Basal Hormones and Biochemical Markers as Predictors of Overtraining Syndrome in Male Athletes: The EROS-BASAL Study

J Athl Train. 2019 Aug;54(8):906-914. doi: 10.4085/1062-6050-148-18. Epub 2019 Aug 6.


Context: Overtraining syndrome (OTS) and related conditions cause decreased training performance and fatigue through an imbalance among training volume, nutrition, and recovery time. No definitive biochemical markers of OTS currently exist.

Objective: To compare muscular, hormonal, and inflammatory parameters among OTS-affected athletes, healthy athletes, and sedentary controls.

Design: Cross-sectional study.

Setting: Laboratory.

Patients or other participants: Fifty-one men aged 18 to 50 years (14 OTS-affected athletes [OTS group], 25 healthy athletes [ATL group], and 12 healthy sedentary participants [NCS group]), with a body mass index of 20 to 30.0 kg/m2 (sedentary) or 20 to 33.0 kg/m2 (athletes), recruited through social media. All 39 athletes performed both endurance and resistance sports.

Main outcome measure(s): We measured total testosterone, estradiol, insulin-like growth factor 1, thyroid-stimulating hormone, free thyronine, total and fractioned catecholamines and metanephrines, lactate, ferritin, creatinine, creatine kinase, erythrocyte sedimentation rate, C-reactive protein, lipid profile, hemogram, and testosterone : estradiol, testosterone : cortisol, neutrophil : lymphocyte, platelet: lymphocyte, and catecholamine : metanephrine ratios. Each parameter was statistically analyzed through 3-group comparisons, and whenever P < .05, pairwise comparisons were performed (OTS × ATL, OTS × NCS, and ATL × NCS).

Results: Neutrophils and testosterone were lower in the OTS group than in the ATL group but similar between the OTS and NCS groups. Creatine kinase, lactate, estradiol, total catecholamines, and dopamine were higher in the OTS group than in the ATL and NCS groups, whereas the testosterone : estradiol ratio was lower, even after adjusting for all variables. Lymphocytes were lower in the ATL group than in the OTS and NCS groups. The ATL and OTS groups trained with the same intensity, frequency, and types of exercise.

Conclusions: At least in males, OTS was typified by increased estradiol, decreased testosterone, overreaction of muscle tissue to physical exertion, and immune system changes, with deconditioning effects of the adaptive changes observed in healthy athletes.

Keywords: hormonal physiology; metabolism; sports endocrinology.

MeSH terms

  • Adaptation, Physiological
  • Adult
  • Athletes
  • Biomarkers / analysis
  • Biomarkers / blood
  • Cross-Sectional Studies
  • Cumulative Trauma Disorders / complications
  • Estradiol / blood*
  • Exercise / physiology*
  • Exercise Test / methods
  • Fatigue* / etiology
  • Fatigue* / immunology
  • Fatigue* / metabolism
  • Fatigue* / physiopathology
  • Humans
  • Immunologic Tests / methods
  • Male
  • Middle Aged
  • Nutrition Disorders / complications
  • Sports / classification
  • Sports / physiology*
  • Testosterone / blood


  • Biomarkers
  • Testosterone
  • Estradiol