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With Defense Secretary Pete Hegseth fueling a national conversation about testosterone, many men may wonder whether their own levels are where they should be.
On July 15, Hegseth directed the Pentagon to begin mandatory testosterone-deficiency screening for active-duty and reserve personnel age 30 and older as part of their periodic health assessments, with testing available upon request for younger service members.
Testosterone replacement therapy (TRT), when clinically indicated, will be voluntary, according to the Associated Press.
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The screening protocol is designed to “optimize performance, combat ‘Operator Syndrome’ and maximize mission readiness,” according to a statement posted by the U.S. Department of War, as provided by Hegseth’s office to Fox News Digital.
“I think Hegseth has a good idea,” Dr. Marc Siegel, Fox News senior medical analyst, told Fox News Digital. “I already screen for it in men over 50, and it makes sense to check for it in men who rely on tip-top physical performance.”
Unlike the Pentagon’s policy, the Endocrine Society does not recommend routine testosterone screening for men without symptoms.
“There is insufficient evidence to support a general recommendation to perform population-level screening for hypogonadism in asymptomatic men with measurement of blood testosterone level,” the society states on its website.
What constitutes low testosterone?
There is no single ideal testosterone level for every man. A harmonized reference range cited by the Endocrine Society is 264 to 916 ng/dL (nanograms per deciliter) for healthy, non-obese men ages 19 to 39, although ranges can vary by laboratory and testing method.
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The American Urological Association says that a total testosterone level below 300 ng/dL, when combined with symptoms of low testosterone, should be considered deficient.
The Endocrine Society estimates that hypogonadism affects roughly 2% of men overall, although rates vary by age and underlying health. The condition becomes more likely as men grow older, and certain medical conditions, such as obesity and diabetes, can also play a role.
Symptoms of testosterone deficiency
“Low testosterone can cause chronic fatigue, weight gain, bone and muscle loss, cognitive problems and increased body fat,” Siegel said.
The Endocrine Society shares the following list of common symptoms and signs of testosterone deficiency.
- Decreased sex drive (low libido)
- Erectile dysfunction
- Reduced sperm count and infertility
- Fatigue or low energy
- Loss of muscle mass and strength
- Depressed mood, irritability or difficulty concentrating
- Breast enlargement or tenderness (gynecomastia)
- Shrinking testicles
- Hot flashes
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Over time, men with untreated testosterone deficiency may also experience loss of body hair, decreased bone density (osteoporosis) and anemia (low red blood cell count).
Sexual symptoms, such as reduced libido and erectile dysfunction, are more specific signs of testosterone deficiency than fatigue or difficulty concentrating, which can have many possible causes, experts say.
Diagnosing low testosterone
Because testosterone varies by time of day and can be temporarily affected by food intake, illness and other factors, diagnosis generally requires symptoms or signs plus low results on at least two separate early-morning, preferably fasting blood tests, per the Endocrine Society.
If low testosterone is confirmed, doctors may order additional blood tests to determine the underlying cause, including luteinizing hormone (LH), which helps distinguish whether the problem originates in the testes, pituitary or hypothalamus.
Follicle-stimulating hormone (FSH) may also be measured, particularly when infertility or impaired sperm production is a concern.
In some cases, doctors may recommend testing prolactin, a hormone produced by the pituitary gland. Elevated levels of prolactin can suppress testosterone production and may indicate an underlying pituitary disorder.
Doctors may also measure free testosterone — the amount that is available for the body to use — if total testosterone levels are borderline or don’t fully explain a man’s symptoms.
Treatment methods
Before prescribing TRT, doctors generally look for potentially reversible or temporary factors, including obesity, certain medications, untreated obstructive sleep apnea, acute illness and excessive alcohol use.
“It makes sense to check for it in men who rely on tip-top physical performance.”
For men whose low testosterone is primarily related to obesity, weight loss is typically the first-line treatment, according to the Endocrine Society.
When consistently low levels and clinically significant symptoms are present, TRT may be considered after reviewing potential benefits, risks and treatment goals.
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TRT can be administered in the form of topical gels, transdermal patches, injections, buccal tablets, nasal gel or subcutaneous pellets, per the Endocrine Society.
In June 2026, the U.S. Department of Health and Human Services (HHS) announced that it has asked the FDA to update the prescribing information for TRT based on “a comprehensive review of new clinical data and existing scientific evidence.”
The proposed changes would remove labeling language stating that the safety and effectiveness of TRT have not been established in men with age-related hypogonadism and would update information about prostate cancer risk based on newer research.
“We are putting science back at the center of men’s healthcare,” said HHS Secretary Robert F. Kennedy, Jr., in a statement on the HHS website.
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“By updating testosterone therapy labels to reflect current evidence, we are giving patients and physicians clearer information, supporting informed medical decisions, and improving care for millions of American men.”
The announcement only pertains to drug labeling and does not change existing clinical guidelines.
Potential risks of TRT
Some patients may not be candidates for TRT, the Endocrine Society says.
Those include men with active breast or prostate cancer, elevated hematocrit (the percentage of total blood volume that consists of red blood cells), untreated severe obstructive sleep apnea, recent heart attack or stroke (within the previous six months) or thrombophilia (a blood disorder that increases your tendency to form abnormal clots inside your blood vessels).
Men who are trying to conceive should also avoid TRT, as it suppresses sperm production and can impair fertility.
Those receiving TRT should be monitored regularly by a physician, experts advise. Follow-up typically includes checking hormone levels, blood counts (as the treatment can increase red blood cell levels), symptoms and, when appropriate, prostate health and other potential adverse effects.
Latest evidence on TRT safety
In 2023, the TRAVERSE trial — led by Cleveland Clinic and published in The New England Journal of Medicine — found that TRT did not increase the overall rate of heart attack, stroke or cardiovascular death compared with placebo among middle-aged and older men who had confirmed hypogonadism and pre-existing cardiovascular disease or high cardiovascular risk.
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The trial did, however, suggest increased rates of pulmonary embolism, kidney injury and atrial fibrillation in the testosterone group, highlighting the importance of ongoing monitoring.
A separately published TRAVERSE substudy later found a higher rate of clinical fractures among men receiving testosterone.
“The results provide long-awaited reassurance about the cardiovascular safety of testosterone therapy when used as indicated in appropriately selected men,” said senior author Steven Nissen, MD, chief academic officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic, in a press release.
“Low testosterone can cause chronic fatigue, weight gain, bone and muscle loss, cognitive problems and increased body fat.”
“Although the trial showed some evidence that testosterone treatment may be safe for men with low levels of testosterone, these findings should not be used as a justification for widespread prescription of these products to large numbers of men.”
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While TRT has been shown to improve libido, sexual function, anemia, bone density, lean body mass and some symptoms in appropriately selected men, doctors emphasize that it is not guaranteed to improve energy, cognition or overall vitality.
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