Hegseth’s dubious low-T screening may flag up to 25 percent of the Army

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Up to a quarter of active-duty Army members could receive a low testosterone result from mandatory military screening, despite the true prevalence of the condition likely being a tiny fraction of that figure, according to a study published Thursday in JAMA.

根据周四发表在《美国医学会杂志》（JAMA）上的一项研究，尽管男性性腺功能减退症的真实患病率可能仅占该数字的一小部分，但多达四分之一的现役陆军人员在强制性军事筛查中可能会得到睾酮水平偏低的检测结果。

The finding adds to concerns that the mandatory screening announced by Defense Secretary Pete Hegseth in July will lead to a cascade of unnecessary medical evaluations for military members. Those evaluations could result in inappropriate testing, inaccurate results and diagnoses, and overtreatment that could cause harm, including infertility.

这一发现加剧了人们的担忧，即国防部长皮特·海格塞斯（Pete Hegseth）于7月宣布的强制性筛查将导致军人面临一系列不必要的医疗评估。这些评估可能导致不恰当的检测、不准确的结果和诊断，以及可能造成包括不孕不育在内伤害的过度治疗。

Medical experts, including the Endocrine Society and the American Urological Association (AUA), have recommended against blanket screenings for these reasons. Still, the Pentagon has moved forward with the plans, releasing clinical guidance in September.

出于这些原因，包括内分泌学会和美国泌尿外科学会（AUA）在内的医学专家建议不要进行全面筛查。尽管如此，五角大楼仍推进了相关计划，并于9月发布了临床指南。

The JAMA study highlights the reasons why testosterone levels are not measured in men without symptoms—and also offers a glimpse of how many Army members could become ensnared in the clinically dubious screenings. Researchers at the Pennington Biomedical Research Center in Louisiana and the US Army Research Institute of Environmental Medicine in Massachusetts conducted the study.

这项JAMA研究强调了为何不应对无症状男性进行睾酮水平检测的原因，同时也揭示了有多少陆军成员可能会被卷入这些临床上存疑的筛查中。路易斯安那州彭宁顿生物医学研究中心和马萨诸塞州美国陆军环境医学研究所的研究人员进行了这项研究。

The researchers drew data from a large military health survey, which included members at five US Army installations. The survey data included morning blood draws from fasting military members. The samples were collected between August 2024 and January 2026.

研究人员从一项大型军事健康调查中提取了数据，该调查涵盖了五个美国陆军基地的成员。调查数据包括军人在空腹状态下的晨间抽血结果。样本采集时间为2024年8月至2026年1月。

From those samples, total testosterone levels were measured from 479 male, active-duty Army service members. (Those receiving testosterone treatment were excluded from the study—three men were excluded for this reason.) With some statistical weighting, the 479 included members were representative of the active-duty US Army personnel; the weighted mean age was about 30 years old, and the weighted mean body mass index (BMI) was 28.4, which falls in the “overweight” category.

从这些样本中，研究人员测量了479名现役男性陆军军人的总睾酮水平。（接受睾酮治疗的人员被排除在研究之外——有三名男性因此被排除。）经过统计加权，这479名成员代表了美国陆军现役人员；加权平均年龄约为30岁，加权平均体重指数（BMI）为28.4，属于“超重”范畴。

Generally, experts are wary of universally screening men for low testosterone because testosterone measurements can be highly variable—and unhelpful. Levels can dip for a number of different reasons, including age, time of day, obesity, illness, physical stress, poor sleep, trauma, and various medications.

通常情况下，专家对普遍筛查男性睾酮水平持谨慎态度，因为睾酮测量结果波动极大，且往往缺乏参考价值。睾酮水平会因多种原因下降，包括年龄、一天中的时间、肥胖、疾病、身体压力、睡眠不足、创伤以及各种药物。

Moreover, the conditions that can cause clinically significant low testosterone—a condition called male hypogonadism—are rare, affecting 1 percent of men at most. They include genetic conditions and problems with the pituitary gland. Given the complexity, experts recommend that evaluations be prompted by patients self-reporting symptoms.

此外，可能导致临床意义上睾酮水平偏低的情况——即男性性腺功能减退症——非常罕见，最多影响1%的男性。这些情况包括遗传疾病和垂体问题。鉴于其复杂性，专家建议应根据患者自述的症状来启动评估。

In those cases, doctors use repeat testing and comprehensive evaluations to come to a firm diagnosis of male hypogonadism. With that being the current norm, researchers aren’t sure exactly what the military’s new universal screen will yield. According to the new data, a large portion of the military may face alarming results.

在这种情况下，医生会通过重复检测和全面评估来确诊男性性腺功能减退症。鉴于这是目前的常规做法，研究人员尚不确定军队新的全面筛查会产生什么结果。根据新数据，很大一部分军人可能会面临令人担忧的检测结果。

From the Army members in the survey, the weighted mean for morning total testosterone was 405 ng/dL. The Pentagon’s clinical guidance uses a threshold of less than 300 ng/dL for low testosterone, in line with recommendations from the AUA. Using that cutoff and extrapolating the data to the entire Army population, the researchers estimate that about 26 percent of active-duty Army service members would get a test result suggesting low testosterone.

在参与调查的陆军成员中，晨间总睾酮的加权平均值为405 ng/dL。五角大楼的临床指南将低于300 ng/dL作为睾酮偏低的阈值，这与美国泌尿外科学会（AUA）的建议一致。研究人员利用这一临界值并将数据推算至整个陆军群体，估计约有26%的现役陆军军人会得到睾酮偏低的检测结果。

The Centers for Disease Control and Prevention has a harmonized reference cut-off that’s a little lower, at 264 ng/dL. With that threshold, about 15 percent of Army service members would be estimated to have a low testosterone result.

美国疾病控制与预防中心（CDC）设定的统一参考临界值略低，为264 ng/dL。按照该阈值，估计约有15%的陆军军人会得到睾酮偏低的检测结果。

As expected, the likelihood of low results scaled with weight and age; the higher the age and/or higher the BMI, the greater the odds of having a testosterone reading under either threshold. Of men under age 30, 19.5 percent had a low measurement, while 33 percent of men aged 30 and older had low levels.

正如预期的那样，检测结果偏低的概率随体重和年龄的增加而上升；年龄越大和/或BMI越高，睾酮读数低于上述任一阈值的几率就越大。在30岁以下的男性中，19.5%的人测量值偏低，而30岁及以上的男性中，这一比例为33%。

“Published estimates of clinical hypogonadism are substantially lower than the prevalence of low testosterone observed here, underscoring that many men with a single low screening measurement do not have clinical hypogonadism,” the researchers write.

研究人员写道：“已发表的临床性腺功能减退症的估计患病率远低于此处观察到的睾酮偏低比例，这强调了许多单次筛查结果偏低的男性并不患有临床性腺功能减退症。”

But each positive screening result will require thorough follow-up, including repeat testing, further evaluation, counseling on modifiable factors (such as losing weight or improving sleep), and treatment considerations, the researchers note. “Because testosterone replacement therapy is long-term and has potential adverse effects, distinguishing an isolated low screening value from clinically significant hypogonadism is essential,” they write.

但研究人员指出，每一次阳性筛查结果都需要进行彻底的后续跟进，包括重复检测、进一步评估、针对可改变因素（如减肥或改善睡眠）的咨询以及治疗方案的考量。他们写道：“由于睾酮替代疗法是长期的且具有潜在的不良反应，因此区分孤立的低筛查值与具有临床意义的性腺功能减退症至关重要。”

While the study looked at results from all men—without first assessing possible symptoms of male hypogonadism—the military’s screening will likely be more limited. The mandatory screening only applies to men aged 30 and above, while younger men are allowed to opt in. It’s unclear how many will do so.

虽然这项研究考察了所有男性的结果——且未预先评估男性性腺功能减退症的可能症状——但军队的筛查可能会受到更多限制。强制筛查仅适用于30岁及以上的男性，而更年轻的男性可以选择参加。目前尚不清楚会有多少人选择参加。

The first step in the screening is to ask members about possible symptoms and risk factors. From there, some men might not proceed to having a testosterone test. Still, the symptoms and risk-factor screening will likely be more widespread, leading to far more service members getting tested than before.

筛查的第一步是询问成员有关可能的症状和风险因素。在此之后，一些男性可能不会继续进行睾酮检测。尽管如此，症状和风险因素筛查可能会更加普及，导致接受检测的军人人数远超以往。

Possible symptoms include vague problems that aren’t closely linked to male hypogonadism, such as “diminished physical performance,” “disturbed sleep,” and “low motivation.” The risk factors considered also include common conditions, such as obesity, type 2 diabetes, and low-trauma fractures. Those with such risk factors can go on to be tested even in the absence of symptoms, according to the Pentagon’s guidance.

可能的症状包括与男性性腺功能减退症关联不紧密的模糊问题，如“身体机能下降”、“睡眠障碍”和“动力不足”。所考虑的风险因素还包括肥胖、2型糖尿病和低创伤性骨折等常见疾病。根据五角大楼的指南，即使没有症状，具有这些风险因素的人员也可以继续进行检测。