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.
Highlights
Many national and international organizations have touted the health benefits of being physically activity and engaging in exercise training [1, 2]
The renewed interest and explosion of new research on exercising men and hypogonadism development seems long overdue; as the topic has flown under the radar for many years
Investigators must approach this topic with a grasp of the scope of what has been done, what is known, and what needs to be addressed
Summary
Many national and international organizations have touted the health benefits of being physically activity and engaging in exercise training [1, 2]. Perhaps the most notable endocrine dysfunction linked to exercise training is that which involves disrupts in a woman’s reproductive system leading to the development of secondary amenorrhea—what was originally referred to as “athletic amenorrhea.” This occurrence is recognized as part of the consequences of the medical condition known as the Female Athletic Triad (Triad) which is associated with increased risk for infertility, bone mineral loss, potentially disordered eating behaviors as well as reduced reproductive hormone levels [7]. This article is organized into several sections addressing specific questions related to the topic: [1] How is hypogonadism defined? [2] What is normal testosterone levels in men? [3] Why is testosterone so critical to athletes-exercisers? [3] What are situations inducing exercise hypogonadism? [4] Dysfunction or adaption-regulatory adjustment? [5] What are actions to deal with low testosterone in athletes-exercisers? and [6] Summary, conclusions and perspective
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