Bob Schwartz

Pete Hegseth says soldiers over age 30 to be screened for testosterone deficiency
US defense secretary unveils plan that will work to ensure service members have the ‘right testosterone levels’

Pete Hegseth announced Wednesday that the Department of Defense will offer testosterone deficiency screening for soldiers 30 and older.

The US defense secretary unveiled plans for a new screening program for testosterone deficiency among troops that will work to ensure service members have the “right testosterone levels” to perform at their optimal conditions in a video posted to X.

“I’m authorizing a new screening program for testosterone deficiency for our service members, ensuring you have the right testosterone levels to operate at your absolute best…As we know, the modern battlefield is brutal and unrelenting. It requires and demands maximum psychological and mental readiness, and by addressing these health markers early, we’re keeping you on the leading edge of lethality, and giving you the same level of support that you give this nation – the absolute best.”

I asked my research partner Claude Opus 4.8 to evaluate this proposed policy:

The Endocrine Society and the American Urological Association both explicitly recommend against population screening for testosterone deficiency in asymptomatic men. That’s not a fringe position — it’s the settled guidance, and it exists because of specifics that apply with unusual force to this population.

Testosterone is a noisy measurement. It’s diurnal, pulsatile, and assay-variable. Diagnosis requires two separate early-morning fasting draws, and a meaningful fraction of men with one low value are normal on retest. A “periodic health assessment” is not where careful morning-fasted serial testing happens.

Levels are suppressed by exactly the things military service consists of: sleep restriction, caloric deficit, heavy training load, psychological stress, acute illness. A soldier coming off a field problem with a low reading doesn’t have a disease; he has a normal adaptive response to being a soldier. Screening a population under chronic physiological load will manufacture a large number of “cases” whose correct treatment is sleep and food….

“Leading edge of lethality” is doing work that testosterone can’t do….Nothing in that literature touches marksmanship, judgment under fire, fire discipline, or unit cohesion. And “psychological and mental readiness” is a particularly awkward pitch, since the mood benefits of TRT are small…

TRT [testosterone replacement therapy] suppresses spermatogenesis — often reversibly, sometimes not, and this is a population in its reproductive years. It causes erythrocytosis requiring monitoring. TRAVERSE (2023) established cardiovascular non-inferiority in symptomatic hypogonadal men, which was reassuring, but flagged excess atrial fibrillation, pulmonary embolism, and acute kidney injury. And it’s typically lifelong — you’re enrolling people into permanent therapy and permanent monitoring, often starting from a false-positive lab.

Treatment being voluntary matters and is the right call. But voluntariness under a banner reading “The High-T Department of War,” in an institution built on conformity and hierarchy, is thinner than it looks on paper. If low T is publicly coded as a deficit in warrior-ness, declining treatment carries a cost the consent form doesn’t capture.

The screening design is at odds with the relevant clinical guidelines in ways that are hard to defend on medical grounds; the stated performance rationale isn’t supported by the endocrine literature; and there’s a genuinely good policy — targeted case-finding in TBI and chronic-opioid populations — sitting adjacent to it that this doesn’t do.