Hegseth wants a “High-T” military; doctors call it a clinical minefield

海格塞斯想要一支“高睾酮”军队；医生称其为临床雷区

On Wednesday, Defense Secretary Pete Hegseth made the startling announcement that the US military would begin requiring all active duty and reserve personnel aged 30 and older to undergo mandatory screening for testosterone deficiency. The screenings will take place during yearly health assessments. Those under age 30 can also get screened on request. 周三，国防部长皮特·海格塞斯（Pete Hegseth）发布了一项令人震惊的声明：美军将开始要求所有30岁及以上的现役和预备役人员进行强制性的睾酮缺乏症筛查。筛查将在年度健康评估期间进行。30岁以下的人员也可根据要求进行筛查。

In a short video posted on social media, Hegseth explained to the military community that the screenings and possible subsequent treatments are intended to “optimize your performance, your resilience, and your long-term health.” While saying that the initiative wasn’t about “artificial enhancement” and that members could decline treatment, Hegseth claimed that the testing and potential treatment was for “restoring and optimizing” capabilities, protecting “longevity,” and “ensuring you have the biological foundation required to sustain the fight.” 在社交媒体发布的一段短视频中，海格塞斯向军方群体解释称，这些筛查及随后的潜在治疗旨在“优化你们的表现、韧性和长期健康”。尽管海格塞斯表示该倡议并非为了“人工增强”，且成员可以拒绝治疗，但他声称，这些检测和潜在治疗是为了“恢复和优化”能力、保护“长寿”，并“确保你们拥有维持战斗所需的生物学基础”。

But will testosterone screening and treatment actually “optimize” our “warfighters”? Will it help most of them live longer? Should everyone else get screened and treated, too? “A big fat ‘Oh, no’” 但睾酮筛查和治疗真的能“优化”我们的“战斗人员”吗？这能帮助他们大多数人活得更久吗？其他人是否也应该接受筛查和治疗？答案是一个“大大的‘噢，不’”。

Screening people widely for medical conditions and then treating those who need it may sound like a huge social positive. But issues around male hypogonadism—the condition in which the body doesn’t produce enough testosterone—can be complex. That’s why the Endocrine Society—made up of experts in the complex systems that release hormones in the body—posted a statement on the topic in the wake of Hegseth’s announcement. 对人群进行广泛的医疗状况筛查，然后对有需要的人进行治疗，听起来似乎是一项巨大的社会福利。但围绕男性性腺功能减退症（即身体无法产生足够睾酮的疾病）的问题可能非常复杂。正因如此，由研究人体激素释放复杂系统的专家组成的内分泌学会（Endocrine Society），在海格塞斯宣布该消息后发表了一份相关声明。

The document notes that “there is insufficient evidence to support a general recommendation to perform population-level screening for hypogonadism in asymptomatic men with measurement of blood testosterone level.” To find out why, Ars Technica spoke with Professor Bradley Anawalt, chief of medicine at the University of Washington Medical Center. He specializes in endocrinology and men’s health. 该文件指出：“目前没有足够的证据支持对无症状男性进行群体层面的睾酮水平测量，以筛查性腺功能减退症。”为了探究原因，Ars Technica采访了华盛顿大学医学中心内科主任布拉德利·安纳沃尔特（Bradley Anawalt）教授。他专门研究内分泌学和男性健康。

“This is a great big fat ‘Oh, no,’” Anawalt said in reaction to Hegseth’s announcement. “We’re turning the clock back on rational healthcare. … I’m worried about the ethics. I’m worried about the health consequences. I’m worried about unnecessary evaluations, incorrect assessments, and incorrect diagnoses that lead to inappropriate prescriptions of testosterone.” “这是一个大大的‘噢，不’，”安纳沃尔特在回应海格塞斯的声明时说道。“我们正在让理性的医疗保健开倒车……我担心其中的伦理问题。我担心对健康的影响。我担心不必要的评估、错误的评估以及导致不当开具睾酮处方的错误诊断。”

To understand why, let’s start with the basic question: Why might someone have low testosterone? 为了理解原因，让我们从基本问题开始：为什么一个人的睾酮水平会偏低？

Causes of “low T”

“低睾酮”的成因

Disease states that can cause low testosterone include genetic conditions, such as Klinefelter syndrome (when a male has an extra X chromosome) or a problem with the brain’s pituitary gland, which controls hormone levels in the body. Pituitary problems may come from damage, dysfunction, or tumors (which are often noncancerous). 可能导致睾酮水平偏低的疾病状态包括遗传性疾病，例如克氏综合征（男性多出一条X染色体），或者大脑垂体出现问题（垂体控制着体内的激素水平）。垂体问题可能源于损伤、功能障碍或肿瘤（通常为良性）。

For these patients, “It’s not difficult to make the diagnosis,” Anawalt said. Genetic tests can detect Klinefelter disease, for instance, confirming an explanation for low testosterone levels. Similarly, in patients with pituitary problems, tests for other blood hormones (such as luteinizing hormone and follicle-stimulating hormone) can confirm the source of the problem. 对于这些患者，“做出诊断并不困难，”安纳沃尔特说。例如，基因检测可以检测出克氏综合征，从而证实睾酮水平偏低的原因。同样，对于垂体有问题的患者，通过检测其他血液激素（如黄体生成素和卵泡刺激素）可以确认问题的根源。

But these conditions are uncommon, affecting maybe 1 percent of men at most, Anawalt said. Meanwhile, many other things can lower testosterone levels, such as: cancer treatments, medications (such as corticosteroids or opioids), anabolic steroids, obesity, HIV, surgery, trauma, stress, sleep deprivation, and the natural process of aging. Many of these causes would not necessitate testosterone replacement therapy. For someone with sleep deprivation, the best treatment would be rest, for instance. 但安纳沃尔特指出，这些疾病并不常见，最多影响约1%的男性。与此同时，许多其他因素也会降低睾酮水平，例如：癌症治疗、药物（如皮质类固醇或阿片类药物）、合成代谢类固醇、肥胖、艾滋病毒、手术、创伤、压力、睡眠不足以及自然的衰老过程。其中许多原因并不需要进行睾酮替代疗法。例如，对于睡眠不足的人来说，最好的治疗方法是休息。

Symptoms

症状

In patients with true hypogonadism, the primary symptoms are lower libido, erectile dysfunction, lowered sperm count, breast enlargement or tenderness, reduced energy, reduced muscle mass, shrinkage of testes, mood changes (such as irritability or depressed mood), and hot flashes. Over time, low testosterone can cause loss of body hair, muscle bulk, and bone density, and it can reduce red blood cell counts. 在真正的性腺功能减退症患者中，主要症状包括性欲减退、勃起功能障碍、精子数量减少、乳房增大或触痛、精力下降、肌肉量减少、睾丸萎缩、情绪变化（如易怒或抑郁）以及潮热。随着时间的推移，低睾酮会导致体毛、肌肉量和骨密度流失，并可能降低红细胞计数。

In clear cases of disease, these symptoms are easy to spot. In the general population, it’s much harder. “What’s more difficult to suss out is the men that have vague symptoms,” Anawalt said. “‘I don’t feel so good. I’m tired. My energy’s not so good. My erections aren’t what they used to be. My mood is not very good. I’m not concentrating well.’ These are all common things that people are concerned about, but they’re neither specific nor particularly common symptoms of testosterone deficiency.” 在明确的疾病病例中，这些症状很容易发现。但在普通人群中，这要困难得多。“更难辨别的是那些症状模糊的男性，”安纳沃尔特说。“‘我感觉不太好。我很累。我的精力不太好。我的勃起不如以前了。我的情绪不太好。我无法集中注意力。’这些都是人们关心的常见问题，但它们既不是睾酮缺乏症的特异性症状，也不是特别常见的症状。”

The testing process

检测过程

The actual testing mechanics can also be tricky. “Tests that measure testosterone are a disaster unless you use a CDC validated or certified testosterone assay,” Anawalt said. In recent years, the Centers for Disease Control and Prevention began certifying testosterone blood tests for quality, accuracy, and reliability. Still, not all laboratories use certified tests. This can lead to unusual results. 实际的检测机制也可能很棘手。“除非使用美国疾控中心（CDC）验证或认证的睾酮检测方法，否则测量睾酮的测试简直是一场灾难，”安纳沃尔特说。近年来，美国疾控中心开始对睾酮血液检测的质量、准确性和可靠性进行认证。然而，并非所有实验室都使用认证测试。这可能导致异常结果。

In addition, some laboratories use nonstandard reference ranges for what they consider “normal.” The Endocrine Society reports that a common, generally accepted clinical threshold is near 300 ng/dL, though some clinicians may consider the threshold slightly lower, such as in the 260s. Anawalt recalled a patient who had been diagnosed with low testosterone based on a normal testosterone test result of 489 ng/dL. The patient’s previous doctor had used a lab that considered the minimum threshold for normal to be 700 ng/dL. 此外，一些实验室对所谓的“正常”范围使用非标准参考值。内分泌学会报告称，一个普遍公认的临床阈值接近300 ng/dL，尽管一些临床医生可能认为阈值略低，例如在260 ng/dL左右。安纳沃尔特回忆起一位患者，其睾酮检测结果为正常的489 ng/dL，却被诊断为睾酮偏低。该患者之前的医生所使用的实验室将正常的最低阈值定为700 ng/dL。

“It’s a whole other topic to get into the ‘whys’ and the ‘wherefores’ of that, but it’s largely to promote prescriptions of testosterone,” Anawalt said. Even if you use an accurate test with a high-quality reference range, testing for testosterone isn’t simple. Hormone levels fluctuate and tend to be highest in the morning. Thus, experts say the testing must be done early in the morning. “深入探讨其中的‘原因’和‘缘由’是另一个话题，但这在很大程度上是为了推销睾酮处方，”安纳沃尔特说。即使你使用准确的测试和高质量的参考范围，睾酮检测也并不简单。激素水平会波动，且通常在早晨最高。因此，专家表示，检测必须在清晨进行。