Secretary of Defense Pete Hegseth recently announced a new policy to screen service members over 30 for low testosterone and offer replacement therapy to those who qualify.
The intent — a stronger, more capable force — is a good one. Policies built on good intentions, however, can still go wrong, and this one deserves careful scrutiny before it is implemented at scale.
The goal of having a more effective military is understandable, but the question remains whether the science supports the strategy.
Testosterone replacement therapy is an important treatment for men with true hypogonadism, a carefully diagnosed medical condition. But expanding hormone screening across hundreds of thousands of healthy service members represents a significant shift in military medicine — one that deserves far more public discussion than it has received.
The military has always embraced innovation, but medicine is different. Good intentions are not enough. Before introducing any intervention on a broad scale, policymakers should be confident that the benefits outweigh the risks for the entire force.
So, does the evidence actually show testosterone makes troops more lethal or better fighters? Not clearly.
The Army’s own research is instructive. In the service’s first Optimizing Performance for Soldiers study, men given weekly testosterone injections during a simulated combat energy deficit preserved more lean muscle than men on placebo, but their physical performance declined at about the same rate as the untreated group.
The hormone helped the body hold onto muscle, but did not translate into better fighting performance. Put simply: the case that testosterone will make service members deadlier hasn’t been made.
It’s also worth considering what a low testosterone reading often actually represents. A low laboratory value may reflect the normal physiological demands of military service rather than a chronic hormonal disorder.
Sleep deprivation, combat deployments, chronic stress, obesity, alcohol use and intensive physical training can all temporarily suppress testosterone levels. Low testosterone is often a symptom rather than the underlying problem.
If the Department of Defense wants to build a stronger military, investments in sleep, nutrition, physical conditioning, behavioral health and recovery science are likely to produce broader and more lasting benefits than widespread hormone replacement.
Without careful evaluation, including repeat testing and assessment for reversible causes, many healthy service members could be labeled as testosterone deficient and begin long-term treatment they may never have needed. That decision carries consequences.
Once testosterone therapy begins, the body’s own production is suppressed. Fertility may decline. Testicular atrophy can occur. Some men become dependent on continued treatment because normal hormone production does not fully recover.
Ongoing monitoring is required to watch for elevated red blood cell counts, prostate-related concerns, sleep apnea and other potential complications. Researchers continue to study the long-term cardiovascular effects, particularly in younger, healthier populations.
Behavioral effects deserve equal attention. Testosterone influences mood, confidence, motivation and aggression. When appropriately prescribed, these effects may improve quality of life in men with genuine deficiency. But unnecessary treatment, or excessive hormone levels, may increase irritability, impulsivity, emotional volatility or impaired judgment in susceptible individuals.
In a military that depends on discipline, restraint and sound decision-making under extreme pressure, even uncommon adverse effects warrant careful consideration.
Testosterone therapy has an important place in modern medicine. That is indisputable. The key issue, though, is whether routine screening and expanded hormone treatment across one of America’s healthiest working populations will strengthen military readiness or create long-term health challenges that outweigh the expected benefits.
Many of these issues will need to be addressed by the Department of Veterans Affairs after the service member transitions to civilian life.
America’s military superiority has never depended on a laboratory value. It is built on leadership, training, discipline, resilience and the judgment of the men and women who serve. Those remain the greatest sources of our strategic advantage.
David Shulkin, MD, was secretary of the U.S. Department of Veterans Affairs during the first Trump Administration and served as VA’s under secretary of health during the Obama Administration.
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