"Out of every 1,000 male service members, almost 3 are inappropriately receiving TRT," researchers wrote in a report published on Health.mil, the military's health system website. (That report is available on the Wayback Machine.)
"Those being inappropriately treated may experience adverse effects of the medication," including obstructive sleep apnea and edema, the report continued. TRT may worsen sleep apnea and cause swelling in the limbs from water retention. "These adverse effects have the potential to impact deployability and medical readiness."
It is unclear how the policy might affect female service members. Live Science contacted the Department of Defense, which declined to answer questions about the expected testing protocol or criteria for offering service members TRT.
"One of my big, big concerns around this is, how are these tests going to be conducted?" said Luke Cox, a lecturer in sport and exercise science at Swansea University in the U.K. who studies performance-enhancing drugs, including steroidal hormones like testosterone.
"[I]t's about restoring and optimizing your natural capabilities, projecting your longevity and ensuring you have the biological foundation required to sustain the fight," Hegseth said.
In men with genuinely low circulating testosterone levels — often defined as lower than 300 nanograms per deciliter (ng/dL) — TRT does have benefits. (This 300 ng/dL threshold isn't the universal definition for "low testosterone," as not everyone below that line has troubling symptoms. We'll unpack that later.)
TRT has been shown to improve mood and reduce depressive symptoms in men with low testosterone, and in older men, it's also been shown to improve bone density. Boosting testosterone also boosts muscle mass in middle-aged and older men.
One side effect of TRT is that it often dramatically lowers sperm count, because supplementing testosterone prompts the body to stop making it in the testes. (Image credit: SCIEPRO/SCIENCE PHOTO LIBRARY via Getty Images)In 2024, 42.8% of active-duty military members, including men and women, were 25 and younger. Only 8.3% were 41 or older. But the prevalence of low testosterone is generally on the rise, said Dr. Joshua Halpern, chief scientific officer and regional medical director at Posterity Health and a reproductive urologist at Northwestern University's Feinberg School of Medicine.
Dr. Joshua Halpern, Posterity Health and Northwestern University's Feinberg School of Medicine
"While active service members are typically among the healthiest of men, and therefore at lower risk for testosterone deficiency, a significant proportion of service members could have a low testosterone number," Halpern told Live Science. "But that doesn't necessarily mean they should receive treatment."
Treating with testosterone
Plus, testosterone doesn't act in isolation. In fact, some symptoms of "low T" in aging men may actually arise from low estrogen, which stems from these individuals' declining testosterone levels. That's because the male body converts a portion of its total testosterone into estrogen. The two hormones normally work together to regulate sexual desire and erectile function, while estrogen specifically regulates fat accumulation, studies suggest.
"Making a diagnosis of testosterone deficiency in the absence of signs and/or symptoms increases the likelihood of making a false diagnosis and reduces the potential benefit of testosterone therapy," the association's guidelines state.
That's why doctors recommend two separate blood tests, both taken in the morning, before diagnosing low testosterone. This helps to ensure that a person's levels are consistently in a low range.
Meanwhile, pushing testosterone levels too high can lead to erythrocytosis, an overconcentration of red blood cells that can bring a risk of blood clots and stroke. What constitutes "too much" varies person to person. Due to some testosterone being converted into estrogen, too-high levels can also lead to unwanted side effects like breast growth in some men on TRT.
Related storiesThe other major side effect of TRT is that testosterone replacement shuts off the body's own production of testosterone in the testes. TRT only raises the level of testosterone circulating in the blood, not in the testes where sperm production takes place. Sensing the testosterone in the bloodstream, the brain suppresses its production in the testes, thus diminishing or stopping sperm production. This can cause infertility, and sperm production may take several years to recover after a person stops TRT.
Meanwhile, a federal judge has questioned the treatment program. An ongoing lawsuit against the federal government's ban on transgender troops states that "the Armed Forces must adhere to high mental and physical health standards ... without the benefit of routine medical treatment or special provisions." The judge raised questions about how the TRT that will be offered to cis men differs from that which transgender men would use.
This article is for informational purposes only and is not meant to offer medical advice.
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