Pete Hegseth wants a testosterone-fueled military. The science doesn’t back the macho fantasy

It’s been just about a month since U.S. Secretary of Defense Pete Hegseth announced his plan for the “High-T” Department of War, which he says includes giving testosterone replacement therapy, known as TRT, to cisgender troops deemed to have low levels of the male sex hormone.

The fallout has been swift, while Hegseth has doubled down. As previously reported by The Advocate, on July 22, U.S. District Judge Ana Reyes challenged Hegseth, asking thePentagon to explain why Hegseth is denying hormone replacement therapy (HRT) for transgender troops, categorizing the treatment as an unnecessary expense when he wants to recommend TRT as a performance-enhancing treatment for cis service members. He did not know how much the “high T” program would cost when asked, but asserted that the treatments would give “our warriors the absolute best medical care in the world.”

“It’s about restoring and optimizing your natural capabilities, protecting your longevity, ensuring you have the biological foundation required to sustain the fight,” Hegseth said in his initial policy announcement.

The question is whether testosterone replacement therapy is actually the cure-all treatment to strength, endurance, and physical prowess Hegseth and his Department of Defense have framed it to be? Experts say that the short answer is no. The long answer is that understanding healthy testosterone levels is far more nuanced than calling an increase of the hormone the answer to masculinity and strength. More so, too much testosterone can actually lead to some health concerns in the long term.

“Testosterone is not a superhuman cure, and it should not be sold as a shortcut to strength, readiness, or resilience,” Dr. Demetre Daskalakis, Chief Medical Officer at Callen-Lorde Community Health Center and former director of the U.S. Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, tells The Advocate.

Related: The Pentagon said transgender hormone care costs too much. Now Pete Hegseth wants testosterone boosts

Below, Daskalakis explains the complexities of testosterone therapy, what it actually is meant to treat, and why “high T” is not always a good thing.

What is the difference between TRT and HRT?

The goals of testosterone replacement therapy as opposed to testosterone-based hormone replacement therapy are slightly different, though there is overlap in each treatment’s impact on the body. Daskalakis explains that in cis men, TRT is used to treat hypogonadism, or low testosterone caused by underproduction in the testes, by bringing levels in the body back to the appropriate physiological range. He says that TRT is only prescribed, “after confirming consistently low levels and looking for underlying causes.”

For trans people who are taking testosterone-based HRT, the treatment helps give people characteristics like a deeper voice, increased muscle mass, more facial and body hair, and fat redistribution, among other effects.

“The medication may be the same, but the indication is not the same. In both settings, the right approach is individualized dosing, informed consent, lab monitoring, and respect for the patient’s goals,” Daskalakis says.

Related: Judge in trans military ban case demands Pentagon explain Hegseth’s testosterone double standard

The important thing to note is that testosterone levels in anyone taking it, cis or trans, are monitored carefully through blood tests to ensure they are doing so within a safe range. For cis men considering TRT, treatment is only recommended after establishing someone is experiencing negative symptoms and has a documented and consistently low level of testosterone.

“When someone has a real, clinically diagnosed testosterone deficiency, treatment can be meaningful,” he says. “But routine population-wide screening of people without symptoms is not generally recommended by endocrine experts, and testosterone therapy requires careful diagnosis, discussion of risks and benefits, and monitoring. The public-health answer is: treat deficiency when it is real; do not mythologize a hormone into a performance ideology.”

Are there detriments to high testosterone levels?

Despite Hegseth’s new directive, high T does not always equate to good T. Per Daskalakis, unmonitored, high levels of testosterone can have adverse side effects like increasing red blood cell count, which can translate to increased risk of clotting. High testosterone levels can also worsen acne and cause hair loss for people who are genetically predisposed. Additionally, it can suppress fertility and reduce sperm production in cisgender men, and negatively impact mood, sleep, and blood pressure.

“More is not automatically better,” Daskalakis tells The Advocate. “For people on masculinizing therapy, the goal is typically to keep testosterone in a physiologic male range — not to push it above that range. Good care is not about chasing the highest number; it is about achieving the patient’s clinical goals safely or address the clinical manifestations of a true deficiency.”