U.S. Secretary of Defence Pete Hegseth at the Pentagon on Tuesday.Pool/Getty Images
U.S. Secretary of Defence Pete Hegseth has found a new tool in his quest to restore a “warrior culture” to the United States Armed Forces: testosterone, a potent hormone that the Pentagon will now distribute widely among its members.
The world’s most powerful military is now overseen by the “High-T Department of War,” Mr. Hegseth said Wednesday as he unveiled a policy that seems to follow a trend among men trying to recapture the vigour of their youth, despite decades of warnings that testosterone replacement therapy can harm the heart, promote cancer growth and boost aggression.
Mr. Hegseth has ordered annual testosterone testing for military members older than 30 and offered testosterone replacement therapy to anyone for whom it is medically recommended.
“We’re keeping you on the leading edge of lethality,” he said in a video address released on social media.
Mr. Hegseth came into his cabinet post with promises to do things differently. He had Defence renamed the Department of War, oversaw the armed abduction of Venezuelan leader Nicolás Maduro, has rained deadly munitions on Iran and blocked the promotions of some women and Black officers.
The U.S. military has a history of using experimental pharmaceuticals on its members. In the Gulf War, hundreds of thousands of troops were administered drugs meant to shield them from chemical and biological weapons. Those drugs were later linked to a host of health problems that have come to be known as Gulf War syndrome.
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The use of testosterone replacement therapy has long been controversial, with researchers warning it could elevate heart risks and feed the growth of prostate cancers. In 2014, for example, Health Canada warned about “a risk of serious and possibly life-threatening cardiovascular (heart and blood vessel) problems” from use of testosterone products.
But that advice has been called into question.
“There is now consistent evidence that testosterone therapy does not increase a man’s risk for developing prostate cancer,” a panel of experts wrote for Canadian Urological Association (CUA) guidelines published in 2021.
Other research, some of it military-backed, has complicated the findings on heart risks. One 2015 study used data from 83,000 male veterans in the U.S. to show that men treated for low levels of testosterone were less, not more, likely to have strokes or heart attacks than men who did not receive treatment. But the scientific literature on heart risk is “conflicting and continues to evolve,” the CUA wrote.
It also noted that testosterone deficiency is widespread, affecting an estimated one in four men between the ages of 40 and 62.
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“Every man over 30 should be screened,” said Mohit Khera, the chair in urology at Baylor College of Medicine in Texas. He was among the experts who wrote the guidelines for the CUA and also led an expert panel for the U.S. Food and Drug Administration. “There’s not a better marker of a man’s health than testosterone.”
Low levels are associated with less muscle mass, weaker bones, more fat, worse sleep, low libido and erectile dysfunction.
“If a man is caught taking testosterone playing a major sport, they’re kicked out, they’re banned,” Dr. Khera said. “Why is that? Because it gives them an unfair advantage. If you have your military, wouldn’t you want them to have an advantage over someone else?”
But for the military – and for medicine more generally – the most important imperative, Dr. Khera said, is to push someone up out of low levels.
“Take him from low to normal – that’s it,” he said.
For the military, the problem until now has been that men taking testosterone are “not considered deployable,” Dr. Khera said, partly because of concerns about maintaining testosterone levels on extended tours of duty.
Some of that may be remedied by injections that can last 10 weeks. A number of military-backed studies have shown potential benefits for troops, including maintaining muscle mass during prolonged periods of physiological stress. It is “a viable countermeasure to effectively reverse the cascade of physical and mental consequences experienced by tactical operators,” Australian scholars wrote in a 2019 report.
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There are potential problems. Testosterone replacement therapy can make a man infertile. Raising levels to very high thresholds can make a man aggressive and enlarge his breasts.
Such risks have done little to dissuade many men. At Providence Healthcare in British Columbia, the number of testosterone tests has risen nearly threefold over the past decade, said Daniel Holmes, who leads the testing lab.
That has put pressure on the Canadian public health care system as it copes with people seeking to reverse the feeling that “I’m not the man I used to be,” he said.
But it would be hard to argue, he added, against the benefits of testosterone for anyone in a physically demanding position, soldiers included.
“People prefer to feel the strength and the agility and the stamina and the alertness and the drive that they had when they were young,” Dr. Holmes said.