The story so far:
The U.S. Department of Defense has announced mandatory annual testosterone screening for all active-duty service members aged 30 years and above. Announced by U.S. Defence Secretary Pete Hegseth on July 15, the policy will make testosterone testing part of routine annual medical assessments. Personnel found to have low testosterone may undergo further clinical evaluation and can choose whether to receive testosterone replacement therapy (TRT), while those below 30 years may request testing voluntarily.
Mr. Hegseth said maintaining healthy testosterone levels could help personnel “operate at their absolute best”. The announcement comes weeks after the U.S. Department of Health and Human Services (HHS) said it would seek to ease some restrictions on testosterone replacement therapy, including expanding access for men with age-related low testosterone.
The move has also prompted political debate. Democratic lawmakers have questioned how expanding access to testosterone therapy for some service members aligns with the military’s broader policies affecting transgender personnel who receive gender-affirming hormone therapy. The Department of Defense has maintained that the screening programme is intended to improve troop health and readiness.
What is testosterone?
According to the U.S. National Institutes of Health (NIH), testosterone is the principal male sex hormone, although it is also produced in smaller amounts in women. Produced mainly by the testes, it plays a key role in puberty, muscle and bone growth, red blood cell production, fertility, sexual function and mood.
Testosterone levels usually peak during late adolescence and early adulthood before gradually declining with age. However, hormone levels vary widely between individuals, and this decline is a normal part of ageing.
What is testosterone deficiency?
The Endocrine Society defines testosterone deficiency, or male hypogonadism, as a condition in which the body does not produce enough testosterone to maintain normal physiological functions.
It may result from disorders affecting the testes, pituitary gland or hypothalamus, as well as certain genetic conditions, cancer treatment, obesity, type 2 diabetes, chronic kidney disease, obstructive sleep apnoea or some medications. Symptoms include reduced sexual desire, erectile dysfunction, infertility, fatigue, loss of muscle mass, increased body fat, low bone density, depressed mood and poor concentration. Because these symptoms can also occur in several other medical conditions, diagnosis cannot be based on symptoms alone.
How is testosterone deficiency diagnosed?
According to the Endocrine Society’s Clinical Practice Guideline, testosterone deficiency should be diagnosed only in men with symptoms consistent with the condition and consistently low testosterone levels confirmed through laboratory testing.
Blood samples are usually collected in the morning, when testosterone levels are highest, and the test is repeated on a separate day to confirm the diagnosis. Additional investigations may be needed to identify the underlying cause. The American Urological Association (AUA) also advises against diagnosing testosterone deficiency on the basis of a single laboratory result.
Why is the Pentagon’s screening policy unusual?
Screening involves testing people who do not necessarily have symptoms to detect a condition early, whereas diagnosis evaluates people with symptoms.
Routine testosterone screening for healthy men without symptoms is not currently recommended. The Pentagon’s decision therefore represents a departure from routine civilian practice by introducing age-based screening irrespective of symptoms. The Department of Defense has not explained why it selected 30 years as the threshold for mandatory testing.
Current clinical guidelines state that evidence is insufficient to recommend population-wide screening for testosterone deficiency, and whether routine testing improves long-term health outcomes or military performance remains uncertain.
What is testosterone replacement therapy?
According to the U.S. Food and Drug Administration (FDA), testosterone products are approved for men with hypogonadism caused by medical conditions affecting testosterone production. Treatment may be given through injections, skin gels, patches, oral formulations or implants.
Testosterone is also used as part of masculinising gender-affirming hormone therapy for some transgender people. However, this is a separate clinical indication from testosterone replacement therapy for hypogonadism, which is the focus of the Pentagon’s policy.
For appropriately selected patients, TRT can improve sexual function, muscle mass, bone density, mood and energy levels. However, the Endocrine Society notes that treatment requires regular monitoring because it may increase red blood cell counts, suppress fertility, worsen untreated obstructive sleep apnoea and require monitoring of prostate health. Managing underlying conditions such as obesity or poorly controlled diabetes may also improve testosterone levels without lifelong hormone replacement.
Why has the policy generated debate?
The announcement has sparked both medical and political debate. Medical organisations such as the Endocrine Society and the AUA continue to recommend that testosterone testing and treatment be guided by symptoms, repeated laboratory findings and an individual’s overall clinical condition rather than routine age-based screening. Some experts caution that widespread screening could lead to overdiagnosis or unnecessary treatment, while others say it may identify previously undiagnosed testosterone deficiency in some individuals.
The move has also drawn criticism from Democratic lawmakers and LGBTQ+ advocacy groups, who argue that expanding access to testosterone therapy for some troops while restricting military service by many transgender personnel receiving gender-affirming hormone therapy reflects an inconsistency in the administration’s policies. The Department of Defense has said the programme is intended specifically as a health and readiness measure for military personnel.
How common is testosterone deficiency?
According to the Endocrine Society, testosterone levels gradually decrease with age, but not every decline amounts to testosterone deficiency. Clinically significant hypogonadism is more common among older men and those with obesity, type 2 diabetes, chronic kidney disease and other long-term illnesses.
Experts emphasise that testosterone deficiency is a clinical diagnosis requiring careful medical evaluation. While testosterone replacement therapy can benefit appropriately selected patients, current guidelines recommend confirming the diagnosis through symptoms and repeated blood testing before treatment is initiated.
Published – July 17, 2026 02:16 pm IST
