The Pentagon has directed mandatory testosterone-deficiency screening for active-duty and reserve personnel aged 30 and older as part of periodic health assessments, with testing available upon request for younger service members.
Testosterone replacement therapy will remain voluntary when clinically indicated. The screening protocol is designed to optimize performance and maximize mission readiness.
A senior medical analyst noted that screening makes sense for men who rely on peak physical performance, arguing the policy is a sound approach to identifying deficiency early.
Contrary to the Pentagon's approach, the Endocrine Society does not recommend routine testosterone screening for men without symptoms, citing insufficient evidence for population-level testing in asymptomatic individuals.
There is no single ideal testosterone level for every man. A harmonized reference range for healthy, non-obese men ages 19 to 39 is 264 to 916 ng/dL, though ranges vary by laboratory and method.
The American Urological Association considers a total testosterone level below 300 ng/dL, combined with symptoms, to indicate deficiency. Hypogonadism affects roughly 2% of men overall and becomes more likely with age.
Low testosterone can cause chronic fatigue, weight gain, bone and muscle loss, cognitive problems, and increased body fat. Untreated deficiency may also lead to loss of body hair, decreased bone density, and anemia.
Sexual symptoms such as reduced libido and erectile dysfunction are more specific signs of deficiency than general fatigue or poor concentration, which can stem from many causes.
Because testosterone fluctuates by time of day and can be affected by food, illness, and other factors, diagnosis requires symptoms plus low results on at least two separate early-morning, preferably fasting, blood tests.
If deficiency is confirmed, doctors may order luteinizing hormone tests to determine whether the issue originates in the testes, pituitary, or hypothalamus. Follicle-stimulating hormone may be measured when infertility is a concern.
Prolactin testing can reveal pituitary disorders that suppress testosterone, while free testosterone measurement helps when total levels are borderline or unexplained by symptoms.
Before prescribing therapy, physicians look for reversible factors including obesity, certain medications, untreated sleep apnea, acute illness, and excessive alcohol use. Weight loss is typically first-line treatment for obesity-related deficiency.
Therapy may be considered when consistently low levels and significant symptoms are present. It can be administered as gels, patches, injections, tablets, nasal gel, or pellets.
The Department of Health and Human Services has asked the FDA to update prescribing information for testosterone therapy based on a comprehensive review of clinical data and existing evidence.
Proposed changes would remove labeling language about unestablished safety in age-related hypogonadism and update prostate cancer risk information. The announcement affects drug labeling only and does not alter clinical guidelines.
Certain patients are not candidates for therapy, including those with active breast or prostate cancer, elevated hematocrit, untreated severe sleep apnea, recent heart attack or stroke, or blood-clotting disorders.
Men trying to conceive should avoid therapy, as it suppresses sperm production. Those receiving treatment require regular monitoring of hormone levels, blood counts, symptoms, and prostate health.
A 2023 trial found testosterone therapy did not increase heart attack, stroke, or cardiovascular death rates compared with placebo in older men with hypogonadism and cardiovascular risk. A substudy later found a higher fracture rate among treated men.
Researchers said the findings provide reassurance about cardiovascular safety when therapy is used as indicated in appropriately selected patients, but should not justify widespread prescription.
While therapy improves libido, sexual function, anemia, bone density, and lean mass in selected men, doctors emphasize it is not guaranteed to boost energy, cognition, or overall vitality.
