U.S. DoW Health Initiatives (Flu vax policy, testosterone, etc.)

[Staff Weenie]

Something to think about, posted by Dr Karl Nadolsky, Clinical Endocrinologist and obesity specialist in the US (note that I do not have the education/license to verify or counter the claims below but it matches what I have heard from other clinicians, I was also unable to find the footnotes):

"As a former active-duty endocrinologist, I felt the "duty" to respond to this apparent effort by Secretary of Defense, Pete Hegseth, to screen all active-duty (presumably men) over age 30 for testosterone deficiency.

We have great active duty endocrinologists, especially at Walter Reed National Military Medical Center where I completed my fellowship and stayed on as faculty, that hopefully can curtain this foolish effort.

Men should only be screened for hypogonadism (#LowT) if they have symptoms of such (ie low libido, reduced erections, muscle loss, reduced drive/motivation, mood change like irratibility.

Specifically, in the military, we must be more vigilant for potential traumatic causes such as TBI, testicular injuries or other injuries that require opioid pain meds which cause low testosterone or chronic glucocorticoid (like prednisone) use.

Every major endocrine society explicitly recommends against routine screening for hypogonadism in asymptomatic men.

The rationale can be organized around several key domains:

1. Hypogonadism fails established criteria for population-level screening

2. Low prevalence in the target population

The prevalence of hypogonadism due to hypothalamic-pituitary-testicular pathology is less than 1% in the general male population.[2]

The most common cause of secondary hypogonadism, obesity, affects 2–8% of men, but the first-line treatment is weight loss, not testosterone as suggested by the SecDef.[2][7]

Active-duty military men over 30 are generally younger and should be more physically fit than the general population, making the expected yield of screening even lower.

3. High risk of false positives and overdiagnosis

Serum testosterone has substantial biological and analytical variability that makes single-measurement screening problematic.

A universal screening program would inevitably generate a large number of false-positive results, triggering unnecessary confirmatory testing, specialist referrals, anxiety, and potential inappropriate treatment.

4. Harms of unnecessary testosterone therapy

#TRT is only indicated for men with irreversible causes of hyogonadism and treating men who are identified through screening but without true irreversible deficiency carries real risks without established benefit (even if just infertility and life-long potential need of therapy once on it)"

Before people go jumping on the bandwagon, they need to ensure that they understand all of the science/medicine involved, the risk factors, and potential impact.

 

[dapaterson]

Before people go jumping on the bandwagon, they need to ensure that they understand all of the science/medicine involved, the risk factors, and potential impact.

You must be new to the internet.

 

[QV]

I don't think the Sec Def intends to put everyone on TRT. But making it easier to check and monitor is a good thing and better than the current default which is: do all of this for women but not men.

 

[medicineman]

What makes you say that?

Common health effects include:
Lower muscle mass and strength
Increased body fat
Reduced bone density
Lower energy and fatigue
Mood changes
Reduced libido and erectile difficulties
Reduced fertility
Anemia
Cognitive effects

This kind of screeing could help the CAF's issues with obesity and mental health.

There are a lot of other things that cause all of that as well...this is an RFK Jr thing, not based on actual science. While I do screen people for it, it's one of the last things you screen for, because, strangely enough, stuff like ED and low llibido and mood changes are also caused by things like untreated/poorly managed cardiovascular disease, diabetes, liver disease, thyroid issues, nutritional deficiencies, drug/alcohol abuse and depression. If a guy presents with an anemia, it's literally the last thing I look for, as most common cause isn't hypogonadism, it's most commonly gastrointestinal blood losses, nutritional deficiency/malabsorption, liver disease, cancers, bone marrow issues, alcoholism (where I work, almost always GI losses/alcoholism/nutritional deficiencies first, then the rest), drug interactions, some genetic disorders and then somewhere in there is lowered testosterone. I've seen a few people over the years that NEEDED TRT...lots that want it. The ones I've seen over the years that actually need it were those that had pituitary cancers, so knocking out the feedback axes, another one with treatment resistant depression that we tested and actually had levels so low as to be undetectable, others with castration secondary to cancer or had actual primary hypogonadism. A lot of people ask for it before checking the other reasons out - there are clinics in the US that make a killing making up their own levels that require treatment, giving people stuff they don't actually need with the resultant potential adverse effects that go with that...and still not treating what's actually causing the presentation in the first place. And now I see Staff Weenie weighed in saying similar stuff.

Now screenings...these are based on Canadian Preventative Health Task Force screening guidelines (which now got taken over by PHAC earlier in the spring) - so what gets tested for and when, though it's also occupation and diagnosis dependent in the CAF. As SKT noted, it's often like pulling birds' teeth trying to get a primary care appointment for an actual PHA/occupational medical exam - for aircrew/divers, unless you have intrinsic medical support, you'll be due the next exam by the time you get the one you're trying to get booked. This day and age though, I think due to the prevalence in society of dyslipidemia and type 2 diabetes and rising rates of both alcoholic and non-alcohol (metabolic associated) fatty liver disease, should be screened earlier than we were doing when I left the CAF.

 

[HavokFour]

If treatment is mandatory, it’s the opposite argument he used when he instituted the anti-flu vaccine policy.

No to stray too far off topic, but it also kind of pokes a hole in their transexual ban. Keeping up with an HRT regimen being a big part of the argument against.

 

[Staff Weenie]

Reminds me of a briefing to the Surg Gen that I sat in on in the early 2000s, where a certain GDMO was proposing that they could administer two meds to folks from the Hill;

a. A drug that raises core temp by approximately 2 degrees - he felt it might make our troops easier to recognize on IR (they'd appear 'brighter') and thus avoid blue on blue; and

b. A managed program of anabolic steroids to build muscle mass quickly and provide a physical edge over opponents.

The shocked silence in the crowd of senior clinicians said it all...

"I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous." - I know it is not universally applied as an oath any longer, but there's something to be said for this.

 

[PuckChaser]

Literally Hegseth said TRT only if indicated by a medical professional. If they find LowT but there's other factors, guess what a proper medical doctor won't prescribe? TRT. Doesn't sound like rocket appliances to me.

 

[Halifax Tar]

Literally Hegseth said TRT only if indicated by a medical professional. If they find LowT but there's other factors, guess what a proper medical doctor won't prescribe? TRT. Doesn't sound like rocket appliances to me.

Who are you to get in the way of someone else's biases against this Administration ?

 

[PuckChaser]

The politics crap is deleted. I think most of us are mature enough to discuss the policy not the policy maker.

 

[The Bread Guy]

For the record, here's the Secretary's statement on the initiative (about 2 1/2 minutes long) ...

... as well as a one-pager signed by the SecWar on the initiative, attached. This stood out for me from the letter (highlights mine):

... This enhanced screening protocol directly supports the Department's focus on Human Performance Optimization while comprehensively addressing Operator Syndrome. Originally identified among Special Forces in 2020 through collaborative research between the Department of War (Do W) and leading academic institutions, Operator Syndrome represents a unique convergence of health challenges that require proactive clinical intervention. Additionally,applying lessons learned from treating Operator Syndrome across the Total Force includingtargeted testosterone therapy directly optimizes Warfighter readiness ...

First I've heard of "Operator Syndrome" - here's a touch more back story on that bit going back a few years:

Congress demands answers on low testosterone issues among special operators

Congress wants a briefing on low testosterone interventions and testing in the military to understand an issue known as “Operator Syndrome.”

taskandpurpose.com

• Frueh, B. C., Madan, A., Fowler, J. C., Stomberg, S., Bradshaw, M., Kelly, K., Weinstein, B., Luttrell, M., Danner, S. G., & Beidel, D. C. (2020). “Operator syndrome”: A unique constellation of medical and behavioral health-care needs of military special operation forces. The International Journal of Psychiatry in Medicine, 55(4), 281–295. https://doi.org/10.1177/0091217420906659
• Preprint (not peer reviewed yet): "Validation and Refinement of Operator Syndrome in Active-Duty Special Operations Forces," Shane W. Adams, B. Christopher Frueh, Jerome Sabangan, Carey Pawlowski, Robert Oh, Cameron Pugach, Odette Harris, doi: https://doi.org/10.1101/2025.11.06.25339692

 

[medicineman]

Literally Hegseth said TRT only if indicated by a medical professional. If they find LowT but there's other factors, guess what a proper medical doctor won't prescribe? TRT. Doesn't sound like rocket appliances to me.

The question I'd then ask is what are they using as the low/high markers? The ones we normally use in practice or the ones RFK Jr suggests which are based on vibe alone?

For the record, here's the Secretary's statement on the initiative (about 2 1/2 minutes long) ...

... as well as a one-pager signed by the SecWar on the initiative, attached. This stood out for me from the letter (highlights mine):

First I've heard of "Operator Syndrome" - here's a touch more back story on that bit going back a few years:

Congress demands answers on low testosterone issues among special operators

Congress wants a briefing on low testosterone interventions and testing in the military to understand an issue known as “Operator Syndrome.”

taskandpurpose.com

• Frueh, B. C., Madan, A., Fowler, J. C., Stomberg, S., Bradshaw, M., Kelly, K., Weinstein, B., Luttrell, M., Danner, S. G., & Beidel, D. C. (2020). “Operator syndrome”: A unique constellation of medical and behavioral health-care needs of military special operation forces. The International Journal of Psychiatry in Medicine, 55(4), 281–295. https://doi.org/10.1177/0091217420906659
• Preprint (not peer reviewed yet): "Validation and Refinement of Operator Syndrome in Active-Duty Special Operations Forces," Shane W. Adams, B. Christopher Frueh, Jerome Sabangan, Carey Pawlowski, Robert Oh, Cameron Pugach, Odette Harris, doi: https://doi.org/10.1101/2025.11.06.25339692

Operator Syndrome (another term I've heard is Breacher Syndrome) is like CTE in that the brains of, in particular Special Warfare Operators, and others, are exposed to recurrent close range blast waves/concussive forces from repetitive explosive entries/enclosed space concussion grenades/gunfights, etc that can damage many systems in the brain, including the various pituitary axes like the pituitary-gonodotropin axis. This was mentioned by Staff Weenie's endocrinologist. Another possible explanation could also be the fact some of those operators may have also been juicing and then stopped when in back in garrison when exposed to random drug testing - the additional exogenous testosterone stops the feed back loop, so they're playing catch up after stopping it. Could even be a combination of both in some cases. Frig, pretty sure a number of us on this site, myself included, have been exposed to a lot of blast waves over the years, just not on a daily basis like Tier 1/2 units doing sometimes multiple hits a night for prolonged periods of time, not to mention the live fire training they do working up to those.

Now this puts things in perspective, as I'd have initially thought that this was an RFK Jr thing, given he thinks his levels are higher than the average teenager's these days...and they likely are, because I'm pretty sure he's prescribed TRT; whether he actually needs it or just pays his doc to prescribe it is between him and his physician(s). My opinion on the matter is just that - an opinion, based on my observations.

End of the day, if it were recommended by actual medical professionals in lieu of a wannabe, then so be it...I still have issues about pan screening like some people suggest just for shiggles - however if there is a bona fide reason, ok then.

 

[medicineman]

There are a lot of other things that cause all of that as well...this MAY BE an RFK Jr thing, not based on actual science.

Fixed that for myself based on new info...

 

[OldSolduer]

I’ve no experience with Testosterone replacement but anecdotally I’ve heard it can cause side effects.

 

[McG]

Operator Syndrome (another term I've heard is Breacher Syndrome) is like CTE in that the brains of, in particular Special Warfare Operators, and others, are exposed to recurrent close range blast waves/concussive forces from repetitive explosive entries/enclosed space concussion grenades/gunfights, etc that can damage many systems in the brain ...

If it's a repetitive blast exposure thing, it must affect everyone in the mortar community?

End of the day, if it were recommended by actual medical professionals in lieu of a wannabe, then so be it...I still have issues about pan screening like some people suggest just for shiggles - however if there is a bona fide reason, ok then.

The branding that they chose to put on the information video suggests there may be as much (or more) macho concern as medical concern underlying this.

 

[medicineman]

If it's a repetitive blast exposure thing, it must affect everyone in the mortar community?


The branding that they chose to put on the information video suggests there may be as much (or more) macho concern as medical concern underlying this.
View attachment 101260

That's why I added "and others"...mortars, arty, EOD, HMG gunners, Carl G gunners, even snipers potentially. I've had my own bell rung being around arty while it's firing, mine strikes, explosives being cooked off, BIP's, wrong side of a Carl G firing, etc.

I got the impression, and to a point listening to the way things are reported, that there is still may be some RFK Jr stuff in the background, depending on how the reporter presents it. If the Human Factors gurus are bringing this up, I'd say there is more of an actual medical reason, however it could also be them trying to expand their study to those that may/may not have been exposed to recurrent blast wave trauma outside the SOF community by doing blanket testing. If it's as a study, they should present it that way though. for now I guess.