The Defense Department is being directed by Congress to look into incidents of special operators reporting low levels of testosterone, a deficiency leading to a range of physical and mental health effects that this community has been dealing with on their own for years.
The health effects of lowered testosterone among special operations veterans have become so well-known in the community that many refer to it as “Operator Syndrome.”
First defined in a 2020 research paper by Dr. Christopher Frueh, Operator Syndrome considers the unique lifestyle of special operators and low testosterone levels as a result of chronic stress. By 35 years old, many special operators have the same testosterone levels of 80-to-90-year-old men, Frueh told Task & Purpose.
The Secretary of Defense is directed to brief members of Congress next year on available treatments for low testosterone in the military health system and current protocols for testing and screening. The briefing will look closely at how “high-stress operating environments are linked to low testosterone among servicemembers.”
The congressional measure that calls for the briefing is included in the fiscal year 2025 national defense bill which passed the House and is headed to the Senate for a vote this week.
The measure is a long time coming, according to special operations veterans and experts. Many SOF veterans have established nonprofits and non-traditional treatment plans to help former service members dealing with a host of physical and mental health issues linked to low testosterone levels: Sleep disruptions, emotional numbing, feelings of detachment, decreased sense of worth and loss of motivation.
Former special operations personnel and medical experts interviewed by Task & Purpose said they welcomed the idea of studying testosterone, but cautioned that it’s just the tip of the iceberg for common health problems among current and former special operators.
Frueh said the syndrome is a way to address “a complex set of injuries and impairments” and describe “interrelated” physical conditions that special ops vets are vulnerable to such as traumatic brain injuries, hormonal dysfunction, sleep problems, psychological difficulties like depression, anxiety, post-traumatic stress disorder, social difficulties and relationship problems.
As men age, testosterone levels naturally decrease. The decline can lead to symptoms like sexual dysfunction, depression, concentration issues, sleep problems and metabolic effects. But research indicates a strong connection between stress and low levels of testosterone, even in younger men. The connection between testosterone and its corresponding health impacts are well understood. A Department of Veterans Affairs website page for “Improving Low Testosterone Naturally” even advocates for avoiding excessive stress.
Rep. Jimmy Panetta (D-Calif.) originally proposed a five-year study of the problem in the 2025 Pentagon budget. The House-originated measure called for the Defense Department to look at training and deployment impacts on testosterone levels and the long-term health impacts for those assigned to special operations units. But that study was dropped in the final language of the bill passed this month, with the Congressional briefing included as a compromise. The original amendment focused on the impacts of low testosterone on special operations service members but the briefing could be broadened to include health effects across the broader military.
“Despite surveys of both veterans and active duty servicemembers indicating a potential link between the stress of military service and decreased testosterone levels, we still lack comprehensive data on this issue,” Panetta said in a statement to Task & Purpose. “This is especially true for our Special Forces, whose work requirements can place them under extreme stress, long periods of sleep deprivation, enduring starvation, and high-intensity training that can lead to testosterone depletion.”
Panetta added that the congressionally directed briefing “is an important step forward for our overall understanding of this issue.”
Low testosterone impacts on special operators
Panetta’s original policy focused on soldiers in Special Forces, but low testosterone levels are impacting troops across the special operations community. The Warrior Health Foundation, an organization established by former Navy SEAL Sean Rosario, helps connect current and former SEALs with medical providers to treat low testosterone levels. Rosario said that the issue impacts overall military preparedness.
“At a tier one level of special operations, you’re literally on the all-star team playing in the World Series every single day,” Rosario said. “You have to bring that energy and you have to bring that commitment every single day, whether in training or deployed overseas. And guys are having to do that basically at a deficit.”
Ryan Ziegler held two different special operations jobs during his career, first as an Air Force Tactical Air Control Party Specialist, or TACP, and then as a Green Beret in the Army. He left the military after an injury on a 2017 deployment to Afghanistan. When he left the service and went to school to become a physician’s assistant, Ziegler found himself mixing up information, getting lost on test questions, losing sleep and feeling disconnected. After going through a few months of treatment to regulate his hormones, he felt instantly better.
“Three months later, I’m getting A’s on my tests. I’m passing everything. I’m actually teaching other students,” Ziegler said. “It was a complete transformation.”
Ziegler’s treatment was designed by Dr. Mark Gordon, who studies neuroendocrinology and translates research into clinical treatments at his own practice. Like other non-traditional medical practices that veterans turn to, Gordon does not take insurance but has self-funded or used donations to cover veteran hormone treatments in the past. Using funds from the Special Operations Association of America, Gordon created a blood panel that tests for 28 biomarkers which helps give patients predictive treatments and recommendations for follow-up procedures.
“In endocrinology, you’ll see low testosterone and the knee-jerk response will be ‘let’s just shove in some testosterone’ as opposed to what we’ve been doing, which is, we don’t mask the causation,” Gordon said. “We don’t give testosterone. What we do is we fix the reason for it being deficient.”
Immediately providing testosterone, Gordon said, through injectable, oral or topical means, can put providers “on the hook for the rest of that person’s life” with testosterone supplementation.
Gordon will provide testosterone-based treatment plans for patients where options are limited, he said, but he advocates for using supplements like Clomid, the brand name for clomiphene citrate, a medication typically used to treat female infertility but has been studied as a way to stimulate the brain’s pituitary gland or in Gordon’s words, can help “restart their system” and help re-regulate the body’s brain signals and endocrine system by “fixing the cause for the deficiency.”
Experts said that testing for testosterone is a good first step to treating conditions that are common among current and former special operators but that there’s still a lack of understanding or willingness to look at the larger role hormones play.
“They’re looking at only one of the four tires on the car that’s deflated. You need to look at the broader picture and it’s not just testosterone. That is the problem,” Gordon said. “It could be Operator Syndrome. It could be blast trauma over-pressure. It could be chronic stress. They all lead to inflammation in the brain.”
Geoffrey Dardia, a former Special Forces soldier and current functional medicine coach, pointed to the Army’s Holistic Health and Fitness System which has contracts with lifestyle medicine professionals and look at optimizing hormones, but said that it’s still limited to certain groups. Ultimately Dardia said this approach is a cost saver as opposed to addressing symptoms like erectile dysfunction or attention deficit hyperactivity disorder, ADHD, with expensive medications.
“I’m a huge advocate for functional performance-lifestyle medicine where it’s precise. They look at all these things and they go for the root-cause dysfunction, and then they resolve it and they don’t have to spend billions of dollars every year on prescription drugs,” Dardia said. “There’s a reason why a lot of the tier one units are contracting performance lifestyle medicine docs to do this because they understand the implications.”
Acceptable testosterone levels
The health issues associated with “low T” levels are not limited to veterans, but accessing hormone replacement therapy can be difficult for active duty troops because prescriptions for injectable testosterone could make them non-deployable because of the medication’s refrigeration requirements, experts said. While there are topical and oral testosterone replacements, injectables can provide more reliable levels and only need to be administered once every few weeks.
Joey Fio, a former SEAL and chief program officer for the SEAL Future Foundation, another nonprofit that helps provide resources to veterans for hormone and endocrine treatments, said regular physical assessments and hormone tests “should be a protocol” and part of a better standard of care. He said for his exit physical, he had to beg his provider to give him a blood test.
The levels of testosterone that are considered acceptable or normal can vary across health systems. In order to qualify for testosterone replacement therapy, military providers use American Urological Association guidelines to diagnose low testosterone or hypogonadism. Patients have to have two separate instances of total serum testosterone measurements below 300 nanograms per deciliter of blood, an active duty physician assistant told Task & Purpose. Before making a formal diagnosis, however, providers also look at other reported symptoms like fatigue, hair loss, cognitive dysfunction, irritability and sex drive.
With differing standards around acceptable measurements and the fact that hormone levels can be highly individualistic, Dardia advocates for baseline assessments of new recruits at Military Entrance Processing Stations, or MEPS. Dardia said there has to be “context to the number” regarding testosterone levels since hormone measurements can present differently in people.
“If I had a 200 testosterone level and I wanted to kill myself and if someone else had a 200 something and they were at the top of the world, we can’t say that number is good or bad,” Dardia said.
People who join the military with adverse childhood experiences, for example, might have lower baseline testosterone levels because of their lifetime adaptations to stress, he said. With a baseline assessment, “you would be able to trend over time,” Dardia said. “Instead of telling them ‘you fell within the reference range, you’re normal,’ you can see what’s normal for them at the beginning and then when they drop, you can do an intervention,” Dardia said. “That’s where we’re failing.”
Low testosterone levels are not only a special operations issue but across the broader military and even the U.S. broadly. One study indicated a steady decline in adolescent and young men’s testosterone levels since the 1990s.
“There’s gonna be a point in time where if we stress people out, stress-inoculate them, sleep deprive them and keep their op-tempo high, and then we pump them full of energy drinks and nicotine in PXs and commissaries to keep them going, something’s gonna fail,” Dardia said. “When you get to the point of exhaustion, low testosterone is guaranteed.”