Pentagon reboots testosterone screening plan for men 30 and over

Two months after announcing mandatory testosterone screenings, and weeks after rolling back an initial plan for it, the Department of Defense is directing all male service members ages 30 and above to get screened to see if they have a deficiency.

On Thursday, the Defense Department issued “Clinical Practice Guideline for Testosterone Deficiency in the Male Service Member.” The new guidance is effective “immediately,” according to a Pentagon spokesperson, and notes that health assessment questions around the military are being updated to match the new rules.

Defense Secretary Pete Hegseth announced the screenings in July, saying that the screenings are meant to help troops “have the right testosterone levels to operate at your absolute best,” and that the voluntary hormone replacement therapy is about “restoring and optimizing your natural capabilities, protecting your longevity, and ensuring you have the biological foundation required to sustain the fight.”

“By proactively identifying and treating suboptimal hormone levels, the Department continues to invest in the health of its warfighters, strengthen their performance, and maximize force readiness,” the Pentagon said in its release announcing the clinical guidance.

The screenings will be worked into troops’ annual Periodic Health Assessments and when they join the armed forces, according to the Defense Health Agency. Health screeners will check with male troops for symptoms including reduced sexual desire, erectile dysfunction or loss of spontaneous morning erections, as well as unexplained loss of muscle mass, depressed mood or low motivation, and diminished physical performance not tied to injuries. Health assessors will also note risk factors in male troops such as Type 2 diabetes, previous traumatic brain injury, sleep apnea, and other issues.

If one of those risk factors is present or the screening suggests low testosterone, troops will then get laboratory testing.

Testosterone deficiency can overlap with stress, sleep deficiencies, and caloric deficits, the guidance notes, “all of which are prevalent in the operational population.”

Guidelines for women are still being reviewed, according to Vice Adm. Darin Via, director of the Defense Health Agency.

For troops under 30, there are optional screenings available. The Pentagon is just screening troops for low levels of the hormone; they can take voluntary testosterone replacement therapy if they choose to.

The release comes two weeks after the Pentagon initially issued, then quickly rescinded, detailed screening guidelines for both men and women in the military, with different screening paths for them to determine if they suffered from low testosterone. The early September guidelines were supposed to go into effect immediately but were pulled within a day to “allow for updates,” according to a Pentagon statement.

According to researchers, testosterone decreases naturally in men as they age, although factors including stress can contribute to early decreases in testosterone levels.

The Defense Health Agency’s guidance says that testosterone replacement therapy has a “demonstrated benefit for sexual function and improves body composition and bone mineral density”; however, it pushes back on arguments Pentagon leadership has made. 

“Evidence does not support its use to improve energy, vitality, physical function, or cognition, and the American College of Physicians recommends against initiating therapy for those indications,” the agency noted.