Military testosterone screening plan draws medical skepticism over cost, efficacy

Defense Secretary Pete Hegseth announced a new military health policy this week that will require all service members over 30 to undergo annual testosterone screening, with younger troops given the option to be tested as well. Those found to have low levels will be offered testosterone replacement therapy. The announcement, made just days ago, has already drawn sharp criticism from endocrinologists and other medical specialists who question both the scientific foundation of the program and its practical costs.

Hegseth has spoken repeatedly about physical standards in the military, framing appearance and masculinity as markers of combat readiness. The testosterone screening policy appears to extend that thinking into medical practice. But doctors say the science doesn't support it. The Endocrine Society and the American College of Physicians both recommend against routine testosterone screening in the general population, citing insufficient evidence that normal hormone levels affect performance or health outcomes.

Dr. Marcus Goncalves, who directs the endocrinology division at NYU Langone Health, explained that testosterone naturally varies widely among healthy men. The normal range spans from 270 to over 900 units, and a man at 350 is just as healthy as one at 650. "Putting people on that scale has no link to how masculine they are or feel or look," Goncalves said. Testosterone does help maintain muscle and bone, and it affects mood and energy. But it isn't inherently tied to strength or capability. For young men especially, the risk of genuinely low testosterone is very low, and when levels do dip, it's often temporary—caused by stress, poor sleep, or overexertion, all common in military life. The body typically rebounds on its own once the stressor passes.

Testing itself presents practical problems. Testosterone levels fluctuate throughout the day and are highest between 8 and 10 a.m., so proper diagnosis requires testing in that narrow window, ideally after fasting. A single low result isn't enough; guidelines call for repeat testing over months to confirm a diagnosis. Dr. Céline Gounder, CBS News medical correspondent, predicted that blood draws alone would cost the military "tens of millions of dollars a year," with follow-up tests, treatment, and monitoring driving the total far higher. "There's no published analysis showing this is a good use of money," Gounder said, "and that should matter for an administration concerned with waste, fraud and abuse."

The medical risks of testosterone replacement therapy add another layer of concern. The therapy uses anabolic steroids, delivered by injection, pill, gel, or patch. It can increase red blood cell production to dangerous levels, raising the risk of blood clots, pulmonary embolisms, and kidney injury. It can also suppress the body's own testosterone production, causing testicular shrinkage and reduced sperm production—a serious problem for men planning to have children. High testosterone can convert to estrogen, leading to breast tissue growth. And mass screening of millions of service members would inevitably produce false positives, triggering unnecessary medical workups and overtreatment in people who were never actually ill.

For men with genuine medical conditions—testicular dysfunction, pituitary problems, or injury—testosterone replacement can be genuinely beneficial. But for healthy men whose testosterone happens to fall in the lower part of the normal range, the evidence doesn't support treatment. "For most men over 30, we don't have evidence that finding and treating a low testosterone number makes them healthier, stronger or more capable," Gounder said. "We do have evidence that it carries risk."

The policy arrives amid a broader cultural moment. Testosterone replacement prescriptions in the United States have more than tripled in recent years, often prescribed to men who were never properly diagnosed. Wellness influencers and marketers promote "optimization" of the body as a given good. Health and Human Services Secretary Robert F. Kennedy Jr. has called himself a fan of such medications. But Goncalves cautioned against the assumption that pushing hormone levels higher always yields better results. "We have a lot of examples in medicine where that is not the case," he said. The military's new screening program, if implemented as announced, will test that assumption at scale—and at considerable expense.