The presence of symptoms of testosterone deficiency in the exercise-hypogonadal male condition and the role of nutrition

Eur J Appl Physiol. 2017 Jul;117(7):1349-1357. doi: 10.1007/s00421-017-3623-z. Epub 2017 May 3.


Purpose: High volumes of aerobic exercise have been associated with reduced testosterone (T), known as the exercise-hypogonadal male condition (EHMC). Although the presence of low T has been identified, few studies have assessed the presence of androgen-deficient symptoms. The purpose of this investigation is to assess men exhibiting EHMC and evaluate their hypothalamic-pituitary-gonadal axis, the presence of hypogonadal symptoms, and also investigate a possible contribution of inadequate nutrition to the condition.

Methods: A cross-sectional design compared 9 long-distance runners exhibiting EHMC to 8 non-active controls. Comparisons included serum T, luteinizing hormone (LH), follicle-stimulating hormone, and cortisol, the Aging Male Symptoms (AMS) questionnaire score, bone mineral density (BMD), and a food frequency questionnaire.

Results: Mean T was significantly reduced in the EHMC group (EHMC 9.2 nmol L-1 vs. CONT 16.2 nmol L-1). The EHMC group demonstrated significantly higher AMS scores (EHMC 27.1 ± 7.3 vs. CONT 19.7 ± 2.5). There were no differences in bone density, although 3 cases of osteopenia were noted for EHMC in the lumbar spine, 1 in the right femur, and 1 in the radius. Energy availability was significantly reduced in EHMC (EHMC 27.2 ± 12.7 vs. CONT 45.4 ± 18.2 kcal d FFM-1).

Conclusions: Men exhibiting EHMC do appear to present with symptoms associated with androgen deficiency. For the most part, these symptoms are limited to those reported on the AMS questionnaire, although there are also some cases of clinically low BMD. It is possible that inadequate energy intake is contributing to this condition.

Keywords: Energy balance; Exercise-hypogonadal male condition; Hypogonadism; Low testosterone.

MeSH terms

  • Adult
  • Bone Density
  • Energy Intake*
  • Eunuchism / blood
  • Eunuchism / etiology*
  • Eunuchism / pathology
  • Follicle Stimulating Hormone / blood
  • Humans
  • Hydrocortisone / blood
  • Hypothalamo-Hypophyseal System / physiology
  • Luteinizing Hormone / blood
  • Male
  • Middle Aged
  • Nutritive Value
  • Running*
  • Testosterone / blood*
  • Testosterone / deficiency


  • Testosterone
  • Luteinizing Hormone
  • Follicle Stimulating Hormone
  • Hydrocortisone