Hypogonadism in Exercising Males: Dysfunction or Adaptive-Regulatory Adjustment?

Abstract

For decades researchers have reported men who engaged in intensive exercise training can develop low resting testosterone levels, alterations in their hypothalamic-pituitary-gonadal (HPG) axis, and display hypogonadism. Recently there is renewed interest in this topic since the International Olympic Committee (IOC) Medical Commission coined the term "Relative Energy Deficiency in Sports" (RED-S) as clinical terminology to address both the female-male occurrences of reproductive system health disruptions associated with exercise. This IOC Commission action attempted to move beyond the sex-specific terminology of the "Female Athlete Triad" (Triad) and heighten awareness/realization that some athletic men do have reproductive related physiologic disturbances such as lowered sex hormone levels, HPG regulatory axis alterations, and low bone mineral density similar to Triad women. There are elements in the development and symptomology of exercise-related male hypogonadism that mirror closely that of women experiencing the Triad/RED-S, but evidence also exists that dissimilarities exist between the sexes on this issue. Our research group postulates that the inconsistency and differences in the male findings in relation to women with Triad/RED-S are not just due to sex dimorphism, but that there are varying forms of exercise-related reproductive disruptions existing in athletic men resulting in them displaying a relative hypogonadism condition. Specifically, such conditions in men may derive acutely and be associated with low energy availability (Triad/RED-S) or excessive training load (overtraining) and appear transient in nature, and resolve with appropriate clinical interventions. However, manifestations of a more chronic based hypogonadism that persists on a more permanent basis (years) exist and is termed the "Exercise Hypogonadal Male Condition." This article presents an up-to-date overview of the various types of acute and chronic relative hypogonadism found in athletic, exercising men and proposes mechanistic models of how these various forms of exercise relative hypogonadism develop.

The Interplay Between Plasma Hormonal Concentrations, Physical Fitness, Workload and Mood State Changes to Periods of Congested Match Play in Professional Soccer Players

“…A wide variety of biochemical, hematological, and physiological markers have been used for long-term monitoring of athletes (Heisterberg et al, 2013;Silva et al, 2013). In particular, cortisol (C) and testosterone (T) have been identified as reliable markers of training stress and could be considered two important hormones in the biochemical assessment of athletes (Adlercreutz et al, 1986;Hackney, 2020). In addition, the T/C ratio has additionally been used to evaluate soccer players' anabolic/catabolic status (Urhausen et al, 1995).…”

Hormonal Changes in High-Level Aerobic Male Athletes during a Sports Season

“…However, in a recent review suggesting that running mileage alone is not enough to predict the low T concentrations [ 52 ], it was proposed that the alterations in the endocrine–reproductive hormonal system observed in endurance runners are related to the development of low energy availability (LEA) [ 33 ]. In healthy and active women, it has been established that an adequate energy intake is ≥45 kcal/kg FFM [ 53 ]; whether intake in men is similar is currently under debate [ 52 ]. In our study, runners reported an energy intake lower than 45 kcal/kg FFM initially and especially at 3 months, a period when the runners ran more km/week, and basal T and LH concentrations were the lowest of the season.…”

The hypothalamic-pituitary-gonadal axis dysfunction in men practicing competitive sports

“…A diagnosis of male hypogonadism must compriseboth persistent clinical symptoms and biochemical evidence of testosterone deficiency (38). Testosterone threshold levels for diagnosis of hypogonadism are below 3-4 ng per ml (34).…”

“…Specifically, such conditions in men may derive acutely and be associated with low energy availability (i.e., Relative Energy Deficiency in Sports) or excessive training load (i.e., overtraining). However, manifestations of a more chronic based hypogonadism that persists on a more permanent basis (years) exist and is termed the "Exercise Hypogonadal Male Condition" (33,34).…”

“…In 2005 Hackney et al proposed the use of the term "Exercise Hypogonadal Male Condition" (EHMC) for exercise trained men who showed lowered testosterone. Hackney et al showed that highly trained or overtrained male athletes had 40-80% lower levels of testosterone compared to controls (34). Men with this condition have certain characteristics:…”