Fertility and the Military’s Testosterone Policy: Here’s What to Ask

The Pentagon’s new testosterone screening policy requires medical providers to ask a service member who is undergoing screening about plans for children before writing a single treatment prescription.

If the answer is yes to children, or hasn’t decided, the policy bars starting standard testosterone therapy and requires an alternative drug that preserves fertility instead, according to the Defense Health Agency’s Clinical Practice Guideline for Testosterone Deficiency in the Male Service Member, dated Sept. 17, 2026.

That requirement, not the widely reported 300 nanogram-per-deciliter threshold that triggers screening, is what a men’s health physician who closely reviewed the policy says matters most for the mostly young, active-duty population it reaches.

“My biggest concern as an internist has always been fertility,” said Dr. Haleem Mohammed, chief medical officer of Gameday Men’s Health, a men’s health clinic network with more than 400 locations across the U.S. and Canada. “If someone wants children, or hasn’t decided, they wouldn’t start testosterone outright — they’d use HCG so the patient keeps making sperm.”

Related: Troop Testosterone Testing Now Available: Why? And Treatment Pros & Cons

What the Policy Actually Requires

The guideline instructs providers to “ask about fertility intent before any prescription.” If a service member wants children or hasn’t decided, the document states plainly that “exogenous testosterone will not be initiated.” Instead, providers are directed to prescribe human chorionic gonadotropin, or HCG, which the guideline notes is “FDA-approved for hypogonadotropic hypogonadism in males,” or, off-label, clomiphene citrate.

Only service members who don’t want children, or have completed their families, are routed to standard testosterone replacement.

Mohammed explained the medical reasoning behind that split. Straight testosterone replacement supplies the hormone from outside the body, which signals the brain to stop sending the signals that drive natural testosterone and sperm production in the testes. “It can shut down fertility, and the longer someone’s on it at higher doses without medical supervision, the harder that may be to reverse,” Mohammed said. “Guys who’ve abused anabolic steroids — synthetic derivatives of testosterone — for a long time may not get their fertility back.”

HCG works differently: It mimics the natural signal that keeps the testes producing both testosterone and sperm on their own, preserving fertility while still treating the deficiency.

How the Screening Itself Works

The guideline does not test every service member’s blood. It starts with a structured symptom and risk-factor assessment, and only troops who screen positive move to lab testing: two separate fasting blood draws between 7 a.m. and 10 a.m. on different mornings, since testosterone peaks early in the day, plus a follicle-stimulating and luteinizing hormone test taken with the second draw. A diagnosis requires a total testosterone reading below 300 nanograms per deciliter on both draws, together with consistent symptoms — the number alone is not sufficient.

The guideline also requires a 30-day recovery window after intense training before testing is considered valid, because, as the document explains, intense physical training, sleep restriction and sustained operations produce a temporary suppression of the hormone system that resolves with rest and normal eating and isn’t true hypogonadism.

Related: Why Low Testosterone and PTSD Get Confused in Veterans

Mohammed described the same safeguard from the clinical side: “I think the misconception in the news I saw was that they’re going to give testosterone to everyone, and that’s absolutely not the case,” he said.

The guideline applies only to male service members; the Defense Health Agency states that female service members are addressed in a companion guideline.

A Younger Force With a Different Set of Problems

Mohammed said military service sets troops up for low testosterone at younger ages than the general population would expect, pointing to a mix of poor sleep, sustained caloric deficits during hard training, head injuries and blast exposure that can damage the pituitary gland, and prevalent sleep apnea.

“There were studies out of Ranger School that showed testosterone levels falling to what you’d see in much older men during the course of training,” he said. He added that many of the resulting symptoms — irritability, low sex drive and what he called brain fog — overlap with PTSD and depression, which he said has become common among veterans.

That overlap, combined with a fertility question that rarely comes up for the older men typically associated with testosterone therapy, is what Mohammed said separates screening a mostly young, active-duty population from screening the general public. Under the guideline, that conversation isn’t optional or left to a provider’s discretion: It’s a required step before any prescription can be written.

Where the Policy and a Doctor’s Own Practice Diverge

Mohammed’s clinics take a more sequential approach with civilian patients than the military does with its own. Roughly half of the men who come through his clinics for low testosterone, he said, don’t end up on treatment at all once reversible causes — excess weight, poor sleep, stress, smoking and marijuana use — are addressed first, with patients retested roughly six months later.

“Losing 15 to 20 pounds can raise testosterone naturally by 200 to 300 points,” he said.

The military’s guideline handles that sequencing differently. It states that “addressing a reversible cause and initiating therapy are not mutually exclusive” and that a reversible cause “is not a reason to defer treatment of a symptomatic service member with a confirmed diagnosis.” In practice, that means the military offers lifestyle intervention for reversible causes without withholding treatment while a service member works on them, rather than delaying a prescription the way Mohammed’s clinics generally do.

The Safety Questions That Follow Any TRT Policy

Mohammed also addressed two safety concerns that have followed testosterone therapy for years: prostate cancer risk and cardiovascular risk. He pointed to the TRAVERSE trial — short for Testosterone Replacement therapy for Assessment of long-term Vascular Events and efficacy ResponSE in hypogonadal men” — along with updated 2025 guidance from the FDA and the American Urological Association, as having found no increased cardiovascular risk from therapeutic, medically supervised treatment.

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The real risk, he said, shows up when someone uses testosterone without a doctor monitoring their blood work, whether from an illicit source or with no supervision at all.

“Testosterone is a controlled substance, and I’ve heard some guys in the military have used it without a prescription,” Mohammed said. “Without medical supervision, yes, there’s risk. With supervision, it’s a very safe treatment.”

What a Service Member Should Ask Before Starting Treatment

For a service member who screens positive, Mohammed said the fertility conversation should come before any prescription, not after — which is also what the guideline requires. Anyone considering treatment should ask their provider:

• Whether the plan involves HCG or a fertility-preserving alternative, if they may want children now or later.
• Whether reversible causes such as weight, sleep and stress are being addressed alongside treatment, not instead of it.
• How the plan will monitor blood work over time rather than issuing a prescription and moving on.

“If they’re skeptical, I’d want them to know this is something normal we’re seeing, and we’re seeing it at younger ages,” Mohammed said. “There are things we can help with before jumping to a prescription. Getting tested isn’t a stigma.”

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