Ocular Considerations for the Department of War's New Testosterone Initiative

On 15 July 2026, the Secretary of War announced that the Department of War will begin annual testosterone deficiency screening for male Active Duty and Reserve Component personnel aged 30 and older as part of the periodic health assessment, with screening available on request to younger servicemembers. This policy will increase testosterone testing and may increase testosterone replacement therapy (TRT). Primary care, flight, and operational medicine providers will be on the front line of a hormonal intervention with possible ocular implications. This Commentary summarizes the ophthalmic manifestations of low and elevated testosterone states relevant to a military population and proposes pragmatic recommendations for providers implementing this initiative. Screening identifies testosterone concentrations, not symptoms of deficiency, and should not be equated with an indication for treatment. Androgen deficiency is associated with meibomian gland dysfunction and evaporative dry eye, but benefit from replacement remains unproven. The evidence linking testosterone exposure to central serous chorioretinopathy, retinal vascular occlusion, and intracranial hypertension is real but heterogeneous. Cohort findings, case reports, and observations in transgender patients do not establish a common risk in hypogonadal male servicemembers. Glaucoma findings are similarly mixed. We propose a brief, targeted ocular history, symptom counseling and inquiry during TRT follow-up and periodic health assessments, and referral according to clinical urgency. For vision-critical specialties, baseline dilated examination should be coordinated through existing occupational clearance processes when an adequate recent examination is unavailable. These measures are precautionary; screening benefit and an optimal repeat-examination interval have not been established. The Military Health System is uniquely positioned to prospectively answer the ocular questions this literature has only partially resolved.