After the Headlines: What the Military’s Testosterone Push Really Means for Readiness

The military has always liked measurable things. Run times, body fat, promotion points, dental readiness, weapons qualification, etc. If something affects performance, someone eventually finds a way to put a number on it. Now, testosterone is part of that conversation.

When the Pentagon announced an expanded testosterone-deficiency screening initiative this summer, it did so in the language of performance and readiness. Secretary of Defense Pete Hegseth directed an enhanced screening protocol “to optimize performance and maximize mission readiness,” while the broader Warfighter Performance Optimization initiative was framed around health, peak performance, and resilience across the force. Anyone who has spent time around a military formation can imagine how some service members heard that message.

Testosterone already carries a reputation, deserved or not, as something tied to strength, muscle, recovery and aggression. Pair it with words like performance and readiness, and the conversation tends to drift toward stronger, faster, and harder to fatigue. Just as easily, it swings the other way, toward familiar worries about “roid rage,” reckless behavior, and unnecessary hormone treatment. The medical reality is less dramatic than either version.

The Endocrine Society responded in July with a note of caution, not against testosterone replacement therapy for appropriately diagnosed hypogonadism, but about getting the correct diagnosis before treatment begins. Hypogonadism requires symptoms consistent with testosterone deficiency along with consistently low, accurately measured testosterone levels. The Society also says there is insufficient evidence to support population-level screening of asymptomatic men. Then, the policy itself started moving. Detailed clinical guidance was published in early September and withdrawn less than a day later so it could be updated. The broader screening initiative remained in place.

On September 17, the Defense Health Agency released the revised clinical practice guideline for male Service Members. The details matter. For men 30 and older, screening starts with a structured symptom and risk-factor assessment, not an automatic testosterone blood test. Laboratory testing follows when that screen is positive or a listed risk factor is present. A diagnosis requires compatible symptoms and two morning fasting testosterone measurements on separate days. The guideline also says testing should not be done within 30 days of extreme training involving physical or mental distress or sleep deprivation, during acute illness, or within 30 days of recovery from that illness. Those conditions can temporarily suppress testosterone. That is a much more careful process than the headline version of “mandatory testosterone screening” might suggest.

Testosterone does not operate in isolation. The symptoms that bring someone in for testing can overlap with poor sleep, stress, depression, metabolic problems, medication effects and other health conditions. That makes this more complicated than deciding whether more Service Members should get a testosterone test. The new DHA guidance makes that distinction explicit, saying current evidence does not support a treatment approach built around performance enhancement rather than a diagnosed deficiency. The more I looked into this issue and talked with people who have lived it, the less interested I became in the simple question of whether TRT is good or bad. There is a bigger readiness conversation here.

When the Symptoms Overlap

Low testosterone can cause real symptoms, including changes in libido, energy, mood, muscle mass, and sexual function. But none of those symptoms belong exclusively to testosterone deficiency. A service member who is exhausted and struggling with motivation may have low testosterone. He may also be sleeping four or five hours a night or have undiagnosed sleep apnea. Depression, chronic stress, obesity, diabetes, medication use, or another condition may be contributing.

That is why the Endocrine Society's clinical practice guideline calls for confirming low testosterone and evaluating the underlying cause rather than diagnosing hypogonadism from symptoms or a single laboratory result. A senior Army physician who provided clinical background for this article described TRT as one piece of a much larger medical conversation. His concern was not that testosterone therapy lacks a legitimate role. It was the risk of tunnel vision, deciding what the problem is before fully evaluating the patient. That point reframed how I looked at the initiative.

There may be readiness reasons for screening a broader population, but once a service member is sitting in an exam room, healthcare becomes individual again. What symptoms are present? What else could explain them? Is another condition contributing? And if treatment is appropriate, what are we actually trying to accomplish?

One Soldier's Experience

For Chief Warrant Officer 3 Tim Carter, an active-duty Army 880A Marine Deck Officer, those questions became personal. Before seeking treatment, Carter said he was dealing with depression, low motivation, and low energy. Like a lot of service members, he pushed through it for a while. Eventually, pushing through it stopped making sense.

“I was tired of feeling this way, and I knew something was wrong,” Carter said.

An advertisement for a men's wellness clinic caught his attention because the symptoms it described sounded familiar. He was evaluated, told his testosterone was below normal, and started TRT.

Carter remembers the experience positively, describing physical, mental, and emotional improvement after treatment began. His experience also shows why TRT cannot simply be reduced to raising a number. At one point, Carter said his testosterone climbed above 1,100 nanograms per deciliter. Reference ranges vary by patient, laboratory, and testing method, but a harmonized reference-range study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism established a range of 264 to 916 ng/dL among healthy, nonobese men ages 19 to 39. Carter said his estrogen levels rose as well and he was prescribed medication to bring them down. Looking back, that was one part of treatment he specifically wishes he had known more about going in.

“I would let them know about the estrogen levels,” Carter said. “That was something I didn't know about prior to accepting the treatment plan.”

His doctors continued monitoring those levels and adjusting his treatment as needed. That experience is a useful reminder that TRT involves more than getting a prescription and watching a testosterone number rise.

Eventually, Carter stopped TRT, mainly because of the cost of continuing through a commercial clinic. He still looks back on the experience positively but does not credit TRT alone.

“It was a combination of TRT program, change in lifestyle and diet,” Carter said.

That broader picture is worth paying attention to. Whether TRT prompted those changes or simply happened alongside them, Carter's experience became about more than correcting a hormone level.

Before and After the Prescription

Once testosterone deficiency is confirmed, there are still questions to answer. Why is the testosterone low? Could obesity, medication use, chronic disease, or another condition be contributing? Is the patient planning to have children? That last question matters because testosterone therapy can suppress sperm production. The Endocrine Society recommends against starting TRT in men planning fertility in the near term. For a younger service member who may want children, that belongs in the conversation before treatment begins.

That fertility question also raises a longer-term one: what happens if a service member later wants to stop TRT? Exogenous testosterone suppresses the hormonal signals involved in the body's own testosterone and sperm production. The new DHA guideline says that suppression is usually reversible, but recovery can take time. After sustained treatment, stopping TRT can create a period of symptomatic low testosterone while natural production recovers, and recovery of the hormonal axis and sperm production may take 6 to 24 months. Recovery can be slower or less certain after longer exposure, higher doses, older age, or pre-existing testicular dysfunction. That is different from saying everyone who starts TRT will need it for life. But it does mean the decision can have consequences well beyond the first prescription. For a service member who may want children or may not want to remain on therapy indefinitely, that belongs in the conversation before treatment begins.

Monitoring matters after treatment starts too. Cardiovascular safety has been one of the larger questions around TRT, and the evidence has evolved. The large TRAVERSE trial found no increase in its primary measure of major cardiovascular events among men with hypogonadism and preexisting or elevated cardiovascular risk who received testosterone compared with placebo, although several adverse events occurred more often in the testosterone group. The FDA has since revised testosterone labeling as that evidence developed. That does not make TRT risk-free. It reinforces the need to select patients appropriately and keep evaluating them after treatment begins.

What About Aggression?

Few words invite stereotypes around testosterone faster than “aggression.”

One question raised around the military's renewed focus was whether broader TRT use could contribute to domestic violence or military sexual trauma. Based on the evidence I reviewed, I found no basis for making that leap.

A 2020 meta-analysis examining testosterone and human aggression found only weak associations between testosterone and aggression. In studies where testosterone levels were experimentally manipulated, the overall causal effect was weak and not statistically significant.

That does not mean changes in mood or behavior should be ignored, particularly if a patient or family notices something different after treatment begins. It does mean an issue as serious as domestic violence, or MST, deserves evidence rather than assumption.

A Lesson From Women's Hormone Therapy

The Army physician I spoke with described himself as an early adopter of technology but a slower adopter of medicine. His example was hormone therapy for women.

It is not a perfect comparison, and he was not suggesting testosterone therapy will follow the same path. His point was about how medicine changes as evidence improves.

For years, postmenopausal hormone therapy was believed to offer broader protection against chronic disease. The Women's Health Initiative changed that understanding. Long-term follow-up has since produced a more individualized picture, with NIH emphasizing that hormone therapy decisions should account for age, risk, symptoms, and the reason treatment is being considered. The lesson is not that testosterone is destined for the same story. It is that medicine gets better when we are willing to adjust as the evidence improves.

The Bigger Readiness Opportunity

I am a registered respiratory therapist, so I have a sleep bias. That comes from watching people spend months, sometimes years, trying to fix fatigue with caffeine, energy drinks, supplements, medications, or whatever health trend happens to be popular at the time, while they may simply be sleeping terribly. Fatigue can absolutely be associated with low testosterone. It can also come from sleep apnea, chronic insomnia, depression, medications, stress, metabolic disease, or simply not getting enough sleep.

The body does not sort those problems neatly into endocrinology, sleep medicine, behavioral health, primary care, and nutrition before presenting symptoms to the patient.

They overlap.

The current VA/DoD Clinical Practice Guideline for chronic insomnia and obstructive sleep apnea reflects that broader evaluation, with separate pathways for screening and management. The new DHA testosterone guideline now brings some of that same thinking directly into this issue. It tells clinicians to look for reversible contributors, including obstructive sleep apnea, certain medications, alcohol use, sleep and energy availability, rather than treating testosterone as if it exists in a vacuum. That is why I keep coming back to what happens after screening.

Service members become very good at pushing through things. Fatigue becomes part of the job. Poor sleep is expected. Stress comes with the territory. Changes in weight, mood, motivation, or performance can gradually become something a person learns to live with rather than a reason to seek care. Military culture places a premium on toughness, and there are times when pushing through discomfort is necessary. But people can also spend a long time convincing themselves something is normal simply because they are still capable of functioning through it. If the attention around testosterone gets more service members to notice that something has changed and ask why, that has value.

A service member may walk into a clinic believing his testosterone is low and hoping TRT will help. Maybe he is right. If testing confirms hypogonadism and TRT is medically appropriate, then TRT may be the right tool. But the prescription is not the finish line. Continued monitoring still matters. Maybe testosterone is not the problem. Maybe he has sleep apnea. Maybe depression or chronic stress is contributing. Maybe weight, diet, diabetes, medication use, or another medical condition is affecting his health and performance. That treatment matters just as much.

A sleep study that identifies obstructive sleep apnea does not improve readiness if the service member never follows through with treatment. A behavioral health referral cannot accomplish much if stigma keeps someone from using it. Recommendations involving nutrition, weight, or metabolic health will not change anything if they are dismissed simply because they require more work than the treatment someone hoped to receive. TRT can be one of many valuable tools to improve readiness and performance. It is not an easy button.

If peak performance is really the goal, testosterone belongs alongside sleep medicine, behavioral healthcare, nutrition, physical conditioning, weight management, medication changes, and treatment of underlying disease. Some service members will leave that evaluation with TRT. Others will leave with an entirely different treatment plan. Both can be successful outcomes. We spend a lot of time in the military teaching people to push through discomfort, and there are good reasons for that. Resilience is part of the profession. But resilience and ignoring a treatable health problem are not the same thing.

If you are dealing with fatigue, low motivation, poor recovery, changes in mood, weight, or sexual health, talk with your provider and get evaluated. Maybe testosterone is part of the problem. Maybe it is not. If TRT is appropriate, follow through with the monitoring and treatment plan. If the answer turns out to be sleep apnea, depression, metabolic disease, nutrition, medication effects, or something else, follow through with that too.

Work with your provider and use the resources available to address whatever is keeping you from feeling and performing at your best. If the military’s new focus on testosterone gets more service members to start that conversation, great. The prescription does not have to be the point. Getting service members to pay attention to what their bodies are telling them, ask why they do not feel right, and actually follow through with the answer may be the bigger readiness win.