Defense Secretary Pete Hegseth recently announced a policy to screen service members older than 30 for low testosterone and offer replacement therapy to those who qualify.
David Shulkin, a former Veterans Affairs secretary and former VA under secretary of health, wrote that the goal of a stronger military is understandable, but said the policy should receive closer review before wider use.
He wrote that testosterone replacement therapy is an established treatment for men with diagnosed hypogonadism. But he said expanding hormone screening across a large, generally healthy military population would mark a significant change in military medicine.
Shulkin said the evidence does not clearly show testosterone improves combat performance. He cited the Army’s first Optimizing Performance for Soldiers study, which found that men given weekly testosterone injections during a simulated combat energy deficit preserved more lean muscle than those given a placebo, but their physical performance declined at about the same rate.
He also wrote that low testosterone readings can reflect conditions common in military service rather than a chronic hormonal disorder. Sleep deprivation, combat deployments, chronic stress, obesity, alcohol use, and intensive physical training can temporarily lower testosterone, he wrote.
He wrote that without repeat testing and evaluation for reversible causes, some service members could begin long-term treatment they did not need. He said testosterone therapy can suppress the body’s own production, reduce fertility, and cause testicular atrophy. He also said ongoing monitoring is needed for elevated red blood cell counts, prostate-related concerns, sleep apnea, and other possible complications, while researchers continue to study long-term cardiovascular effects.
Shulkin wrote that testosterone can affect mood, confidence, motivation, and aggression. In some people, unnecessary treatment or excessive hormone levels may increase irritability, impulsivity, emotional volatility, or impaired judgment, he wrote.
He said the main question is whether routine screening and broader treatment would improve military readiness or create longer-term health issues, including for the Department of Veterans Affairs after service members leave the military.
Shulkin served as Veterans Affairs secretary during President Donald Trump’s first administration and as the department’s under secretary of health during the Obama administration.