Pentagon issues immediate clinical guidance for military testosterone screening

The Pentagon on Wednesday issued detailed clinical guidance to begin mandatory screening for testosterone deficiency in active-duty and reserve service members aged 30 and older, moving Defense Secretary Pete Hegseth's July mandate from announcement to implementation.

The guidance takes effect immediately and is meant to standardize how the military tests and treats hormonal and energy-availability problems. Pentagon officials say the broader goal is to improve unit readiness by identifying issues that could eventually slow troops down. Men 30 and older will receive testosterone blood tests as part of routine care. Younger men will not be tested automatically, but can be tested when medically warranted or if a service member asks for it.

The policy takes a different approach for women. There is no requirement for routine testosterone testing, but the guidance calls for screening around fatigue and menstrual cycle disruption, recognizing conditions such as hormonal dysregulation, low energy availability and relative energy deficiency in sport. It also gives clinicians instructions on when off-label testosterone may be considered for women, with the main example being postmenopausal patients who report unusually low sexual desire.

Hegseth, a longtime proponent of testosterone, announced the screening mandate in July and has argued more broadly that hormone health is connected to military strength. Medical experts have questioned the premise. Some physicians say there is little evidence that universal testing for low testosterone in the military will improve combat readiness, and they worry the testing campaign could lead to unnecessary or potentially harmful treatment.

The Food and Drug Administration has scheduled an expert meeting for mid-September to review medical uses of testosterone, which could sharpen the debate just as the Pentagon's program ramps up. Because the policy covers such a broad population, it is likely to generate extensive data on testosterone levels, follow-up care and prescriptions. Whether that experience supports the Pentagon's rationale or fuels more skepticism will be watched closely by both supporters and critics.