Defense Secretary Pete Hegseth has branded his new military initiative the “High-T Department of War” – but medical experts warn the plan to test thousands of active-duty service members for low testosterone is flatly ignoring standard clinical science.
The directive, which will add mandatory testosterone screenings to annual health assessments for troops 30 and older, has drawn sharp criticism from experts who warn the policy lacks scientific backing, defies established clinical guidelines and could introduce unnecessary health risks, particularly for female service members.
“This is a surprising advent because they’re targeting recruits or military personnel over the age of 30, both males and females, and just doing a screening test, devoid of whether you have symptoms or not,” Dr. Hugh Cassiere, a physician in critical care at Northwell Health, told The Independent. “That really goes against guidelines.”
Hegseth announced the program in a video posted to X Wednesday.
“We must constantly look for new ways to optimize your performance, your resilience and your long-term health,” Hegseth said in the video, framing the initiative as a way of “restoring and optimizing your natural capabilities, protecting your longevity.”
Cassiere explained that standard medical practice only dictates testosterone screenings for patients already presenting clear clinical symptoms of hypogonadism, such as fatigue, muscle loss and sleep disturbances.
Other medical experts shared these concerns. Adriane Fugh-Berman, a professor in the department of pharmacology and physiology at Georgetown University, told The Washington Post that the initiative “is non-evidence-based and could cause harm.”
Stuart Phillips, a kinesiology professor at McMaster University, told the publication that a blanket screening policy was flawed.
“People go to their doctor with symptoms … and then get a testosterone-level test and then that informs whether they receive the treatment,” Phillips said. “So [a] blanket [policy], like, we’re going to screen everybody over the age of 30, is kind of a ridiculous notion.”
Though the policy is being promoted as a performance-enhancing measure, experts point out that there is no established correlation between baseline testosterone levels and physical capability.
“You can have a male who has a testosterone level of 1,000, which is high, and a male that has a testosterone level of 450, and the 450 male outperforms the male with 1,000,” Cassiere said. “It’s not just about a testosterone level. It’s about the individual, and whether that individual is healthy, fit, so there’s a real loose correlation between the two, and there’s no direct relationship at all.”
The screening program’s application to female service members has raised significant clinical concerns. Testosterone levels naturally decline with age, but women naturally have significantly lower levels than men.
“Everyone over 30 years old will be tested annually,” a Department of Defense official told The Independent.
The enhanced screening “represents a continued investment in the health, peak performance, and resilience of the force. The protocol will enable the Department to establish a comprehensive baseline and offer targeted testosterone therapy, ensuring that it sustains a healthy, capable, and decisively dominant fighting force,” said Chief Pentagon Spokesman Sean Parnell.
Cassiere emphasized that because women’s biological baselines are so low, widespread testing makes little clinical sense.
“Females have 10 times less testosterone level than men,” he said. “Women in the military perform the same as men in military, and their testosterone levels are 10 times less than men. That should tell you everything you need to know about testosterone levels and performance.”
Cassiere added that testosterone replacement therapy was not FDA-approved for women, and introducing it could cause severe health complications, such as blood clots or elevated red blood cell counts, which could lead to strokes and heart attacks.
“How about women who are supposed to have low testosterone levels, and you’re doing all these negative things by treating them?” Cassiere asked. “I think it’s a little unfocused to do screening that includes women for this.”
Beyond the physiological risks, physicians worry about how the program will operate within the military hierarchy. Even though the testing is required, the Pentagon frames the hormone therapy as “voluntary” – but the power dynamics of military command could cloud that distinction.
“My big concern is although it’s voluntary, you’re in the military,” Cassiere told The Independent. “You found out that you have a low testosterone level. The medical officer knows you have a low testosterone level. Does your commander know that, and the people in your infantry or division? There’s going to be peer pressure or some type of external pressure to treat something that doesn’t need to be treated.”
The actual science of testing also presents logistical hurdles. Hormone levels fluctuate wildly throughout the day, depending on stress and physical exertion.
Levels vary “hourly, daily, weekly and seasonally,” Fugh-Berman said. “Testosterone levels go up if you hold a gun, they go down if you hold a baby.”
To implement such a directive safely, Cassiere advises that the Pentagon establish strict protocols, such as ensuring tests are taken in the morning under low-stress conditions, verifying any low results with a secondary test, requiring clinical symptoms before diagnosing or treating, and keeping all results strictly confidential.
