Abstract
Sport-related brain injury (SRBI) occurs when a blow to the head causes the brain to move back and forth in the skull, and can lead to neuroendocrine dysfunction. Research has shown that males and females experience and recover from SRBI differently, yet most of what is known regarding diagnosis, treatment, and recovery of SRBI is based on male normative data even though females meet or exceed incidence numbers of SRBIs compared to those of males. Females also have been known to have worse outcomes and a greater number of symptoms following SRBI than males. Research is limited as to why females have worse outcomes, but sex hormones have been suggested as a potential reason. SRBI may cause a dysregulation of the hypothalamic–pituitary–gonadal (HPG) axis, which is responsible for regulating the sex hormones estrogen and progesterone. Initial research has shown that SRBI may suppress estrogen and progesterone, and the concentration of these sex hormones could be indicative of injury severity and recovery trajectory. This review discusses the sex-specific differences in SRBI and also the future direction of research that is needed in order to identify the repercussions of SRBIs for female athletes, which will eventually lead to better clinical treatment, sideline care, and recovery profiles.
Highlights
Since the passage of Title IX in 1972, female sport participation has steadily increased in the United States
The passage of Title IX mandated, among other things, equal sport opportunities for females. While this did not lead to equal numbers of males and females playing all sports, female athlete participation in high-contact and collision sports that were historically limited to male athletes, such as ice hockey, rugby, and tackle football [1,2] has increased—and by extension, the number of sport injuries in female athletes has increased, including sport-related brain injury (SRBI)
There are no diagnostic processes or well-established algorithms to screen for hypopituitarism in female athletes when a SRBI is experienced. This is problematic since recent research has suggested that hypopituitarism after SRBI may be more common than once thought and that anterior hypopituitarism is likely to be seen in approximately 25% of female athletes with SRBI [56]
Summary
Since the passage of Title IX in 1972, female sport participation has steadily increased in the United States. The passage of Title IX mandated, among other things, equal sport opportunities for females. While this did not lead to equal numbers of males and females playing all sports, female athlete participation in high-contact and collision sports that were historically limited to male athletes, such as ice hockey, rugby, and tackle football [1,2] has increased—and by extension, the number of sport injuries in female athletes has increased, including sport-related brain injury (SRBI). Depending on the severity and magnitude of the SRBI, hypopituitarism can cause a withdrawal of hormones such as estrogen and progesterone, resulting in neuroendocrine dysfunction [11,12,13]. Most of what is known regarding the diagnosis and treatment of, and recovery from SRBI is based on male normative values, which is problematic given that males and females experience and recover from SRBI differently [6,14,15]
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