The Pentagon’s recent memorandum marked a milestone in military health policy, mandating annual testosterone screening for all service members over 30 and directing the creation of an advisory council to address Operator Syndrome. This action puts health and human performance optimization front and center as a readiness issue.
Human performance optimization, or HPO, is intended to improve health and readiness force-wide. Operator Syndrome, meanwhile, is a clinical construct that describes the cumulative health effects experienced by special operations personnel.
Comprehensive assessments of the two will require Pentagon leadership and the advisory council to establish a standardized, evidence-informed framework to assess special operations and other combat-focused jobs susceptible to cumulative operational injuries within the military health system.
The advisory council’s success will depend on both the recommendations it produces and its ability to develop a coherent, scalable framework for service members with suspected Operator Syndrome across the MHS.
Along the way, the council has a unique chance to shift the MHS from a fragmented, symptom-based approach to one that addresses cumulative effects of operational service through holistic, multidisciplinary care.
The value of this approach has been demonstrated by existing human performance and operator health programs such as the U.S. Special Operations Command’s Preservation of the Force and Family (POTFF) and the Army’s Holistic Health and Fitness (H2F) program.
Right now, the advisory council has an opportunity to leverage decades’ worth of lessons learned from these programs to establish evidence-based clinical standards for continuous evaluation and refinement.
As the science of Operator Syndrome evolves, this framework should function as a learning health system, with new evidence informing ongoing updates that improve health, function, and operational readiness.
Dr. Chris Frueh’s foundational work first introduced Operator Syndrome in 2020 as a multisystem effect resulting from allostatic load and cumulative operational exposure. This work has driven multidisciplinary research to develop standardized methods for its characterization and assessment.
One example of this ongoing work is the collaborative development and preliminary validation of a standardized self-report instrument to assess Operator Syndrome-related symptom patterns.
The Operator Syndrome Symptom Scale–Self Report, or OSSS-SR, is guided by existing scientific literature, multidisciplinary clinical expertise and principles of patient-reported outcomes. This multisystem screening tool is designed to identify common symptom patterns affecting the mind and body and to support occupational performance and overall health among operators.
Currently advancing to its next phase of development, the OSSS-SR includes items for the empirical evaluation of multiple symptom domains across physical, mental, physiological and other performance health systems.
As the advisory council establishes its agenda, it should actively encourage and leverage similar collaborations. The future of military medicine depends not only on government-led initiatives but also on strategic partnerships that unite operational experience and clinical expertise.
Ongoing research efforts, meanwhile, also reinforce an important implementation challenge.
A validated clinical framework should guide these new screening initiatives. Recognizing Operator Syndrome as a military health priority is an important first step, but sustainability will depend on the Pentagon’s ability to build the scientific infrastructure that supports evidence-based decision-making. The Pentagon should treat investment in measurement science as a foundational priority.
Implementing screening before establishing a validated clinical framework introduces avoidable risks. Without standardized assessment methods and evidence-based referral criteria, identification of Operator Syndrome will likely vary across providers and military treatment facilities, leading to inconsistent clinical decision-making, unnecessary referrals and missed opportunities to identify service members who would benefit from comprehensive multidisciplinary care.
These challenges are not unique to Operator Syndrome. Similar concerns have been raised by certain organizations — such as the Endocrine Society — about broad population-based testosterone screening.
The Endocrine Society supports targeted testing for individuals with specific symptoms and risk factors, emphasizing that no single symptom or biomarker should serve as the basis for identifying cumulative operational injury, and that laboratory findings should be interpreted in an appropriate clinical context to avoid unnecessary intervention.
While expanded screening may facilitate earlier identification of health concerns, testosterone testing should serve as the starting point — not the endpoint — of clinical evaluation.
Combining testosterone results with a comprehensive medical history, a validated assessment tool such as the OSSS-SR and additional laboratory testing provides a more complete picture of physiological dysfunction and supports more targeted, multidisciplinary care.
A holistic screening framework supports treatment of the impacts of occupational performance. This is essential for military readiness and retention and can improve screening and continuity of care during and after service.
Addressing Operator Syndrome through a single symptom or isolated laboratory value, such as relying on testosterone testing alone, or by evaluating the broader physiological systems increases the likelihood that the underlying condition will remain inadequately addressed.
Council members must understand military healthcare, its operational systems and clinical outcomes, and how to optimize health and wellness to enhance lethality.
Extensive research on Operator Syndrome and the development of a self-report instrument have emphasized the need for multidisciplinary expertise to enhance holistic assessments of special operations personnel.
It is imperative, therefore, that physical and psychological assessments and treatments be evidence-based and include continuous, cumulative diagnostics throughout a military member’s entire career.
The Pentagon must prioritize selecting a multidisciplinary group of health and policy specialists when evaluating the proposed advisory council’s nominated members. Relying on a single viewpoint for an entire advisory panel is as ineffective as isolating a single symptom in a comprehensive diagnosis.
Ultimately, ensuring warfighters can respond to conflict at a moment’s notice requires a fully functioning mind-body connection that supports both health and readiness.
Mackenzie Witt, Pepper Phillips, MPH, and KayleighBealer, MS, are with A-G Associates, which partners with federal agencies, public health systems, and mission-driven organizations to turn strategies into results across behavioral health, military and veteran wellbeing, and systems transformation.
Jennifer Byrne, OTD, and Kelli Cabrera, OTD, are with 5by5 Performance Therapy, an organization committed to contributing to blast-injury and operator-centric research and academia to improve knowledge and understanding of the Special Operator family’s strengths and challenges.
