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Defense Secretary Pete Hegseth kicked a hornet’s nest with his move this week to test troops’ testosterone levels.
Hegseth argues the effort, to become part of the military’s periodic health assessment for troops over 30, will ensure the optimal performance and long-term health of warfighters.
But medical experts say Hegseth’s rationale for the directive isn’t backed by science, warning of overdiagnosis and warning of side effects like heart problems and infertility.
Coming amid the broader embrace of the hormone among White House officials, the move plays into Hegseth’s focus on appearances and masculinity, which one Democrat said this week borders on “homoeroticism.”
Derek Griffith, the director of the program for research on men’s health at the University of Pennsylvania, told The Hill that as only 2 percent of the male population suffers from low testosterone, it doesn’t “suggest that this is a major problem” in the military — a group of relatively younger, fitter men and women.
Griffith said that for those who have low testosterone, testosterone replacement therapy, or TRT, could help improve their health. That’s exactly what the Pentagon is offering should troops find they have low levels of the hormone.
But Griffith was skeptical that the Defense Department was putting the correct amount of energy into the issue versus addressing the primary drivers of poor health outcomes in men, including heart disease, cancer, hypertension, diabetes, depression and alcohol abuse.
“I don’t fully understand,” he said of the new screening guidelines. “I don’t know what they’re seeing or what data they’re using to say ‘this is where we need to really focus and put our energy.’”
And when it comes to the age to start screening for low testosterone, he said 30 is “not probably where I would start.”
“It’s not what’s usually a major issue for healthy men,” Griffith said. “I imagine for most active-duty military, they’re pretty much at a healthy weight. So I would be curious what percentage they’re expecting to identify who have low testosterone and would be in need of a treatment.”
In the second Trump administration, traditional masculinity has taken center stage, with Hegseth, a former National Guard member and Fox News host, often shown working out with troops, doing pushups and lifting weights in posts to social media.
He also has imposed new, stricter fitness standards on the U.S. military that will require everyone to meet a “male standard.”
Health and Human Services Secretary Robert F. Kennedy Jr., likewise, has sought to show off his virility, notably working out shirtless in jeans and riding an exercise bike in a sauna alongside musician Kid Rock in a video released in February.
Kennedy often has extolled TRT as part of his “anti-ageing protocol,” and since joining the Trump administration has called slowly declining testosterone levels worldwide over recent decades an “existential” threat to humanity.
The attention on testosterone, a cultural marker of masculinity, has shifted the debate on who should be able to access the hormone after decades of the Food and Drug Administration recommending it only be prescribed to men with medical issues affecting testosterone production.
Hegseth in a video message said the new screening program, announced on Wednesday, would ensure troops “have the right testosterone levels to operate at [their] absolute best because it’s well-established science that as we age, testosterone levels often naturally drop.”
Should treatment be recommended following the test, service members have the choice to receive TRT.
“This initiative, it’s not about artificial enhancement; it’s about restoring and optimizing your natural capabilities, protecting your longevity, ensuring you have the biological foundation required to sustain and fight,” Hegseth said. “We owe our warriors the absolute best medical care in the world. And this program delivers on that obligation.”
It’s not yet known whether service members who failed new combat fitness standards and are found to have low testosterone levels could then seek treatments and retest.
There are benefits and risks of replacing testosterone, the hormone that affects sex drive, mood weight and fitness. Low testosterone can be linked to other serious health conditions including diabetes, cardiovascular disease, osteoporosis and depression.
But one of testosterone’s clearest known side effects is low sperm count, posing a fertility risk in young service members who might be thinking about starting a family, Griffith said.
“Testosterone even in low doses increases heart problems, kidney problems, infertility and fractures, which hardly seems like a good way to keep soldiers in fighting form,” Adriane Fugh-Berman, a professor in the department of pharmacology and physiology at Georgetown University, told The Hill.
“Hegseth’s remarks seem to imply that testosterone increases longevity, and there is no evidence for that. It shrinks testicles, too. How manly is that?” she added. “It’s ridiculous to screen a population for a questionable condition which has a treatment with unproven benefits and proven risk.”
Joel Heidelbaugh, a clinical professor of urology at the University of Michigan, said screening all service members 30 and older “is probably a little bit aggressive,” given that low testosterone is usually coupled with specific symptoms such as low energy and reduced sex drive.
And given that the normal range of the hormone is 300 to 1,000 nanograms per deciliter in men, with levels likely to spike in the morning versus later in the day, routine testing for low testosterone with no symptoms present runs the risk of over-diagnosis. The Endocrine Society advises against such routine testing without symptoms.
Others worried that the focus on testosterone levels “appears to be happening in tandem with mis- and disinformation about masculinity circulating on social media,” according to Brooke Nickel, a public health researcher in the Faculty of Medicine and Health at the University of Sydney.
“Young, healthy men are being told that common experiences like tiredness, stress or changes in libido are signs that something is medically wrong and that testosterone is the solution,” Nickel said in a statement.
She added that there’s a range of “normal” testosterone levels, with “little science to back the Pentagon’s decision to offer yearly routine screening for those over the age of 30.”
Rep. Becca Balint (D-Vt.) on Thursday said Hegseth’s testosterone screening requirement “is indicative of the fact that there are so many people in this administration that have some weird, like, intense homoerotic feelings towards men while also being incredibly homophobic.”
Balint, who is openly gay, told reporter Scott MacFarlane with MeidasTouch that she does not find the homoeroticism to be “the weird part.”
“The weird part is that they pretend that that’s not what it’s about,” the lawmaker continued. “And so, Pete Hegseth is like the example of this manly, manly, rugged, macho man.”
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