Testosterone: A Missing Biological Link in Morbidity and Mortality Among U.S. Veterans

Abstract

Testosterone deficiency is highly prevalent among male veterans and represents an underrecognized contributor to morbidity, mortality, and healthcare utilization within the Veterans Health Administration (VA). Low testosterone has been associated with increased all-cause mortality, cardiovascular disease, depression, inflammation, and suicide risk. Despite this, testing and treatment remain inconsistent and frequently inadequate.
Normalization of testosterone levels has been associated with reductions in mortality, myocardial infarction, and stroke, as well as improvements in depressive symptoms, inflammatory burden, and functional status. These findings suggest that testosterone is not merely a reproductive hormone but a systemic regulator linking neuroendocrine, immune, and cardiovascular pathways.
This article argues that testosterone deficiency represents a modifiable biological driver of disease in veterans. A structured approach to identification and longitudinal management may provide a high-yield strategy to improve outcomes and reduce healthcare costs within the VA system.