Doctors question evidence behind Pentagon plan for testosterone screening | US military

U.S. defense secretary ⁠Pete Hegseth this week ordered annual testosterone deficiency screening for active-duty and reserve service members ages 30 and older, saying it would help maintain military readiness.

But many medical experts warn that this may do no good and could instead increase the risk of infertility or other consequences in soldiers if testosterone is prescribed inappropriately.

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

Hegseth also reversed the military’s long-standing flu vaccine mandate; this decision was withdrawn after the flu epidemic; The Department of Health and Human Services removed 17 members from its vaccine advisory panel and changed vaccine recommendations.

⁠Five of six men’s health experts contacted by Reuters for this story said they were surprised by the announcement about testosterone testing and worried it could lead to unnecessary or even harmful treatment.

Hegseth said the tests would be accompanied by advice to help soldiers make decisions about treatment and that it would be voluntary.

He added that the goals are to ensure troops have the correct testosterone levels so they can function at their absolute best, and to increase their endurance, longevity and performance to ensure the military is combat-ready.

Four out of six doctors said there is no solid evidence to suggest that screening for low testosterone in all military personnel age 30 and older would optimize U.S. combat readiness.

said Dr., a urologist on the medical advisory board of Rugiet, a telehealth platform that provides testosterone supplements. “We hear from patients that when you treat low T, things like cognitive alertness and endurance improve. But the evidence is inconclusive, and it comes from patients who were treated because they were symptomatic,” said Kevin McVary.

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

Recommended tests for symptoms

The American Urological Association and Endocrine Society recommend ‌testosterone supplements for patients with confirmed testosterone deficiency and symptoms such as decreased libido, erectile dysfunction, fatigue, decreased muscle mass, and decreased bone density.

McVary said giving testosterone without medical indications leads to overtreatment, which can have its own negative consequences.

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

“There is a 1% annual decline in the population level after age 30-40 and it accelerates as we get older,” but these patterns are not the same for everyone, Muhammad said.

Endocrinologist Dr. of Dartmouth Hitchcock Medical Center. Ugis Gruntmanis noted that most studies on testosterone replacement have been done in older men, and the new mandate provides an opportunity to collect data on younger men.

But he added that widespread implementation of screening without preliminary study data would mean putting the cart before the horse.

FDA lifts warning

Based in part on a study led by Cleveland Clinic’s Dr Steven Nissen of more than 5,200 men aged 45 to 80 with low testosterone and a high risk of heart disease, the US Food and Drug Administration (FDA) has revised testosterone labels to remove a warning about an increased risk of heart attack or stroke. However, Nissen said participants had higher rates of atrial arrhythmia (abnormal heart rhythm) and bone fractures, and this finding could be meaningful for the military.

All of the experts interviewed by Reuters also mentioned the serious impact of testosterone therapy on male fertility.

“Many in our armed forces are young men who cannot reunite with their families,” McVary said. “If you reduce testosterone, the testicles shrink. And you can’t really count on them coming back.”

Other risks include thickening of the blood, prostate problems, acne, hair loss, enlargement of breast tissue, and mood swings.

Hegseth said in his announcement that one of the goals of the new screening mandate is to comprehensively address operator syndrome, which affects special forces warriors such as Delta Force members and Navy Seals and includes low testosterone as well as traumatic brain injury, hormonal and metabolic dysregulation, sleep disturbance and other illnesses.

However, Dr. from the University of Hawaii, whose team first described the syndrome in 2020. B Christopher Frueh said special forces operators do not represent all active duty and reserve members.

“These operators are at the high end of the spectrum,” Frueh said. “They’re at much higher risk from explosions, from aircraft splashes, from all kinds of different weapons firing, from shoulder-launched rockets, from machine guns.”

Other soldiers may have some elements of the syndrome, he said, “but should we screen 100% of everyone? Maybe. I don’t know.”

He believes that many young soldiers can rebuild their testosterone levels by regulating hormones through sleep, rest and diet, rather than resorting to replacement therapy.

Weight and low testosterone

Still, medical experts emphasize the potential benefits of proper testosterone testing, as with other types of medical testing.

Gameday Health’s Muhammad said reservists in the general population may be overweight, which could be another correctable factor that could contribute to low testosterone.

“Testosterone is one of the most useful blood tests we use to measure men’s health,” Muhammad said. “Broader screening would identify many men with reversible causes and some with true deficiency. Both groups would benefit from clinician-led care, whether that means correcting reversible causes or initiating treatment when truly necessary.”

The Pentagon did not provide detailed guidance on how abnormal test results would be evaluated or whether screenings would be applied equally to men and women.

Large screening could also reveal new information about the hormones of female soldiers, said Frueh of the University of Hawaii.

“Women probably won’t need testosterone replacement, but they may need other hormonal interventions,” he said.