Commentary: Should testosterone be in the US military's playbook?

The US administration sees scientific evidence as an optional, flexible handmaid to the more vital business of masculinity, says this science commentator for the Financial Times.

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LONDON: What looked at first like a parody has turned out to be true. Pete Hegseth, the US defence secretary, announced last week he was introducing testosterone screening for American soldiers to create a “High-T” fighting force at the “leading edge of lethality”.

Troops aged 30 and over - including women - would be routinely screened, with younger members able to opt in. Those falling short would be offered optional testosterone replacement therapy. Hormone experts question the wisdom of the scheme, not least because of the potential for harm, including to fertility.

But it is revealing of how the current administration applies scientific evidence to health issues: as an optional, flexible handmaid to the more vital business of wellness, masculinity and “looksmaxxing”, the online trend fixated on physical perfection. There is an intriguing crossover between science-sceptical MAGA circles; the manosphere, made up of social media influencers that offer young men tips on relationships, power dynamics and fitness; and the online market for loosely regulated substances such as peptides, supplements, weight-loss pills and hormones.

NO LINK WITH LONGEVITY AND PERFORMANCE?

Testosterone is the main male sex hormone. It is critical to sexual development; it deepens the voice and promotes the growth of body hair; it helps to build and strengthen muscles and bones. It also regulates sex drive and sperm production.

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Hegseth said the initiative would improve “combat readiness” and cited the hormone’s link to longevity and performance. But while there is a clear and agreed threshold for being low-T, not all men suffer as a result. Testosterone replacement therapy (TRT), often a gel, is usually recommended only when low levels come with symptoms, which include lowered fertility, weak muscles, fatigue and poor concentration.

Saira Hameed, consultant endocrinologist at Imperial College Healthcare NHS Trust in London and author of Signals: The Inside Story of Our Hormones, tells me there is no robust evidence linking testosterone to longevity. She adds that because low-T individuals can have no symptoms and others can respond differently to treatment, “TRT doesn’t guarantee heightened cognitive or physical performance”.

But overtreatment, she adds, does carry risks. Too much testosterone can thicken the blood, raising the risk of clots, impair fertility, cause liver inflammation and quicken tumour growth in the prostate. It can also trigger mood changes, including aggression and hypersexuality, and acne.

TRT, she adds, should only be administered under medical supervision.

“We endocrinologists would urge caution. The body’s hormones are perfectly calibrated, and most men will go through their lives without any issue with their testosterone level. Testosterone is essential for men’s health ... but it’s not a case of if some is good, then more must be even better.”

A WEAPONS-GRADE IRONY

Though levels decline with age, most men never need TRT (which is why they can father children into their eighties). In comparison, all women suffer oestrogen deficiency after menopause. Men who feel run down, Hameed advises, should be encouraged to look beyond hormones, including at lifestyle.

For some, however, hormones are synonymous with lifestyle. Health secretary Robert F Kennedy Jr is open about taking testosterone as part of an anti-ageing regimen and worries about falling levels among men (experts cite obesity, inactivity and poor sleep as possible causes). Kennedy is pushing for reduced warnings on some testosterone products. Interestingly, a small study published last year hinted that administering testosterone could shift a person’s political leaning slightly to the right.

Hegseth, meanwhile, has posted videos of himself running and lifting weights. Last year, he said it was unacceptable to have “fat generals and admirals” and railed against beards. Collectively, these messages from the top seem less about health and more about valorising sanitised masculinity.

There is, though, a weapons-grade irony in Hegseth trying to devise a build-your-own-warrior playbook given his previous attempts at changing health policy. In April, he abolished mandatory flu shots for military personnel; in June, after a serious outbreak in Texas that affected nearly 300 and hospitalised several recruits, the Pentagon reinstated the requirement.

Barking commands on bellies, beards and biceps is one thing but making your troops genuinely healthy and combat-ready means getting the basics right.

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