The Pentagon’s new requirement for periodic testosterone screening for males over 30 aims to restore energy, metabolism, muscle strength, concentration and energy. Hegseth’s directive states that “targeted testosterone therapy directly optimizes Warfighter readiness.”
But testosterone replacement therapy (TRT) can also shrink testicles.
The Endocrine Society and the American College of Physicians) and other health experts criticize universal screening as unnecessary and potentially harmful. They say testosterone replacement therapy and artificial hormone injections carry known medical risks, not just the potential for smaller cojones.
How testosterone affects the psyche is more nuanced, according to science writer Robert M. Sapolsky.
Sapolsky explains the pros and cons –– and misconceptions –– about testosterone in his books “The Trouble with Testosterone: and other Essays on the Biology of the Human Predicament” (Scribner, 1997) and “Behave: The Biology of Humans at Our Best and Worst” (Penguin Press, 2017).
In the tradition of Stephen J. Gould, Oliver Sacks, and Edward O. Wilson, Sapolsky takes complicated scientific issues and translates them for the general public in a readable, friendly, and humorous style. His main idea about testosterone is this: it “isn’t causing aggression, it’s exaggerating aggression that is already there.”
From The Trouble with Testosterone:
“Round up some male monkeys. Put them in a group together, and give them plenty of time to sort out where they stand with each other –– affiliative friendships, grudges and dislikes. Give them enough time to form a dominance hierarchy, a linear ranking system of numbers 1 through 5. This is the hierarchical sort of system where number 3, for example, can pass his day throwing around his weight with numbers 4 and 5, ripping off their monkey chow, forcing them to relinquish the best spots to sit in, but, at the same time, remembering to deal with numbers 1 and 2 with shit-eating obsequiousness.”
In other words, with increased testosterone, those in the mid-level ranks will kowtow to their superiors while have increased aggression to subordinates. [Incidentally, it can take big testicular fortitude to stand up to those in power.]
Notably, at the same time that Hegseth touts TRT as necessary for enhanced readiness, critics and medical studies show that hormone interventions can shorten emotional triggers and increase reactivity and aggression. This is especially true, as Sapolsky reveals, in individuals with pre-existing impulsive or dominance traits.
From Behave by Sapolsky:
“Testosterone has far less to do with aggression than most assume. Within the normal range, individual differences in testosterone levels don’t predict who will be aggressive. Moreover, the more an organism has been aggressive, the less testosterone is needed for further aggression. When testosterone does play a role, it’s facilitatory — testosterone does not 'invent' aggression. It makes us more sensitive to triggers of aggression. Also, rising testosterone levels foster aggression only during challenges to status. Finally, crucially, the rise in testosterone during a status challenge does not necessarily increase aggression; it increases whatever is needed to maintain status.”
Testosterone, therefore, is a building block to a caste system, cementing a rank structure that relies on aggressive behavior to subordinates especially in stressful situations.
Critics of Hegseth’s requirement for TRT also decry the costs, likelihood of false-positives, and risk of unnecessary over-diagnosis and over-treatment. Thoughtful experts note the inequality of the “MANdate” –– requiring screening for men only. Does the policy give an unfair advantage to males for key assignments and promotions?
The controversy seems to be in line with Hegseth’s previously stated stance against women in combat as he expressed in his book War on Warriors and in a 2024 podcast shortly before his nomination as Secretary of Defense. Prior to his nomination Hegseth announced, “I'm straight up just saying we shouldn't have women in combat roles.” Since then he said if women can’t meet male standards “so be it.”
While the Pentagon has excluded women from hormone screening so far, officials say they are reviewing a “female clinical practice guideline” related to “hormone disruptions,” with consideration of possible estrogen-based therapies.
Critics also renounce the apparent hypocrisy of removing vaccine mandates to protect service members from influenza and COVID while requiring mandatory testosterone screening.
In removing vaccine requirements last April, Hegseth proclaimed, ”your body, your faith and your convictions are not negotiable.” Some say forcing hundreds of thousands of male troops 30 years old and older to undergo blood draws for hormone levels may violate that exact principle of medical autonomy.
By the way, public health officials criticized dropping the flu mandate, saying it was an ideological choice rather than an informed decision backed by medical science. (After Lackland Air Force Base experienced a massive flu outbreak, the military quickly reinstated the vaccine for basic recruits.)
Some free thinkers argue the testosterone policy mirrors a similar disregard for established medical professionals’ consensus. It should be noted that only screening for testosterone levels is required, and TRT is not yet mandatory.
But men who wish to advance in rank or be selected for plum assignments may feel compelled to accept TRT regardless of the health consequences (including, as mentioned, testicular atrophy.) One can easily see how those who get the T will be considered as more promotable Team players.
Some men may even try to juice up on testosterone prior to their screenings in order to be considered for promotion.
Hegseth’s finalized clinical guidance related to career advancement goes one step further: leaders diagnosed with testosterone deficiency and undergoing TRT may face immediate disqualification for duty in high-stakes specialized fields, including aeromedical, dive, submarine, and nuclear operations.
In one of his Dr. Seuss-like utterances, Hegseth said the U.S. military should conduct operations with “maximum lethality, not tepid legality.” (His recent announcement of wanting to conduct a public execution by firing squad for the religiously inspired Fort Hood shooter seems to dovetail with that philosophy. His desire for hormonally enhanced warfighters also fits the mold.)
Yet, author Sapolsky’s research highlights that testosterone, as a baseline level for "lethality" and physical dominance, is scientifically flawed for three reasons: (1) the “volume control” myth, (2) environmental impacts, and (3) exaggeration of what testosterone actually does.
Environment: Sapolsky writes about the mystery of nature vs. nurture, and in the case of testosterone, he notes the fallacy of believing low testosterone causes poor performance or lack of readiness. Sapolsky’s research shows that social context and environment dictate testosterone levels. A temporary drop in testosterone levels does not justify an arbitrary and artificial universal baseline via injections, ignoring health risks.
Exaggeration: Sapolsky writes, “Violence is more complex than a single hormone.” Testosterone does not create a superior, tougher alpha male, and because the Pentagon is purportedly targeting clinical hormonal deficiency, the actual results are negligible and could actually have a negative impact on readiness.
Consider submarine crews operating in high-stress, closed environments. If Sapolsky is right that an environment dictates that status and authority are maintained through intimidation within the hierarchy, a spike in testosterone could cause more volatile intimidation of subordinates and perceived inferiors.
Citing a New England Journal of Medicine report, Sapolsky acknowledges in The Trouble with Testosterone that, “I have emphasized that while testosterone levels in the normal range do not have much to do with aggression, a massive elevation of exposure, as would be seen in anabolic steroid abusers, does usually increase aggression.”
Considering all the risks, however, the biggest concern for men may be the possible link between Hegseth’s Big-T policy and small-t outcome.
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