The Pentagon has republished clinical guidance on its testosterone screening program for all male service members aged 30 and older, outlining details of the policy that has raised questions among some experts over its scientific basis.
The original guidelines were briefly published in early September, but then rescinded for updates.
Pentagon spokesman Sean Parnell said Thursday the department was investing in “the health of its warfighters” through “proactively identifying and treating suboptimal hormone levels.”
The guidance contains details for implementation of the policy announced by Defense Secretary Pete Hegseth in July. It will see all male service members aged 30 and over screened for testosterone deficiency on entry to the military or during their annual health assessment. Those with low levels will be offered voluntary testosterone replacement therapy.
Testosterone naturally declines with age, and low testosterone has been associated with loss of muscle mass, fatigue, and low sex drive in men and women. It also affects physical performance, which could impact a service member’s ability to pass new fitness tests Hegseth is requiring for those in combat roles.
“While we invest heavily in our weapon systems, platforms and gear, our most decisive tactical advantage will always be the individual warfighter,” Hegseth said in a July video titled the “The High-T Department of War.”
Hegseth’s original announcement about the screening did not differentiate between male and female service members, raising questions about the impact on female troops.
The newly-published guidelines apply to male service members only, and say screening and treatment for female service members will be addressed at a later date.
The Pentagon declined to comment when asked by The Washington Post about when clinical guidelines for female service members would be released, and whether service members who failed fitness tests and had low testosterone levels could take fitness tests again after treatment.
The guidelines published Thursday state that testosterone levels will be tested on two separate days, though tests will not be undertaken within 30 days of training involving extreme physical and mental distress or sleep deprivation, or during illness. Symptoms and risk-factors such as obesity and Type 2 diabetes will also be taken into account, and service members under 30 can also be screened upon request.
Those that are shown to have low levels of testosterone will have the option of hormone replacement therapy, and other health risks will be discussed as part of the treatment, the Pentagon said.
Physicians and researchers have questioned the policy, previously telling The Post that it is wrong to assume that more testosterone necessarily indicates better strength or health, and that there is no consensus that testosterone improves longevity. It is unusual to screen patients for low testosterone unless there are symptoms, they added.
Testosterone levels can naturally fluctuate, even hour by hour, complicating the screening process, experts added. Hormone replacement therapy can also impact sperm production in men.
The guidelines released Thursday acknowledge the difficulty of screening the military population, stating that the symptoms attributed to low testosterone “overlap substantially” with the effects of the sleep restriction, calorie deficits and mood disorders. It said the pretest conditions of the screening process, including testing at consistent times of day, and not testing within 30 days of extreme training, would control for this.
The updated guidance also notes that while testosterone therapy has benefits for sexual function and bone mineral density, “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,” referencing a 2020 guideline on the subject.
A patient information sheet included in the guidelines also highlighted various side effects from testosterone treatment, including increased blood thickness and impacts on fertility.
“Testosterone shuts down your body’s own production of sperm,” the guidance said, adding that while “most men recover after stopping” treatment, that was not guaranteed.
“If you want children now or in the future, tell your provider before you start. There are other treatments that raise testosterone without shutting down sperm production, and sperm banking is available,” the guidance said.
It also noted that testosterone therapy is “not a performance enhancer.”
“If your levels are normal, this treatment is unlikely to help you and may cause harm,” it states.
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