Study Reveals One in Four US Troops May Need Testosterone Treatment

A new study published in JAMA has uncovered that a significant portion of active-duty soldiers may require testosterone treatment following routine screening. The research, conducted by the Pennington Biomedical Research Center and the U.S. Army Research Institute of Environmental Medicine, found that 25% of troops tested below the established threshold for testosterone levels set by the American Urological Association at 300 nanograms per deciliter (ng/dL). Among younger soldiers under 30 years old, 20% had sub-threshold testosterone levels, while approximately one-third of service members aged 30 and older fell below this mark.

The study's findings are based on data collected from the Military Health and Nutrition Examination survey conducted at five Army bases between August 2024 and January 2026. The results suggest that routine screening for low testosterone levels could lead to a substantial number of troops needing further medical evaluation and potential treatment, which may include injections or oral medications.

Defense Secretary Pete Hegseth announced in July that the Pentagon would begin testing testosterone levels among all service members over age 30 as part of an initiative aimed at ensuring optimal physical performance. The screening is voluntary for younger soldiers unless they are experiencing symptoms such as fatigue, low libido, depressed mood, impaired concentration, or diminished physical performance.

The program's objective is to maintain troops' biological capabilities and ensure their readiness for combat operations. However, the study highlights potential challenges related to overdiagnosis and unnecessary medical interventions. According to researchers, positive screening results typically require further clinical interpretation and may prompt additional testing and evaluation before treatment is recommended.

Environmental factors such as lead exposure, combat scenarios, physical injuries, sleep deprivation, and mental health conditions can contribute to low testosterone levels in service members. Treatment for severe cases of hypogonadism involves hormone replacement therapy but carries risks including mood swings, irritability, blood clots, and infertility due to reduced sperm count.

The Defense Health Agency's clinical practice guidelines stipulate that service members will be screened twice on separate mornings if their morning testosterone levels fall below 300 ng/dL. Those who test positive can opt for treatment options like once- or twice-weekly injections or daily oral medications, but this is not mandatory.

This initiative follows a growing trend in the $4.5 billion industry centered around testosterone supplements, which are marketed as enhancing physical performance and overall well-being. However, studies have shown mixed results regarding the effectiveness of testosterone therapy beyond improving sexual function and mood for older men.

The findings underscore the need for careful clinical interpretation to avoid unnecessary medical interventions and associated costs. Researchers caution that distinguishing between isolated low screening values and clinically significant hypogonadism is crucial to ensure appropriate care without overburdening military healthcare resources.