Approximately 25.7% of active-duty US Army men had morning testosterone concentrations below 300 ng/dL, compared with 14.7% using a lower threshold of 264 ng/dL, according to a cross-sectional analysis. The findings come amid a new military policy requiring annual testosterone screening for active-duty and reserve personnel aged 30 years or older.
Researchers conducted a cross-sectional analysis of the Military Health and Nutrition Examination Study, a multisite survey performed at 5 US Army installations from August 2024 through January 2026. The study included 479 active-duty men with fasting morning serum total testosterone measurements, excluding 3 receiving testosterone replacement therapy. Participants had a weighted mean age of 29.9 years and body mass index (BMI) of 28.4. Survey weights calibrated to the active-duty US Army population were used to generate Army-wide estimates.
The researchers estimated the prevalence of total testosterone concentrations below 300 ng/dL, a cutoff recommended by the American Urological Association, and below 264 ng/dL, the lower limit established in a harmonized reference study of healthy, nonobese men aged 19 to 39 years. Additional analyses examined differences by age and BMI, including their associations with low testosterone concentrations.
These prevalence estimates corresponded to approximately 100,691 active-duty Army men using the 300-ng/dL threshold and 57,788 using the 264-ng/dL threshold. The weighted mean morning total testosterone concentration was 405 ng/dL.
Low testosterone concentrations were more common among men aged 30 years or older than among younger men, at 32.8% vs 19.5% using the 300-ng/dL threshold and 18.6% vs 11.4% using the 264-ng/dL threshold.
Age and BMI were associated with low testosterone concentrations in survey-weighted logistic regression analyses. Each 5-year increase in age was associated with 29% higher odds of testosterone concentrations below 300 ng/dL and 20% higher odds of concentrations below 264 ng/dL. Each 5-unit increase in BMI was associated with 90% and 82% higher odds of falling below the respective thresholds.
Among men without obesity aged 19 to 39 years, 9.7% had testosterone concentrations below 264 ng/dL, corresponding to an estimated 23,115 men Army-wide. Sensitivity analyses excluding participants taking medications or reporting medical conditions that could affect testosterone concentrations did not materially alter the results.
Current clinical guidelines recommend testosterone testing only for men with compatible signs or symptoms, and low morning concentrations require confirmation through repeat testing because of intraindividual and diurnal variation. Clinical interpretation should also account for factors that can influence testosterone concentrations, including obesity, illness, and physical stress. Study limitations included the cross-sectional design, reliance on a single testosterone measurement, and potential assay-related misclassification near clinical thresholds.
The researchers note findings suggest that routine testosterone screening could prompt confirmatory testing and clinical evaluation for many active-duty US Army men, with the magnitude depending on the biochemical threshold selected.
"These screening estimates should not be interpreted as the prevalence of hypogonadism," wrote lead study author Stephen R. Hennigar, PhD, of Pennington Biomedical Research Center in Baton Rouge, Louisiana, and colleagues.
Hennigar, Bukhari, and Berryman reported grants from the US Army Medical Research and Development Command. Heymsfield disclosed consulting or advisory relationships with Tanita, Medifast, Merck, Novo Nordisk, Lilly, Regeneron, and Abbott. The funder had no role in the research or publication process beyond financial support.
Source: JAMA
