DoD Testosterone Screening: A Urologist Flags Risks
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- Defense Secretary Pete Hegseth announced Wednesday that the Department of Defense will begin mandatory testosterone screening for military servicemembers ages 30 and over, with treatment decisions left to individual members.
- The Endocrine Society recommends against routine population-level screening of asymptomatic men for hypogonadism and against routine supplementation in younger men with low testosterone — a stance the opinion piece says is at odds with the DoD directive.
- The global testosterone therapy market has grown from $18 million annually in the late 1980s to nearly $2 billion in 2025, fueled by direct-to-consumer marketing, online prescribing, and wellness influencers, the article notes.
- The 2010 TOM trial was halted early after finding higher rates of major cardiac events in men taking testosterone, while the 2023 TRAVERSE trial found no excess cardiac risk but did identify higher rates of acute kidney injury, atrial fibrillation, and pulmonary embolism.
- Cole's research using TRICARE data on military beneficiaries found higher rates of kidney stones and obstructive sleep apnea among testosterone users, though one of those studies also showed improved cardiovascular outcomes.
- Testosterone replacement therapy reduces testicle size and sperm counts, and both the American Urological Association and the Endocrine Society caution against its use in men planning to have children — a concern the piece flags given the affected age group.
- Proper diagnosis of low testosterone requires morning measurements, a confirmatory test, and screening for conditions that may worsen with treatment, including sleep apnea, high prostate cancer risk, heart failure, and thrombophilia — monitoring the author says will be difficult to scale across the entire DoD health system.
Why it matters: Roughly hundreds of thousands of active-duty service members ages 30 and over could be swept into a screening program that diverges from Endocrine Society guidance and that prior trials have linked to specific harms including cardiac events, kidney stones, sleep apnea, and reduced fertility. The piece's core concern is implementation: Hegseth framed the choice as individual, but safe testosterone therapy requires confirmatory testing and ongoing monitoring that the military health system has not previously delivered at this scale.
