Testosterone Is Not a Weapons System

By Dr. Christopher Piercecchi, MD.

Physician and Wellness Manager, Founder, The Men’s Clinic for Wellness & Vitality

This is a clinical and policy commentary. It’s for education, not personal medical advice. Full disclaimer at the end.

On July 15, 2026, Pete Hegseth announced that every service member 30 and older will now undergo mandatory annual testosterone screening as part of their periodic health assessment.[1] Troops under 30 can request it, and any resulting testosterone replacement therapy is voluntary. He framed it as a way to keep troops on the “leading edge of lethality.” The move comes as the FDA, this June, requested labeling changes easing a longstanding restriction on prescribing testosterone for age-related low testosterone, a limitation that had been in place since 2015.

Treating men clinically is what I do every day. I see hundreds of them a year, and a lot of them walk in thinking, or feeling, or having been told, that they have low testosterone. I screen them, diagnose them, and, in some cases, treat them. This is my business, and I understand it cold. That’s exactly why I feel compelled to cut through the nonsense, especially now that the Secretary of War has stepped onto the stage to convince the country that low testosterone is some crisis hollowing out the force. It isn’t.

Where This Came From

There is a large movement of physicians and self-styled experts who believe they have the testosterone question figured out. They believe men today have less testosterone than men did decades ago. They believe almost any man whose number isn’t high should be on therapy. And they’ve been loud enough, long enough, that the message now reaches people like Hegseth, who is not a physician, knows very little about testosterone physiology, and is listening to advisers who either have an agenda or don’t understand the medicine themselves.

Many of the loudest voices in this space aren’t physicians at all, and plenty of the ones who are don’t spend their days in clinical practice. A lot of them have never really followed a man on testosterone over the long haul, prescribed it, watched how it plays out, and seen what the outcomes actually look like.

You’ve heard me say I favor a more liberalized approach to testosterone treatment. The rigid rule that a man must fall below one specific number multiple times before treatment can even be considered is too strict, and some of the endocrine guidelines have been overly restrictive.[2] I’ll grant that freely.

What this really means: Roughly eighty percent of the men who come to me, convinced they need testosterone, or already on it from another provider, do not need it. Full stop.

Many of these men show up in my clinic after years of taking “TRT” and still have the fatigue, the poor sleep, the low motivation, the exact symptoms that supposedly justified the prescription. The reason is simple. Testosterone was never the cause of their problems, and it was never going to be the cure.

Testosterone Was Never the Cause

Take almost any man and ask whether he’s tired, sleeping poorly, gaining weight, or not feeling like himself. Then check his testosterone, and find it sitting in the lower third of the normal range, low-ish, but not deficient. The people advising Hegseth would say the answer is obvious: treat it.

Nothing could be more wrong. The real question is why that number is relatively low, and that’s the part Hegseth and his people don’t seem to be considering. If they were screening to actually work out why a man’s testosterone is low and treat that, fine. That’s medicine. But that’s not the message. The message is: screen the man, and if the number’s low, start injecting, as if a syringe of testosterone turns him into a super-warrior. Low testosterone has many causes, and most of them aren’t fixed by adding more testosterone. It just moves the value on the lab report. Testosterone will not fix untreated sleep apnea, chronic sleep deprivation, obesity, metabolic disease, depression, alcohol, or overtraining. Raising a laboratory number is not the same as treating the problem.

Hegseth said the modern battlefield is brutal and unrelenting, that it demands maximum psychological and mental readiness, and that catching these markers early keeps troops on the leading edge of lethality.

That’s a conclusion he has no business drawing. He’s not a physician, he’s not a scientist, and this isn’t a subject you get to reason your way into from a podcast. I say that as someone who agrees testosterone should reach more appropriately selected men than it does now. Testosterone does not manufacture readiness, toughness, resilience, or lethality. It restores normal physiology in specific men who are genuinely deficient. That is a narrow and different thing.

One Number Tells You Almost Nothing

Total and free testosterone also fluctuate far more than most people realize. I went back through years of my own patients’ labs and found fluctuations approaching 40 percent in the same men over time, low on one draw, considerably higher months later, down again after that. Excessive work, stress, poor sleep, hard training, undereating, weight gain, illness, medications, and shifts in binding proteins can all pull a single value down temporarily. One number is a snapshot, not a diagnosis.

That’s exactly why mass screening is the wrong tool. Testing every man over thirty, most of them without symptoms, guarantees a flood of borderline and temporarily low results, and each one becomes a prompt to treat rather than an occasion to think. This is well-trodden ground in medicine. Screen a large, mostly healthy population for a number, and you manufacture false positives, repeat tests, and pressure to prescribe, whether or not anyone is sick.

Now, the claim you’ll hear most: men today have less testosterone than their fathers. There’s some truth buried in it, and it deserves to be dealt with honestly rather than the way the internet does.

The observation is real and has been replicated. Average total testosterone has drifted down across several populations. What it means is another matter. The Massachusetts Male Aging Study followed men from 1987 to 2004 and found an age-independent, generation-over-generation drop that persisted after adjusting for weight, smoking, and health.[^3] A large Israeli health-system analysis of over 100,000 men reached the same conclusion, which the authors judged unlikely to be explained by obesity.[4]

But the mechanism is genuinely contested, and that matters. A large Danish survey series complicates that picture. Once you adjusted for rising body weight, the testosterone trend was no longer significant, calculated free testosterone hadn’t meaningfully declined at all, and the change tracked binding-protein shifts rather than falling testosterone production.[5] In other words, part of what looks like “men are losing testosterone” is men getting heavier and their binding proteins shifting.

And here’s the part the testosterone evangelists never mention. Even taking the decline at face value, the men who are genuinely, symptomatically deficient are a small minority. The European Male Ageing Study surveyed 3,369 men aged 40 to 79 and required real symptoms alongside a genuinely low level before making the diagnosis. Only about 2 percent qualified, and they were disproportionately the oldest and most obese.[6] A longitudinal analysis of the same cohort showed the decline is modified by weight and lifestyle, with weight loss raising testosterone and weight gain lowering it, which points the cause back at health rather than the calendar.[7] Then there’s the Healthy Man Study: researchers took men over 40 in genuinely excellent health with no symptoms, and their testosterone did not decline with age at all.[8]

In healthy men, the famous decline barely exists, and the men who are truly deficient are mostly the ones who are less healthy and overweight.

What this really means: The population’s testosterone is drifting down largely because the population is getting less healthy, not because a mysterious force is draining it out of otherwise healthy men. A trend line across millions of men is an argument for understanding the cause, not an excuse for injecting everybody with testosterone.

The Question Nobody Asked

There’s an operational issue Hegseth and his advisers appear not to understand at all. Injectable testosterone has to be given on a schedule, often weekly, to hold a stable level, which means it depends on reliable resupply.

Now consider the soldier who’s actually on it. He’s deployed across the world, in a war zone, and the supply chain breaks. Has anybody thought through what happens when he runs out and can’t get the next dose?

Here’s what most people don’t understand about testosterone therapy. The moment a man begins TRT and starts taking testosterone, his body stops making its own. Its ability to produce testosterone essentially shuts off, and from that point on he’s dependent on the injections. Pill forms exist in some cases, but the situation is identical.

Now you’ve created a dependence problem, and for a man deployed in a wartime theater, that’s a serious one. If he abruptly comes off testosterone because he can’t get it, a realistic concern in a war zone, he’s thrown into true hypogonadism. His body has no testosterone of its own to fall back on, because it can often take months, and in rare cases up to a year, before natural production comes back. Picture that soldier downrange when the supply runs out. The injected testosterone clears his system, his own production is still offline, and nothing bridges the gap. For that entire stretch he’s running on almost nothing: exhausted, weak, unmotivated, foggy, and materially worse off than before anyone decided to “optimize” him. You’ve taken a man whose body made its own testosterone and left him dependent on a shipment reaching a war zone.

The Policy Already Says This

This is something Hegseth should have worked through before he ever spoke, and something his advisers should have walked him through, because the military already has rules built around exactly this kind of problem.

Under the Defense Department’s own deployment policy, a service member whose condition requires periodic evaluation or treatment that isn’t readily available in theater can be found non-deployable without a waiver.[9] Testosterone therapy fits that description. It isn’t set-and-forget. It needs ongoing monitoring, periodic bloodwork to track hematocrit and other markers, careful dose management, and uninterrupted resupply. That’s precisely the kind of continuous medical dependency the policy is written to flag.

That same policy already treats insulin-dependent diabetes as deployment-limiting. The reason there is acute: lose the drug and the man can go down fast. Testosterone runs on a slower fuse, but the principle underneath is identical, and it’s the one Hegseth is walking straight past. The military restricts deployment for men whose function depends on a medication and a supply line a war zone can’t promise to deliver.

So follow his logic to the end and you arrive at one of two absurd outcomes.

Either you apply the rule as written, in which case every otherwise-healthy man you talk onto testosterone becomes a man you now have to monitor, resupply, or waiver downrange. You didn’t build a lethal warrior. You built a maintenance requirement.

Or you carve out an exception and send these men to a war zone dependent on a hormone shipment reaching them. But the moment you do, you’ve conceded that dependence on a resupplied medication isn’t disqualifying after all, and you’re left explaining why that logic applies to testosterone but not to the insulin-dependent diabetic you keep home. You’ve either got a standard or you don’t.

You cannot screen healthy men onto open-ended, resupply-dependent therapy and call it a readiness gain, when the military’s own rules already treat that kind of dependency as a liability to manage, not an advantage to chase.

This is not a hypothetical concern about sloppy prescribing, either. Testosterone testing and prescriptions have nearly tripled in recent years, and by some estimates up to a quarter of men started on it never had their levels properly tested first.[10] Now scale that culture across the force.

What the Military Should Actually Do

The military should absolutely care about the health and performance of its people. It should diagnose and treat legitimate testosterone deficiency, and it should keep that treatment available downrange for the men who truly need it. It should also do the harder, less marketable work: diagnosing and treating obesity, sleep deprivation, sleep apnea, poor nutrition, metabolic disease, training overload, and inadequate recovery, because those are the actual reasons most screened men will test low in the first place.

Fix those, and something predictable happens. In my clinical practice, about eighty percent of the men who’d otherwise be put on TRT by some testosterone clinic don’t actually need it. We address the real problem upfront, the fat, the apnea, the sleep, the training, and their testosterone climbs back on its own. They raise it naturally, and they never go on testosterone at all.

And here’s the question no one at the podium has answered. No one has shown that screening every man over thirty and nudging his number upward produces a fitter, tougher, more lethal force. That evidence doesn’t exist.

Testosterone is not a shortcut to lethality, and a low or borderline lab value is not proof that a man needs injections. Every physician pushing this message to the Secretary should be asked a harder question. Not whether they practice medicine, but how they consider themselves an expert in this when they don’t practice this kind of medicine at all. Most of them don’t. They’re researchers, or personalities with a brand to sell.

This is what happens when people stop treating testosterone as a hormone and start treating it as an ideology.

This was never about politics for me. It’s about the medicine, and the medicine here is wrong.

This article is for education and general information only. It is not personal medical advice and does not create a physician-patient relationship. Testosterone therapy carries real risks and benefits that depend on the individual, and decisions about testing or treatment should be made with a qualified clinician who knows your history, labs, medications, risk factors, and goals. If you are a service member, follow your command’s medical guidance and your treating provider’s direction.

Refrences

1. U.S. Department of War. Statement on enhanced screening protocol to optimize warfighter performance and enhance force readiness, July 15, 2026.

2. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744.

3. Travison TG, Araujo AB, O’Donnell AB, Kupelian V, McKinlay JB. A Population-Level Decline in Serum Testosterone Levels in American Men. J Clin Endocrinol Metab. 2007;92(1):196–202.

4. Chodick G, Epstein S, Shalev V. Secular trends in testosterone: findings from a large state-mandated care provider. Reprod Biol Endocrinol. 2020;18:19.

5. Andersson AM, Jensen TK, Juul A, Petersen JH, Jørgensen T, Skakkebaek NE. Secular Decline in Male Testosterone and Sex Hormone Binding Globulin Serum Levels in Danish Population Surveys. J Clin Endocrinol Metab. 2007;92(12):4696–4705.

6. Wu FCW, Tajar A, Beynon JM, et al. Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men. N Engl J Med. 2010;363(2):123–135.

7. Camacho EM, Huhtaniemi IT, O’Neill TW, et al. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. Eur J Endocrinol. 2013;168(3):445–455.

8. Sartorius G, Spasevska S, Idan A, et al. Serum testosterone, dihydrotestosterone and estradiol concentrations in older men self-reporting very good health: the Healthy Man Study. Clin Endocrinol (Oxf). 2012;77(5):755–763.

9. U.S. Department of Defense Instruction 6490.07, “Deployment-Limiting Medical Conditions for Service Members and DoD Civilian Employees,” February 5, 2010, Enclosure 3.

10. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423–432.

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