Service-linked causes worth screening for
Military service can leave behind health problems that lower testosterone or affect erections years later, so a veteran’s evaluation looks for them on purpose. The symptoms, such as fatigue, low drive, poor sleep and weaker erections, look the same as in any man. The causes, and therefore the right treatment, can be different.
| Service-related factor | How it can affect hormones or erections | What gets checked |
|---|---|---|
| Head injury, including blast exposure | Can damage the pituitary, which signals the testes | LH, FSH, prolactin and other pituitary hormones |
| Sleep apnea | Lowers testosterone and worsens fatigue | Sleep history and, when needed, a sleep study |
| PTSD and depression medicines | Many cause ED or lower desire | A full medicine list and timeline |
| Chronic pain treated with opioids | Opioids suppress testosterone | Pain medicine history |
| Weight gain after service | Excess weight lowers testosterone | Body composition and metabolic labs |
MedlinePlus lists head trauma, meaning traumatic brain injury, among the causes of hypopituitarism, a condition in which the pituitary does not make enough of its hormones, including the signals that drive testosterone. The National Institute of Diabetes and Digestive and Kidney Diseases names antidepressants and some pain relievers among the many medicines that can cause ED, along with anxiety, depression and stress.
Head injury and the pituitary
A past concussion or blast injury is a reason to look at the whole pituitary, not just testosterone. If testosterone is low and LH and FSH are low or normal, the signal from the brain may be the weak link. Your provider may add prolactin, a morning cortisol, thyroid tests and, when the pattern calls for it, imaging of the pituitary arranged through a specialist.
This matters because a pituitary problem can affect more than one hormone, and treating testosterone alone would miss the rest. Our page on low testosterone after a head injury explains the connection, and our answer on pituitary MRI before TRT covers when imaging is used.
Sleep, medicines and the picture behind the symptoms
Sleep problems are common after service, and untreated sleep apnea is one of the reversible causes of low testosterone. The National Heart, Lung, and Blood Institute describes loud snoring, breathing pauses and daytime sleepiness as common signs. If you already use a CPAP machine through the VA, bring its usage reports; if you have never been tested, that may come first. Veterans now working nights can also read our page on care for night shift workers.
Medicines get the same careful review. The Endocrine Society’s 2026 statement asks providers to rule out reversible contributors such as opioid or corticosteroid use before diagnosing low testosterone. Antidepressants and other PTSD medicines often affect erections and desire rather than testosterone itself. Never stop a mental health medicine on your own to fix a sexual side effect; your provider can work with the clinician who manages it. Our pages on ED from antidepressants and opioid-induced low testosterone cover both.
Treatment options once the cause is clear
Once the cause is identified, treatment follows it rather than a default. A pituitary problem may need a specialist and treatment of more than one hormone. Sleep apnea treatment, weight loss or a medicine change can sometimes lift testosterone without hormones at all. When low testosterone is confirmed and the cause is permanent or not reversible, testosterone therapy by injection, capsule or pellet becomes a reasonable discussion.
Erection problems often need their own track, because a medicine side effect or blood vessel changes will not respond to testosterone alone. Options at the clinic include oral ED medicines and, when pills are not enough, compounded injectable medicines such as Trimix. Your provider checks every heart and mental health medicine on your list first, since some combinations are unsafe. Our ED treatment roadmap shows how those steps usually unfold.
Bringing your outside records
Records from VA care, military treatment facilities or civilian doctors save time and prevent repeated tests. Useful items include recent lab results, your medicine list, sleep study results, notes on any head injury or concussion, and imaging reports. You can usually download or request your VA records before the visit.
Recent labs may cover part of what is needed, though testosterone is often repeated so it is drawn in the early morning and on the clinic’s timing. Our answer on using blood work from another doctor explains which results can be reused.
Paying for care alongside the VA
Ultimate Male is a direct-pay clinic, so care here runs alongside your VA benefits rather than through them. The clinic does not bill insurance, including VA programs or TRICARE. You pay per visit with no membership, receive itemized receipts and can use financing through CareCredit, Prosper Healthcare Lending or Afterpay.
Many veterans use a health savings account. IRS Publication 969 says you may still be an eligible HSA participant even if you receive hospital care or medical services from the VA for a service-connected disability. For other VA care, check with your HSA administrator or a tax adviser. Our page on HSA and FSA eligible treatments explains which services usually qualify.
Keep your VA team informed. Our guide on coordinating TRT with your primary care doctor covers what to share and when.
Questions to ask at your consultation
- Could a past head injury explain my labs, and what would confirm it?
- Should I be tested for sleep apnea before anything else?
- Which of my current medicines could be affecting my erections or energy?
- How will my results be shared with my VA provider?
- If testosterone is not the answer, what is the next step?
How Ultimate Male works with veterans
At Ultimate Male, a veteran starts with the free 10-minute phone call, where you can mention service history, injuries and current VA care. Labs are drawn on site at San Gabriel or Downey, with results usually in 24 to 48 hours, and your consultation with a PA-C or MD reviews them together with your outside records. Clinical director Matthew A. Schafer, PA-C, worked as an EMT and paramedic before becoming a physician assistant, and brings that emergency medicine background to the visit.
If testosterone is part of the plan, it is monitored closely and shared with your other providers on request. You can read more about the clinic’s testosterone therapy program before you call.
If you are in crisis or thinking about harming yourself, call 988 and press 1 to reach the Veterans Crisis Line, or call 911.
