Military testosterone testing puts a growing therapy market under scrutiny

The U.S. military’s plan to test service members’ testosterone levels is putting a fast-growing men’s health treatment back in public view. For everyday investors, the move matters because testosterone replacement therapy has become a larger commercial category for drugmakers including AbbVie, Pfizer and Marius Pharmaceuticals, while doctors continue to debate where medical need ends and performance marketing begins.

Defense Secretary Pete Hegseth said last week that the military will start checking troops’ testosterone levels and offer replacement therapy to service members who qualify, according to NBC News. He said the goal is to help troops perform at their “absolute best.” The plan comes as the Trump administration has pushed to promote broader access to testosterone treatments.

Testosterone replacement therapy uses a synthetic version of testosterone, a hormone tied to sex drive, mood, muscle mass, bone density and other functions. It is commonly delivered through injections, gels, implantable pellets or oral medications.

Prescriptions have climbed sharply. Health-care research firm IQVIA said testosterone prescriptions rose from 7.3 million in 2019 to more than 11 million in 2024. That growth has been helped by men’s health clinics, telehealth firms and online influencers promoting testosterone for fatigue, aging and performance.

Who doctors say the treatment is for

Physicians cited by CNBC said testosterone therapy is generally meant for men with clinically diagnosed hypogonadism, a condition in which the body does not produce enough testosterone. A diagnosis usually includes both low hormone levels and symptoms such as reduced sex drive, fatigue, erectile dysfunction, depressed mood, low bone density or loss of muscle mass and strength.

Dr. Adrian Sandra Dobs, an endocrinologist at the Johns Hopkins School of Medicine, said testosterone can be appropriate for people who need it, but doctors must be careful not to “overreplace” the hormone.

Marcus Goncalves, director of the Holman Division of Endocrinology, Diabetes and Metabolism at NYU Langone Health, said obesity, stress, fatigue and poor sleep can lower testosterone. In those cases, he said, improving those underlying conditions is the right approach, though it can be difficult.

Doctors also warned that one blood test may not tell the full story. Goncalves said medical guidelines generally call for two separate morning blood draws because testosterone levels move throughout the day. Dr. Richard Auchus, a professor of internal medicine at the University of Michigan, said levels can also fall temporarily during severe stress, illness, weight loss or intense exertion.

Benefits, risks and the military question

For men with confirmed deficiency, doctors said testosterone therapy can improve sex drive, erectile dysfunction, muscle mass, bone density, energy and mood. It can also help reduce osteoporosis and fracture risk in men with low hormone levels.

Evidence is less clear for men whose testosterone is normal or only mildly low. Dobs said the treatment does not improve intelligence or make someone a better pilot.

The risks require monitoring. Goncalves said testosterone therapy can raise red blood cell counts, which can thicken blood and increase the risk of complications such as blood clots. A 2023 trial published in the New England Journal of Medicine found no higher rate of heart attack, stroke or cardiovascular death among men receiving testosterone than among those on placebo, but researchers saw higher rates of atrial fibrillation, acute kidney injury and pulmonary embolism.

The treatment can also suppress natural testosterone production, reduce sperm production and affect fertility. Doctors generally discourage it for men who may want children. Other possible side effects include acne, breast tenderness or enlargement, fluid retention and worsening untreated sleep apnea.

The military setting adds another complication. Goncalves said sleep deprivation, intense training and prolonged exertion can temporarily depress testosterone. One study of U.S. Marines in Survival, Evasion, Resistance and Escape training found testosterone levels fell by about half during the exercise before recovering afterward. Goncalves said there is no evidence that restoring testosterone during that period improves performance.

Auchus said long-term therapy could create problems if a service member becomes dependent on treatment and then cannot access it during deployment or another operation. Dobs said testosterone should not be viewed as a shortcut to better combat performance.

This story draws on original reporting from CNBC.