Endocrine Society Statement on the Defense Health Agency’s Clinical Practice Guideline for Testosterone Deficiency in the Male Service Member

There is insufficient evidence to support a population-level screening for hypogonadism in asymptomatic men with measurement of blood testosterone levels, as noted in the Society’s Clinical Practice Guideline on testosterone replacement therapy in men with hypogonadism. 

Screening men over age 30 is likely to result in a high number of false positives, and the testing process is expensive and time-consuming. 

As of 2023, 24.2% of active service members had obesity. Men with obesity are more likely to have low total testosterone levels in blood tests. While this could be addressed with obesity treatment, the DHA guideline calls for men with low testosterone levels and obesity to be offered testosterone replacement therapy as well as weight management care.

The DHA guideline, as written, raises concerns about fertility. The DHA guideline recommends men with low testosterone levels who wish to protect their fertility receive hCG therapy. Because hCG therapy suppresses serum FSH, which is a hormone necessary for normal sperm production, this approach will lead to decreased sperm production and fertility in those with obesity-induced hypogonadism who typically have normal serum FSH concentrations. When men receive testosterone replacement therapy and hCG therapy for two or more years, it leads to delays in the body’s ability to recover normal levels of sperm and hormone production.

About the Endocrine Society
Endocrinologists are at the core of solving the most pressing health problems of our time, including diabetes, obesity, infertility, bone health, and hormone-related cancers. The Endocrine Society is the largest global organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

With more than 18,000 members in 133 countries, the Society serves as the voice of the endocrine field. Through its renowned journals and ENDO, the world's largest endocrine meeting, the Society accelerates hormone research, advances clinical excellence in endocrinology, and advocates for evidence-based policies on behalf of  the global endocrine community. To learn more, visit our online newsroom.