Pete Hegseth leaned in toward the camera.

Since the early days of his tenure as secretary of defense, the former Fox News host had been posting clips on social media for the public. But this time, with an amber glow illuminating the American flag in the background, he spoke directly to those under his command while launching a major health initiative. 

Going forward, military members age 30 or older would receive annual screenings for testosterone deficiency, while younger service members could request one. And the Defense Department would offer testosterone replacement therapy to those who needed it. 

In announcing the testosterone initiative, Hegseth said it was “not about artificial enhancement” but about optimizing service members’ performance and resilience. 

“It’s about restoring and optimizing your natural capabilities, protecting your longevity, and ensuring you have the biological foundation required to sustain the fight,” he said.

Testosterone is a hormone that affects reproduction, muscle mass, cardiovascular function, and other functions throughout the body. 

Testosterone therapy may be medically appropriate and beneficial for people diagnosed with serious deficiencies, including some patients with traumatic brain injury, cancer, or seniors with significant age-related decline. But even for them, treatment carries risk and requires careful diagnosis and monitoring.

Existing research suggests that testosterone deficiency is rare within the U.S. military. In 2025, researchers at Madigan Army Medical Center reviewed the medical records of 2.8 million active-duty male service members and found that just 0.43% had been diagnosed with hypogonadism, the clinical term for testosterone deficiency.

For most of them, the diagnosis was likely a symptom of some other condition—such as diabetes, insufficient sleep, poor nutrition, alcohol use, or opioid use—according to Anthony Hackney, professor emeritus of exercise physiology and nutrition at the University of North Carolina.

Hegseth’s video, branded “The High T Department of War,” tapped into a growing cultural fascination with boosting testosterone as a path to greater masculinity, physical performance, cognition, mood, and longevity—along with a $4.1 billion supplement market built around those promises.

And Hegseth has continued to tout testosterone as emblematic of the culture he wants to build in the military.

“The ideological clowns are out. The patriotic cowboys are in—with testosterone testing on top,” Hegseth said in a speech to military leaders in late September.

The testosterone initiative also comes amid Hegseth’s broader push to measure service members to “the highest male standard,” his ordering of a new study into the long-settled debate over women in ground combat roles, and his firing of several women from senior leadership positions. While women biologically need testosterone, none of the experts who spoke with The War Horse considered the program as especially relevant to women. A federal judge has also ordered the Pentagon to explain why it would provide testosterone therapy for male service members while restricting hormone therapy for their transgender peers.

Experts and service members who spoke with The War Horse questioned both the rationale for such broad screening and the military’s ability to carry it out. At best, they said, the testosterone initiative may consume resources without meaningfully improving readiness. At worst, the emphasis on “optimizing” testosterone could encourage some service members to seek treatment they do not need, exposing them to avoidable health risks. Some worry that men will underestimate those risks or conclude that raising their testosterone levels is something military leaders expect of them.

Those concerns may already be coming to fruition: An active-duty Navy officer who spoke with The War Horse on condition of anonymity because he feared career repercussions said sailors are asking him “10 times a day” when the Navy will start giving them testosterone.

The Pentagon’s New Testosterone Treatment Guideline 

On Sept. 2, 2026, the Pentagon released its first formal guidance for testosterone screening and treatment for both men and women. 

The document immediately raised questions. Among other provisions, it directed physicians to regularly assess whether hormone levels and related symptoms in women affected their fitness for duty, while imposing no comparable requirement for men. 

The guidance also came as a surprise to Dr. Larry I. Lipshultz, a professor of urology at Baylor College of Medicine and chief of its division of male reproductive medicine. 

Lipshultz was one of four physicians the Pentagon enlisted to develop a testosterone screening and treatment guideline. He said his team was already working on the project when the Sept. 2 document was issued but did not know who wrote it or why it was released. 

“I don’t think there’s anything wrong with it. It just wasn’t what they needed,” Lipshultz told The War Horse. 

To him, the document read more like a medical textbook, when the department needed a more practical guide for providers. 

Within a day, the Pentagon withdrew the document and said it had been released in error. Just over two weeks later, the Pentagon issued a replacement guideline written by Lipshultz and the other physicians. 

Long considered a legend in the field of urology, Lipshultz became involved at the suggestion of guideline co-authors Dr. Shane Kronstedt, a former Navy SEAL and medical resident at Baylor, and his wife, Dr. Gabrielle Lyon, a physician and bestselling health author. Both knew Tim Parlatore, an attorney and Navy Reserve commander now serving as a senior advisor to Hegseth. 

“They knew this document was coming, they got me involved with him,” he said. 

A fourth co-author, Dr. Mohit Khera, was another Baylor urology professor with extensive research experience in testosterone deficiency and men’s health. 

The War Horse repeatedly asked to interview Pentagon officials who could discuss the policy, but the department declined and instead referred questions to written statements. After The War Horse learned that Lyon had hosted Parlatore for an extended podcast discussion about the initiative, the Pentagon was asked to confirm the accuracy of Palatore’s statements. It declined to comment. 

The War Horse also sought interviews with all four guideline authors. Only Lipshultz responded. 

“Nobody wanted to help you?” he asked. “And you had questions.” 

Lipshultz said the team spent several weeks developing the policy, drawing heavily from guidelines by the American Urological Association and other materials. He said the authors frequently challenged their own proposals and generally chose more conservative approaches to screening and treatment. 

“No plan is ever perfect, but we really did try to be very conservative in what we’re going to offer and how we’re going to test,” Lipshultz said. “I think it is a very conservative document, in terms of not only who gets treated but how they’re treated.”

“We’re not making these guys into anabolic freaks,” he added. “We are just replacing testosterone into the normal range. I mean, that’s it. This is treating a deficiency. This is not for treating a whim or a lifestyle.” 

The treatment guideline applies only to male service members. The Pentagon has said separate guidance for women is forthcoming, but Lipshultz said he does not know whether he will be involved in developing it. 

Under the new guideline, all male service members age 30 and older will answer questions about symptoms and risk factors associated with low testosterone during their annual Periodic Health Assessment, or PHA. Younger men may request screening. 

Those who screen for potential testosterone deficiency will be offered a blood test. If the result is low, the service member undergoes a second confirmatory test before treatment is offered. 

Because studies have shown that exertion, stress, and sleep loss can temporarily lower testosterone levels, the guideline says men who recently experienced those conditions during military training must wait at least 30 days before the blood draw. A separate patient information sheet, however, says they need only wait two weeks.

Providers are instructed to address potential reversible causes of low testosterone, including obesity or alcohol abuse, but not to delay treatment because those factors exist. Providers are also supposed to explain potential risks, including reduced fertility. 

Both the policy and Hegseth’s announcement make clear that treatment is voluntary.

Lipshultz is a longtime proponent of testosterone therapy when it is medically necessary. But he drew a distinction between treatment prescribed by a physician and the testosterone marketed by some commercial clinics as a route to better performance or a longer life.

“There’s apples and oranges between a physician hopefully giving someone testosterone and going to a low-T center or longevity center run by somebody who’s not a physician,” he said.

On a podcast, Lipshultz said clinics selling testosterone as a tool for longevity and performance enhancement were damaging the entire field’s legitimacy. Testosterone, he said, could not overcome genetics or guarantee a longer life. 

So The War Horse asked what he thought of Hegseth’s announcement video. 

Lipshultz said he had never seen it. 

He was unaware the video was titled “High T Department of War.” He also didn’t know Hegseth had promoted the initiative in terms of optimizing performance and protecting longevity.

Does Higher Testosterone Mean Better Military Performance?

In his announcement video, Hegseth said the screening initiative was about “ensuring you have the right testosterone levels to operate at your best.” 

That raises a basic question: Do higher testosterone levels result in better military performance? 

Testosterone is often perceived as the hormonal synonym to machismo and brawn, along with an assumption that more must be better. Research suggests it’s more complicated than that. 

Hackney and his colleagues have studied testosterone levels among elite athletes and found that lower levels do not necessarily hinder performance. In one study of national-team athletes, 25% of the men had low testosterone, including powerlifters with levels researchers described as “remarkably low.” At the 2011 Ironman World Championships, scientists estimated that roughly half of the men competing had below-normal testosterone. And Hackney has found no relationship between testosterone levels and whether an Olympic athlete won a gold, silver, or bronze medal.

Military studies have found similar patterns.

During Ranger School, one study found that soldiers’ testosterone levels fell by roughly 50%. Higher testosterone levels were weakly associated with faster run and march times, but did not predict grit, resilience, or the number of pullups a soldier could complete. They also did not predict which soldiers ultimately became Rangers. 

In another experiment, scientists observed that testosterone levels did not predict which West Point cadets prevailed in hand-to-hand combat. 

Researchers have tested whether replacing testosterone lost during grueling, military-style exercises improves performance. Testosterone administration helped participants preserve muscle mass, but it did not improve muscle function or cognitive performance. 

“Is testosterone important to physical performance? Yes, it is. But it is only one component,” said Hackney, whose career studying exercise physiology and hormones began at the Naval Health Research Center and NASA. 

Part of the problem, Hackney said, is that testosterone is often treated as binary: Either someone has the right amount or they do not.

But the body can compensate when testosterone levels fall. During intense exercise, other hormones can help support some of the same muscle-building and energy-related functions, according to Hackney.

That’s why overtraining can temporarily lower testosterone without necessarily signalling a problem. Levels should recover as the training load decreases.

Testosterone levels also vary with psychological and social context, said Justin Carré, a social psychologist and psychology professor at Nipissing University who studies how testosterone changes during competitions and other heightened social interaction. How testosterone rises or falls in the moment can be more important than someone’s usual baseline, he said.

American clinicians commonly use 300 nanograms per deciliter as the threshold for low testosterone in men. But Carré said a soldier with baseline levels of 299 could see it rise substantially when preparing for combat. Carré would be reluctant to describe that man as “low T” without other symptoms. 

That idea is consistent with what military researchers have found.

Two months before Hegseth announced the screening policy, Army scientists reviewed military studies dating from the Korean War to the present and found that declines in testosterone among service members were typically related to stress, sleep, diet, and overexertion in the field.

“Testosterone is a barometer, not a treatment target,” the researchers wrote.

Testosterone Therapy Comes With Risks

Testosterone replacement therapy is not simply a way to move a laboratory number higher. 

Testosterone therapy suppresses the body’s natural production of the hormone. That reduces a man’s own testosterone output and lowers sperm production, reducing fertility in nearly all men. Recovery depends on the dosage and length of use. Testosterone therapy has also been associated with higher rates of some tendon and orthopedic injuries.

Another known risk is polycythemia, a dangerous increase in red blood cells that can thicken the blood, raising the risk of blood clots and other potentially fatal conditions, said Dr. John Mulhall, director of the male sexual and reproductive medicine and urology service at Memorial Sloan-Kettering Cancer Center.

Some benefits often attributed to testosterone administration may also be overstated. Mulhall’s research team, for example, has found no relationship between testosterone levels and low sex drive. 

“There’s unquestionably placebo effects,” Mulhall said. 

For people with serious deficiencies—such as cancer patients—the benefits may outweigh the risks. But for most military members, low testosterone is likely a temporary condition, and they don’t need testosterone therapy. 

That is why Hackney worries that the Pentagon’s emphasis on testosterone could encourage unnecessary treatment instead of addressing its underlying causes. 

“Are we creating a scenario where we may, in 20 years from now, have some severe health problems in veterans?” Hackney asked.

Where the New Guideline Raises Questions 

Both the Endocrine Society and the American Association of Clinical Endocrinology have criticized broad testosterone screening in the military.

AACE said current evidence does not support routine population screening because it could lead to overdiagnosis and overtreatment. The Endocrine Society raised similar concerns after reviewing the Pentagon’s new guideline, warning that screening men over 30 could produce unnecessary testing and treatment.

Although the Endocrine Society incorrectly described the policy as mandating population-wide blood tests, its larger concern remains valid: The process could send otherwise healthy men into a costly diagnostic process. 

Lipshultz acknowledged that the guideline could have been clearer. 

Experts say that there is no questionnaire that can reliably diagnose testosterone deficiency. That’s because many of the symptoms associated with low testosterone—including fatigue, depression, lack of motivation, and weight gain—are generic and can have many causes.

Lipshultz said the authors were aware of those limitations and ultimately used the same symptoms they would ask about during a traditional in-person screening.  

But no one yet knows how well that approach will work when folded into the military’s Periodic Health Assessment. 

The PHA already has limitations. In 2024, RAND researchers reported that many military practitioners did not believe the PHA was an effective diagnostic tool, saying service members often rushed through the 361-item questionnaire or answered inaccurately and that follow-up care varied among the services.

The new guideline also leaves questions about what a diagnosis could mean for a service member’s career. Although the guideline states that hypogonadism does not automatically limit duty or make someone nondeployable, it notes that the diagnosis or its treatment can affect eligibility for certain jobs, including aviation, diving, submarine, and nuclear duties. And men who begin testosterone therapy cannot deploy until their condition has stabilized.

Department of Defense medical-retention standards include hypogonadism among conditions that can make a service member medically ineligible for continued service when, despite treatment, it interferes with their ability to perform required duties.

The new guideline says testosterone therapy is voluntary. But given those retention standards, it does not clearly explain what happens if a service member has symptomatic hypogonadism that interferes with his duties and chooses not to undergo treatment.

The issue also intersects with a related Pentagon dispute over hormone therapy.

The Trump administration has sought to remove transgender service members from the military while restricting gender-affirming hormone treatment. In July, U.S. District Judge Ana Reyes ordered government lawyers to explain how the Pentagon distinguishes that policy from its effort to provide testosterone therapy to male service members with testosterone deficiency.

Lipshultz, who has treated transgender patients, said he had not been involved in discussions about that policy and could not explain the distinction.

“I’ve not ever been in any conversation about that.”

A ‘Logistical Nightmare’

The physicians who wrote the Pentagon’s testosterone guideline were not asked to consider how the military would actually carry out the new policy, Lipshultz said. Instead, the Defense Health Agency was responsible for developing an execution plan, and he did not know how the agency would handle the plan going forward. 

“We just came up with this document as kind of a guideline on how to get to the point where you can initiate therapy if indicated,” he said.

Other experts and service members told The War Horse that those logistics could determine whether the initiative succeeds or fails.

There is reason for caution. 

Studies have found that testosterone is both underevaluated and overprescribed. One study found that 94% of men receiving testosterone through VA did not have one of the classic medical conditions associated with hypogonadism.

The VA Office of Inspector General in 2018 found that physicians were not consistently following testing, treatment, or monitoring protocols—including requirements to warn patients about risks—and they were frequently failing to provide the needed follow-up care.

It took years for VA to respond. The department did not issue more rigorous guidance for diagnosing and treating low testosterone until January 2026.

“No one would ever accuse the Veterans Administration of being nimble, right?” said Mulhall, who helped develop both the American Urological Association’s testosterone-treatment guidelines and VA’s revised recommendations.

Mulhall said about 30% of his practice involves patients with hypogonadism. When he considered the scale of the Pentagon’s initiative, he said, “This is all under the umbrella of the logistical nightmare.”

“No matter how perfectly designed this will be, the logistics behind managing such a program are going to be just ginormous,” he said. 

A well-run program requires three things: accurate screening, accurate diagnosis, and consistent monitoring of patients who begin testosterone therapy. 

“A badly run T program can be a big problem,” Mulhall said. 

The military may struggle at each step.

The Pentagon plans to begin screening through the Periodic Health Assessment. A 2025 Military Medicine study examining nearly 85,000 PHAs found that only 13% of service members received follow-up care afterward. And of the 857 medical personnel who reviewed the assessments, few, if any were endocrinologists or urologists.  

That means much of the testosterone screening and treatment could fall to the same nonspecialist clinicians and medical personnel who review PHAs—from reviewing symptoms and ordering blood tests to deciding when specialty care is necessary.

Testing itself presents another challenge. 

The guideline says that service members who experience intense training, significant sleep loss, or other major physical stress should wait 30 days before testing, but experts said that could be difficult in a force where disrupted sleep and strenuous training are routine. 

“I don’t see how this is practically executable anywhere in the Navy,” said the active-duty Navy officer. 

The Navy, he said, “has a long and well-documented history of sleep deprivation.”

And physical exertion is unavoidable: “We have people whose job it is to haul around heavy shit all day.”

Maintaining consistent care is likely to be equally difficult.

“Soldiers don’t have the time, resources, or access to get those follow-ups, and specialty clinics are overwhelmed,” said Dr. Tara Caberwal, an assistant professor at Campbell University who has treated service members at Fort Bragg since 2008. 

Deployment adds another layer of complexity.

The guideline acknowledges that testosterone is a Schedule 3 controlled substance and that supply, custody, and continuity of treatment should be worked out before deployment.

The Navy officer said that every naval community and type of ship will have to develop unique procedures to fulfill the requirements—adding new burdens to already strained medical and supply systems. 

A helicopter carrying supplies has limited capacity, he added, and if the choice were between personnel, replacement parts, mail, and testosterone—the drugs wouldn’t make it aboard. 

“If they don’t give us a ‘how’ that is practical and executable, it’s never going to happen,” he said. 

As far as he was concerned, the entire initiative was a case of “ready, fire, aim.”

A Road Paved With Good Intentions, Tragic Circumstances, and Hasty Actions

So why launch the program now?

According to Tim Parlatore, Hegseth’s senior advisor, the initiative began largely with him.

During his podcast discussion with guideline co-author Lyon, Parlatore said he had begun developing the idea before President Donald Trump had been reelected. 

Parlatore said that a friend of his was a Marine veteran who had died by suicide. The veteran had been using anabolic steroids, and Parlatore thought that low testosterone and steroid use had played a role in his death.

Parlatore concluded that his friend may have been trying to self-medicate—and that testosterone was a key to all of it. 

Around the same time, Parlatore learned about “operator syndrome,” a proposed framework developed by psychologist and University of Hawaii at Hilo professor Chris Frueh to describe a cluster of coexisting health concerns seen in some special operations veterans, including traumatic brain injury, sleep disorders, chronic pain, and hormonal disruption. 

Parlatore also came to believe that similar problems could be found throughout the military, beyond special operations.  

He and Frueh began developing the idea for a military-wide testosterone screening and treatment initiative. 

When Parlatore took the idea to Hegseth, he said he touted three immediate benefits: a fitter and more lethal force, fewer military suicides, and less anabolic steroid use. 

Parlatore said the proposal reached the Pentagon in April 2026 and encountered substantial internal resistance. Officials repeatedly recommended first conducting a study or a small pilot program. 

“What’s the point of that?” Parlatore recalled asking. 

According to Parlatore, Hegseth agreed. 

“This is already well established by civilian medicine,” Parlatore recalled the secretary saying. “We’re doing it now.”

Hegseth later wrote that applying lessons from treating operator syndrome across the force, including “targeted testosterone therapy,” would optimize warfighter readiness.

The rationale surprised researchers who have studied operator syndrome.  

“I’m shocked,” Caberwal said after hearing how Parlatore described the origins of the initiative. 

“I’m dumbfounded,” said Dr. Amy Cecchini, a physical therapist and researcher who is a colleague of Caberwal’s who also works with the military population at Fort Bragg.

Operator syndrome itself remains an emerging and disputed concept. Caberwal and Cecchini led a review of studies relating to it, recently published in Military Medicine, and concluded that there is currently no consensus definition, diagnostic criteria, or standardized way to identify the syndrome.

They also found that the existing research focused exclusively on special operators with traumatic brain injury who were already seeking treatment. Healthy operators have not been studied as a comparison group. 

That makes it difficult to confirm if operator syndrome is a distinct medical condition or just a label for already recognized health problems.

Caberwal credited Frueh with developing a “catchy phrase” that could reduce the stigma of special operators’ seeking care.

But, she said, “it is not a formal medical diagnosis, and currently there is virtually no evidence to support it as a construct.”

The evidence is even thinner for presenting testosterone as the solution. 

Research has not established that testosterone therapy reduces suicidal thinking or improves recovery from traumatic brain injury. And the relationship between testosterone and mental health is complicated: Low levels have been associated with suicide risk among older men, while higher levels have been associated with that same risk in young men. 

“Testosterone is incredibly difficult to analyze,” Cecchini said.

At the end of the day, Caberwal said, the health of the service member receiving care is “all I care about.” And a mandatory program that the military doesn’t yet have the infrastructure to execute is not the answer. 

“My greatest concern is that the assessment and intervention component is going to get way ahead of ourselves,” Cecchini said. 

The military may invest in specific lanes of policy and courses of treatment before knowing what really makes a difference. 

Rather than spending millions screening and treating service members based on a hormone number—or encouraging service members to chase higher testosterone at potential risk to their health—Hackney said the Pentagon should focus on a simpler question:

“Are they performing? Are they doing mission-specific activity and being successful? If they are, then you’re looking for a problem when it doesn’t exist.”

This article from The War Horse was edited by Paul Szoldra, fact-checked by Jess Rohan, and copy-edited by Mitchell Hansen-Dewar.