Does the Pentagon want to create a testosterone-infused fighting force?

The Washington Post headlined: “Hegseth touts a high-testosterone military as doctors question his claims”

What Secretary Hegseth’s July 15 press release says:

“Effective immediately, all Active Duty and Reserve Component personnel aged thirty and older will be screened for testosterone deficiency as a mandatory element of their Periodic Health Assessment (PHA). Service members under the age of thirty may also request this screening during their PHA.”

While universal screening for over-30s is mandated, the Pentagon clarifies that, while options for testosterone replacement will be made readily available, they won’t be required and remain voluntary.

“Operator Syndrome”?

The press release explains that testosterone testing is part of a plan to address “Operator Syndrome”, a constellation of service-related problems that are said to impair combat efficiency:

“Operator Syndrome represents a unique convergence of health challenges that require proactive clinical intervention . . . including targeted testosterone therapy [to] directly optimize Warfighter readiness.”

According to the Coast Guard Foundation:

“Operator Syndrome refers to a unique constellation of medical, cognitive, and psychological challenges primarily seen in military special operations forces (SOF). [my emphasis] It is driven by an exceptionally high ‘allostatic load’—the cumulative physical and emotional wear-and-tear from chronic stress, grueling deployments, repeated blast exposures, and intense physical training”

“Operators” is a euphemism for special operations forces, like the Navy Seals, the Green Berets, etc. The “tip of the spear” of our military, they are are subject to extraordinary stresses of combat, time zone shifts, long deployments, blast exposure and traumatic brain injury, repetitive stress injury from lugging heavy equipment across forbidding terrain, prolonged sleep deprivation and PTSD, which indeed might have endocrine effects.

Prolonged high cortisol from hypervigilance, concussions, chronic pain, sleep deprivation, and PTSD are known to be testosterone killers.

Questions arise . . .

Can this edict be generalized to a diverse military workforce that includes large numbers of behind-the-lines support personnel, often stationed remotely, out of the combat zone? Does a drone operator, safely ensconced in a base in Florida, require Herculean strength?
Are women subject to this edict (they have one twentieth to one tenth the testosterone levels of men)? Nevertheless, females can mount pretty serious levels of aggression in combat situations. They’re significant contributors to the Israeli Defense Force. And 18% of the U.S. active-duty military is female.
And what of male-to-female trans military personnel? The Pentagon has implemented a ban on transgender people serving, though the policy is currently facing intense legal battles regarding service members who are already in the military. Their testosterone levels are already artificially suppressed—deliberately. Is adding testosterone levels as a criterion of male combat readiness intended to further rationalize trans exclusion from the military?
How about men currently serving who are contemplating fathering children? Most—not all—forms of testosterone replacement act as contraceptives, and may have lingering effects on fertility once discontinued.
Do men really need to start worrying about low T as young as 30? While it is true that testosterone levels naturally decline by about 1% per year starting around age 30, a severe drop in your 30s usually points to underlying health or lifestyle factors rather than natural aging.

Does testosterone make men better fighters?

Testosterone is associated with muscle mass, strength, injury recovery, motivation, and to some extent, aggression. Low levels of testosterone are hallmarks of physical deconditioning, obesity, alcoholism, and depression, conditions which might impair combat readiness.

But will administering testosterone to young men with low or even just borderline testosterone turn them into better warriors?

The specter of a testosterone-infused military invites hyperbolic comparisons to juicing body builders and MMA fighters who, subject to “roid rage”, punch their fists through walls.

But they’re taking many times more testosterone than is required to achieve normal levels; plus, they “stack” with additional anabolic steroids with weird emotional effects.

Alternatively, there’s the persistent urban legend of Nazi SS “Supermen”, mass-injected with steroids to maximize endurance and aggression. Indeed, it was German scientists who first developed synthetic testosterone in the 1930s. But, while Blitzkrieg warriors were actually given tablets of “Pervitin” (a powerful methamphetamine) to stave off fatigue, historians have found no evidence that Nazis ever invented or used anabolic steroids in military combat.

Bottom line, there’s no reliable evidence that testosterone replacement makes better soldiers.

What constitutes “testosterone deficiency?

Part of the problem is that the criteria for “low T” are arbitrary. True hypogonadism is defined as a total serum testosterone level below 300 ng/L. But the diagnosis is also prompted by characteristic signs and symptoms like low libido, fatigue, depression, loss of muscle mass, and insulin resistance.

It’s also age-defined. While a testosterone of 300 might be unusually low for a 28-year-old, it might suffice for a 55-year-old.

And total testosterone is an unreliable indicator of free testosterone, which is the body-ready form of the hormone. Sex hormone binding globulin and albumin “sop up” some of men’s testosterone, rendering it less “free”.

It doesn’t stop there. There’s evidence that for testosterone to supercharge cells, it needs to activate special receptors; even in the presence of seemingly adequate blood levels of testosterone, anabolic resistance may compromise its action.

Testosterone is having a moment

For a long time, doctors were wary of prescribing testosterone. It was thought to hike the risk of heart disease and fuel prostate cancer growth. But newer studies have mostly vindicated testosterone on both counts. I’ve long prescribed it, but only where appropriate.

Equated with virility, strength and anti-aging, its use is skyrocketing, even among younger men who don’t formally meet the criteria for outright hypogonadism, but want to “top off their tank” to restore youthful levels. Witness the proliferation of “natural” testosterone boosters, as well as the ubiquity of online dispensers with minimum guardrails for prescribing.

How the military can optimize testosterone naturally

Rather than prescribing testosterone wholesale for its young recruits, there are easy non-pharmacological ways to boost T levels in military personnel:

Do hard things. Resistance training amps up testosterone production. Lift heavy, and engage in martial arts exercises as a proxy for combat.
Provide opportunities for adequate sleep. Sleep deprivation, and undiagnosed conditions like sleep apnea, deplete testosterone.
Avoid excess alcohol. While banned during basic training, furloughs and shore leave, as well as well-stocked base commissaries, often facilitate binge-drinking; alcohol reduces testosterone and enhances estrogen.
Nutrition. Adequate protein and healthy fats—including cholesterol—are essential cofactors for natural testosterone synthesis. Magnesium, zinc, and vitamin D in particular are important cofactors. A diet heavy in ultra-processed foods can lower testosterone levels by roughly 11% in as little as three weeks
Shed excess body fat. Adipose tissue acts like a sponge for the body’s finite supply of testosterone. T levels can often be restored to normal with weight loss alone.
Minimize exposure to harmful environmental chemicals. So called “gender-benders”—endocrine disruptors—include plastic residues, herbicides and pesticides, heavy metals, lubricants, and fire retardants.
Control stress. The inordinate demands of prolonged combat readiness and absence from home can stoke cortisol levels, which drain testosterone. Low T is a hallmark of occupational “burnout”.

BOTTOM LINE: Secretary Hegseth’s initiative is a symbolic affirmation of his commitment to remake the U.S. armed forces into a more deadly fighting force, in reaction to an allegedly “wussified” military culture. Whether it will materially affect combat readiness is an open question. At the very least, the availability of routine testing will inform military personnel of an important proxy of overall fitness. For some, testosterone replacement may enhance well-being; for others, feedback may spur efforts to get into better shape via natural means.

Oo-rah!!