Hypogonadism in Exercising Males
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
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Hypogonadism in exercising males resembles Triad/RED-S in women, but has some unique differences.
Both disorders can be caused by varying forms of reproductive disruption and a heavy training load.
However, the cause of the condition is still unknown. Other possible causes include inadequate energy supply and overtraining.
MetaboAnalyst
Despite the similarities to Triad/RED-S syndrome in women, hypogonadism in exercising males has a distinct biological mechanism.
Hypogonadism may be the result of reproductive disruption caused by exercise, such as an overload of energy or overtraining.
Symptoms of hypogonadism are mild to moderate and can be difficult to detect, as hypogonadism is sometimes misdiagnosed as aging or a chronic comorbidity.
Despite the lack of direct symptoms, hypogonadism can affect men's sexual performance.
This is confirmed by a study by the Massachusetts Male Aging Study (MMAS) which included 1,709 males aged 40-70 years.
Hypogonadism is frequently associated with metabolic disorders and obesity, so the first line of therapy in obese males is weight loss.
A low-calorie diet has been shown to reverse secondary hypogonadism caused by obesity. This diet also reduces the circulating levels of oestrogens, a hormone that inhibits testosterone production.
Hypogonadism is a prevalent condition that affects males with T2DM, MetS, CVD, chronic obstructive pulmonary disease, or renal disease.
Genetics are the most common cause of hypogonadism in adults. The 47,XXY karyotype is associated with this condition.
Metabolic syndrome
Physiological signs of hypogonadism in exercising males include low hematocrit and hemoglobin.
Treatment with androgens can return these parameters to normal. However, exercise-induced hypogonadism may not have the same effect as natural hypogonadism.
Hypogonadism in exercising male athletes can persist for years. It is a condition that can occur due to intensive training and low testosterone levels.
The International Olympic Committee's Medical Commission coined the term "Relative Energy Deficiency in Sports" to raise awareness of reproductive disturbances in male athletes.
Several studies have attempted to define hypogonadism in exercising males, but they have not found a unified definition.
While most studies use testosterone cut-off values that are within the normal range, there is little consensus on the clinical definition of hypogonadism.
While the causes of exercise-induced hypogonadism are unclear, the main cause appears to be HPG axis dysfunction. This disorder affects a significant proportion of endurance athletes.
The condition is caused by disrupting processes involving testosterone and HPG. Hypogonadism in exercising males is estimated to occur in up to 15% of men.
Adaptive-Regulatory Adjustment
Male athletes who exercise heavily may experience hypogonadism, which is marked by low resting testosterone levels and disturbances to the HPG axis.
This condition has been studied in both women and men, and it may be associated with various types of reproductive disruption and an increased training load.
Hypogonadism in adults is often mild and difficult to diagnose. It can be confused with ageing or a chronic comorbidity.
It is important to understand that hypogonadism may result in sexual impairment, so it is essential to identify symptoms.
In an observational study conducted in the United States, ageing and obesity were the most common causes of hypogonadism.
Men with hypogonadism are prone to obesity, which can exacerbate the condition.
Hypogonadism is associated with greater fat mass and lower lean mass, and it has been linked to atherosclerosis. In addition to this, hypogonadism impairs glucose uptake into subcutaneous and ectopic fat depots.
While the symptoms of hypogonadism are largely independent of the underlying aetiology, the age at which hypogonadism manifests is significant.
In the foetal stage, androgen deficiency may be accompanied by various defects of virilisation and genitalia, and may result in delayed puberty.
Genetics
Genetics of hypogonadism is a complex issue. The disorder is most common in men who are over 50 years old.
This condition affects a man's ability to produce testosterone. As a result, the range of testosterone in his blood is lower than it is in a 20 to 30-year-old man.
The clinical symptoms of hypogonadism vary greatly and depend on the type and severity of the condition.
Symptoms may include reduced libido, decreased bone mineral density, muscle loss, and infertility. Some males may also lose their hair.
The disease also affects mood and energy levels and may be accompanied by depression or fatigue.
There are several genetic causes of hypogonadism in males. Some of these disorders are caused by the presence of an extra X chromosome in the man's sperm.
The condition can cause smaller testes, resulting in lower testosterone levels. The most common form of hypogonadism in men is Klinefelter syndrome, which is characterized by delayed or absent puberty, low sperm counts, and decreased testosterone.
Genetic testing can help diagnose hypogonadotropic hypogonadism. A patient's medical history, physical exam, and laboratory tests may help determine the condition.
Using next-generation sequencing technology, doctors can test for a wide range of genes at once. Treatment for CHH depends on the severity of hypogonadotropic hypogonadism and the desire to preserve fertility.
Treatment options often involve the administration of human chorionic gonadotropin or recombinant follicle stimulating hormone (rFSH), which are hormones that stimulate testosterone production and spermatogenesis.
A recent study of 14,000 men found that men with three or more SHBG gene variations were six times more likely to have low testosterone than those with none.
This association was even more significant in men who had a BMI of 30 kg/m2 or higher. It is therefore important to monitor testosterone levels closely and discuss any concerns with your doctor.
Treatment
Exercise-induced hypogonadism in males has been linked to a hypothalamic-pituitary-testicular axis dysfunction.
However, the exact mechanism is not yet known. It is not known whether hypogonadal men exhibit impaired testosterone and/or a decrease in hemoglobin levels.
While a testosterone-like substance like clomiphene citrate may help the hypogonadal male to restore his sex life, more research is required to confirm its effectiveness.
A study conducted by Francomano et al. found that testosterone improved endothelial function in hypogonadal males with obesity.
However, it was an open-label study and did not include supervised exercise or a control group.
Further, the study did not assess adherence or compare testosterone levels between the exercised and control groups.
Conclusion
Hypogonadism is a condition where testosterone levels are lower than normal in men.
It can be caused by a number of factors, including age, obesity, and smoking. It is also inherited, which may lead to its complications.
Hypogonadism in exercising males is a condition characterized by the presence of testosterone-deficiency and adverse effects on multiple organ functions and quality of life.
To be diagnosed with hypogonadism, a man must exhibit persistent clinical symptoms and biochemical evidence that testosterone levels are below normal.
Generally, testosterone levels of under three to four ng per ml are regarded as hypogonadal.
Hypogonadism may be secondary or primary and may have a wide spectrum of symptoms.
Treatment for primary hypogonadism focuses on normalising testosterone levels. Treatment of secondary hypogonadism aims to reestablish normal ejaculation and normal reproductive functions.
Secondary hypogonadism is a form of the disease that affects both males and their sex life. It can result in premature puberty and various virilisation defects.
Low levels of testosterone are also associated with metabolic disorders, including obesity and diabetes. For men who are overweight and suffer from hypogonadism, weight loss should be the first treatment.
Studies have demonstrated that losing excess weight may reverse secondary hypogonadism. Dietary restriction may reduce circulating oestrogen levels and restore testosterone levels to normal.
