Testosterone and endurance exercise: the "exercise-hypogonadal male condition"


Posted by Coach Manuel Delgado Goana

Exercise Produced, Exercise Treated


Athletes who are involved in endurance exercise such as marathons, triathlons, cycling and race walking are subject to tremendous stress due to the volume, frequency, and intensity of training. This can result in non-positive physiological responses, particularly in the neuroendocrine system which is extremely sensitive to stress - not just exercise-related stress, but work, financial, and family stresses as well.

For male athletes, chronic exposure to endurance exercise training could produce alterations such as low basal resting testosterone concentrations. Some men exhibit testosterone concentrations at the extreme low end of normal range that could technically be considered as “normal” concentrations, but they are 40-75% that of normal, healthy, age-matched sedentary men. Clinically this low concentration is expressed as low libido and fertility issues. Muscular mass usually is not affected by this low concentration.

Other important body system alterations associated with chronic exposure to endurance exercise is low bone density expressed frequently as stress fractures or non-logical fractures resulting from mild running or bikes crashes.

X-ray of a 30-year old professional triathlete after a 5 mph bike crash, he has history of previous foot stress fracture. The x-ray shows important low bone density at cortical and trabecular bone.


Alterations in mood, sleep, recovery and appetite have also been associated with this, creating a vicious cycle.

Often, laboratory findings in men with exercise-hypogonadal male condition show low concentrations of Luteinizing Hormone -LH- and high levels of Prolactin and Cortisol. It is well established that low levels of LH and high levels of prolactin and cortisol affect the concentration of testosterone as result of a dysfunction of the hypothalamic-pituitary-testicular regulatory axis.

In my experience as doctor, coach, athlete, husband and father, and supported by research, I would say this condition is a multifactorial condition, with endurance exercise as only a fraction (an important one but not the only one) of the etiologic factors.

Here are other important etiologic factors that can potentially affect the testosterone levels:


We know that pressures related to work, family, health, social and economic conditions are capable of producing high levels of cortisol and prolactin in sedentary people and these directly impact the regulation of testosterone secretion. For professional and age group athletes, these stresses are additive to that of the chronic endurance exercise, increasing the probability that the regulation of testosterone secretion is affected.


Antihistaminic, antidepressive, hypertensive and antifungal medications are typically used long-term: antidepresive medication at least 6 months, antifungal and antihistaminic a mean of 3-6 months, and hypertensives for even longer. These medications affect, in different ways, plasmatic testosterone concentration and similarly to stress, could add, synergized or potentiate the effect of exercise in producing a dysfunction of the hypothalamic-pituitary-testicular regulatory axis resulting in lower testosterone plasmatic concentration.

High Altitude

One of the endocrine effects of physical performance at high altitudes – such as high altitude training camps or living at high altitude - included an increase in prolactin and progesterone and decrease in testosterone levels as result of the hypoxic condition. This effect is further increased if the exercise is performed at high intensity.


As you can see, male athletes are exposed to multiple conditions that could affect testosterone regulation resulting in low testosterone concentration. This low concentration can have negative effects on the athlete’s health and social/family life.

In the next article I will review the diagnosis and treatment of this condition.

Dr. Manuel Delgado Gaona is a USAT Level II and Youth & Junior Coach, FMTri Level II Certified Coach, an ACSM exercise physiologist, and a physician specializing in anatomic pathology. He has coached age group and professional athletes at national and world levels, including those who have competed at ITU and Ironman 70.3 World Championships. Coach Manuel has been the doctor for “burned out” and chronically injured athletes, helping them get back into sport successfully and keeping them free of injuries for years. Two years ago he moved to Del Rio, Texas, to open an endurance coaching and exercise physiology studio and promoted triathlon and endurance sports among the south Texas population. His coaching philosophy is based on exercise efficiency, not only for professional athletes but for age group athletes as well. He can be reached at manuel@teamMPI.com

Share |

Keep up with the Blog with RSS.




Posted by Coach Allen Stanfield on March 19, 2018

I race for me

Posted by Coach Laura Henry on March 19, 2018

A Gut Feeling: Fueling Your Unique Body

Posted by Coach Becky Piper on March 18, 2018

Plan Your Taper to Peak on Race Day

Posted by Coach David Bauerle on March 10, 2018

Finding Your Ideal “Race Weight”

Posted by Coach Amanda Leibovitz on March 08, 2018

Christine Palmquist named USAT Paratriathlon Coach of the Year

Posted by admin on March 05, 2018

Exercise-Hypogonadal Male Condition: Exercise Produced-Exercise Treated

Posted by Coach Manuel Delgado Goana MD on March 04, 2018

The Control Game

Posted by Coach Liesl Begnaud on March 04, 2018

The Don'ts of my first Ultramarathon

Posted by Coach Adam Sczech on February 25, 2018

Less is often More

Posted by Coach Chris Palmquist on February 25, 2018


Full Blog Archive

Sign up for our Newsletter

Keep up with the latest tips, news, and events from Team MPI.