The military community is buzzing right now about a recent Department of War memo and so is much of the medical community. Based on the wildly different interpretations, I wanted to have an open and honest conversation about the memo with someone who had the facts. So, I invited someone who helped write it onto the podcast: Tim Parlatore, a Navy reservist and special advisor to the Secretary of War, who is also one of the most prominent trial lawyers in the country. What he described was not the story the headlines ran with.
Many media outlets ran with a very polarized version of the story saying that the Pentagon is handing out testosterone to build bigger, more aggressive soldiers. The real version is much narrower, highly conventional medically, and long overdue. For decades, the military has treated testosterone as if it belonged in the same category as anabolic steroids: a performance-enhancing drug to be policed, not a hormone to be measured and, when deficient, treated. Given that the military routinely evaluates and treats numerous endocrine conditions to maintain operational readiness, adding testosterone to that standard panel is not controversial; it is decades overdue.
What the Memo Features
There are two documents in play and conflating them causes most of the public confusion. The short, public-facing memo the Secretary signed adds a testosterone check to the blood panel service members already receive during their annual physical. As a first step, a box gets checked on a test that is already being drawn. If a result comes back low, that opens the door to a referral (a urologist, additional labs, a conversation about symptoms and lifestyle) rather than an automatic prescription.
The longer internal memo, which Parlatore drafted with input from military and civilian medical professionals, lays out the reasoning and the larger goal: comprehensive hormone optimization, eventually extended to women as well, built on testing that evaluates fundamental endocrine function across both men and women from the start. Critically, per Parlatore, the decision to treat is voluntary. The Secretary has been outspoken against mandatory medical treatment, so a service member who tests low and decides they do not want intervention is not forced into one. This provides symptomatic and consenting individuals with a diagnostic pathway that civilian medicine has offered for years. It is not a mandate, and it is not aimed at otherwise healthy high performers looking to add twenty pounds to their bench press. Parlatore was direct about this in our conversation: if someone comes in asymptomatic and simply wants to break through a training plateau, that is not the intent of this policy.
The Diagnostic Gatekeeping Problem
Parlatore shared a story of a friend that illustrates the military’s antiquated categorization of testosterone. A Navy captain with 24 years of service was struggling with weight gain and depression and asked his physician for a testosterone test. The physician’s response was blunt: “Do you have erectile dysfunction?” No. “Then you don’t need the test.”
He advocated for himself and eventually secured the panel. His total testosterone came back at 160 ng/dL. Clinical guidelines define anything under 300 ng/dL as hypogonadal, with international standards placing the threshold closer to 350 ng/dL. It took two months to get a urology referral, where the specialist reportedly tried to talk him out of intervention, calling treatment “a life sentence.” He started TRT anyway. Parlatore noted that his friend has since lost 60 pounds and missed a perfect score on his physical readiness test by just three seconds.
I want to be careful with a narrative like this. It is one man’s account, relayed secondhand, not a clinical case series. However, it illustrates a pattern I have seen consistently in the operators and service members I have treated over the last 15 years. Erectile dysfunction is used as the sole gate to testing when it is merely one symptom among many. Depression, weight gain, severe fatigue, loss of lean mass, and impaired recovery are all driven by low testosterone. Gatekeeping behind a single symptom means many genuinely deficient individuals are never measured.
The True Scope of Endocrine Disruption
Parlatore cited a figure in our conversation of roughly 27 percent of special operations personnel testing below the standard threshold for low testosterone. The number he described as likely conservative given the physical demands of that career track. I have not independently verified that exact figure, and I treat any single statistic from a policy conversation as directionally important rather than precise. What is not in dispute is the underlying biology. Chronic sleep deprivation, sustained physical stress, and the cumulative wear of a multi-decade military career are well-established disruptors of natural testosterone production. This is not a niche finding. It is basic endocrinology applied to a population systematically excluded from a diagnostic standard civilian medicine already uses.
Low testosterone is not an aesthetic or performance vanity metric when left untreated. It is a vital health indicator directly correlated with increased cardiovascular risk, accelerated bone density loss, and progressive metabolic dysfunction over time. Framing it as an anabolic-steroid adjacent indulgence, rather than a hormone deficiency with real downstream health consequences, is precisely the perspective this memo aims to correct.
Curbing Unsupervised Anabolic Abuse
One argument in the memo that deserves more attention is how standard testing fixes a broken incentive structure. Currently, service members who know they are deficient are forced outside the military system. This causes them to pay out-of-pocket for civilian care, receive variable quality of treatment, and risk severe disciplinary action for taking medications without military approval.
Annual screening removes that threat. It brings legitimate hormone treatment inside the military medical infrastructure, ensuring proper clinical oversight while removing the incentive to seek unchecked civilian prescriptions. At the same time, universal testing naturally flags unsupervised anabolic steroid abuse, separating true medical care from illicit use.
Addressing the Objections
Several viral criticisms such as accusations that this policy disregards female service members, represents a covert fertility experiment, or turns junior enlisted troops into “super-soldiers” do not reflect the content of the document Parlatore described. Testing is symptom-triggered, voluntary, and includes women because hormone health matters for women too, even though female androgen optimization requires a more nuanced, highly specialized approach than standard male replacement. Fertility preservation options, including sperm banking, are part of the individualized conversation a service member has with their physician before deciding on treatment: the same conversation any civilian patient has.
None of this means the policy is beyond scrutiny. Rolling out population-level hormone testing across a system with limited historical fluency in this area is a massive operational lift. The process includes training clinicians, standardizing referral pathways, and following through on the promise that this is symptomatic and voluntary. How effectively the medical infrastructure executes it is the critical metric to watch over the next year.
Broader Implications for Medicine
Medicine treats deficiency. If a patient’s thyroid panel comes back abnormal, no one debates whether to test again next year or run a pilot program first; we treat it. Testosterone has been the outlier, carrying a stigma from its association with abuse in strength sports that has nothing to do with how it functions as a legitimate biomarker in a fatigued, symptomatic 45-year-old who has spent two decades sleeping four hours a night on a ship. The data generated by annual testing across a population this large, paired with body composition and physical readiness scores the military already collects, will produce a research dataset that few civilian trials can match.
Health policy should not be a partisan issue. Testosterone screening for symptomatic deficiency is standard, evidence-based endocrinology. Whether an administration signed the memo should not change whether the underlying medicine is sound. It is not controversial when applied to a civilian patient in my clinic, and it should not be controversial when applied to the people asking the most of their bodies on our behalf.
