No cost estimate for Pentagon's testosterone screening program

The Department of War did not respond to a request for a cost estimate Friday. The Center Square asked in July, when Secretary of War Pete Hegseth ordered the screening, and again after the Defense Health Agency issued its clinical guidance Sept. 17. The health agency said Friday that the Pentagon press office "is indeed handling all queries on the topic."

Neither Hegseth's July 15 memo nor the clinical guidance carries a cost estimate. The guidance says the number of service members to be screened, tested, diagnosed and treated is "not currently known," and that no prior guidance projected those figures. The department says it will report those numbers 12 months after the guidance is published.

Hegseth's July memo applied to all service members 30 and older. The clinical guidance covers male service members only, and the Defense Health Agency says a companion guideline for women is still under review.

The department has not said how many men the mandate reaches. Not all of them will be tested: the guidance directs providers to screen with a symptom and risk-factor questionnaire and to order a blood test only when that screen is positive or a risk factor is present.

The Endocrine Society also faulted the guidance for how it handles obesity. Obesity among active-duty service members rose from 14.7% in 2013 to 24.2% in 2023, according to the Medical Surveillance Monthly Report, the military's own health surveillance journal.

Men with obesity are more likely to show low testosterone on a blood test, the Society said. The guidance offers those men weight management and testosterone therapy together, and says treatment will not be withheld while the weight is addressed. The Society said that obesity should be treated first.

The Society also said the guidance's fertility safeguard may not work as intended. The guidance tells providers that men who want to preserve fertility should receive human chorionic gonadotropin, a hormone therapy known as hCG, rather than testosterone. But hCG suppresses FSH, the hormone needed for normal sperm production, the Society said, and that will reduce sperm production in men whose low testosterone stems from obesity, who typically have normal FSH levels.

The guidance supports the Society's concern about false positives. It says about 30% of men with an initial low testosterone reading are normal on a repeat test, and it requires two morning fasting testosterone tests, taken at least 30 days after training involving extreme physical or mental stress, before any diagnosis is made.

Dr. Richard Auchus, an endocrinologist at the University of Michigan, told The Center Square last week that the guidance is "largely evidence-based" because it screens for symptoms before ordering blood tests, an approach "consistent with society guidelines and good clinical practice." He said he was relieved it was "not recommending broadly blood-test based screening everyone over 30."

The House and Senate Armed Services committees and the defense appropriations subcommittees did not respond Friday to questions about whether the department has given them a cost estimate.

The department's fiscal 2027 budget request eliminates the Defense Health Program appropriation and splits it into two new accounts, the Combat and Operational Medicine Program at $20.3 billion and the Private Sector Care Program at $22.2 billion, a change the department says will improve accountability and transparency. The budget overview does not identify the screening program as a separate line in either account.

The guidance says the department will report the number of service members screened, tested, diagnosed and treated 12 months after publication. Until then, the program runs at a size and cost the department has not disclosed and, by its own account, does not yet know.