The Pentagon has ordered testosterone screening for active-duty and reserve service members age 30 and older, a group of roughly 2 million troops, but it has not released a public cost estimate for the program, according to reporting by The Center Square.
The mandate was announced in July, and new Defense Health Agency guidance issued this week says the number of service members who will be screened, tested, diagnosed or treated “are not currently known.” The guidance also says no prior guidance projected those totals.
The Center Square reported that it asked for a cost estimate in July and again this week. The Defense Health Agency declined to answer questions and referred them to the Pentagon press office, which did not respond this week and did not provide a cost estimate in July, according to the outlet.
No Clear Price Tag
Neither the July memo nor the new clinical guidance says how the screening and any resulting treatment would be paid for. The documents do not state whether the work would come out of the existing Military Health System budget or require new funding.
The House Armed Services Committee’s majority and minority offices also did not immediately respond Friday to The Center Square’s questions about whether they had received a cost estimate.
Readiness Argument Meets Clinical Limits
The Pentagon has described the effort as a readiness measure. Secretary of War Pete Hegseth’s July 15 memo said that “applying lessons learned from treating Operator Syndrome across the Total Force including targeted testosterone therapy directly optimizes Warfighter readiness.”
Chief Pentagon Spokesman Sean Parnell said in a Sept. 17 statement that the effort would help sustain “a healthy, capable, and decisively dominant fighting force.”
But the clinical guidance draws a line around what testosterone therapy is meant to do. It states that testosterone “is not a performance enhancer” and that “guidance premised on performance enhancement rather than on treatment of a diagnosed deficiency is not supportable on the current evidence.”
In other words, the guidance treats testosterone deficiency as a medical diagnosis to confirm and treat, not as a broad fitness tool to distribute across the force.
Not Everyone Over 30 Would Get a Blood Test
The new guidance also appears to narrow earlier descriptions of the program. In July, a Pentagon official told The Center Square that “everyone over 30 years old will be tested annually.”
The guidance does not call for universal annual blood testing. Instead, it directs providers to use a symptom and risk-factor questionnaire first, then order blood testing only when that screening is positive or a risk factor is present.
Dr. Richard Auchus, an endocrinologist at the University of Michigan, told The Center Square the guidance is “largely evidence-based” because it screens for symptoms before ordering blood tests. He called that approach “consistent with society guidelines and good clinical practice.”
Auchus also said he was “relieved” the guidance was “not recommending broadly blood-test based screening everyone over 30.”
Operator Syndrome and the Evidence Gap
The program traces part of its rationale to “Operator Syndrome,” a term coined in 2020 by psychologist Chris Frueh to describe a cluster of health problems in special operations forces, including brain injury, sleep disruption and hormonal dysfunction.
Hegseth’s memo cited Operator Syndrome as a reason to expand testing across the force. Frueh reviewed the new guidance and told The Center Square it was “very good.”
The guidance also notes limits in the evidence for testosterone therapy. It says the treatment can help with sexual function, body composition and bone density, but that evidence “does not support its use to improve energy, vitality, physical function, or cognition.”
It also cites the American College of Physicians’ recommendation against prescribing testosterone for those reasons. According to the guidance, a major trial found testosterone did no better than a placebo at improving men’s energy or walking distance.
For now, the Pentagon’s plan leaves two major unanswered questions: how many troops will ultimately be tested and treated, and what the program will cost.
