Hormonal Imbalances and Bone Density Loss Occurs in Male Athletes

By Elissa Rosen, MD, CEDS-S


There is a lot of talk of menstrual cycles in female athletes. Why? Menstruation is an easy marker to follow for possible signs of insufficient energy intake. A female athlete with low energy availability may develop irregular or absent menstrual cycles. While there is no direct equivalent marker in male athletes, insufficient fueling can impact hormone levels in male athletes, in particular testosterone. (1) Testosterone is a male sex hormone that serves many important functions including increasing muscle mass and bone growth. As energy deficiency becomes more severe, the hypothalamus in the brain stops the release of gonadotrophin releasing hormone (GnRH), which then leads to decreased testosterone production. Low testosterone can manifest as decreased libido, low bone mineral density, decreased muscle mass, and fatigue to name a few. Just like with female athletes, male athletes that have low testosterone due to inadequate energy intake can suffer from bone density loss. As bone density loss can be one of the irreversible consequences of insufficient fueling, it is important to reverse RED-S in order to prevent bone loss. In non-athlete males with bone density loss due to low testosterone, testosterone replacement therapy can be given in the short terms. However, testosterone is a banned substance for competitive athletes and should NOT be given to male athletes. In this situation, athletes are encouraged to work with an expert team that understands the medical, nutritional, and psychological effects of RED-S and can help advise treatment.


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