The policy context of direct‐to‐consumer personal genomic testing (DTC‐PGT) has been evolving over the last decade, with little empirical data available about consumers’ perspectives. A majority of consumers of DTC‐PGT supported expanded access to services and their integration into the medical context and opposed more governmental regulation. Consumers’ attitudes about access to services and regulation did not vary based on the specific genetic risk information they received from companies, but may vary based on whether consumers perceived their DTC experience negatively. Context While policymakers have been considering the appropriateness of direct‐to‐consumer personal genomic testing (DTC‐PGT) for more than a decade, there is little empirical data on consumers’ views regarding the regulation of these products. No research has assessed whether consumers’ personal experience with testing is related to their views about access to and regulation of DTC tests. Methods Data were analyzed from the PGen Study, a longitudinal prospective cohort of DTC‐PGT customers of 23andMe (n = 564) and Pathway Genomics (n = 377; total N = 941). Consumers were sent an electronic survey before receiving genetic test results and again 6 months after receipt of results. Findings At the 6‐month follow‐up, more than 80% of participants believed that people have a right to access genetic information directly, that parents should be able to get DTC‐PGT testing for their children, and that genetic information should be kept private. Participants supported health insurance coverage of PGT (60%), wider availability of PGT (68%), and inclusion of genetic information in medical records (63%). Participants were less supportive of government regulation (28%) and restricting testing to clinical settings (14%). Conservative political ideology was associated with less support for government regulation (P < 0.001), as was feeling more confident in one's genetic knowledge (P < 0.05). Participants’ level of computed genetic risk for common diseases, as indicated by their actual test results received from companies, showed no relationship with attitudes. However, those who perceived that they had received elevated risk results expressed lower support for expanded availability and incorporation of PGT into health care (P < 0.01). Those who reported being upset by their genetic test results were less likely to endorse access to DTC products without a medical professional (P < 0.01). Conclusions PGT consumers supported expanded access to these services and opposed additional regulation. Users who had a negative personal experience with PGT testing were less supportive of expanded availability without a medical professional.

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The Female Athlete Triad has recently been suggested to be a threat to male athletes. This review aims to examine the evidence, and associated effects, of low energy availability (LEA) in male athletes. A comprehensive search of PubMed and SPORTDiscus was performed. Three RCT and seven CS studies were included that measured energy availability and included well-trained males. Clinical LEA (<30 kcal/kg LBM/d) or subclinical LEA (36 ± 6 kcal/kg LBM/d) was evident within all CS studies, documenting 25% of middle-and long-distance runners and racewalkers and 70% of cyclists with LEA. Two out of three RCTs and three out of seven CS studies reported disrupted endocrine functioning, particularly reduced testosterone levels, in association with LEA. One CS study reported that up to 40% of cyclists with LEA had low BMD. One CS study assessed metabolic health, reporting those with suppressed levels spent more time in a severe energy deficit. This review highlights that LEA appears prevalent across male athletic populations, in particular endurance and weight class athletes, and is a potentially serious threat to bone, endocrine, and metabolic health. Future larger scale longitudinal studies, using appropriate study designs, should be undertaken to confirm these threats. K E Y W O R D Sbone health, endocrine function, energy availability, exercise physiology, metabolic health, sports nutrition

Purpose Evidence suggests low energy availability (LEA) is prevalent in elite male Gaelic football (GF) players. Previous research in male and female team sports found LEA may negatively impact endocrine function. The aim of this study was to examine the seasonal variations in energy availability (EA) and its associations with salivary measures in elite male GF players across the competitive season. Methods Energy availability was assessed using field-based methods in conjunction with salivary testosterone (s-T), cortisol (s-C) and immunoglobin A (s-IgA) concentrations at pre-season (PRE), in-season (IN) and post-season (POST). Results 38% reported LEA at PRE, 33% at IN, and 28.5% at POST. s-C, s-T and s-IgA levels were within normal ranges at PRE, IN and POST. Salivary cortisol declined significantly from PRE to IN, remaining reduced at POST. Salivary testosterone decreased significantly from PRE to IN but was significantly elevated at POST compared to IN. Salivary IgA was significantly greater at POST than IN. No significant associations were found between s-C or s-T and EA at any time point. Pre-season s-IgA exhibited a significant inverse association with PRE EA. Decreased s-IgA flow rate and s-IgA secretion rate were significantly associated with decreased EA at PRE. Reduced carbohydrate (CHO) intake was also associated with decreased s-IgA secretion rate at PRE. Conclusion This study suggests that LEA is prevalent in elite male GF players, but is not associated with s-C or s-T. However, EA is associated with s-IgA which may impact the immune system. Therefore, education and interventions surrounding the prevalence and associations of EA should be implemented in this population.

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