Last week, a research letter published in the Journal of the American Medical Association—using data from a sample of nearly five hundred military members—reported that approximately twenty-five per cent of participants had at least one measured testosterone level that could qualify them as deficient. The letter is something of a Rorschach test, offering new information that could either bolster or undermine Pete Hegseth’s effort to establish a “high-T Department of War.” Universal screening for testosterone deficiency among men thirty and older has become one of Hegseth’s signature policies: “No fatties, no trannies, no beardos, no weirdos,” he crankily told a crowd of mid-level military members last month, during his “State of the Force” speech. “The patriotic cowboys are in—with testosterone testing on top.”
Every relevant medical society recommends against screening asymptomatic men for testosterone deficiency, because it is akin to scouring a hotel room with a black light: you’re going to find a lot of stuff of indeterminate significance that you wish you hadn’t seen. The data in the JAMA letter, collected across five U.S. military sites between August, 2024, and January, 2026, suggest that more than a hundred thousand men in current service could qualify for testosterone-replacement therapy (TRT) if their screening results are treated as diagnostic. Other military data collected between 2018 and 2025 had estimated the prevalence of diagnosed testosterone deficiency in male military members at less than one per cent.
This variation reflects that a diagnosis of testosterone deficiency can be made rigorously, with a desire to rule out, or capaciously, with a desire to rule in. Decreased testosterone is often cited as an explanation for an array of nonspecific symptoms, including depressed mood, poor libido, fatigue, and spotty memory. Serum testosterone levels vary with stress, sleep, body shape, and time of day; borderline low levels are common and are hard to interpret outside the context of a careful clinical evaluation. Different organizations even use different thresholds to determine what a “low” value is: the Centers for Disease Control uses two hundred and sixty-four nanograms per decilitre, whereas the American Urological Association and the military use three hundred.
These ambiguities make the condition a perfect container for all manner of dysphoria and shame, and set patients and doctors up for conflict. Before prescribing TRT, evidence-based doctors will require multiple confirmatory tests, disregard symptoms that are vague and easily attributed to other causes, and recommend other interventions to boost testosterone production. Patients who are intent on starting injections may then flee to wellness influencers and direct-to-consumer prescribers. “I’ve been experiencing lack of energy, motivation, and 0 sex drive,” an aspiring T user lamented on Reddit’s r/Testosterone forum, dismayed that his physician would not offer him a prescription because his blood work looked fine.