Low Testosterone in Male Veterans: Prevalence and Impact

Low testosterone, or hypogonadism, is common among men, including veterans. It is a deficiency in the male sex hormone testosterone, which can lead to a wide range of physical and psychological symptoms. In male veterans, the prevalence of low testosterone is much higher than in non-veterans, ranging from 20-50%. It is associated with an increased risk of various health outcomes, such as cardiovascular disease, type 2 diabetes, and all-cause mortality.

This article aims to increase awareness of the issue of low testosterone in male veterans and to provide information on this condition’s prevalence, impact, and treatment options.

Prevalence of Low Testosterone in Male Veterans

Several studies have investigated the prevalence of low testosterone in male veterans. For example, a study by Kravitz et al. (2018) found that the prevalence of low testosterone among male veterans was 32%. Similarly, a study by Shores et al. (2015) reported that the prevalence of low testosterone in male veterans was 50%. The prevalence of low testosterone in male veterans may vary depending on the population and criteria used, but it is generally considered high.

A study published in the Journal of Clinical Endocrinology & Metabolism found that male veterans have a higher prevalence of low testosterone than non-veterans.

A data from over 8,000 veterans, found that male veterans had low testosterone levels, which are 35% more prevalent compared to non-veterans.

JAMA VA Study

Several factors may contribute to the high prevalence of low testosterone in male veterans. For example, aging is a known risk factor for low testosterone. Physical injuries, such as blast injuries and spinal cord injuries, can also lead to low testosterone. Additionally, mental health conditions such as post-traumatic stress disorder (PTSD) and depression are associated with low testosterone. Studies have also reported that veterans who have served in combat are more likely to have low testosterone than non-veterans (Lu et al., 2018)

Impact of Low Testosterone on Veterans’ Health and Well-being

Low testosterone can lead to a wide range of physical and psychological symptoms, including fatigue, depression, and sexual dysfunction (Mulligan et al., 2006; Roitman et al., 2007). In addition to these symptoms, low testosterone links with an increased risk of various health outcomes in male veterans, such as cardiovascular disease, type 2 diabetes, and all-cause mortality (Shores et al., 2015; Lu et al., 2018). Low testosterone can also significantly impact veterans’ overall quality of life and functional ability, affecting their ability to work and participate in daily activities.

TRT significantly reduced all-cause mortality, heart attacks, and strokes in a large observational study of veterans with extended follow-up with normalized testosterone levels through treatment.

European Heart Journal

A case study published in The International Journal of Adolescent Medicine and Health revealed that a young combat veteran with a dual diagnosis and suicidal behavior was found to have low testosterone levels, which may have contributed to their mental health issues. This highlights the crucial need for healthcare professionals to consider testosterone levels when treating veterans with mental health concerns.

Psychoneuroendocrinology research by the Journal of Clinical Endocrinology and Metabolism found that a combination of high cortisol and low testosterone levels may predict the development of PTSD in deployed veterans to war zones. This research highlights the importance of considering hormonal imbalances in treating and preventing PTSD in veterans.

The Journal of Sexual Medicine published a population-based cohort study that revealed a high prevalence of sexual dysfunction among male Iraq and Afghanistan War veterans. This study showed that this sexual dysfunction is associated with PTSD and other combat-related mental health disorders. Furthermore, low testosterone levels may play a role in this sexual dysfunction, as previous research has established a link between low testosterone and PTSD.

Testosterone Replacement Therapy for Veterans

Testosterone replacement therapy (TRT) is the standard treatment for hypogonadism in men, including veterans, and is effective in improving symptoms and health outcomes (O’Connell et al., 2004; Raval & Murad, 2015). TRT involves administering testosterone in various forms, and shots are the most common.

TRT Access for Veterans

Accessing TRT can be a problem for veterans, primarily due to the high cost of the treatment and lack of access to healthcare. Furthermore, many veterans may be hesitant to seek treatment for low testosterone due to the stigma associated with this condition. However, these barriers to accessing TRT for veterans can be overcome by educating them about the prevalence, impact, and treatment options for low testosterone and providing them with access to affordable and appropriate healthcare.

VA’s Testosterone Replacement Therapy Criteria: A Cause for Concern

Regarding testosterone replacement therapy (TRT), the Department of Veterans Affairs (VA) has some unique and potentially concerning guidelines.

• According to the VA’s TRT Criteria for use in adult men from March 2019, if a patient’s testosterone levels fall outside the normal range of 300 to 1050 ng/dL, the therapy must be discontinued.
• Additionally, if a patient’s testosterone level is more than 700 ng/dL on topical therapy or midway between injections, the dose must be decreased.

These strict guidelines raise questions about whether the VA prioritizes numbers over patient care and whether they are following the latest and most effective TRT regimens.

Furthermore, a study conducted by the VA’s Healthcare Inspection found that VA providers must adhere to the 2010 Endocrine Society Clinical Practice Guidelines or even the VA’s criteria for TRT use.

Specifically, providers needed to adequately discuss the risks and benefits of TRT with patients before initiating therapy and were not conducting follow-up evaluations within the recommended 3-6 months. The VA’s approach to TRT requires reevaluation and reform.

Patients deserve to have their individual needs and concerns taken into account and provided with the most up-to-date, evidence-based care.

The VA must ensure that its providers follow the latest guidelines and best practices in TRT and that they are putting the well-being of veterans first.

Take Home Message

Low testosterone, or hypogonadism, is a common condition among male veterans, with a prevalence ranging from 20-50%. It can lead to a wide range of physical and psychological symptoms and is associated with an increased risk of various health outcomes, such as cardiovascular disease, type 2 diabetes, and all-cause mortality. Testosterone replacement therapy is the standard treatment for hypogonadism, but it is vital to consider the potential risks and benefits before starting therapy.

Veterans may face barriers to accessing testosterone replacement therapy, such as high cost and lack of access to healthcare, as well as the stigma associated with the condition. Therefore, veterans need more education about low testosterone prevalence, impact, and treatment options to access affordable and appropriate healthcare. Increasing awareness and addressing barriers to care can improve male veterans with low testosterone health and well-being.

Overcoming Stigma and Affordability: Providing TRT for Veterans

Many veterans struggle to afford the high costs of testosterone replacement therapy (TRT), which can financially burden them and their families. Unfortunately, this financial burden can also create a stigma attached to seeking treatment.

However, the IAM Clinic has been working to change this narrative for the past three years by providing veterans with affordable TRT options. The clinic’s mission is to ensure that all veterans have access to the necessary treatments to improve their health and quality of life, regardless of their financial situation.

The IAM Clinic’s team of dedicated medical professionals understands the unique needs of veterans and works closely with them to find the best treatment plan at the right price. By providing personalized care and support, the clinic has helped many veterans overcome stigma and affordability barriers to TRT toward significant improvements in their health and well-being.

At the IAM Clinic, veterans can rest assured that they will receive the best care tailored to their needs at a manageable cost for them and their families.

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