A retired infantry sergeant from Fort Benning sat across from me last spring. Three combat deployments. Carrying a formal PTSD diagnosis from the VA for nine years. He was on an SSRI, had done two rounds of trauma-focused therapy, and was sleeping four hours a night on a good night. He was 41 years old. He had come in because his wife had pushed him to look at hormones — not because he believed in it, but because he was running out of other things to try. His total testosterone came back at 218 ng/dL. His morning cortisol was 22 mcg/dL with a flat afternoon curve. His thyroid showed an elevated reverse T3 with a low free T3. His vitamin D was 14.
He is one of dozens of veterans from the Fort Benning community I have evaluated over the last few years where the picture looks substantially the same. I want to be careful here, because I am not the right provider to treat the trauma itself — that work belongs with mental health clinicians who specialize in it, and most of the veterans I see are already engaged with that care or have been. What I can address is the hormonal and metabolic wreckage that combat exposure, chronic operational stress, and the years of sympathetic nervous system overdrive leave behind. That wreckage is real, it is measurable, and it is treatable. And in my experience, it gets in the way of the trauma work doing what it is supposed to do.
This article is for the veteran community in Columbus and the surrounding middle Georgia area who have been told their symptoms are "just PTSD" without anyone running the labs that might explain why those symptoms are not responding to the standard treatments.
What chronic operational stress does to the HPA axis
The hypothalamic-pituitary-adrenal axis is the body's stress response system. Under normal conditions, a stressor triggers a cortisol release, the cortisol does its job, and a feedback loop tells the system to stand down. The whole arc is supposed to take minutes to hours. The system is built for acute stressors — a threat shows up, you respond, the threat ends, you recover.
Combat does not work that way. Neither does the multi-month grind of deployment, the sleep deprivation of long operational tempos, or the hypervigilance that does not switch off when you come home. The HPA axis was not designed for years of activation, and when it gets years of activation, it changes. The early phase of chronic stress looks like elevated cortisol across the board — high mornings, high evenings, blunted feedback. That is the picture I see in active-duty patients and in veterans within the first few years of separation.
Past that, the system shifts. Cortisol output flattens. The morning peak that is supposed to wake you up gets blunted. The evening trough that is supposed to let you sleep does not drop the way it should. Pregnenolone, which the adrenal glands use as a substrate to produce both cortisol and DHEA, gets shunted toward cortisol production at the expense of DHEA — what older literature called "pregnenolone steal." DHEA falls. Testosterone production, which depends on a healthy HPA-gonadal relationship, falls with it. The patient ends up exhausted in the morning, wired at night, sleeping badly, gaining weight in the midsection, losing muscle, losing libido, and feeling like they have aged a decade in three years.
That entire picture can develop on top of, or independently of, the PTSD diagnosis. And the SSRI is not addressing any of it.
Why testosterone collapses in this population
Veterans I evaluate from the Fort Benning community show low testosterone at rates that look nothing like the general population age curve. There are several converging mechanisms.
Chronic cortisol elevation directly suppresses the HPG axis at the hypothalamic and pituitary level. Sleep deprivation — and almost every combat veteran I see has sleep architecture that has been wrecked by years of disrupted nights — slashes testosterone production, because the largest pulse of testosterone secretion in a 24-hour cycle happens during slow-wave sleep. Visceral fat, which accumulates fast under chronic cortisol exposure, contains aromatase enzyme that converts testosterone to estradiol — driving total testosterone down and shifting the ratio. Traumatic brain injury, which is common in this population whether formally diagnosed or not, can produce hypothalamic and pituitary dysfunction that depresses testosterone for years after the inciting event. Add chronic pain, opioid exposure during recovery from injuries, and the metabolic effects of years of poor sleep, and you have a stack of mechanisms all pulling in the same direction.
The result is that a 38-year-old veteran with a total testosterone of 240 is not unusual in my practice. That number in a civilian of the same age would prompt a workup. In a veteran, it routinely gets dismissed as "within range" because the lab reference range is built for an average that the population I am describing has already fallen below.
What I look for when I evaluate a veteran
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The history I take is detailed. I want to know about deployments, the timeline of symptom onset, sleep patterns, head injury history (formal and informal — including blast exposure that did not produce a documented TBI), current and prior medications, alcohol intake, current mental health care, and what the patient is hoping to fix. I am explicit at the first visit that I am not their PTSD provider. If they do not have one and they should, that is a referral conversation. I am the hormonal and metabolic provider, and that scope is what I deliver.
The lab panel is broad. Sex hormones include total and free testosterone, SHBG, estradiol, DHEA-S, and pregnenolone. Adrenal markers include morning cortisol and, when the picture warrants it, a four-point salivary cortisol curve to map the rhythm rather than just the morning value. Thyroid is the full panel — TSH, free T3, free T4, reverse T3, and antibodies — because the reverse T3 elevation that chronic stress produces is one of the most overlooked drivers of fatigue in this population. Metabolic includes fasting insulin, HOMA-IR, HbA1c, and a lipid panel. Inflammatory and nutritional markers include hs-CRP, ferritin, vitamin D, B12, magnesium, and homocysteine. If the story includes head injury, I add IGF-1 and sometimes a more detailed pituitary screen.
Most veterans I see have never had this panel run. The VA system does excellent work in many areas; comprehensive hormonal and metabolic workup for the post-combat physiology is generally not one of them.
How treatment proceeds
The treatment plan depends entirely on what the labs show, and in this population they show a lot. Men's hormone therapy, when the testosterone picture warrants it, is often the most leveraged single intervention. Testosterone replacement in deficient veterans frequently produces noticeable improvements in sleep, mood, energy, and motivation within four to eight weeks — not because testosterone is a mood drug, but because the deficiency was contributing to the picture in ways the SSRI was never going to address. I dose conservatively and titrate based on labs and symptom response. I monitor estradiol, hematocrit, PSA, and lipids on the schedule the protocol requires.
Adrenal support, when the cortisol pattern is dysregulated, is layered on carefully. This is not a "throw a bunch of adaptogens at it" situation. The interventions that actually move the needle are sleep restoration, deliberate circadian exposure, blood sugar stability, and in some cases targeted DHEA supplementation when DHEA-S is genuinely deficient. The biggest lever is sleep, and sleep is also where the trauma piece interacts with the hormonal piece — which is why coordinating with the patient's mental health provider matters.
Thyroid correction, when reverse T3 is elevated and free T3 is low, can move the needle on its own and often makes the testosterone work better. Vitamin D repletion to the optimal range (not just above the deficiency cutoff) measurably improves mood, immune function, and muscle performance in deficient patients. The medical weight loss program is on the table when visceral fat accumulation has become a driver of its own — and in the veteran population, it often has, because the metabolic dysregulation drives the fat gain and the fat gain drives more metabolic dysregulation.
For some patients, IV therapy protocols for nutritional repletion or NAD+ are useful adjuncts when the deficiency picture is significant. None of these tools are a substitute for trauma-focused care. They are the physiological foundation that lets the trauma-focused care actually work.
How this fits with what the VA is doing
I get this question at almost every veteran consultation. The honest answer: the work I do is meant to complement, not replace, what the VA and your mental health providers are doing. I keep notes the patient can share with their VA primary care if they choose. I will coordinate with a VA provider when the patient wants me to. I am not the provider for the PTSD diagnosis itself, and I am not in the business of telling a veteran to come off a medication a psychiatrist prescribed.
What I do is the hormonal and metabolic workup that the average VA primary care visit does not have time to do, the lab panel that goes deeper than what is standard, and the treatment plan that addresses the physiological consequences of years of operational stress. For most of the Fort Benning veterans I see, that work has been the missing piece.
The next step if this is your picture
If you are a veteran in the Columbus or middle Georgia area and what I have described sounds like the situation you are in, the next step is a comprehensive workup and a real consultation. Bring whatever lab work you have from the VA, your current medication list, and an honest summary of what is and is not working. If you would prefer to talk through scheduling first, the Columbus clinic line is (762) 261-3880 and the Warner Robins clinic schedules through the same JaneApp portal. Online booking is open 24/7.
The infantry sergeant I opened with started testosterone replacement, addressed his vitamin D and reverse T3, and rebuilt his sleep with a deliberate protocol. Four months in, he was sleeping six and a half hours, his cortisol curve had started to normalize, and he reported that the trauma-focused therapy he had been doing for years suddenly felt like it was working in a way it had not before. None of that fixed his PTSD. It addressed the physiology underneath, which is what I am here to do.
Medical disclaimer: This article is for educational purposes only and does not constitute medical advice. Individual clinical decisions should be made in consultation with a qualified healthcare provider following appropriate evaluation. References to specific treatments, dosing, or protocols are informational.
Travis spent 17+ years in high-acuity clinical medicine — emergency, cardiac ICU, and cath lab — before founding Revitalize. He is a Certified Platinum Biote hormone therapy provider, the published author of You're Not Broken — You're Unbalanced, and the founder of the Rebuild Metabolic Health Institute. His clinical writing reflects the same precision he brought to critical care: specific, honest, and built around what actually works.
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