Originally published in The Intercept
Written by Austin Campbell

Providing continuing hormone-replacement therapy at “the High-T Department of War,” as Secretary Pete Hegseth is calling it, may prove difficult for the federal government because the department in charge of healthcare for veterans has already documented a struggle to manage service members’ hormone therapy, The Intercept has found.

A person on testosterone therapy can’t just stop it abruptly. Dr. Adrian Dobs, a professor of medicine and oncology at Johns Hopkins University School of Medicine, told The Intercept testosterone therapy can suppress the body’s natural production of the hormone and sperm, as well as create medical needs that persist after treatment stops. “We’re sort of creating a dependency on testosterone,” she said.

Under Hegseth’s new initiative, service members age 30 and older are slated for annual testosterone screening, regardless of whether they have any symptoms, while troops under 30 may request screening during their periodic health assessments. Doctors and endocrinologists warned that this proactive screening could lead to overprescription of hormone-replacement therapy for people who don’t need it. This could affect their fertility in the short term, Dobs said, because “men who take testosterone will have a reduction in their sperm counts.”

And after a service member leaves the military, they may require continued medical care. That care could eventually fall to the Department of Veterans Affairs, which has previously struggled with the same treatment.

In a 2018 review of testosterone replacement therapy, the VA Office of Inspector General found that providers often started patients on testosterone without adequately documenting symptoms or confirming low testosterone levels and frequently failed to conduct recommended follow-up after treatment began. Approximately 2 out of 3 patients did not get a documented discussion of the risks and benefits of the treatment before starting.

Dr. Alvin Matsumoto, a professor emeritus at the University of Washington School of Medicine and former attending physician and associate director at the VA Puget Sound Health Care System, said the findings show why testing for low testosterone is not enough to determine whether someone should receive treatment. Matsumoto helped develop the Endocrine Society’s clinical practice guidelines for testosterone treatment, which the inspector general found the VA had routinely violated in its 2018 review.

Testosterone levels can change depending on when a patient is tested, whether they have recently eaten, exercised heavily, or are sick, among other factors, Matsumoto said. In about a third of men whose testosterone initially tests low, a second test produces a normal result.

That creates a risk under a program that will routinely screen otherwise healthy troops and make testosterone therapy available to those subsequently diagnosed with a deficiency.

“Initiating testosterone therapy in men who have a single low testosterone [test] but no clinical manifestations of testosterone deficiency will likely result in treatment of some men who do not have hypogonadism,” Matsumoto told The Intercept.

Medical guidelines instead call for doctors to establish that a patient has symptoms and repeatedly low testosterone levels before beginning treatment. Matsumoto said those steps would need to occur either while a service member remains under Pentagon care or after they transition to Veterans Affairs.

The question becomes particularly important when those patients move between the two systems. Matsumoto said a VA provider inheriting a patient already receiving testosterone should review why treatment was started in the first place, including whether the patient had symptoms and repeatedly low testosterone levels.

But he does not expect that reassessment to routinely happen. Usually, “the diagnosis will be assumed to be correct,” Matsumoto said.

It’s a similar problem to one the inspector general identified in its review of VA care. Some providers appeared to be testing patients for low testosterone without first documenting symptoms suggesting a deficiency.

The inspector general made seven recommendations to bring VA practices up to standards, including repeat testing and monitoring. According to the inspector general, the VA implemented all seven recommendations and closed them as implemented, as the VA noted in response to questions from The Intercept.

Among the changes the VA implemented was a requirement that providers establish signs and symptoms of testosterone deficiency before testing a patient’s testosterone level for confirmation — a higher standard than Hegseth’s call for annual testosterone screening based on age alone.

“I would be against universal screening, which is what we’re talking about here,” said Dobs, a position consistent with guidance from the Endocrine Society, which represents physicians and researchers specializing in hormonal health.

The Pentagon’s new initiative presents a different question: What happens when service members arrive at the VA already receiving testosterone treatment initiated while they were on active duty?

The Intercept asked the VA whether it has the clinical capacity to continue testosterone treatment for veterans who begin therapy under the Pentagon’s new initiative, whether those prescriptions would automatically continue after separation or require a new VA evaluation, and whether the VA and the Pentagon have coordinated on transitioning those patients between the two healthcare systems.

The Department of Veterans Affairs did not answer any of those questions.

“VA provides testosterone testing and replacement therapy when medically necessary,” VA Press Secretary Quinn Slaven told The Intercept.

Defense Department personnel data from 2024 show roughly 451,000 active-duty troops were age 31 or older, a conservative figure that excludes 30-year-olds, who would also fall under Hegseth’s screening requirement. More than 1 million of the military’s 1.27 million active-duty service members were men.

“Here we have men who are in their prime of reproduction, and we’re causing a drop in their sperm counts when there really may not be sufficient benefit,” Dobs said.

The Pentagon did not provide The Intercept with the scientific evidence behind the mandate, say whether it assessed the fertility consequences that can follow testosterone treatment, or address safeguards to prevent unnecessary treatment.

Screening asymptomatic patients is “sort of opening up a can of worms,” Dobs said, citing the difficulty of interpreting test results and determining when treatment is warranted. She was particularly concerned about treating otherwise asymptomatic men whose levels fall within a low or low-normal range — a likely risk in a military overwhelmingly composed of young adults.

The Endocrine Society also recommends against starting testosterone therapy in men who are planning to father children in the near term.

In response to The Intercept’s questions, Defense Department officials pointed to Hegseth’s health and human performance directives, statements from Pentagon officials, and the “High-T Department of War” video.

“It’s not about artificial enhancement,” Hegseth said in his video. “It’s about restoring and optimizing your natural capabilities, protecting your longevity and ensuring you have the biological foundation required to sustain the fight.”

But testosterone treatment can interfere with overall health. Patients placed on testosterone may require continued clinical monitoring to ensure they are not receiving excessive amounts of the hormone. Testosterone can also increase the proportion of red blood cells in a person’s blood, requiring additional monitoring during treatment. It introduces a complex treatment regimen with “very little real proven benefit in this healthy population,” Dobs said.

And there’s the financial cost.

“Who is going to pay for this testosterone while they’re in the service, and who is going to pay for it after,” Dobs asked, “if they require it for many years afterwards?”

Healthcare Replacement Therapy

The virility program Hegseth introduced also intersects with a long-running gap in military reproductive healthcare.

In May, a Congressional Research Service report identified testosterone exposure among the factors that can contribute to infertility. Yet TRICARE, the health insurance military members have, generally does not cover assisted reproductive technologies, including in vitro fertilization, intrauterine insemination, and cryopreservation, which can easily cost tens of thousands of dollars.

Congress nearly expanded that coverage last year. Both the House and Senate versions of the fiscal year 2026 defense authorization bill included provisions requiring TRICARE coverage of certain assisted reproductive technologies. Neither provision survived the final legislation.

The Pentagon is now preparing to routinely screen hundreds of thousands of troops and offer potentially unnecessary testosterone therapy even as TRICARE generally excludes treatments for infertility, one of its potential consequences.

And the plan gives scant consideration to another massive population.

“Nobody’s discussing women,” Dobs said.

Rep. Chrissy Houlahan, D-Pa., an Air Force veteran and member of the House Armed Services Committee, raised the same concern.

“Testosterone is important for both men and women,” Houlahan told The Intercept. “But when [Hegseth] says ‘biological foundation,’ clearly, he has only one sex in mind.”

Houlahan pointed to years of congressional efforts to expand access to fertility treatment for service members and their families.

“This administration not only has opposed efforts to expand access to IVF for service members and their families but has rolled back policies that enable them to take time off to get the full suite of health care they need,” Houlahan said.

She has pushed for research into how military service affects women entering perimenopause and menopause, including the potential effects of toxic exposure, combat, military sexual trauma, and post-traumatic stress disorder. “There is little to no research” on how those risk factors affect women’s health, Houlahan said.

Hegseth has repeatedly framed the testosterone initiative around military readiness and lethality. But “if Secretary Hegseth was truly looking to improve readiness, he would consider ways to support all service members, not just 49% of the population,” Houlahan said.

She was blunter about what she believes the testosterone initiative says about Hegseth’s priorities.

“This announcement about testosterone proves that Secretary Hegseth is only concerned about reproductive health when it serves his own political and misogynistic agenda,” Houlahan said.