"Hegseth: Flu Vaccine Optional"

[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.

 

[GK .Dundas]

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.

Do you suppose the Sec Def /War ( or whatever title it is this week) is dealing with some deeply personal issues.
Of course at his age it's not uncommon for men to experience some performance issues.....

 

[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 be 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.

 

[Halifax Tar]

Do you suppose the Sec Def /War ( or whatever title it is this week) is dealing with some deeply personal issues.
Of course at his age it's not uncommon for men to experience some performance issues.....

Oops! There we go, that didn't take long.

 

[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.