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Providing continuing hormone-replacement<\/span> therapy at \u201cthe\u00a0High-T Department of War,\u201d as Secretary Pete Hegseth is calling it, may prove difficult for the federal government because the department in charge of healthcare for veterans has already documented a struggle to manage service members\u2019 hormone therapy, The Intercept has found.<\/p>\n A person on testosterone therapy can\u2019t just stop it abruptly. Dr. Adrian Dobs, a professor of medicine and oncology at Johns Hopkins University School of Medicine, told The Intercept testosterone therapy can suppress the body\u2019s natural production of the hormone and sperm, as well as create medical needs that persist after treatment stops. \u201cWe\u2019re sort of creating a dependency on testosterone,\u201d she said.<\/p>\n Under Hegseth\u2019s new initiative, service members age 30 and older are slated for annual testosterone screening, regardless of whether they have any symptoms, while troops under 30 may request screening during their periodic health assessments. Doctors and endocrinologists warned that this proactive screening could lead to overprescription of hormone-replacement therapy for people who don\u2019t need it. This could affect their fertility in the short term, Dobs said, because \u201cmen who take testosterone will have a reduction in their sperm counts.\u201d<\/p>\n And after a service member leaves the military, they may require continued medical care. That care could eventually fall to the Department of Veterans Affairs, which has previously struggled with the same treatment.<\/p>\n \u201cMen who take testosterone will have a reduction in their sperm counts.\u201d<\/p>\n<\/blockquote>\n<\/figure>\n In a 2018 review<\/a> of testosterone replacement therapy, the VA Office of Inspector General found that providers often started patients on testosterone without adequately documenting symptoms or confirming low testosterone levels and frequently failed to conduct recommended follow-up after treatment began. Approximately 2 out of 3 patients did not get a documented discussion of the risks and benefits of the treatment before starting.<\/p>\n Dr. Alvin Matsumoto, a professor emeritus at the University of Washington School of Medicine and former attending physician and associate director at the VA Puget Sound Health Care System, said the findings show why testing for low testosterone is not enough to determine whether someone should receive treatment. Matsumoto helped develop the Endocrine Society\u2019s clinical practice guidelines for testosterone treatment, which the inspector general found the VA had routinely violated in its 2018 review.<\/p>\n Testosterone levels can change depending on when a patient is tested, whether they have recently eaten, exercised heavily, or are sick, among other factors, Matsumoto said. In about a third of men whose testosterone initially tests low, a second test produces a normal result.<\/p>\n That creates a risk under a program that will routinely screen otherwise healthy troops and make testosterone therapy available to those subsequently diagnosed with a deficiency.<\/p>\n \u201cInitiating testosterone therapy in men who have a single low testosterone [test] but no clinical manifestations of testosterone deficiency will likely result in treatment of some men who do not have hypogonadism,\u201d Matsumoto told The Intercept.<\/p>\n <\/p>\n Medical guidelines instead call for doctors to establish that a patient has symptoms and repeatedly low testosterone levels before beginning treatment. Matsumoto said those steps would need to occur either while a service member remains under Pentagon care or after they transition to Veterans Affairs.<\/p>\n The question becomes particularly important when those patients move between the two systems. Matsumoto said a VA provider inheriting a patient already receiving testosterone should review why treatment was started in the first place, including whether the patient had symptoms and repeatedly low testosterone levels.<\/p>\n But he does not expect that reassessment to routinely happen. Usually, \u201cthe diagnosis will be assumed to be correct,\u201d Matsumoto said.<\/p>\n It\u2019s a similar problem to one the inspector general identified in its review of VA care. Some providers appeared to be testing patients for low testosterone without first documenting symptoms suggesting a deficiency.<\/p>\n The inspector general made seven recommendations to bring VA practices up to standards, including repeat testing and monitoring. According to the inspector general, the VA implemented all seven recommendations and closed them as implemented, as the VA noted in response to questions from The Intercept.<\/p>\n Among the changes the VA implemented was a requirement that providers establish signs and symptoms of testosterone deficiency before testing a patient\u2019s testosterone level for confirmation \u2014\u00a0a higher standard than Hegseth\u2019s call for annual testosterone screening based on age alone.<\/p>\n \u201cI would be against universal screening, which is what we\u2019re talking about here,\u201d said Dobs, a position consistent with guidance<\/a> from the Endocrine Society, which represents physicians and researchers specializing in hormonal health.<\/p>\n\n