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

Area of Science:

• Sports Medicine
• Endocrinology
• Exercise Physiology

Background:

• Athletic men engaging in intensive exercise can experience hypogonadism, characterized by low testosterone and hypothalamic-pituitary-gonadal (HPG) axis alterations.
• The International Olympic Committee's "Relative Energy Deficiency in Sports" (RED-S) acknowledges reproductive health disruptions in both sexes, moving beyond the "Female Athlete Triad."
• While similarities exist between male hypogonadism and RED-S in women, distinct differences necessitate further investigation into male-specific conditions.

Purpose of the Study:

• To provide an updated overview of acute and chronic relative hypogonadism in athletic men.
• To propose mechanistic models for the development of exercise-related hypogonadism in males.
• To differentiate between transient and persistent forms of exercise-induced hypogonadism.

Main Methods:

• Review of existing research on exercise-induced hypogonadism in men.
• Analysis of the International Olympic Committee's "Relative Energy Deficiency in Sports" (RED-S) framework.
• Postulation of mechanistic models for acute and chronic hypogonadism development.

Main Results:

• Exercise-related hypogonadism in men can manifest acutely due to low energy availability or overtraining, often resolving with intervention.
• A chronic form, termed "Exercise Hypogonadal Male Condition," involves persistent hypogonadism lasting years.
• Evidence suggests sex-specific differences in the development and presentation of exercise-related reproductive disruptions.

Conclusions:

• Athletic men can experience diverse forms of exercise-related hypogonadism, varying in duration and etiology.
• Understanding these distinct conditions is crucial for accurate diagnosis and effective clinical management in male athletes.
• Further research into mechanistic models will elucidate the complex interplay between exercise, energy availability, and male reproductive health.