EXSS Faculty Friday – Low Testosterone and Exercise Research by Dr. Anthony Hackney

Our recent blog posts highlight the research impact of our faculty and students and describe how this work directly impacts society.  One of the questions that we are often asked by our students is “how did we develop the idea for this research study?”  The story describing how the research idea was formed is often not simple, as many of these research study ideas are formed over the course of an individuals career and each study idea builds from the previous.  Thus, the story behind how these ideas are formed are perhaps just as interesting and impactful as the latest study.

Tony Hackney's Endocring Group 2013-2014

Exercise Endocrine Group 2013-14. Left to right; Tony Hackney, Colin O’Leary, Amy Lane, Michelle Pebole, Timmons Williams, and Elizabeth Walz

We thought it would be of interest to highlight how our faculty developed their ideas for establishing their scholarly agendas and how their most recent work was formed by many years of previous work.  This week we highlight the story of Dr. Anthony Hackney, who is a Professor and Associate Chair in the Department of Exercise and Sport Science.  Dr. Hackney is one of the most prolific researchers in EXSS with over 200 scientific publications and many different academic awards for his scholarly efforts.  He directs the Applied Physiology Laboratory, where he works with his students in the area of endocrinology.

I hope you enjoy this week’s #EXSSFacultyFriday update.

Exercise and Low Testosterone: The “Exercise Hypogonadal Male Condition”

In 1981 I was a young graduate student working in a research project which was trying to determine the causality of “athletic amenorrhea”, a newly identified medical condition associated with women who were intensive exercisers and had poor nutritional habits (which resulted in them losing their menstrual cycle). This was fascinating work for me, but I remember one day asking the endocrinology professor I was working with “if this happens to women who are exercisers, what happens to men who do the same thing?” His response was “I don’t know, why don’t you go find out?” This conversation started a 30+ year pursuit of an answer to my question.

Reproductive Health Issues Research – Men and Women

Women who develop athletic amenorrhea typically have low levels of their reproductive hormones, become anovulatory, have an absence of their menses, are usually infertile, and experience significant bone demineralization which puts them at high risk for stress fractures. These are all major medical concerns that impact the health of a woman. My fundamental question asked so many years ago was essential is men’s health at the same risk for similar concerns? The pursuit of an answer to my question on men has resulted in dozens of research studies and countless hours in the laboratory for my students and me. The findings from this hard work culminated in 2005 with our publishing a seminal summary paper declaring that once gender specific issues are taken into account, exercise does affect the male reproductive system in a negative fashion and can result in what we named the “Exercise Hypogonadal Male Condition” (EHMC). Most of the details of our studies through this long journey are recounted in a book Naama Constantini (MD, Israel) and I published last year, Endocrinology of Physical Activity and Sport (Springer).

The hormonal and endocrinological changes that occur in women with Athletic Amenorrhea and men displaying the Exercise Hypogonadal Male Condition are strikingly similar. For example, women have low estrogen-progesterone levels, men have low testosterone levels, and the reproductive regulatory mechanism in both sexes is disrupted. A key difference, however, is how the conditions manifest themselves – women loses their menstrual cycle and stop menstruating and men have disruption of their sperm production process – impacting on the fertility level of each. However, it is obvious to women when their condition develops (i.e., they know they have lost their period); but, men have no external cue that their problem exists.

Scientific Community Impact

The work my research group has done in this area has led to several major medial and endocrinology societies in the world acknowledging the existence of EHMC, and the need for healthcare providers to take the condition into consideration when dealing with infertility issues in heterosexual couples or as a causative agent in the development of low testosterone (Low T) in men. In the medical community the development of Low T has become an issue of increasing importance; so much so, that recently the American College of Sports Medicine ran a feature article on the topic written by Amy Lane (doctoral student) and me in their publication ACSM Fit Society (Volume 16, No. 1, page 3-4, January 2014).

Public Impact

Our findings beg the question – “Should most men who are involved in exercise be worried about this condition?” The simple answer is no, not to a great extent. The prevalence of EHMC is such that the condition seems to impact a relatively small segment of the exercising population. However, the risk increases considerable in men who have participated in endurance exercise activities (e.g., distance running, triathlons, race walking, cycling) for long periods of time (> 10 years). Typically, these are sporting activities with a consistent demand of high volumes of training, which seems to be a trigger EHMC. Should men with the condition be treated for the Low T?  That’s a decision to make with a healthcare provider; but, some of the men from our research studies, once diagnosed, have chosen to do so.

Future

After more than 30 years of looking at a topic, one might think that our research group has exhausted all avenues of pursuit. That is far from the case, as my research team has started recently to examine what are the relationships between exercise training, EHMC development and sexual libido. Interestingly little to no work has addressed this topic and most certainly in the context of low testosterone and reproductive dysfunction it seems a worthwhile pursuit to know if sexual desire in exercising men is impacted by these factors. We are in the preliminary stages of this work and no answers have been derived yet. The initial aspects of this work involve online questionnaire extraction of information from men who are high volume exercisers and at risk for EHMC. Currently we have a little over 750 participants, but are looking for more all the time (website link: https://uncdentistry.az1.qualtrics.com/SE/?SID=SV_eWESbBdaONSuUPb). Stay tuned as I hope to have results from this work in another year or two and I expect it will generate some new questions that I hope will keep me busy to somewhere near the 40+ year mark.

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