Hormonal Health Beyond the Uniform

Why Military Members and First Responders Need a Better Conversation About TRT and HRT

By Sgt. Ayman Kafel, MSC

Medical disclaimer: This article is educational and does not provide individual medical advice. Decisions concerning hormone testing or treatment should be made with a qualified healthcare professional after an individualized evaluation.

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We talk constantly about readiness in the military and public safety. We inspect weapons, vehicles, medical equipment, body armor, and communications. We measure physical fitness and require continuing training. Yet many of the people carrying that responsibility spend years ignoring changes within their own bodies.

Fatigue becomes normal. Poor sleep becomes part of the schedule. Loss of motivation gets called laziness. Weight gain gets blamed on discipline. Changes in mood, sexual health, recovery, and mental clarity are treated as weaknesses to hide. In professions built around endurance, people learn to function while something underneath them is deteriorating. We reach for energy drinks, poor food, alcohol, or other ways to keep going, then call it part of the job.

I know that culture from experience. I joined the Army after September 11 and served in Iraq as a young noncommissioned officer. I drove thousands of miles on combat patrols. Later, I entered law enforcement and SWAT, working nights, doubles, and critical incidents where my body was already reacting before anything physical happened.

Like many GWOT veterans, I have also been diagnosed with a traumatic brain injury, PTSD, and other conditions. I do not mention that for sympathy, and I do not claim it explains every physical or psychological challenge I have faced. I mention it because a brain injury can affect more than memory, mood, or headaches. It can affect the pituitary gland and the hormonal systems the pituitary helps regulate. That part of the TBI conversation is easy to miss.

From 2008 to about 2010, the VA had me on about thirteen medications, some that pushed me up and others that brought me down. I felt like a zombie much of the time. I eventually cut many of them out. In 2017, an ad on Facebook led me to Core Medical Group. Sidney Gordon founded the organization, which provides hormone-related care and has become an advocate for veterans, service members, and first responders. My experience with Core began with trying to understand my own health. Over time, I saw its medical services, foundation work, and outreach bring hormonal health into a wider discussion about readiness, recovery, TBI, and long-term wellness.

My experience with TRT and HRT is why I think this conversation deserves more than a fight between people who treat testosterone as a miracle and people who dismiss the whole subject as vanity medicine. When I write about something this personal, I want to bring both lived experience and evidence to the page.

The Body Records the Job

Military members and first responders do not face one isolated stressor. The burden accumulates. Shift work can disrupt circadian rhythms. Sleep is shortened or fragmented. Injuries, chronic pain, TBI, metabolic disease, depression, and posttraumatic stress can add to it. Medications and alcohol may also affect endocrine function. None of this proves a person has a hormone deficiency. It does mean that when symptoms persist, the person deserves a closer look.

I began using WHOOP years ago because I wanted a clearer picture of what the job and my training were doing to me. During COVID, I was part of a high-risk arrest warrant operation as an assistant team leader with DEA SRT. The subject reached for a firearm on a bed while I had my weapon trained on him. My heart rate read 209 beats per minute. I had never paid attention to how high it could climb until then. That was when my effort to understand my body began.

More recently, during one call involving an armed person inside an apartment building, my heart rate began around 90 to 100 beats per minute. As we gathered information and prepared to enter, it moved into the 120s and peaked around 135 to 140. There had been no foot chase, fight, or heavy physical effort. My body was mobilizing for a threat that had not yet physically arrived.

I have also watched my data after a suicide call that occurred around 3:15 in the morning during a busy double shift. I got home around 8:00, slept a little more than three hours, and then returned for firearms and less-lethal qualification. I eventually took four hours off and went home early. The data reflected severe sleep loss and poor recovery, but I did what people in these professions often do. I kept moving because the schedule kept moving.

That pattern did not begin in law enforcement. When I came home from Iraq, my resting heart rate was around 120 beats per minute. I was not running, fighting, or carrying equipment. I was home, but my body was still behaving as if I were somewhere else. For years, I described it by saying that my adrenal gland never learned how to turn off. That is how it felt, but the physiology is broader than one gland. The autonomic nervous system, the brain, the cardiovascular system, the hypothalamic-pituitary-adrenal axis, sleep, trauma, pain, and hormones can all influence whether the body returns to baseline. Research on posttraumatic stress has found elevated psychophysiological activation, including increased heart rate, but a resting heart rate near 120 also requires medical evaluation because trauma is not the only possible cause.

This is where I believe the military and the VA failed many of us. We were trained to enter the fight, sustain the mission, and keep moving. We were not prepared to understand what could happen when the fight ended but the body continued receiving the same internal signal. Too often, symptoms were divided into separate administrative boxes. The racing heart went in one box. Sleep went in another. Mood, pain, TBI, sexual health, weight, and fatigue went somewhere else. No one appeared responsible for asking whether those symptoms were connected.

That criticism is not an attack on every military clinician or VA employee. Many have served veterans with competence and compassion. It is a criticism of systems that have repeatedly failed to provide consistent identification, assessment, and coordinated care. In 2023, the Department of Defense Inspector General reported that military health providers did not consistently identify and assess patients with TBI, and that the Department lacked consistent processes for managing their care and determining return to duty status. The Government Accountability Office had identified challenges in VA screening and evaluation of veterans with mild TBI as early as 2008. These are not only personal frustrations. They are documented institutional failures.

I should have received a coordinated evaluation that treated a resting heart rate of 120 as a serious signal. It should have considered cardiac causes, autonomic dysfunction, trauma-related hyperarousal, sleep, medications, TBI, and endocrine disruption. I cannot say that one cause explains everything. I can say that sending someone home from war without helping him understand why his body still feels at war is not a complete transition plan.

Wearable data cannot diagnose low testosterone or any other endocrine disorder. A heart rate spike is not a hormone panel. A low recovery score is not hypogonadism. These numbers are useful because they make accumulated load visible. They show that the body can remain highly activated before, during, and after an event, even when the person appears outwardly composed. When that pattern is repeated for years, it should at least lead to better questions about sleep, cardiovascular health, mental health, metabolic health, and hormonal function.

A small laboratory study published in JAMA placed ten healthy young men on five hours of sleep per night for one week. Their daytime testosterone levels fell by approximately 10 to 15 percent. The sample was small, so the percentage should not be treated as a universal prediction. Its direction still matters to people who routinely work nights, doubles, rotating shifts, and emergency callbacks. A field study of police officers working consecutive night shifts also documented altered daily rhythms of testosterone, cortisol, and melatonin. These findings do not mean every tired officer needs testosterone. They do show why chronic disruption deserves more than caffeine and an order to toughen up.

A 2020 exploratory study of health screening data from 341 male career firefighters found that 10.6 percent had total testosterone below 264 ng/dL, while 26.4 percent fell in the borderline range of 264 to 399 ng/dL. The study involved firefighters from a single metropolitan department. It cannot establish that the job caused these levels or that TRT would improve health. It does show why hormone health in the fire service deserves more study instead of being written off as a normal result of age, stress, or the job.

TBI, the Pituitary, and the Symptoms We Misread

The pituitary gland helps regulate testosterone, estrogen, thyroid hormones, cortisol, growth hormone, and other systems. A traumatic brain injury can disrupt that system. The resulting symptoms may overlap with posttraumatic stress, depression, chronic fatigue, sleep disturbance, sexual dysfunction, cognitive problems, and changes in body composition. When the symptoms overlap, it becomes easy to assign everything to one diagnosis and stop looking.

One 2012 study examined 26 male veterans with blast-related mild traumatic brain injuries. Eleven showed hormone abnormalities tied to pituitary function, and three had results consistent with hypogonadism. A later study found at least one hormone disorder more often among veterans with blast-related brain injuries than among deployed veterans without those injuries. These studies were small. They cannot tell us how common hormone disorders are across the veteran population or whether hormone treatment improves persistent symptoms. They do show why an evaluation for ongoing fatigue, irritability, poor concentration, diminished libido, sleep problems, or depression may need to consider neurological, psychological, and hormonal factors together.

My own TBI diagnosis changed how I understand these systems. It reminded me that the mind and body are not separate jurisdictions. Trauma, sleep, relationships, physical conditioning, purpose, and hormonal health can all affect one another. Good care should not force veterans to choose between psychological and physiological explanations. It should be willing to investigate both.

Treatment Has to Consider the Whole Person

Hormonal health should never be separated from the rest of a person’s health. Fatigue, diminished motivation, poor concentration, changes in mood, weight gain, sexual dysfunction, and difficulty recovering can be connected to low testosterone, but they can also be influenced by sleep deprivation, chronic stress, traumatic brain injury, depression, medications, alcohol use, obesity, chronic pain, metabolic disease, or sleep apnea. Looking only at a laboratory number can miss the larger story.

A holistic approach begins by listening to the person and understanding what has happened to the body over time. For military members and first responders, that history may include combat, blast exposure, shift work, repeated critical incidents, physical injuries, disrupted sleep, and years of remaining operational while the body absorbs the consequences. Laboratory testing is important, but it should be considered alongside symptoms, medical history, medications, cardiovascular health, mental health, sleep, nutrition, physical activity, and personal goals. When low testosterone is suspected, the Endocrine Society recommends confirming it with consistent morning measurements and investigating what may be causing it.

When testosterone deficiency is properly identified, TRT may become one part of a broader treatment plan. In the Testosterone Trials, 790 older men with symptoms and testosterone levels below 275 ng/dL received testosterone gel or a placebo for one year. Treatment produced moderate improvements in sexual function, along with benefits involving anemia and bone density in selected men. Improvements in vitality were less consistent. That matters because treatment does not affect everyone in the same way, and testosterone alone cannot repair every consequence of chronic stress, poor sleep, injury, or trauma.

Cardiovascular health also has to remain part of the conversation. The TRAVERSE trial followed 5,246 men with symptoms, low testosterone, and existing cardiovascular disease or increased cardiovascular risk. Testosterone treatment did not increase the overall rate of major cardiovascular events compared with placebo during the study period. The findings contributed to the FDA removing earlier boxed warning language concerning cardiovascular outcomes. However, the FDA also required warnings that testosterone products can increase blood pressure, and researchers identified signals involving pulmonary embolism and fractures. The evidence is reassuring in some areas, but it does not eliminate the need for careful monitoring.

TRT can raise hematocrit, suppress sperm production, affect fertility, and complicate certain untreated medical conditions. Responsible treatment should include continued monitoring of testosterone levels, hematocrit, blood pressure, symptoms, cardiovascular risk, fertility concerns, sleep, and overall health. It should also include the willingness to adjust treatment, involve another specialist, or address a different cause when testosterone is not the whole answer.

The goal is not to chase the highest number a laboratory can produce. It is to help the person function and feel better while protecting long-term health. Hormone therapy should support sleep, recovery, physical conditioning, mental health, relationships, and quality of life. It should be part of a complete approach to the person, not a replacement for one.

Hormone Health for Women

The military and first responder conversation often treats hormone health as a male issue. That excludes women serving in the same demanding environments while navigating perimenopause, menopause, surgical menopause, menstrual disruption, or other endocrine disorders.

Menopausal hormone therapy can be highly effective for hot flashes and night sweats, and it can help prevent bone loss. It is not one universal medication. Treatment may involve estrogen alone or estrogen combined with a progestogen, depending in part on whether a woman has a uterus. Route, dose, timing, medical history, and personal risk all matter.

The original Women’s Health Initiative identified important risks with certain hormone regimens in older postmenopausal women. Later analysis made the picture more nuanced. An 18-year follow-up of the randomized trials found no significant difference in overall mortality between women assigned to menopausal hormone therapy and those assigned to placebo. That does not make therapy risk-free. Breast cancer, blood clots, stroke risk, age, time since menopause, and the specific formulation must be considered individually.

For a woman working nights, wearing heavy equipment, commanding a scene, treating patients, or deploying overseas, disrupted sleep and temperature regulation are not merely inconveniences. They can affect concentration, recovery, and quality of life. She deserves a serious clinical conversation rather than being told to endure it quietly.

The Military Screening Debate

This issue has reached the federal level. On July 15, 2026, the Department of War announced enhanced testosterone deficiency screening during periodic health assessments. Under the directive, active-duty and reserve personnel age 30 and older are to receive annual screening, while younger service members may request it. The stated goal is to establish better baselines and offer targeted treatment when appropriate.

Sidney Gordon, CEO of Core Medical Group, took part in the broader advocacy effort alongside veterans, clinicians, lawmakers, and other organizations. Gordon and others met with Pentagon officials about connecting the department with clinicians and industry leaders as screening and treatment protocols were developed. Colton Hill, who directs outreach for the Core Medical Foundation, also participated in recent meetings at the Pentagon and within the Office of the Secretary of War concerning hormone health for military members and veterans.

Being in the room matters, but it does not prove that every proposal is medically correct. In its September 2026 response to the Defense Health Agency guideline, the Endocrine Society raised concerns about population screening of asymptomatic men, false positives, fertility, and the need to consider appropriate alternatives. That caution belongs in the same conversation. Advocacy can draw attention to a problem. Medical standards and individual evaluation must guide what happens next.

I respect Core’s advocacy when it pushes the conversation toward careful evaluation, not automatic treatment. Nobody should leave believing every service member needs testosterone. Fatigue, depression, sexual dysfunction, cognitive changes, and loss of physical capacity deserve a complete evaluation before they are called weakness, age, or answered with a prescription.

Why Core Medical Group Matters to Me

I chose Core Medical Group as a patient, and I believe that relationship should be stated plainly. My support for the organization comes from my experience with its people, the care I have received, and the conversations I have had with CEO Sidney Gordon and Colton Hill. I cannot speak for every patient or guarantee every outcome. I can only speak honestly about what I have seen and how I have been treated.

Readers who want to learn more can visit Core Medical Group’s website, including its military focus page.

Sidney and Colton have never made me feel like a sale. We have talked about veterans, military members, and first responders whose health changed after years of serving others. Our conversations have covered TBI, posttraumatic stress, sleep disruption, hormonal health, and how difficult it can be to find care when each issue is treated as if it exists alone. What has stayed with me is that they take the work personally. In my experience, they talk about people first.

I have watched them bring these questions to veterans, first responders, clinicians, lawmakers, and military leaders, including meetings at the Department of War. They have advocated for better screening, greater access, and care that considers the whole person. I respect that effort. It still has to remain connected to sound clinical judgment and individualized care.

That does not mean every veteran or first responder needs testosterone. It means they deserve to be taken seriously when something no longer feels right. They deserve more than a rushed appointment, an isolated laboratory number, or another prescription intended to silence a symptom. They deserve someone willing to examine the full picture and help them understand their options.

Core provides reduced pricing and other support for veterans, active-duty personnel, law enforcement officers, and first responders. Through the Core Medical Foundation, the organization has also helped veterans obtain hormone care and created opportunities for support and connection. Those efforts matter because access means very little if the people who need care cannot afford it or do not know where to begin.

There is a difference between selling a service and treating a person as a person. My experience with Sidney, Colton, and the Core team has left me feeling that they take that responsibility seriously. I can speak to the attention and care I received, not to every patient’s experience.

Readiness Includes the Person

The uniform teaches us to place the mission first. That principle has meaning, but it becomes distorted when people believe caring for themselves is selfish. A depleted person can continue functioning for a long time. Many of us have proven that. Functioning is not the same as being healthy.

Hormonal health belongs inside a broader readiness conversation that includes sleep, nutrition, physical training, body composition, mental health, TBI, cardiovascular risk, medications, alcohol use, relationships, and purpose. TRT or HRT may be one part of that picture when a qualified clinician identifies a legitimate indication. It should never become the entire picture.

My WHOOP data have shown me how much can be happening inside the body while the uniform still looks composed. My TBI diagnosis has shown me that an injury can reach systems we do not immediately see. My experience as a Core patient has shown me that hormone care can be approached seriously without pretending it solves everything.

We do not need another culture of shortcuts. We need a culture in which military members and first responders examine what is happening within them with the same seriousness they bring to the equipment and people entrusted to their care. Asking for an evaluation is not weakness. Receiving appropriate treatment is not cheating. Monitoring that treatment and confronting its limits are parts of self-command.

Core Medical Group and the Core Medical Foundation can help expand access. The work has to stay tied to evidence and respect for the person beneath the uniform.

Sources and Further Reading

1. Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men, by R. Leproult and E. Van Cauter (JAMA, 2011). Read source
2. Changes in the Diurnal Rhythms of Cortisol, Melatonin, and Testosterone After Consecutive Night Shifts in Male Police Officers, by M.A. Jensen et al. (Chronobiology International, 2016). Read source
3. High Prevalence of Chronic Pituitary and Target Organ Hormone Abnormalities After Blast-Related Mild Traumatic Brain Injury, by C.W. Wilkinson et al. (Frontiers in Neurology, 2012). Read source
4. Chronic Hypopituitarism Associated With Increased Postconcussive Symptoms Is Prevalent After Blast-Induced Mild Traumatic Brain Injury, by A. Undurti et al. (Frontiers in Neurology, 2018). Read source
5. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline, by S. Bhasin et al. (Journal of Clinical Endocrinology and Metabolism, 2018). Read source
6. Effects of Testosterone Treatment in Older Men, by P.J. Snyder et al. (New England Journal of Medicine, 2016). Read source
7. Cardiovascular Safety of Testosterone Replacement Therapy, by A.M. Lincoff et al. (New England Journal of Medicine, 2023). Read source
8. FDA Issues Class-Wide Labeling Changes for Testosterone Products, by U.S. Food and Drug Administration (FDA, Feb. 28, 2025). Read source
9. Menopausal Hormone Therapy and Long-Term All-Cause and Cause-Specific Mortality, by J.A.E. Manson et al. (JAMA, 2017). Read source
10. Military Focus, by Core Medical Group (Core Medical Group). Read source
11. Statement on the Defense Health Agency’s Clinical Practice Guideline for Testosterone Deficiency in the Male Service Member, by Endocrine Society (Endocrine Society, Sept. 24, 2026). Read source
12. Statement on Enhanced Screening Protocol to Optimize Warfighter Performance and Enhance Force Readiness, by U.S. Department of War (Department of War, July 15, 2026). Read source
13. The Advocacy Effort Behind the Military Testosterone Screening Order, by Fox News (Fox News, July 2026). Read source
14. Pentagon Meeting Concerning Hormone Health and Military Readiness, by C. Robichaux (Facebook, 2026). Read source
15. The Psychophysiology of Posttraumatic Stress Disorder: A Meta-Analysis, by N. Pole (Psychological Bulletin, 2007). Read source
16. Evaluation of the DoD’s Management of Traumatic Brain Injury, by Department of Defense Inspector General (Department of Defense, DODIG-2023-059, March 30, 2023). Read source
17. VA Health Care: Mild Traumatic Brain Injury Screening and Evaluation Implemented for OEF and OIF Veterans, but Challenges Remain, by U.S. Government Accountability Office (GAO, GAO-08-276, Feb. 8, 2008). Read source
18. Borderline Low Testosterone Levels Are Associated With Lower Left Ventricular Wall Thickness in Firefighters, an Exploratory Analysis, by A. Lofrano Porto et al. (Andrology, 2020). Read source

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Ayman Kafel is a patrol sergeant, combat veteran, and founder of Project Sapient, with more than 20 years of operational experience. He served in Iraq as a U.S. Army soldier and translator and has worked in law enforcement roles including SWAT, DEA task force work, and plainclothes interdiction; he also holds a master’s degree in counterterrorism. For The Havok Journal, he writes from that background on law enforcement, service, training, stress, resilience, and national security, often focusing on the physical and psychological demands of high-stress work. Follow Project Sapient on Instagram, YouTube, and all podcast platforms for engaging content. He can be reached at ayman@projectsapient.com.

As the Voice of the Veteran Community, The Havok Journal seeks to publish a variety of perspectives on a number of sensitive subjects. Unless specifically noted otherwise, nothing we publish is an official point of view of The Havok Journal or any part of the U.S. government.