The Pentagon Isn’t Just Launching a Testosterone Program—It’s Naming Operator Syndrome

July 30, 2026

By: Jennifer Byrne, OTD, & Kelli Cabrera, OTD, 5by5 Performance Therapy; Chris Frueh, Ph.D., University of Hawaii-Hilo; Lyndsey Tuft, Ph.D., & Kayleigh Bealer, MS, A-G Associates

Last week, Secretary of War Pete Hegseth signed a memo requiring testosterone screening for all Active Duty and Reserve Component personnel aged 30 and older as part of their Periodic Health Assessment—not a special operations-only measure, but a force-wide one.

Within hours, the story had a headline: the Department of War is rolling out a testosterone program for troops. Public reaction was swift. Social media quickly filled with reactionary commentary, while news outlets rapidly sought expert opinions, many of which were from civilian providers, and published analyses. Some healthcare providers questioned the evidence supporting testosterone therapy as a broad solution for low testosterone, while others debated whether the directive is fundamentally about military readiness, broader health optimization, or something else entirely.

What got overlooked

In the commentary surrounding the memo, two important points have been missed.

First, while most news and media commentary references Operator Syndrome, the memo places it at the center of the Department’s rationale for a force-wide policy—not background, but the stated justification. The subject line is "Health and Human Performance Optimization to Enhance Military Readiness," and by the second paragraph it states plainly that the testosterone screening exists to support that effort while comprehensively addressing Operator Syndrome—a framework for interconnected physical, cognitive, and emotional challenges that require a more comprehensive approach to care, first identified among special operations personnel and other high-risk, combat-focused military occupations by Frueh and colleagues in 2020 [1]. Hegseth's directive doesn’t just reference the Operator Syndrome framework, it treats it as significant enough to warrant dedicated military health policy.

Second, much of the recent commentary has come from providers with limited direct experience treating special operations personnel. Special Operators—the service members who carry out the military’s most physically and psychologically demanding missions—are a high-risk population given the cumulative impact of their job on the brain, body, spirit, and family. Some commentators have implicitly treated them as physiologically equivalent to age-matched civilian peers. That assumption doesn’t hold up against the clinical literature on cumulative operational exposure.

This distinction matters because testosterone screening is not the policy’s ultimate intention. Rather, it is one clinical tool within a broader strategy to optimize human performance and address Operator Syndrome.

What is Operator Syndrome

The term emerged from the work of psychologist Dr. Chris Frueh, who spent more than two decades working with special operations personnel observing recurring patterns of physical, cognitive, and psychological symptoms unique to this population. Special Operators who’d spent years bearing the job’s physical and psychological weight presented with tangled combinations of symptoms, including brain injury symptoms, disrupted sleep, chronic pain, hormone irregularities, digestive issues, and emotional strain, often all at once and reinforcing one another.

In 2020, Frueh and his colleagues published their paper describing Operator Syndrome, prompting a small but growing group of multidisciplinary clinicians with extensive experience caring for special operations personnel to further investigate the concept. Since then, these efforts have expanded to better understand its underlying mechanisms, refine its clinical framework, and explore evidence-informed approaches to prevention, assessment, and treatment. [1]

The organizing idea behind Operator Syndrome is allostatic load, the cumulative wear the body and brain absorb from years of chronic stress, disrupted sleep, repeated small- and large-caliber blast injuries, and physical, cognitive, and social demands of the job that never let up long enough for full recovery. It's not a single lesion or a single hormone level. It's what happens when all of the human physiological systems, including neurological, endocrine, sleep, musculoskeletal, gastrointestinal, and emotional health, absorb sustained strain for years without adequate time or adequate care to recover or heal.

An operator walks into a primary care clinic with fatigue and low libido, and it looks like a hormone problem. They walk into behavioral health with irritability and trouble sleeping amongst other natural consequences of the job, and it can look like depression, anxiety, or PTSD. Civilian and military healthcare systems are largely organized around diagnosing and treating symptoms. For operators with complex, multisystem presentations, this often results in multiple diagnoses, referrals, and medications that fail to address—and may even worsen—the underlying injury. Too often, these interventions become ill-fitting Band-Aids, treating isolated symptoms while the root cause remains unrecognized and untreated. As a result, many operators spend years cycling through antidepressants, anxiolytics, stimulants, and sleep aids without meaningful improvement. What is needed instead is a clinician, or team of clinicians, who recognize Operator Syndrome, evaluate the whole person, and coordinate multidisciplinary care to identify and treat the root-cause drivers of their symptoms.

For example, occupational therapy (OT) is a natural fit for this work. OT is uniquely positioned to look beyond individual symptoms and understand how physical, cognitive, emotional, and social challenges come together to affect a person's daily life and ability to function. That's what drew Dr. Jennifer Byrne and her team at 5by5 Performance Therapy to this population in the first place, after years of treating operators holistically and seeing the same interconnected patterns emerge again and again. Operator Syndrome isn't about replacing existing diagnoses or specialties—it's a framework for understanding how symptoms that are often treated separately may actually be connected, allowing clinicians to see the bigger picture and coordinate care that addresses the whole person.

The distinction is important, and one worth being precise about: Operator Syndrome doesn't yet have formal diagnostic status in the systems that psychiatry and medicine use to code conditions. Researchers have been clear that this remains an evolving clinical framework, not a settled diagnosis. But "not yet formalized" is very different from "not real," and empirical validation is underway to test whether Operator Syndrome holds up as a distinct, measurable pattern. [2]

Where testosterone fits

This is where the memo's testosterone provision belongs: as one piece of a much larger, already-forming clinical picture, not the centerpiece. The few expert clinicians already treating Operator Syndrome place endocrine screening, including testosterone, alongside a handful of other priority areas clinicians assess early. [3] That is meaningfully different from screening testosterone in isolation. The endocrine changes researchers are seeing in operators are increasingly understood as downstream effects of cumulative stress overload, not a standalone problem with a standalone fix. Treating the number without addressing what's driving it risks managing a symptom while missing the underlying load.

The medical skepticism directed at universal testosterone screening this week is worth taking seriously, and much of it is indeed well-founded: hormone levels are hard to measure reliably, timing and individual variability complicate interpretation, and treating a number without understanding why it's low can create more problems than it solves. However, that critique concerns screening design, not whether Operator Syndrome deserves military doctrine's attention. Conflating the two risks ignoring real progress simply because one implementation detail needs work—particularly at a moment when Congress has cut Pentagon-funded TBI and psychological health research spending by more than 75% since fiscal year 2024, even as VA data shows reported TBI cases among veterans climbing and misdiagnosis as PTSD remaining a documented risk. [4]

The Endocrine Society recommends testosterone testing only when other symptoms of testosterone deficiency are present. [5] Although appropriate for the general population, this recommendation has important limitations in special operations personnel. Fatigue, impaired concentration, irritability, low motivation, and sleep disturbance are very common complaints in this population—however they are often accepted as part of the job and rarely reported formally to medical professionals. Consequently, waiting for operators to recognize and disclose these symptoms before initiating evaluation risks delaying diagnosis and treatment that could improve and maintain lethality. For populations with predictable, high-risk occupational exposures such as special operators, a more proactive screening strategy should be considered.

What comes next matters more than the headline

Secretary Hegseth’s memo calls for an advisory council of outside experts to help guide implementation. The opportunity before that council is not simply to improve access to testosterone therapy, but to redefine how military medicine evaluates cumulative operational injury. Clinicians across the country are already using the Operator Syndrome framework to guide comprehensive, multidisciplinary care for special operations personnel. The next step is ensuring that this systems-based approach becomes the standard rather than the exception—recognizing that fatigue, sleep disruption, cognitive decline, hormonal dysfunction, chronic pain, and mood changes are often interconnected manifestations of cumulative operational exposure, not isolated conditions requiring isolated treatments—and that is worth celebrating.

References

1. Frueh, B. C., Madan, A., Fowler, J. C., Stomberg, S., Bradshaw, M., Kelly, K., Weinstein, B., Luttrell, M., Danner, S. G., & Beidel, D. C. (2020). “Operator Syndrome”: A unique constellation of medical and behavioral health-care needs of military special operation forces. The International Journal of Psychiatry in Medicine, 55(4), 281–295. https://doi.org/10.1177/0091217420906659 
2. This claim draws on ongoing work to validate the Operator Syndrome Symptom Scale–Self Report (OSSS-SR), a multi-domain self-report instrument developed by a multidisciplinary research team to assess Operator Syndrome symptoms across neurological, autonomic, endocrine, sleep, musculoskeletal, gastrointestinal, emotional, social, and cardiometabolic domains.
3. Ivory, R. A., Graber, J. S., Frueh, B. C., & Cady, H. (2024). Operator syndrome: Nursing care and considerations for military special operations. Nursing2024, 54(8), 25–31. https://doi.org/10.1097/NSG.0000000000000001 
4. Donnelly, J. M. (2026, July 20). Surge in veterans' brain injuries shown in VA records. Roll Call. https://rollcall.com/2026/07/20/surge-in-veterans-brain-injuries-shown-in-va-records/ 
5. Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744. https://doi.org/10.1210/jc.2018-00229