The U.S. military will begin annual screening for testosterone deficiency among service members aged 30 and older, Defense Secretary Pete Hegseth announced, saying the change is meant to “optimize” health and readiness. The tests will be added to the periodic health assessment used in routine medical evaluations; testing will be optional for younger personnel. If follow-up evaluation confirms deficiency, individuals may choose to pursue testosterone replacement therapy (TRT).
Medical experts told Healthline they are not uniformly opposed to identifying and treating true hypogonadism, but they raised significant concerns about routine, population-wide screening starting at age 30. Several specialists said the announcement left important details unspecified — and those details matter for both accuracy and safety.
How low testosterone is diagnosed
Clinically meaningful testosterone deficiency (hypogonadism) is not diagnosed on the basis of a single blood test. Guidelines typically require consistent symptoms plus repeat low lab values, because testosterone levels vary by time of day and can fluctuate with sleep, illness, recent activity, food, medications and other factors. A sample drawn during severe training, deployment, or sleep deprivation may be transiently low. Specialists say repeat testing and attention to reversible causes are essential before making a diagnosis or starting long-term treatment.
What experts worry about
Some urologists and men’s health specialists told Healthline they do not believe routine screening of everyone over 30 is currently justified. They argue that testing younger, asymptomatic people often yields little actionable information and risks false positives or unnecessary interventions. A rigorous screening protocol that includes symptom questionnaires and physical exams, followed by carefully timed laboratory testing only when indicated, would reduce the chance of inappropriate treatment.
Risks and benefits of TRT
For men with confirmed, persistent low testosterone and related symptoms — such as reduced libido, erectile dysfunction, loss of muscle mass, fatigue, decreased bone density or infertility — TRT can improve quality of life. But the therapy has risks that require individualized assessment and monitoring.
One of the most serious concerns for younger service members is fertility. Exogenous testosterone suppresses the hormonal signals that drive sperm production and can cause infertility or prolonged subfertility. Fertility often recovers after stopping treatment, but recovery is not guaranteed or predictable; some patients may have lasting impairment. Because many service members have not completed their families, clinicians say fertility counseling should be mandatory before starting TRT.
Other side effects can include changes in cholesterol (lower HDL), acne, sleep apnea, and concerns related to prostate health: while TRT does not cause prostate cancer, it can accelerate growth of an existing cancer, so appropriate screening and monitoring are important. Since 2015, TRT labels warned of possible increased cardiovascular risk. That warning was reconsidered after the large TRAVERSE randomized trial; in 2025 FDA recommended removing the cardiovascular warning based on that study’s findings that TRT did not increase heart attack or stroke compared with placebo. Still, experts advise individualized cardiovascular assessment and ongoing monitoring when therapy is used.
Does higher testosterone improve combat performance?
There is evidence that correcting low testosterone can improve muscle mass, strength and mood in symptomatic men, which may help job performance. But more is not necessarily better: elevating testosterone above a person’s natural range does not automatically translate to increased combat effectiveness or readiness. Critics of blanket screening say the program should be judged on whether it identifies true cases, leads to meaningful improvement in readiness, and avoids unintended medical, reproductive and ethical harms.
What should a sensible program include?
Experts recommend screening approaches that begin with symptoms and physical exam rather than reflexive blood testing of all asymptomatic people. When testing is indicated, it should be timed and repeated, reversible causes addressed, and counseling provided about risks — particularly fertility — before initiating TRT. The decision to treat should involve shared decision-making, clear follow-up plans and monitoring for metabolic, cardiovascular and prostate-related effects.
The announcement broadens access to evaluation and potential treatment, but without published protocols and outcome data, clinicians and ethicists say the military should demonstrate that the benefits to readiness and long-term health clearly outweigh potential harms. Targeted testing of symptomatic service members, rather than routine population-wide screening, may achieve more benefit with fewer risks.
