Current as of September 22, 2026. This policy is five days old and an earlier draft of it was pulled and reissued, so check with your provider before you act on anything here.
Short answer: Every male service member age 30 and older now gets screened for testosterone deficiency at his Periodic Health Assessment, at entry, or at his annual physical. The screening is required. Treatment is not. A diagnosis by itself is not a duty limitation, with real exceptions for flight, dive, submarine, and nuclear billets.
That is the policy in four sentences. The rest of this is what it means for you, and the parts nobody is telling you yet.
Where this came from
On July 15, 2026, the Secretary of War signed a memo called "Health and Human Performance Optimization to Enhance Military Readiness." It told the services to start screening for low testosterone.
The Defense Health Agency had to write the clinical guidance that tells providers how. A draft went out on September 2 and got pulled the next day for updates. The final version, "Testosterone Deficiency in the Male Service Member," was signed on September 17, 2026 and took effect immediately.
So if you had your PHA in August and nobody asked you about this, that's why.
Who gets screened
Male service members 30 and older, at the PHA, on entry, or at an annual physical.
Under 30, you get screened if you ask, or if your provider sees a reason to look.
Guidance for women is being written separately and hasn't come out yet.
What the screening actually is
It's not an automatic blood draw. It starts as a set of questions about symptoms and risk factors.
The symptoms include reduced libido, loss of spontaneous morning erections, erectile dysfunction, unexplained loss of muscle mass, low motivation or depressed mood, and a drop in physical performance that isn't explained by an injury.
The risk factors include Type 2 diabetes, prior TBI with loss of consciousness, sleep apnea, and obesity.
If your answers flag, or one of those risk factors is in your record, then labs get ordered. Blood work is step two.
The bar for an actual diagnosis
This is the part worth memorizing, because it's also how you tell a good clinic from a bad one.
DoD's standard is two separate morning draws, between 0700 and 1000, fasting, both under 300 ng/dL, plus symptoms that match. LH and FSH get checked to find out where the problem is coming from. Hematocrit before treatment starts. PSA if you're over 40.
There's one more rule most civilian clinics don't know about. A specimen doesn't count if it was drawn within 30 days of training involving extreme physical or mental stress or sleep deprivation, or during an illness or within 30 days of one.
There's a good reason for that. Field problems and selection courses tank testosterone temporarily. Marines in a seven-day SERE course dropped about 44 percent. Soldiers in an eight-day field exercise dropped about 28 percent and were back to baseline within four days. Finnish troops bottomed out at day 12 of field training and fully recovered after three days of rest and food.
Get tested the week you come out of the field and you will look hypogonadal when you aren't. That's not a disease. It's what happens when a man doesn't sleep or eat.
For context on how common this really is: DoD's own surveillance data for 2018 through 2025 shows fewer than 1 percent of male service members carried an active diagnosis in any year.
What treatment is, and what it isn't
The guidance is blunt about this, and so are we. In DHA's words, testosterone therapy treats a confirmed deficiency that's causing symptoms. It is not a performance enhancer. If your levels are normal, it's unlikely to help you and it may cause harm.
The guidance also says that recommendations premised on performance enhancement rather than treating a diagnosed deficiency aren't supportable on the current evidence.
Anyone selling you testosterone as a readiness upgrade is selling against DoD's own clinical guideline and against the FDA label.
The line that matters most for your career
The guidance states that neither a diagnosis of testosterone deficiency nor stable maintenance therapy is, by itself, a basis for a duty limitation.
For most service members that's the end of the worry. A low number doesn't make you non-deployable.
Unless you fly, dive, ride submarines, or work nuclear
Here the rules are older, stricter, and set by your service, not by this new guidance. The guidance says so itself. It doesn't change any of them.
Air Force. Hypogonadism by itself isn't disqualifying. Chronic hormone therapy beyond six months is disqualifying for flying class, ATC, and special warfare duties. Topical androgens are disqualifying for those duties. Injectable hormone replacement is disqualifying for those duties and for retention. Waivers exist and require two or more pre-treatment 0800 draws under 300, plus pre-treatment FSH, LH, and CBC. Men who don't meet the diagnostic criteria in the first place are unlikely to get one. Pellets aren't approved for Air Force personnel at all.
Army. Waiverable and fairly routine once you're stable on a single agent. Diagnosis requires two or more early-morning low draws with symptoms. Annual renewal wants total T in the 400 to 800 range, drawn at the midpoint between injections. Topicals, injectables, and pellets are all acceptable. Monotherapy only. Clomiphene is prohibited in aviators, and compounded formulations and over-the-counter T-boosters are prohibited outright.
Navy and Marine Corps aviation. Disqualifying on diagnosis. A grounding physical is required at the time of diagnosis, and temporary up-chits aren't authorized. Waivers are recommended for designated aviators after 90 days on a stable dose with an endocrinologist workup, but not for applicants.
Navy dive, NSW and special operations, and submarine duty. Ongoing use of exogenous testosterone is flatly disqualifying. There's no waiver path written into the manual the way there is for aviation. If you're on a dive or boat billet, this is the hardest rule in the whole set.
Nuclear and PRP. There's no testosterone-specific rule in the current instructions. It falls under the general rule that medication which may impair performance gets reviewed by the certifying official. If somebody tells you steroid history automatically bars you from PRP, that came from a 1990s directive that isn't current.
If you're in any of these communities, talk to your flight surgeon, dive medical officer, or undersea medical officer before you start anything. For aircrew, starting the medication is itself the grounding event.
The mistake that costs people their waiver
Starting testosterone at a civilian clinic before you've had a proper workup can cost you the military diagnosis later.
Every service wants two or three early-morning, fasting, low draws taken before any treatment, plus LH and FSH. Once you're on exogenous testosterone, that evidence is gone. Reconstructing it means washing out and waiting for your own axis to recover, which can take a long time and doesn't always go smoothly.
So the order matters. Labs first, diagnosis second, treatment third. A clinic that skips to the third step is not doing you a favor.
Deploying on therapy
There are two documents here and they don't fully agree, so you need to know both.
The DHA guidance says a member who's stable on therapy should be deployable without a waiver depending on the formulation, and that you should be started no later than 90 days before deployment with a supply covering the deployment plus 90 days or a documented resupply plan.
CENTCOM's own theater-entry policy says something different. Its medical standards list Schedule III controlled substances, and androgens and anabolic steroids by name, as disqualifying for deployment unless a waiver is granted. Injectable medications of any type also require a waiver.
A combatant commander's theater policy isn't overridden by a clinical guideline. If you're headed to the CENTCOM AOR, plan on needing the waiver and start that paperwork early. Anyone who tells you no waiver is needed hasn't read MOD 18.
Also worth knowing before you count on refills downrange: federal law caps a Schedule III prescription at five refills within six months of the date it was written.
If you want kids
Testosterone suppresses sperm production. For most men that reverses, though not always quickly.
Say it out loud at the first appointment if children are anywhere in your plans. There are approaches that protect fertility, and there's banking sperm before you start. This belongs at the front of the conversation.
Where a civilian clinic fits, honestly
If you're active duty with a PCM, start there. It's covered, it's in your record, and TRICARE requires active duty members to go through their PCM anyway. There's no point-of-service option for you, so a cash-pay clinic is money out of pocket by definition.
The people we actually help look like this. Guard and Reserve members without a military treatment facility nearby. Members within a year of separating who don't want a gap the day their ID card stops working. Retirees and veterans. And guys who want a full panel read carefully by someone with time to do it.
We offer discounted pricing for military, law enforcement, and first responders, and our clinic sits in Destin, Florida, about twenty minutes from Eglin and Hurlburt Field. Telemedicine covers 47 states. Request a consultation at hewhealth.com or call (850) 820-8850.
Two things we'll tell you that some clinics won't. You have an affirmative duty to report significant health information to your chain of command and to let civilian providers release records to the military health system. That's a condition of continued service, not a suggestion. And if you hold a special duty status, we'd rather lose the sale than cost you your wings or your dive quals.
Questions people actually ask
Is the screening mandatory? The screening is mandatory for male service members 30 and older. Treatment is your choice.
Will low testosterone make me non-deployable? Not by itself. The guidance says a diagnosis or stable therapy isn't, on its own, a basis for a duty limitation. Flight, dive, submarine, and nuclear billets are governed by separate service rules that this guidance doesn't change.
Does the random urinalysis catch testosterone? Steroids aren't part of the routine random panel. Under the Army's implementing regulation, a commander has to specifically request steroid testing with a written probable-cause analysis, and it runs at a different lab. A lawful prescription dated before the collection is what makes use authorized. A prescription obtained after a positive doesn't fix it.
Do I have to tell my command about a civilian prescription? Yes. Reporting significant health information and authorizing non-DoD providers to share records with the military health system is a condition of continued service.
Does TRT hurt my security clearance? Lawfully prescribed use taken as directed isn't drug involvement under the adjudicative guidelines. What sinks people in the case record is buying it without a prescription, using more than what's prescribed, and then not disclosing it. We wrote about that separately.
Does TRICARE cover it? For diagnosed hypogonadism, under the pharmacy benefit, yes. It's denied outright for athletic performance. Active duty members have to go through their PCM.
Hew Health is a private medical practice. We are not affiliated with, endorsed by, or connected to the Department of Defense or any branch of the U.S. Armed Forces. This article summarizes public policy as of September 22, 2026 and is general information, not medical advice. Testosterone is a Schedule III controlled substance and is approved for men with low testosterone caused by an associated medical condition. Safety and effectiveness in age-related low testosterone have not been established.
Sources: Secretary of War memorandum, "Health and Human Performance Optimization to Enhance Military Readiness," July 15, 2026. Defense Health Agency clinical practice guideline, "Testosterone Deficiency in the Male Service Member," September 17, 2026. USCENTCOM MOD 18 Tab A medical standards. Air Force Aerospace Medicine Waiver Guide Compendium, June 26, 2026. U.S. Army Aeromedical Policy Letters, December 2021. U.S. Navy Aeromedical Reference and Waiver Guide, July 15, 2026. NAVMED P-117 Chapter 15. AR 600-85. DoDI 6025.19.