Hegseth’s “High-T” initiative: nonsensical, harmful, unethical, unpractical, sexist, and ideologically misguided

Drugging soldiers seems to be an odd idea. Yet, it is not without precedent, e.g.:

• Nazi Germany (WWII): The Wehrmacht and Luftwaffe were systematically supplied with Pervitin (methamphetamine), with tens of millions of tablets issued to keep soldiers and pilots awake, alert and aggressive during the war.
• Britain/US (WWII air operations): Allied air forces issued amphetamine and caffeine tablets to bomber crews and other soldiers to counter fatigue on long missions, representing a state‑sanctioned stimulant program for performance enhancement.
• US (Vietnam War): soldiers were routinely given Dexedrine (dextroamphetamine) and other psychoactive drugs to sustain long patrols and suppress combat stress; hundreds of millions of tablets were thus distributed with official approval.
• Soviet Union (Cold War): State‑run sports programmes, closely tied to military and security structures, systematically administered anabolic steroids and testosterone derivatives to elite athletes to boost strength and recovery, normalising pharmacological enhancement in a militarised setting.

Now, the US Defence Secretary Pete Hegseth’s recent “High-T” initiative mandates annual testosterone screening for US troops aged 30 and older, coupled with optional hormone replacement therapy (TRT). This is a striking case of policy outrunning clinical evidence. While announced as a readiness initiative to keep the joint force on the “leading edge of lethality,” the proposal glosses over critical medical, ethical, and operational realities.

First, the medical rationale for mass screening is weak, to put it mildly. Established clinical guidelines recommend testing only men presenting with specific symptoms and risk factors, not broad, asymptomatic populations. Screening hundreds of thousands of personnel annually risks over-diagnosis and over-treatment, particularly in a young force where borderline-low values are common, highly fluctuating, and often transient. In a word: the “High-T initiative” is nonsense.

Second, oral testosterone undecanoate (TU) shares general testosterone risks, e.g. erythrocytosis, prostate effects (worsening BPH symptoms, small PSA rises, contraindication in prostate cancer), suppression of spermatogenesis and infertility, acne, fluid retention, mood changes, and possible lipid alterations. Compared with transdermal or injectable formulations, oral TU offers convenience but requires strict baseline and ongoing monitoring of blood pressure, haematocrit, PSA, and testosterone levels, and is best reserved for men without uncontrolled hypertension, high cardiovascular risk, or near-term fertility plans, and only after considering safer first-line options. In particular, TRT-induced suppression of spermatogenesis presents a serious threat to fertility for service members of reproductive age, introducing severe clinical trade-offs without clear medical indications. In a word: the “High-T initiative” is likely to do more harm than good.

Third, the policy dangerously blurs the line between therapeutic medicine and performance enhancement. Mass-screening healthy soldiers and offering TRT to asymptomatic individuals normalizes the pharmacological optimization of the force. This sets a dangerous precedent: once hormonal levels are treated as adjustable parameters for “readiness,” the boundary between standard healthcare and state-sponsored enhancement dissolves. In a word: the “High-T initiative” is unethical.

Fourth, the operational logistics remain unresolved. Mandating annual blood draws will strain military medical systems, must generate an influx of equivocal results, and will create a massive administrative trail of counselling, monitoring, and liability. In a word: the “High-T initiative” is unpractical.

Fifth, the policy’s ambiguity regarding female service members exposes a glaring double standard: the Pentagon has not clarified whether women will be screened for sex-hormone deficiencies, or if this “restorative” care is reserved strictly for men. In a word: the “High-T initiative” is sexist.

Sixth, the political optics are highly suspect. The initiative directly mirrors broader administration efforts to liberalize testosterone prescribing, raising concerns that ideology, rather than rigorous military medicine, is driving policy. In a word: the “High-T initiative” is ideological.

Unsurprisingly, many experts have criticised the initiative sharply, e.g.:

• Stuart Phillips, a medical professor at McMaster University, told The Washington Post: “A blanket policy like we’re going to screen everybody over the age of 30 is kind of a ridiculous notion.”
• Adriane Fugh-Berman, a Georgetown University professor of pharmacology and physiology, warned: Hegseth’s claims are “non‑evidence‑based and could cause harm.”

Overall, Hegseth’s policy is out-running clinical evidence, and his stupidity is out-doing common sense. There is no doubt in my mind that his testosterone obsession is extremely ill-advised and – if not urgently stopped – will do an abundance of harm.