Hegseth wants a "High-T" military; doctors call it a clinical minefield - Ars Technica

Skip to content

AI

Biz & IT

Cars

Culture

Gaming

Health

Policy

Science

Security

Space

Tech

Forum

Subscribe

Story text

Size

Small<br>Standard<br>Large

Width

Standard<br>Wide

Links

Standard<br>Orange

* Subscribers only

Learn more

Pin to story

Theme

Search

Sign In

Sign in dialog...

Text<br>settings

Story text

Size

Small<br>Standard<br>Large

Width

Standard<br>Wide

Links

Standard<br>Orange

* Subscribers only

Learn more

Minimize to nav

On Wednesday, Defense Secretary Pete Hegseth made the startling announcement that the US military would begin requiring all active duty and reserve personnel aged 30 and older to undergo mandatory screening for testosterone deficiency. The screenings will take place during yearly health assessments. Those under age 30 can also get screened on request.

In a short video posted on social media, Hegseth explained to the military community that the screenings and possible subsequent treatments are intended to “optimize your performance, your resilience, and your long-term health.” While saying that the initiative wasn’t about “artificial enhancement” and that members could decline treatment, Hegseth claimed that the testing and potential treatment was for “restoring and optimizing” capabilities, protecting “longevity,” and “ensuring you have the biological foundation required to sustain the fight.”

But will testosterone screening and treatment actually “optimize” our “warfighters”? Will it help most of them live longer? Should everyone else get screened and treated, too?

“A big fat ‘Oh, no'”

Screening people widely for medical conditions and then treating those who need it may sound like a huge social positive. But issues around male hypogonadism—the condition in which the body doesn’t produce enough testosterone—can be complex.

That’s why the Endocrine Society—made up of experts in the complex systems that release hormones in the body—posted a statement on the topic in the wake of Hegseth’s announcement. The document notes that “there is insufficient evidence to support a general recommendation to perform population-level screening for hypogonadism in asymptomatic men with measurement of blood testosterone level.”

To find out why, Ars Technica spoke with Professor Bradley Anawalt, chief of medicine at the University of Washington Medical Center. He specializes in endocrinology and men’s health.

“This is a great big fat ‘Oh, no,’” Anawalt said in reaction to Hegseth’s announcement. “We’re turning the clock back on rational healthcare. … I’m worried about the ethics. I’m worried about the health consequences. I’m worried about unnecessary evaluations, incorrect assessments, and incorrect diagnoses that lead to inappropriate prescriptions of testosterone.”

To understand why, let’s start with the basic question: Why might someone have low testosterone?

Causes of “low T”

Disease states that can cause low testosterone include genetic conditions, such as Klinefelter syndrome (when a male has an extra X chromosome) or a problem with the brain’s pituitary gland, which controls hormone levels in the body. Pituitary problems may come from damage, dysfunction, or tumors (which are often noncancerous).

For these patients, “It’s not difficult to make the diagnosis,” Anawalt said. Genetic tests can detect Klinefelter disease, for instance, confirming an explanation for low testosterone levels. Similarly, in patients with pituitary problems, tests for other blood hormones (such as luteinizing hormone and follicle-stimulating hormone) can confirm the source of the problem.

But these conditions are uncommon, affecting maybe 1 percent of men at most, Anawalt said.

Meanwhile, many other things can lower testosterone levels, such as: cancer treatments, medications (such as corticosteroids or opioids), anabolic steroids, obesity, HIV, surgery, trauma, stress, sleep deprivation, and the natural process of aging. Many of these causes would not necessitate testosterone replacement therapy. For someone with sleep deprivation, the best treatment would be rest, for instance.

Symptoms

In patients with true hypogonadism, the primary symptoms are lower libido, erectile dysfunction, lowered sperm count, breast enlargement or tenderness, reduced energy, reduced muscle mass, shrinkage of testes, mood changes (such as irritability or depressed mood), and hot flashes. Over time, low testosterone can cause loss of body hair, muscle bulk, and bone density, and it can reduce red blood cell counts.

In clear cases of disease, these symptoms are easy to spot. In the general population, it’s much harder.

“What’s more difficult to suss out is the men that have vague symptoms,” Anawalt said. “‘I don’t feel so good. I’m tired. My energy’s not so good. My erections aren’t what they used to be. My mood is not very good. I’m not concentrating well.’ These are all common things that people are concerned about, but...