Testosterone is having a moment. From patients requesting testosterone testing, to morning sports radio urging me to “get my T checked,” to Pete Hegseth’s recent recommendation to screen military personnel, testosterone just won’t go away. The renewed interest in testosterone is as much cultural as it is medical. Culturally, prominent male podcasters and proponents of the Make America Healthy Again (MAHA) movement equate muscles and testosterone with masculinity. So, after my morning cup of coffee and the third advertisement urging me to get my testosterone checked, I read Hegseth’s remarks less as a serious medical intervention than as another front in a culture war that glorifies and defines men by their testosterone levels.

Medically, the Department of War’s proposed testosterone screening policy is more than political theater. It rightly highlights the health consequences of low testosterone, which may be more prevalent in certain parts of the military. But Hegseth’s policy gets the story backward.

One-time testosterone screening and optional supplementation won’t improve individual warfighters. Instead, the physical and psychological demands of military service can markedly suppress testosterone levels. Hegseth might argue that this is precisely the point. In his view, testosterone replacement therapy (TRT) would help “restore and optimize your natural capabilities, protecting your longevity.” Will TRT improve military performance? Will it lead to better health and greater longevity? As we’ll see, the evidence suggests that the potential harms outweigh the benefits.

Does more testosterone improve performance?

Renewed enthusiasm for testosterone, particularly in the manosphere, has revived the myth that, when it comes to performance, higher is always better. The evidence paints a more nuanced picture. Among elite athletes, those in the highest third of testosterone levels performed no better in running and track-and-field events than those in the lowest third. In fact, pushing the body to its athletic limits appears to lower testosterone.

A landmark study of the eight-week U.S. Army Ranger training program demonstrated the profound physiological effects of extreme physical training. During prolonged energy deficit, healthy young volunteers lost roughly 50 percent of their fat mass. At the same time, their testosterone levels approached the castrate range before returning to normal after training. Elite Ironman athletes likewise have a higher prevalence of testosterone deficiency.

So, might TRT help those on the lower end of normal? One challenge in interpreting this literature is that testosterone testing is remarkably nuanced. Results vary depending on the assay, time of day, sex hormone-binding globulin (SHBG) levels, and even normal biological variation between tests. Current American Urological Association guidelines define hypogonadism as two separate low testosterone measurements in the presence of compatible symptoms. A policy based on a single screening test could falsely classify up to 30 percent of people as potential candidates for TRT.

More importantly, the treatment may not address the underlying cause. Service members who have recently completed intensive physical training may see their testosterone levels normalize with rest alone. For others, traumatic brain injury, obesity, or chronic opioid use may suppress testosterone production, requiring a more individualized treatment plan. An emphasis on TRT may increase muscle mass and modestly improve endurance capacity. But it also carries significant medical risks.

The hidden risks of TRT

In an aptly titled essay, “Testosterone Therapy: Not a Toy, Not a Hack,” cardiologist James Stein outlines the risks of supplemental testosterone, including cardiovascular disease, blood clots, and neuropsychiatric symptoms. The largest randomized trial to date, the TRAVERSE trial, showed only that TRT was noninferior to placebo. However, it also found higher rates of blood clots and atrial fibrillation among men receiving TRT.

Paradoxically, supplemental testosterone can also cause infertility. The mechanism is straightforward: TRT suppresses the body’s own testosterone production. One study found a 94 percent reduction in intratesticular testosterone levels after just three weeks of therapy. As a result, sperm counts plummet. Many men receiving supplemental testosterone become infertile, a decidedly unmasculine consequence of treatment.

Treat the cause, not the number

Hegseth has called for a “High-T Department of War.” The irony is that the very practices that prepare people for war deplete natural testosterone levels, and so can TRT. He has identified the right problem but prescribed the wrong solution.

Low testosterone is a genuine concern during military training, likely affecting tens of thousands of service members. A more robust policy would measure fasting morning testosterone on two separate occasions before addressing the underlying causes of energy imbalance, chronic stress, traumatic brain injury, and opioid use. Providing comprehensive weight-loss programs and reducing opioid use where appropriate would offer a safer alternative to routine TRT, which carries significant risks.

As of this writing, Hegseth’s screening proposal is just that, an announcement. As the details and supporting evidence emerge, I hope the proposal will spur a broader conversation about the complexities of measuring, screening for, and treating testosterone deficiency. I also hope we can step back and distinguish cultural beliefs from medical evidence. Yes, testosterone can make some men stronger, but intense exercise and chronic stress can also lower testosterone levels. Even for men with low testosterone, we should tread carefully before prescribing TRT. Our hearts, blood vessels, and even our future children may thank us.

Tom Peteet is a board-certified internal medicine physician, educator, and writer. For nearly a decade, he has practiced at Commonwealth Care Alliance, focusing on home-based care for patients with complex disabilities. He also cares for patients in long-term care facilities and works with InstED, a mobile health program that brings acute care into patients’ homes.

As an adjunct professor at Massachusetts College of Pharmacy and Health Sciences, he directs a year-long pharmacology course for physician assistant students. At Boston University, he has taught more than ten courses through its prison education program and is developing courses in neuroscience and medical anthropology.

His scholarship spans medical ethics, medical education, and health equity, including work on the treatment rights of incarcerated patients, the role of theory and the humanities in medical training, and the intersection of quality improvement and equity in residency. His writing has appeared in the AMA Journal of Ethics, Medical Teacher, and the Journal of Family Medicine, and he authored a 2025 textbook chapter on renal disorders in Pathophysiology in Focus.

His writing explores health care ethics, medical education, and the overlooked paradoxes of human physiology. He writes Against Medical Advice, a Substack on the hidden science of medicine, and is working on a nonfiction book about the strange science of blood pressure. More of his work is available on his personal website.