Why medical experts are worried about the military mandate to test testosterone levels

[00:00:05]US US Defense Secretary Pete Hegseth has announced it is now mandatory for all service members age 30 and older to test their testosterone levels every single year. Younger service members have the option to get tested.

[00:00:19]>> Yeah, Hegseth said he authorized this to ensure service members have the right testosterone levels to operate at their {quote} absolute best. Joining us to talk about this is news news medical expert Dr. Payal Kohli. First off, let's talk a little bit about this new requirement and let's begin with the basics. What is testosterone? How do you test for it? And what exactly is happening here?

[00:00:40]>> So, both men and women have testosterone. Men obviously have more testosterone than women. It's made by the testicles. And during the course of a day, Evan, your testosterone levels go up and down. So, they increase in the morning. They kind of drop down to their lowest in the late afternoon. And then they can kind of stabilize out at night while you're sleeping because you're really making and releasing a lot of testosterone during your sleep. So, you can imagine the challenges with checking a random testosterone level. And as we know, testosterone in men especially is involved in sexual function. It's involved in erectile function. It's involved in muscle mass and fatigue and your weight and your energy, all of these types of things. In women, it also plays a role in sexual function. But I have to say this new requirement caught me completely off guard because it is completely coloring outside the lines.

[00:01:25]There is not a single guideline that says you should check testosterone in asymptomatic men or women.

[00:01:31]>> It just seems very odd. Like are you saying, "Oh, more testosterone good, low testosterone bad." Like and is that the correlation that should be made here?

[00:01:41]>> That's exactly what we're saying, Alex, and that is definitely not the correlation. So, the American Urological Society says that even if you find a low testosterone in a man, if he does not have symptoms, you do not treat it because that is not true hypogonadism.

[00:01:54]And so, essentially, it's not higher testosterone levels for everyone, but it's really the right testosterone level for you. And now if they're going to check every 30-year-old man for testosterone, offer him testosterone replacement therapy, even offer the younger men TRT, it raises a lot of questions. For me, the biggest question is, well, what is the long-term health risk? Because we have no data about this. So, if I start to give a young man testosterone, I could shut down his fertility, I could cause blood clots, I could cause prostate cancer, I could cause all these problems. Ethically, it raises the question of are we doping our military, right, to perform better than other militaries? And is that an ethical thing to do again without the data? But the flip side of it is, and a lot of experts are now saying, well, maybe we should be checking testosterone in every man, getting a baseline because it tells us a lot about their health. And we know that troops tend to have lower testosterone levels than than the lay people, and that's because of the nature of their work.

[00:02:49]>> Mhm. I'll tell you, I listen to sports talk radio here in Denver. Every other ad these days is for a low T center or clinic. I'm curious from the medical side of things, how big of a deal this is to you, and should men be checking things like this?

[00:03:04]>> So, I as a cardiologist am alarmed with all the low T centers because we have raised a lot of concerns about cardiac risks, especially with testosterone supplementation. Now, there's some newer data that says it may be safe to use for a short period of time, just like we talk about HRT in women if there's an appropriate indication. But I would say if you're a young man who's thinking of getting your testosterone level checked, the first thing I would say is if you don't have symptoms, do not check it cuz you're going to cause more trouble than benefit. Second, if you do have symptoms, you still need to place it within context because most of us have if we do have a low testosterone, it's not because of dysfunction of our testicles, it's because of the lifestyle that we lead. So, many things that we do can lead to low testosterone, not getting enough sleep, drinking too much alcohol, smoking marijuana, you know, being obese, having sleep apnea. These are all reversible causes. And I have to say Pete Hadsall didn't say anything about treating reversible causes of low T in the military before offering them testosterone replacement therapy.

[00:04:00]>> Oh, interesting.

[00:04:01]>> It's kind of bizarre, this whole thing.

[00:04:03]>> It is very bizarre, and it's very scary to me as a physician, Alex, because now if we start coloring outside the lines of guidelines, we've no science to guide us. What I want to see, because there's still a scientific question, should we be checking men, is a randomized controlled trial where we check men, we don't check men, and then we decide who to treat, and then we look at outcomes.

[00:04:22]That's science driving policy, rather than testosterone replacement therapy is good for all, everybody in the military should get it.

[00:04:31]>> Yeah, interesting. Dr. Coley, thank you.