Mandatory Testosterone Screening Is a Tactical Retreat from Medical Reason

At first, I thought this July 15, 2026 New York Times article was a parody. Then when I found out it clearly wasn’t a spoof, I asked myself, what kind of moronic gesture is this, recommending screening of military people for low testosterone? 

In a move that sounds more like a plot point from a dystopian satire than a Pentagon briefing, Defense Secretary Pete Hegseth recently announced a mandatory annual testosterone screening program for all US service members aged 30 and older. Hegseth’s vision for a “High-T Department of War” treats the complex biological reality of human aging as a “decisive tactical” variable that can be managed through a blood test.

If only life were that simple. If we could only create the perfect screening test, life would be so much easier. But alas….

When I was writing my book on screening (Seeking Sickness, Medical Screening and the Misguided Hunt for Disease) I interviewed Professor Sir Muir Gray from Oxford. He’s an internationally renowned public health expert who transformed the UK’s screening programs in the 1980s and 1990s into highly managed, evidence-based systems. He also published the book Evidence: Screening and Practice, which is probably the most authoritative book on the topic. Muir Gray had a mischievous and entertaining lilt to his voice and I clearly remembered when he told me what must be his signature screening aphorism: “All screening programmes do harm; some do good as well.” 

After researching screening programs for many years, I’d say that he’s mostly right, and most medical screening programs, even the ones highly studied such as screening for breast or prostate cancer overpromise and underdeliver. But where does testosterone screening of middle-aged soldiers fit within that paradigm? Spoiler Alert: On almost all levels, and from whatever angle you examine this idea, it plumbs new levels of dumbness. 

For starters, if the end game is testosterone replacement therapy, ie: augmenting a person’s testosterone level in order to improve sexual function, fatigue, muscle loss, and mood, then we’d hope that the treatment prescribed (typically testosterone gel) would be perfectly safe, right? 

I can tell you that after spending over 30 years examining the gaps between medical marketing and hard clinical science, and reading thousands of clinical trials, I have never come across a drug’s safety profile as weird as that for testosterone gel. 

Most trials measure what happens to the patient taking the drug, compared to those taking a placebo. And the effects of the drug are measured in the person who swallows it. Testosterone can be different. It can affect other people like your spouse or your children through what is known as “secondary exposure.” This risk, known as virilization, is the development of male physical characteristics in females or children, driven by excess male hormones (androgens) like testosterone. Basically when you spread testosterone gel on your skin you can virilize your children—or even your spouse—just by holding them. 

Common signs include facial hair growth (hirsutism), a deepening voice, clitoral enlargement, acne, and male-pattern baldness. The FDA included a warning about secondary exposure to testosterone in children and women, expressly indicating that “signs and symptoms have included enlargement of the penis or clitoris, development of pubic hair, increased erections and libido, aggressive behavior, and advanced bone age.”

Whoa. And that only happens because dad’s taking testosterone gel. 

But how useful is it to screen military personnel for low testosterone? 

Well, it might be useful to identify men who have had damaged testicles or who have hypogonadism (when the body produces little or no testosterone) but those cases are rare. 

But what will happen when you do test America’s servicepeople for “Low -T?” Well, you will find that some of them “have it” as identified. But if it’s not causing symptoms does this arbitrary “testosterone level” really matter? For the answer to that you have to dig a bit into the weeds. 

One European study screened 3,369 middle-aged and older men for testosterone levels and found that 17% of those screened had levels considered “low” but they had no symptoms and were none the wiser. Only 2% had typical symptoms associated with low testosterone such as low sex drive, fatigue, and sexual dysfunction. The other 15% had low testosterone but they didn’t know it. This is the gap which allows the disease-mongerers to enter. We know what’s going to happen next when they discover a person has ‘low’ testosterone. They’ll be considered a “patient” and, of course, be offered testosterone replacement therapy. 

Don’t you think the group dynamics of a platoon or company of soldiers might involve at least a modicum of peer group pressure? How do you think it’s going to work for those soldiers who were tested as ‘low?’ It’s likely some servicemen might try to game the system and get prescribed testosterone supplements before they are screened, so that they won’t be singled out as part of the “Low T” squad. Others will feel the pressure to “man up” and get on the drugs. 

Taking testosterone replacement therapy will be voluntary, the Defense Secretary assures us, but will it really? Hopefully those who choose to pharmaceutically augment their testosterone levels will go into it with their eyes wide open, vis a vis, there are a range of potential adverse effects including blood clots, heart problems, kidney problems, fractures, infertility, and probably the worst of all: shrunken testicles. Hmm. Nothing says “I’m more of a man” than shrunken balls. 

State-Sponsored Disease Mongering

There is no other way to see this than as a massive, state-sponsored exercise in disease mongering. By mandating these tests, the military is unnecessarily widening the definitions of illness to capture healthy people and turn them into permanent patients.

For decades, the pharmaceutical industry has worked to transform the natural, gradual decline of hormones—a “normal natural thing”—into a “deficiency disease” that requires lifelong chemical intervention. This practice, which I have termed the “selling of sickness,” is characterized by the exaggeration of normal human traits to create new markets for drugs. 

What Hegseth calls a “sacred duty” to maintain an advantage is actually a textbook example of “condition branding,” where a common life process is reframed as a frightening medical condition. In the civilian world, this was accomplished through slick “Low-T” quizzes and celebrity-driven fear-mongering; in the military, it is now being accomplished through an administrative mandate.

The fundamental problem with mandatory screening of asymptomatic people is that it fundamentally changes how healthy individuals think about their own bodies. When you take otherwise fit servicemen and women and subject them to a test for a “deficiency” they didn’t know they had, you are performing a “daylight robbery” of their sense of wellness. 

There is also a very subtle, and unacknowledged thing that testosterone screening could cause. By applying a label, however well-meaning your Defense Secretary, he’s unintentionally creating psychological anxiety amongst the troops, with the nuanced suggestion that these men and women are “broken, dysfunctional, or deficient” simply because they have reached the age of 30 and score “below average” on a blood test.

Furthermore, the scientific validity of a single testosterone “number” is notoriously shaky. Testosterone levels are known to go up and down constantly, and a low score on a single test is definitely no guarantee that a person has a genuine medical problem. Many “Low-T” surveys use arbitrary cutoffs that would label many middle-aged men as “deficient,” even in the absence of any symptoms. By mandating this for women as well, the military is doubling down on the medicalization of the female body, which is already specifically targeted by industry efforts to turn natural transitions like menopause into “hormone loss” diseases.

Again, Hegseth claims that hormone treatment will be “voluntary,” but in a military hierarchy, a “voluntary” cure for a “mandatory” diagnosis is a distinction without a difference. You label a soldier “Low-T,” and you’re introducing them to the likelihood of a quick pharmaceutical fix for the “symptoms” of aging, such as fatigue or reduced endurance. 

In my opinion, this program violates the basic tenets of responsible medical screening. According to World Health Organization guidelines, a screening test should only be introduced if it targets an important health problem with a well-understood natural history and an acceptable treatment. Testosterone levels in healthy 30-year-olds do not meet these criteria. 

One might want to classify this program under the “Inverse Screening Law”—a situation where resources which could make a difference in the performance of the lives of servicemen and women are diverted toward the “healthy well.” Meanwhile, genuine health crises—like the epidemic of military suicides, substance abuse, or traumatic brain injuries—remain chronically under-addressed.

Ultimately, real health is about common sense, nutrition, strength, and endurance—not a “risk factor fetish” centered on a blood reading. The military should be encouraging its “warriors” to reclaim their personal agency through lifestyle factors within their control, rather than replacing it with a monthly prescription. 

If this kind of screening of America’s armed forces becomes normalized, I wonder what other screening programs could follow. Maybe screening for “social anxiety disorder” for those who are a little shy and possibly have difficulty public speaking. Or screening for a range of other pseudo diseases that do little more than apply labels and create new platoons of pharmaceutical customers. 

Servicemen and women deserve better than to be used as a captive market for a “high-tech snake oil scam” that pathologizes the very process of living. True tactical advantage comes from independence from the pharmaceutical complex, ensuring that the safety of our troops is never again sacrificed for a bureaucrat’s misguided “High-T” fantasy.