Pentagon moves forward with mandatory testosterone testing for male troops

The Pentagon has rolled out formal guidance for mandatory testosterone testing for male service members 30 and older, a policy that leaves out women for now and faces questions from medical experts about the need and efficacy of such a program.

Defence Secretary Pete Hegseth announced in July that a new program to screen troops for “testosterone deficiency” was necessary to allow them to operate at their “absolute best.” The new clinical guidance, released late Thursday, outlines how the program would work.

The Pentagon's efforts to test for low testosterone coincide with growing interest in the hormone that has been driven by men's health influencers and podcasters, many of whom recommend the drug as a way to boost energy, muscle and feel younger.

However, many experts say those far-reaching benefits aren't supported by the science. Hegseth's messaging on the hormone has blended established scientific facts with broader, and less substantiated, claims.

The new guidance clarifies that the mandatory testing would initially apply to only male service members. Hegseth's initial memo in July directed mandatory testosterone deficiency screenings for all troops, but the clinical guidance released Thursday says it is for “testosterone deficiency in the male service member.”

The guidance says “the female clinical practice guideline is being reviewed and will be posted upon approval.” The Pentagon has not said whether female troops would be able to be evaluated for estrogen-based therapy as they enter perimenopause.

Testosterone declines naturally with age and can affect sexual function, mood, bone density and other measures. But experts have long debated how to diagnose those problems and whether to treat them by replacing the hormone.

In the last decade, federal studies have shown that boosting testosterone improves erectile dysfunction, low libido and other issues in men.

The Pentagon's top spokesman, Sean Parnell, said Thursday that “by proactively identifying and treating suboptimal hormone levels,” the Pentagon aims to “invest in the health of its warfighters, strengthen their performance, and maximise force readiness.”

Medical groups generally don't recommend automatic screening of testosterone levels. Instead, medical guidelines typically recommend testosterone for men who report symptoms -- including low libido and depressed mood -- and have two blood tests confirming low levels of the hormone.

The Pentagon's policy breaks from that approach, requiring testosterone screening for all male personnel 30 and older and allowing younger members also to request screenings.

Otherwise, the new guidelines mostly conform to medical standards, including acknowledging the limited benefits of replacing the hormone.

For instance, the guidelines say, “Evidence does not support its use to improve energy, vitality, physical function, or cognition.” Instead, the document mentions “demonstrated benefits” for sexual function and certain body measures, including bone density.

The policy does not make replacement therapy mandatory should a service member be found eligible, while the guidelines flag long-established side effects of boosting testosterone, including the potential for a drop in sperm count. When men receive testosterone externally, the body typically reduces -- or even stops -- its natural sperm production.

As a result, military doctors are instructed not to prescribe testosterone therapy to anyone hoping to have children in the near future.

Another complicating factor for troops is the controlled nature of testosterone itself. The memo notes that its "use in the deployed environment raises supply, custody, storage, and continuity considerations that should be resolved before departure rather than in theatre.”

The new guidance makes clear that injectable testosterone “requires controlled room temperature storage and controlled substance accountability” and that troops who are on replacement therapies need to ensure they have enough of a supply despite the fact that federal law limits prescriptions on controlled substances like testosterone.

The caution and practical hurdles within the documentation over the use of testosterone while on deployment stand in contrast to remarks from Hegseth in July, when he argued that the rigours of the modern battlefield demand “maximum psychological and mental readiness" and that testosterone therapy was part of the solution.