom questionnaires and physical exams. In that model, a blood test is ordered only when signs or symptoms suggest hypogonadism — for example, persistent low libido, erectile dysfunction, chronic fatigue, loss of muscle mass, or decreased bone density. Targeted evaluation limits unnecessary testing and focuses resources on people most likely to benefit.
Benefits and risks of TRT
When appropriately prescribed for men with confirmed testosterone deficiency, TRT can improve libido, energy, mood, muscle mass, bone density, and some elements of quality of life. But the therapy carries important risks and requires careful patient selection and ongoing monitoring.
Risks highlighted by experts include:
– Fertility suppression: Exogenous testosterone can suppress the body’s sperm production, potentially causing infertility or prolonged subfertility. Many service members are still of reproductive age and may not have completed their families. Fertility often recovers after stopping therapy but not always, and timing and completeness of recovery are unpredictable. Experts urged mandatory fertility counseling before starting TRT in younger patients.
– Metabolic and cardiometabolic effects: TRT can lower HDL (“good”) cholesterol and has been associated with acne and worsening sleep apnea in some people. Since 2015, TRT carried an FDA cardiovascular warning; that warning was recommended for removal in 2025 after results from the large TRAVERSE randomized trial found no increased rates of heart attack or stroke compared with placebo. That trial shifted the regulatory landscape but does not eliminate all potential cardiovascular considerations for individual patients.
– Prostate health: While TRT is not thought to cause prostate cancer to develop, it can accelerate growth of an existing prostate cancer. Clinicians should consider prostate screening and monitoring when initiating TRT in men at risk.
Balancing readiness against medical, reproductive, and ethical risks
Experts emphasized that testosterone matters for physical and psychological health, and treating genuine deficiency could help affected service members perform their jobs. However, they cautioned that more testosterone is not necessarily better: pushing levels above the normal physiologic range or treating asymptomatic individuals is unlikely to improve combat performance and may cause harm.
A successful screening program needs evidence that it identifies true cases, leads to beneficial treatment outcomes, and does so without producing excessive false positives, harms, or costs. Before implementing broad population-level screening, many clinicians said the military should demonstrate that routine testing after age 30 meaningfully improves readiness and health outcomes while outweighing medical, reproductive, and ethical risks.
Practical takeaways
– Service members who have symptoms consistent with low testosterone should discuss them with a clinician, who can evaluate causes and order properly timed repeat laboratory tests when indicated.
– Fertility counseling should be part of any treatment discussion for younger patients considering TRT.
– Robust protocols — including symptom screening, clear lab timing and repeat testing, consideration of reversible causes, patient counseling, and monitoring plans — are essential to avoid unnecessary or harmful treatment.
In short, identifying and treating true testosterone deficiency in service members could be beneficial, but experts say the value of universal annual screening beginning at age 30 depends on the details of how it’s done and on evidence that the program improves readiness without causing unintended harms.
