Risky screening
Hegseth’s dubious low-T screening may flag up to 25 percent of the Army
Medical experts explicitly recommend against blanket screenings.
Up to a quarter of active-duty Army members could receive a low testosterone result from mandatory military screening, despite the true prevalence of the condition likely being a tiny fraction of that figure, according to a study published Thursday in JAMA.
The finding adds to concerns that the mandatory screening announced by Defense Secretary Pete Hegseth in July will lead to a cascade of unnecessary medical evaluations for military members. Those evaluations could result in inappropriate testing, inaccurate results and diagnoses, and overtreatment that could cause harm, including infertility. Medical experts, including the Endocrine Society and the American Urological Association (AUA), have recommended against blanket screenings for these reasons. Still, the Pentagon has moved forward with the plans, releasing clinical guidance in September.
The JAMA study highlights the reasons why testosterone levels are not measured in men without symptoms—and also offers a glimpse of how many Army members could become ensnared in the clinically dubious screenings.
Researchers at the Pennington Biomedical Research Center in Louisiana and the US Army Research Institute of Environmental Medicine in Massachusetts conducted the study. The researchers drew data from a large military health survey, which included members at five US Army installations. The survey data included morning blood draws from fasting military members. The samples were collected between August 2024 and January 2026.
Estimating impact
From those samples, total testosterone levels were measured from 479 male, active-duty Army service members. (Those receiving testosterone treatment were excluded from the study—three men were excluded for this reason.) With some statistical weighting, the 479 included members were representative of the active-duty US Army personnel; the weighted mean age was about 30 years old, and the weighted mean body mass index (BMI) was 28.4, which falls in the “overweight” category.
Generally, experts are wary of universally screening men for low testosterone because testosterone measurements can be highly variable—and unhelpful. Levels can dip for a number of different reasons, including age, time of day, obesity, illness, physical stress, poor sleep, trauma, and various medications. Moreover, the conditions that can cause clinically significant low testosterone—a condition called male hypogonadism—are rare, affecting 1 percent of men at most. They include genetic conditions and problems with the pituitary gland.
Given the complexity, experts recommend that evaluations be prompted by patients self-reporting symptoms. In those cases, doctors use repeat testing and comprehensive evaluations to come to a firm diagnosis of male hypogonadism. With that being the current norm, researchers aren’t sure exactly what the military’s new universal screen will yield.
According to the new data, a large portion of the military may face alarming results. From the Army members in the survey, the weighted mean for morning total testosterone was 405 ng/dL. The Pentagon’s clinical guidance uses a threshold of less than 300 ng/dL for low testosterone, in line with recommendations from the AUA. Using that cutoff and extrapolating the data to the entire Army population, the researchers estimate that about 26 percent of active-duty Army service members would get a test result suggesting low testosterone.
The Centers for Disease Control and Prevention has a harmonized reference cut-off that’s a little lower, at 264 ng/dL. With that threshold, about 15 percent of Army service members would be estimated to have a low testosterone result.
Screening risks
As expected, the likelihood of low results scaled with weight and age; the higher the age and/or higher the BMI, the greater the odds of having a testosterone reading under either threshold. Of men under age 30, 19.5 percent had a low measurement, while 33 percent of men aged 30 and older had low levels.
“Published estimates of clinical hypogonadism are substantially lower than the prevalence of low testosterone observed here, underscoring that many men with a single low screening measurement do not have clinical hypogonadism,” the researchers write. But each positive screening result will require thorough follow-up, including repeat testing, further evaluation, counseling on modifiable factors (such as losing weight or improving sleep), and treatment considerations, the researchers note.
“Because testosterone replacement therapy is long-term and has potential adverse effects, distinguishing an isolated low screening value from clinically significant hypogonadism is essential,” they write.
While the study looked at results from all men—without first assessing possible symptoms of male hypogonadism—the military’s screening will likely be more limited. The mandatory screening only applies to men aged 30 and above, while younger men are allowed to opt in. It’s unclear how many will do so. The first step in the screening is to ask members about possible symptoms and risk factors. From there, some men might not proceed to having a testosterone test.
Still, the symptoms and risk-factor screening will likely catch a large swath of the military, leading to far more service members getting tested than before. Possible symptoms include vague problems that aren’t closely linked to male hypogonadism, such as “diminished physical performance,” “disturbed sleep,” and “low motivation.” The risk factors considered also include common conditions, such as obesity, type 2 diabetes, and low-trauma fractures. Those with such risk factors can go on to be tested even in the absence of symptoms, according to the Pentagon’s guidance.
