Sound the alarm. Alert the media. Call an emergency session of Congress.
Pete Hegseth has brought government-sponsored gender-affirming care into the United States military.
Under Hegseth’s order, all active-duty and reserve service members age 30 and older will undergo annual screening for testosterone deficiency as part of their required health assessments. Those younger than 30 may request testing. The Pentagon will then offer what it calls “targeted testosterone therapy” to eligible service members. Treatment is voluntary, but the hormone screening is mandatory for those covered by the policy.
Mandatory sex-hormone testing. Government doctors. Taxpayer-funded testosterone. Federal treatment intended to reinforce male physical characteristics and help service members conform to the Trump administration’s preferred image of the American warrior.
Republicans have a name for medical treatment involving sex hormones and gender-related physical traits. They call it gender-affirming care.
To be clinically precise, physicians generally call testosterone prescribed to men with diagnosed testosterone deficiency “testosterone replacement therapy.” Gender-affirming hormone therapy usually refers to treatment for transgender patients. But Trump Republicans abandoned clinical precision long ago. They transformed “gender-affirming care” into a political slogan used to frighten parents, attack doctors and imply that any hormone treatment connected to gender is dangerous social engineering.
Their terminology should now be applied to their own program.
Welcome to Pete Hegseth’s gender-affirming military.
The Pentagon is measuring a sex hormone and offering medication to maintain traits associated with maleness. The stated goals include health, physical performance, resilience and readiness. Hegseth has promoted the program as part of creating a “high-T” military, making clear that this is about more than treating a narrowly defined endocrine disorder. Testosterone has become part of his political branding of masculinity.
The history of testosterone in the military makes this new direction more significant.
The public record does not show that the United States military has traditionally administered testosterone across the force or routinely screened every service member above a particular age. Its previous involvement generally fell into three categories: treating individual patients with diagnosed medical conditions, investigating unauthorized steroid use and conducting limited research on whether testosterone could preserve muscle during military stress.
An Army study published in 1990 examined anabolic steroid use after commanders expressed concern about unauthorized use among soldiers, including Rangers, Special Forces personnel and military athletes. In a survey of 447 soldiers, 12, or 2.7%, acknowledged using anabolic steroids. The military response was not to build a hormone-enhancement program. It was to regulate the substances and develop testing procedures for suspected abuse.
More recently, Department of Defense-funded researchers have studied testosterone under controlled experimental conditions. In one randomized study, healthy young men underwent a severe energy deficit intended to simulate the physical stresses troops can experience during sustained operations. Weekly testosterone injections increased lean body mass, but they did not prevent the deterioration of lower-body physical performance. That was a limited research experiment, not an endorsement of routine testosterone treatment for the armed forces.
The military has also treated unauthorized testosterone and anabolic steroid use as a readiness and safety concern. Naval Special Warfare expanded performance-enhancing drug testing after the 2022 death of a Navy SEAL candidate. Navy policy distinguished between medically supervised treatment for legitimate conditions and unauthorized use intended to enhance performance.
Hegseth’s initiative represents a change in scale. Instead of testing people because of symptoms, suspected abuse or participation in a controlled study, the Pentagon will screen an entire age group every year.
That approach is not supported by current Endocrine Society recommendations. The organization recommends diagnosing testosterone deficiency only when a patient has symptoms and repeatedly low testosterone measurements obtained through accurate testing. It advises against population-wide screening of men who do not have symptoms. Physicians are also supposed to investigate potentially reversible causes, including obesity, medication use, sleep problems and underlying illness.
Testosterone is not a vitamin supplement. Treatment can require repeated laboratory testing and continuing medical supervision. The Endocrine Society has noted unresolved questions about long-term safety and evidence of increased pulmonary embolisms and fractures in a major clinical trial. The Food and Drug Administration approves testosterone for men whose low levels are associated with recognized medical conditions, not as a general remedy for aging, low energy or insufficient warrior spirit.
This is especially striking because the Trump administration has argued that hormonal treatment can make someone unsuitable for military service.
Trump’s military order concerning transgender troops cited hormonal and surgical interventions, continuing medical treatment and the availability of medication during deployments as threats to readiness. The Pentagon then moved to separate service members diagnosed with gender dysphoria and stopped paying for newly initiated hormone treatment associated with gender transition.
Apparently, routine hormone monitoring is not a readiness problem when the hormone affirms a form of masculinity approved by Pete Hegseth.
Apparently, dependence on continuing medication is not disqualifying when the prescription helps a man maintain muscle, libido, energy or male secondary sex characteristics.
Apparently, the federal government may involve itself in a service member’s hormones, body and gender presentation as long as the desired result resembles the secretary’s political ideal of a warrior.
Trump Republicans have not removed gender politics from military medicine. They have installed their own version.
The approved gender is aggressive masculinity. The approved transition is from “low T” to “high T.” The approved hormone comes with a Pentagon prescription.
Hegseth says the program is not about artificial enhancement. That assurance deserves scrutiny when he is simultaneously advertising testosterone as an ingredient in a stronger, more lethal military. The line between treating a documented disease and using medicine to pursue an ideological standard of masculinity becomes difficult to see when the secretary himself markets the program with slogans about testosterone.
Service members with genuine endocrine disorders should receive appropriate medical care. That is not controversial. What deserves criticism is the transformation of a medical test into a political performance, coupled with an administration that condemns hormone treatment for one group while celebrating it as warrior medicine for another.
Republicans demanded that the country call hormone treatment gender-affirming care.
Fine.
Pete Hegseth is now running a mandatory gender-screening program, followed by optional taxpayer-funded gender-affirming hormone treatment, inside the United States military.
The syringe is acceptable. The government involvement is acceptable. The continuing treatment is acceptable. Even the affirmation of gender is acceptable.
The only question is whose gender the Trump administration has decided is worthy of affirmation.
