The U.S. Department of Defense has launched a controversial new health policy that is dividing military leaders and top medical professionals: earlier this week, Defense Secretary Pete Hegseth announced that all active-duty male troops aged 30 and older will be required to complete routine screening for low testosterone, also clinically known as hypogonadism. Under the new framework, service members who receive a low testosterone diagnosis will be offered access to testosterone replacement therapy, commonly shortened to TRT, if their providers deem it necessary. Hegseth has framed the policy as a critical investment in troop performance, arguing that optimizing hormone levels will preserve the U.S. military’s greatest tactical advantage: the individual war fighter.
In a public video released Wednesday to promote the initiative, Hegseth stated, “Our most decisive tactical advantage will always be the individual war fighter. We have a sacred duty to maintain that advantage which is why we must constantly look for new ways to optimise your performance.” The policy targets a large group of service members: 2024 military data counts more than 375,000 active-duty men over 30, with an additional 305,500 serving in the National Guard and reserve forces. To date, the Pentagon has released few concrete details about how testing will be rolled out or administered across the force of 1.3 million active-duty troops.
While the policy aligns with a booming national trend of rising TRT use and mainstream cultural interest in testosterone optimization, leading medical professionals who spoke to the BBC are sounding urgent warnings about the risks of mandatory broad screening, arguing that the policy is fundamentally misguided and likely to cause avoidable harm to healthy troops. Data from a May 2026 study published in JAMA Network estimates that roughly one in 10 adult men in the U.S. meet the clinical criteria for hypogonadism, a rate that climbs steadily with age, reaching up to 38% for men over 45. But experts emphasize that a low blood test result alone does not justify starting TRT.
Current clinical standards from the American Urological Association require two key criteria to prescribe testosterone therapy: confirmed low blood hormone levels and documented symptomatic health issues linked to hypogonadism, such as persistent low mood, reduced libido, and unexplained loss of muscle mass. For otherwise healthy people with asymptomatic low testosterone, the risks of unnecessary TRT far outweigh any potential benefits, experts say. Common harmful side effects include a dramatic drop in sperm count and permanent or long-term infertility, as well as shrinking of the testicles. In many cases of unnecessary TRT, it can take a year or longer for natural sperm production to return to baseline levels after stopping treatment.
More severe potential complications include increased risk of irregular heartbeat, blood clots, and abnormal breast tissue growth. Dr. James Anaissie, a Texas-based urologist and co-author of peer-reviewed research on testosterone deficiency, explained to the BBC that aggressive mass screening increases the likelihood of overdiagnosis and overtreatment, noting that symptoms associated with low testosterone can also stem from dozens of unrelated health conditions. “This is the problem with routine screening,” Anaissie said. “People start treating problems they don’t need to treat.”
Dr. Joseph Alukal, professor of urology and director of men’s health at Columbia University Irving Medical Center, went further, calling the Pentagon’s program “misguided.” Alukal explained that starting TRT is a lifelong medical commitment: once the body becomes accustomed to external testosterone, it often loses the ability to produce natural hormone at pre-treatment levels after stopping therapy, leading to worse hypogonadal symptoms than patients started with. “Screening aggressively is going to create that mess for some number of patients,” he said.
Beyond clinical risks, experts warn that delivering safe TRT at military scale creates significant logistical challenges, particularly for deployed troops. Effective TRT requires regular injections (typically one or two doses per week) and frequent blood monitoring to keep hormone levels within a safe, therapeutic range, as levels can fluctuate dramatically during treatment. Sudden interruptions to treatment, common during combat deployments where consistent medical access is not guaranteed, lead to uncomfortable “crash” symptoms including severe fatigue and low libido, even if they do not cause immediate life-threatening harm.
The Pentagon’s new policy comes amid a years-long surge in TRT use across the U.S., where the number of people seeking therapy jumped from 7.3 million in 2019 to 11 million in 2024. The growing popularity of testosterone optimization has been fueled in large part by mainstream cultural influence: high-profile public figures including podcaster Joe Rogan have openly discussed their personal TRT use, while a wave of social media influencers associated with the “looksmaxxing” trend have promoted testosterone as a near-miracle drug for boosting energy, muscle growth, sexual function, and bone density. Anaissie noted that it remains unclear whether the rise in TRT use stems from a real increase in clinically diagnosable hypogonadism, or simply more healthy men chasing the purported lifestyle benefits of hormone therapy.
The push for broader TRT access also aligns with the cultural priorities of the current Trump administration, which has centered “traditional masculinity” as a key cultural theme. Top administration officials have openly embraced testosterone as part of personal health and anti-aging routines: Hegseth, known for publicly projecting a hyper-masculine image through combat training photos and public appearances, spearheaded the new military policy. Health Secretary Robert F. Kennedy Jr., who made headlines for a viral photo of himself grappling with venomous snakes with his bare hands, has cited testosterone as a core part of his own anti-aging protocol. Last month, the Food and Drug Administration, which Kennedy oversees, announced plans to roll back existing public health warnings on TRT, a move that will make the therapy far more accessible to the general public. In January, Kennedy revealed on a podcast that Centers for Medicare and Medicaid Services leader Dr. Mehmet Oz had evaluated President Donald Trump’s testosterone levels, and found the 70-plus-year-old president had “the highest testosterone levels that he’s ever seen for an individual over 70.”