Pentagon issues new guidance for testosterone testing after rescinding previous one

The Pentagon issued new guidance late Thursday instructing mandatory testosterone deficiency screening for male active-duty and ​reserve service members over the age of 30 after temporarily rescinding previous guidance earlier this month.

The department said the updated guidance will address male testosterone deficiency and establish uniform screening and treatment pathways across the Defense Health Agency (DHA).

The Pentagon says this is being done so the U.S. military has a lethal fighting force “prepared to dominate the battlefield and achieve peace through strength.”

“By proactively identifying and treating suboptimal hormone levels, the Department continues to invest in the health of its warfighters, strengthen their performance and maximize force readiness,” Pentagon chief spokesperson Sean Parnell said in a statement .

The screening will consist of a “structured symptom and risk-factor assessment,” the DHA said, while male service members under the age of 30 will be screened on request or where “clinical indicators are identified by the examining provider.”

The DHA said the provider will document the presence or absence of each of the symptoms, along with risk factors.

Symptoms include erectile dysfunction, reduced sexual desire, unexplained loss of muscle mass or gain in fat, depressed mood, low motivation, disturbed sleep, impaired concentration or memory, diminished physical performance or endurance not correlated with injury and loss of spontaneous morning erections.

Risk factors include obesity, type two diabetes or metabolic syndrome, chronic opioid or glucocorticoid therapy, prior traumatic brain injury with loss of consciousness, testicular trauma, torsion, undescended testis, orchitis or prior chemotherapy or pelvic radiation, known or suspected obstructive sleep apnea, low-trauma fracture, recurrent bone stress injury, unexplained anemia, infertility and gynecomastia, according to the DHA.

“The combination of reduced sexual desire, loss of spontaneous morning erections, and erectile dysfunction have been shown to be most specific for androgen deficiency,” the DHA said in the document. “The remaining symptoms are sensitive but nonspecific, and are more commonly attributable to sleep restriction, energy deficit, mood disorder, or overtraining.”

Defense Secretary Pete Hegseth unveiled the Pentagon’s effort to screen service members’ testosterone levels and offer testosterone replacement therapy (TRT) in July, stating it would be a way to keep soldiers on the “leading edge of lethality.”

“While we invest heavily in our weapon systems, platforms and gear, our most decisive tactical advantage will always be the individual warfighter,” Hegseth said in a video at the time . “We have a sacred duty to maintain that advantage, which is why we must constantly look for new ways to optimize your performance, your resilience and your long-term health.”

The female clinical practice guideline is being reviewed and will be posted “upon approval,” Vice Adm. Darin K. Via, director of the DHA, said in a Thursday memo.

For male service members, the diagnosis will not be made after a first test, as the second test will be done on a different day under the same “pre-test conditions,” the guideline said.

Service members will be tested between 7 and 10 a.m., but for those on night or rotating shifts, they will be tested within three hours of waking up after a full night’s sleep. The service members will be tested while fasting and not within 30 days of recovery from being sick.

DHA will consider multiple formulations before offering TRT, including the service member’s preference and convenience when picking the type and dose, ability to comply with treatment and the appropriateness of the selected product.

“Injection therapy will consist of testosterone cypionate or enanthate, subcutaneous or intramuscular, with starting doses of 100 mg once weekly, or the weekly dose divided and administered twice weekly,” the DHA said in the guidance.

TRT can be initiated within 90 days of the service member’s deployment, but continuing during deployment will warrant a four-to-six-week follow-up assessment to show “clinical stability and a testosterone level within the target range of 300–600 ng/dL,” according to the DHA.

“Once stability has been established, the patient would then transition to the every-6-month monitoring schedule,” DHA said. “A Service member who is stable on testosterone therapy should be deployable without requiring a waiver, depending on the formulation.”