A 34-year-old infantry NCO sat across from me last spring, six months back from a rotation, and told me what almost every active duty patient eventually tells me when they finally get the conversation: he had not felt like himself sexually since before deployment, and he had not told anyone — not his wife, not his battalion aid station, not his primary care. He thought it was stress. He thought it would pass. It did not. When I drew his labs, his total testosterone was 218 ng/dL and his free T was bottomed out. He was thirty-four years old.
This is not a rare presentation in the patient population I see from Fort Benning and the broader military community in Columbus. It is the most common one. The combination of deployment cycles, sleep deprivation, sustained operational stress, traumatic brain injury history, weight cycling, and the specific medication exposures that come with military service produces a pattern of sexual dysfunction that the standard medical system in this town is poorly equipped to address. Active duty service members deserve a real workup and a clinician who will actually have the conversation. That is what this article is about.
Why active duty patients underreport this
I see service members from Fort Benning who waited two, three, sometimes five years before bringing this up to anyone in a clinical setting. The reasons are predictable and they are worth saying out loud, because the silence itself is part of the problem.
Service members worry about how a sexual wellness or hormone-related diagnosis will read in a medical record. They worry about flags on physical evaluation boards, security clearance reviews, MEPS for re-up, and how a TRT prescription might affect a deployment cycle or a school slot. They have heard mixed information from peers about what is and is not allowed. Some of that concern is valid and some of it is folklore. None of it gets sorted out in a fifteen-minute appointment with a primary care provider who is not familiar with the specific clinical picture of a thirty-year-old with a TBI history and a flat affect at 9 AM.
I am not going to pretend I can resolve every administrative question — those depend on chain of command, branch policy, and the specific clearance involved. What I can do is run the workup honestly, document what the labs and clinical picture actually show, and have a direct conversation about what is and is not appropriate to pursue, on or off duty. That conversation deserves to happen.
The physiology that drives this in the military population
Several mechanisms produce low testosterone, low libido, and erectile dysfunction in active duty patients more often than they appear in the general population, and recognizing them changes the workup.
Sleep deprivation. Testosterone is produced predominantly during deep sleep. Chronic sleep restriction below six hours a night drops total testosterone by 10 to 15 percent within a week — measured, replicable, published. The operational tempo at Fort Benning does not respect circadian biology. Neither does shift work, neither does jumps that put men on the line at zero-dark-thirty for weeks at a time.
Traumatic brain injury. Even mild TBI — the kind that came from a concussion during airborne training, a blast wave during a CIF rotation, or repeated subconcussive impacts — can damage the hypothalamic-pituitary axis. Post-traumatic hypopituitarism is underrecognized and produces secondary hypogonadism that looks identical to age-related decline in a man who is not yet thirty-five. I check LH, FSH, prolactin, IGF-1, and morning cortisol on every patient with a meaningful TBI history. That panel has flagged real pituitary dysfunction more than once.
Operational stress and elevated cortisol. Sustained elevation of cortisol from chronic stress directly suppresses GnRH at the hypothalamus, which suppresses LH, which suppresses testosterone production. The mechanism is well documented and the clinical picture is consistent — flat libido, blunted morning erections, fatigue that does not respond to a weekend off, and a global sense of "off."
Medication exposures. Opioids prescribed after surgery or for combat-related injuries suppress testosterone aggressively. Some psychiatric medications — SSRIs in particular — produce sexual dysfunction independent of any hormonal effect. Anabolic steroid use, which I do see in this population, suppresses the natural axis sometimes for years after cessation.
Pelvic and vascular factors. Erectile dysfunction in a thirty-year-old is not always hormonal. Sometimes it is vascular, sometimes it is psychogenic, sometimes it is post-traumatic from pelvic injury. The workup needs to differentiate.
This is the framework I bring to every active duty patient who walks in. The question is not whether something is wrong — by the time most service members are sitting in front of me, something is. The question is which mechanism, and what to do about it.
What a real workup looks like for this patient population
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When I evaluate an active duty service member for sexual wellness concerns, the panel I run looks like this: total testosterone (drawn fasting between 7 and 10 AM, on at least two occasions), free testosterone, SHBG, sensitive estradiol (LC-MS/MS, not standard immunoassay), LH, FSH, prolactin, full thyroid (TSH, free T3, free T4, reverse T3, antibodies), DHEA-S, morning cortisol, fasting insulin, HbA1c, lipid panel, hs-CRP, vitamin D, IGF-1 if there is TBI history, and a CBC.
I ask about sleep — actual hours, not what is on the duty roster. I ask about head injury history specifically, because patients often do not volunteer mild TBIs they do not consider clinically relevant. I ask about current and recent medications, including over-the-counter supplements and any prior anabolic steroid use, because honesty about that history changes how I interpret the labs. I ask about psychological factors — depression, PTSD symptoms, relationship stress — because those affect both presentation and treatment decisions. I do a focused physical exam.
The point of the workup is to figure out which mechanism is driving the symptoms, not to pattern-match to the most marketable diagnosis. Two service members can walk in with identical complaints and have completely different physiology underneath. Until you sort that out, anything you offer is a guess.
What treatment options actually look like
For confirmed hypogonadism with the right clinical picture, men's hormone therapy is appropriate and effective — usually testosterone cypionate at a conservative starting dose, twice-weekly subcutaneous injections, with full estradiol and hematocrit monitoring at six to eight weeks and again at twelve weeks. For service members concerned about fertility preservation, HCG or enclomiphene can be added or used as alternatives.
For pituitary dysfunction, the answer might be different — sometimes it is a referral to endocrinology for further imaging and workup before any treatment is initiated. For erectile dysfunction with vascular contribution, PDE5 inhibitors are often the first-line answer regardless of testosterone status. For partner-focused concerns where female sexual wellness is part of the picture, hormone therapy for the spouse may be relevant — and yes, those conversations come up frequently in this patient population.
For the mood, sleep, and stress contributors that are almost always part of the picture in this group, I will refer out when behavioral health is the right primary intervention. I do not pretend hormone therapy fixes PTSD. I do work alongside it when the hormonal piece is part of the broader recovery.
The other thing I will say plainly: I do not run a TRT mill. I will not write a prescription based on one borderline lab and a patient's request. The protocols I use are conservative, monitored, and built around the patient's specific physiology and goals — including the operational and administrative realities of being on active duty.
How I evaluate candidacy for active duty patients specifically
The standard candidacy workup applies — confirmed lab abnormality, symptom burden, absence of contraindications. For active duty service members from Fort Benning, I add a few additional considerations.
I want to know whether a treatment will create complications with upcoming deployment, training, or evaluation cycles. Testosterone replacement is not currently disqualifying for most positions, but the documentation needs to be appropriate, and the patient needs to understand how to handle medication during field exercises, deployment, and any future PCS. I want to know whether the patient has a flight physical or a clearance review coming up, because the timing of certain interventions matters. I want to know whether the patient has access to consistent follow-up labs at the right intervals, because TRT without monitoring is a different and worse intervention than TRT with monitoring.
These conversations happen at the consultation. They are not separate from the clinical decision — they are part of it.
The next step that actually matters
If you are stationed at Fort Benning, or you are in the broader Columbus military community, and what you have read here sounds like your situation, the concrete next step is straightforward. Get a fasting morning lab draw — between 7 and 10 AM, on two separate occasions about two weeks apart — that includes total T, free T, SHBG, sensitive estradiol, LH, FSH, prolactin, full thyroid panel, fasting insulin and HbA1c, lipid panel, CBC, and morning cortisol. If you have a TBI history, add IGF-1.
Book online at the Columbus location, which is the closer of our two clinics for most Fort Benning patients, or call (762) 261-3880. If you do not have recent labs, we can order the panel at your first visit. Bring a written timeline of when symptoms started, any deployment or training cycle context that seems relevant, and a list of any current medications.
The conversation deserves to happen with someone who will actually have it. That is what we are here for.
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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