The clinical suspicion of the exercise-hypogonadal male condition is based first on symptoms referred by the athlete to his coach or doctor. These symptoms include, but are not limited to, unexplained weight gain, lack of progress on his sport goals, loss of libido, a state of continuous feeling of fatigue, or simply a feeling of not being the same!
The laboratory findings reviewed in the first part of this series are used to confirm the diagnosis of this condition. It is important that a doctor has ruled out other organic factors that could potentially produce a hypogonadal condition.
In my medical experience, this diagnosis can be difficult for the athlete/patient because of the related loss of virility. But there are treatment options.
The common first treatment path is prescribing testosterone or testosterone precursors. However, these substances are included on the WADA´s list of banned substances. The use of testosterone or T-precursors will result in suspension of the sport no matter if the athlete is amateur or pro. Doctors may be unaware of the athlete status of the patient.
There are different options for treatment. Remember that this is a multifactorial problem, so it is important to investigate and consider other factors that potentially added to the impact of the chronic exposure to endurance exercise training (part I):
For athletes prioritizing fertility issues over athletic goals.
Cease endurance training for at least 3 to 6 months.
Begin a resistance training program focused on power/hypertrophy. This kind of training helps to boost the testosterone levels. It is highly recommended to hire a strength and conditioning specialist to prescribe the individualized resistance training program.
Review the medication history for prescriptions related to allergies, fungus, depression and hypertension and consult a doctor for options that do not affect the testosterone production.
Assess your social/work/personal stress levels. If it is high, consider hiring a stress management specialist.
Review your rest and nutrition and make changes if necessary. A registered nutritionist could help you to implement a nutrition plan that supports your resistance training program.
Analyze testosterone levels consistently at the same time of the day, T-levels fluctuate during the day.
Athletes with no fertility issues but low-T symptoms
Reduce the volume of endurance training by at least 50 to 70% for 3 to 6 months.
Utilize a training program that is focused to avoid a high drop of the VO2 max including short (no more than 60 min) medium to high intensity workouts of the sport (running, triathlon or cycling).
Avoid high altitude camps and training. If you live in a high-altitude place, reduce the intensity of your workouts and keep them short.
Proceed with steps 3,4, 5, 6 of the previous option.
Fortunately, the hypothalamic-pituitary-testicular regulatory axis responds well when stressors are removed and a resistance exercise program is added. Testosterone levels should be restored in a 3 to 6 month period, with the symptoms reducing gradually over that time.