US Army | Beware of prescribing testosterone

The US Secretary of Defense, Pete Hegseth, wants to subject all US military personnel aged 30 and over, including women, to an annual screening of their testosterone levels. Those with a deficiency could, if they wish, receive hormone replacement therapy. A treatment which, however, carries several risks. Here is what we need to understand about a measure that raises as many medical questions as it does political questions.

Why does the Pentagon want to measure the testosterone of military personnel?

According to Pete Hegseth, this measure will ensure that soldiers have the physical capabilities necessary to fight on a battlefield. “It’s about restoring and optimizing your natural abilities,” says the Pentagon chief.

For Éric Sauvé, a former officer in the Canadian Armed Forces, this decision is part of the vision that Hegseth seeks to impose on the American armed forces. “He wants to remake the forces in his image: macho, virile, where women and blacks have no place. He constantly talks about lethality and virility,” he says.

Is systematic testing for testosterone recommended?

No. “There is no evidence that systematically screening for low testosterone is useful,” says Dr.^r Rémi Rabasa-Lhoret, endocrinologist at the Montreal Clinical Research Institute and the University of Montreal Hospital Center (CHUM).

“In good clinical practice, we do not dose testosterone if there are no symptoms of testosterone deficiency. »

Why is it so difficult to diagnose low testosterone?

Because the symptoms are often not specific.

“Fatigue, for example, can have a multitude of causes,” explains Dr.^r Rabasa-Lhoret.

In a soldier, it can be linked to intensive training, lack of sleep, stress or many other factors. Even more suggestive symptoms, such as sexual dysfunction, may have causes other than low testosterone.

Are military personnel more likely to suffer from testosterone deficiency?

possibly

Chronic stress, lack of sleep, repeated head trauma and long periods of training can contribute to low testosterone levels. Research among U.S. Special Forces has also described a phenomenon called “operator syndrome” in which some service members experience more hormonal disturbances after several years of service.

But that doesn’t mean they have a deficit that requires treatment.

“We give testosterone in limited cases. As an endocrinologist, I see a lot more people to whom I tell that it is useless,” underlines the D^r Rabasa-Lhoret.

Does this treatment carry any risks?

Yes, and they can be important.

Testosterone administration can interrupt sperm production and thus compromise fertility. It can also increase the number of red blood cells, which increases the risk of clots, stroke, heart attack or pulmonary embolism.

In some people with certain cancers, it could also promote the progression of the disease.

“Giving testosterone to someone without having carefully monitored everything will cause cancer to flare up,” illustrates Dr.^r Rabasa-Lhoret.

Is testosterone popular?

Yes. In the United States, it has become very popular with men seeking to increase their muscle mass.

According to the D^r Rabasa-Lhoret, this trend is also perceptible in Quebec.

“While it was exceptional 10 years ago, I have at least 10% of men asking me if we could not measure testosterone. »

In many cases, he adds, fatigue or low energy can be explained more by lifestyle, lack of sleep, stress or abdominal obesity than by a hormonal deficiency.

Why are women included?

This is one of the most surprising aspects of the Pentagon’s announcement.

Women produce testosterone naturally, but in amounts 10 to 20 times lower than men. However, there are currently no testosterone treatments approved by the US Food and Drug Administration for women.

The Pentagon did not explain what would be done with the results obtained among female soldiers.

“It’s extremely simplistic thinking, especially in endocrinology, that we’re missing it, we’re going to replace it. Everything is fine, next topic. It’s infinitely more complicated than that,” insists the D^r Rabasa-Lhoret.

He adds: “I am absolutely amazed that people can say stupid things of this nature. »

Is this decision linked to the debate on transgender soldiers?

Yes, indirectly.

Since his arrival at the Pentagon, Pete Hegseth has banned the military service of transgender people, questioned the presence of women in certain combat units and multiplied declarations promoting virility and the “lethality” of the armed forces.

Critics point out that it is paradoxical to cite the difficulties associated with hormonal treatments to justify the exclusion of transgender soldiers, while now offering hormonal treatment to soldiers with low testosterone levels.