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Hunter SK, S Angadi S, Bhargava A, Harper J, Hirschberg AL, D Levine B, L Moreau K, J Nokoff N, Stachenfeld NS, Bermon S. The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine. Med Sci Sports Exerc 2023; 55:2328-2360. [PMID: 37772882 DOI: 10.1249/mss.0000000000003300] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
ABSTRACT Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%-30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, but remains low in females. The primary goal of this consensus statement is to provide the latest scientific knowledge and mechanisms for the sex differences in athletic performance. This review highlights the differences in anatomy and physiology between males and females that are primary determinants of the sex differences in athletic performance and in response to exercise training, and the role of sex steroid hormones (particularly testosterone and estradiol). We also identify historical and nonphysiological factors that influence the sex differences in performance. Finally, we identify gaps in the knowledge of sex differences in athletic performance and the underlying mechanisms, providing substantial opportunities for high-impact studies. A major step toward closing the knowledge gap is to include more and equitable numbers of women to that of men in mechanistic studies that determine any of the sex differences in response to an acute bout of exercise, exercise training, and athletic performance.
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Affiliation(s)
- Sandra K Hunter
- Exercise Science Program, Department of Physical Therapy, and Athletic and Human Performance Center, Marquette University, Milwaukee, WI
| | | | - Aditi Bhargava
- Department of Obstetrics and Gynecology, Center for Reproductive Sciences, University of California, San Francisco, CA
| | - Joanna Harper
- Loughborough University, Loughborough, UNITED KINGDOM
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, SWEDEN
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kerrie L Moreau
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, and Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, CO
| | - Natalie J Nokoff
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nina S Stachenfeld
- The John B. Pierce Laboratory and Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Stéphane Bermon
- Health and Science Department, World Athletics, Monaco and the LAMHESS, University Côte d'Azur, Nice, FRANCE
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Enea C, Delpech N, Bosquet L. Comment on: "Menstrual Cycle: The Importance of Both the Phases and the Transitions Between Phases on Training and Performance". Sports Med 2023; 53:761-762. [PMID: 37133672 DOI: 10.1007/s40279-022-01778-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Affiliation(s)
- C Enea
- Laboratoire MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, TSA 31113, 96073, Poitiers Cedex 9, Poitiers, France.
| | - N Delpech
- Laboratoire MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, TSA 31113, 96073, Poitiers Cedex 9, Poitiers, France
| | - L Bosquet
- Laboratoire MOVE (UR20296), Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, TSA 31113, 96073, Poitiers Cedex 9, Poitiers, France
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Smirnov VV, Beeraka NM, Butko DY, Nikolenko VN, Bondarev SA, Achkasov EE, Sinelnikov MY, Vikram PRH. Updates on Molecular Targets and Epigenetic-Based Therapies for PCOS. Reprod Sci 2023; 30:772-786. [PMID: 35764857 DOI: 10.1007/s43032-022-01013-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 12/23/2022]
Abstract
Polycystic ovarian syndrome (PCOS) can cause infertility in females due to hyperandrogenism and neuroendocrine abnormalities. The aim of this study is to decipher the impact of endocrine variables, hyperandogenism, insulin resistance, oxidative stress, and dietary conditions in PCOS conditions, subsequently to depict the role of epigenetic factors relative to phenotypic manifestations in PCOS conditions. We have reviewed several metabolic milieus pertinent to PCOS conditions. Comparative efficacies of various PCOS therapies, and recent clinical recommendations for the effective management of PCOS and role of metabolic/endocrine variables in PCOS conditions were described. Comparative therapeutic effects were vividly delineated according to the variable pathophysiology and internal variables during PCOS syndrome on the female body through the formation of cascade of endocrine pathology, which affects working capacity and fosters redox stress-induced cardiovascular, neural, and liver abnormalities. GLP-1 agonists, insulin sensitizers (metformin), and diet and exercise regimens efficacy were explained in enhancing the fertility outcomes among the overweight or obese females with PCOS. Comprehensive appraisal of DNA methylation as epigenetic changes and the manifestations of methylated genes in PCOS conditions were discussed particularly to screen novel molecular targets for developing efficient diagnostic indicators for predicting PCOS risk or its progression. Due to the reversible nature of epigenetic modifications, it is possible to screen the "druggable" regions to target or to correct abnormalities in the gene expression subsequently to develop chromatin-modifying therapies against PCOS.
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Affiliation(s)
- Viktor V Smirnov
- Department of Medical Rehabilitation and Sports Medicine, Saint Petersburg State Pediatric Medical University of the Ministry of Health of the Russian Federation Saint Petersburg, Saint Petersburg, Russia
| | - Narasimha M Beeraka
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str, Moscow, 119991, Russia. .,Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR; A DST-FIST Supported Center), Department of Biochemistry, JSS Medical College, Mysuru, India.
| | - Dmitry Yu Butko
- Department of Medical Rehabilitation and Sports Medicine, Saint Petersburg State Pediatric Medical University of the Ministry of Health of the Russian Federation Saint Petersburg, Saint Petersburg, Russia
| | - Vladimir N Nikolenko
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str, Moscow, 119991, Russia.,Department of Normal and Topographic Anatomy, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Sergey A Bondarev
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str, Moscow, 119991, Russia
| | - Evgeniy E Achkasov
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str, Moscow, 119991, Russia
| | - Mikhail Y Sinelnikov
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), 8/2 Trubetskaya str, Moscow, 119991, Russia
| | - P R Hemanth Vikram
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India
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Gimunová M, Paulínyová A, Bernaciková M, Paludo AC. The Prevalence of Menstrual Cycle Disorders in Female Athletes from Different Sports Disciplines: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114243. [PMID: 36361122 PMCID: PMC9658102 DOI: 10.3390/ijerph192114243] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 05/05/2023]
Abstract
The aim of this study was to rapidly review the literature on the prevalence of menstrual disorders in female athletes from different sports modalities. Articles were searched in the Web of Science and PubMed database in May 2022. A total of 1309 records were identified, and 48 studies were included in the final stage. The menstrual disorders described in the included studies were primary (in 33% of included studies) and secondary amenorrhea (in 73% of included studies) and oligomenorrhea (in 69% of included studies). The prevalence of menstrual disorders among the studies ranged from 0 to 61%. When data were pooled according to discipline (mean calculation), the highest prevalence of primary amenorrhea was found in rhythmic gymnastics (25%), soccer (20%) and swimming (19%); for secondary amenorrhea in cycling (56%), triathlon (40%) and rhythmic gymnastics (31%); and oligomenorrhea in boxing (55%), rhythmic gymnastics (44%) and artistic gymnastics (32%). Based on the results of this review, the study supports the literature of the higher prevalence of menstrual disorders in gymnastics and endurance disciplines. However, team sports modalities such as volleyball and soccer also presented a considerable percentage of menstrual disorders compared to the general population. It reinforces the importance of coaches and physicians paying attention to athletes' menstrual cycle as the occurrence of menstrual disorders can be associated with impairment on some health components.
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Affiliation(s)
- Marta Gimunová
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
- Correspondence:
| | - Alexandra Paulínyová
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
| | - Martina Bernaciková
- Department of Kinesiology, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
| | - Ana Carolina Paludo
- Incubator of Kinanthropological Research, Faculty of Sport Studies, Masaryk University, 62500 Brno, Czech Republic
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Enea C, Arc C, Delpech N. Les spécificités hormonales de la sportive de haut niveau : adapter la prise en charge pour optimiser la performance. Sci Sports 2022. [DOI: 10.1016/j.scispo.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hirschberg AL. Female Hyperandrogenism in Elite Sports and the Athletic Triad. Semin Reprod Med 2021; 40:32-41. [PMID: 34634825 DOI: 10.1055/s-0041-1736337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Essential hyperandrogenism seems to be overrepresented in female elite athletes. This applies to mild forms such as polycystic ovary syndrome, as well as rare differences/disorders of sex development (DSD). The reason is likely a selection bias since there is increasing evidence that androgens are beneficial for athletic performance by potent anabolic effects on muscle mass and bone mass, and stimulation of erythropoiesis. XY DSD may cause a greatly increased production of testosterone in the male range, that is, 10 to 20 times higher than the normal female range. The established regulations concerning the eligibility of female athletes with severe hyperandrogenism to compete in the female classification remain controversial. The most common cause of menstrual disorders in female athletes, however, is probably an acquired functional hypothalamic disturbance due to energy deficiency in relation to energy expenditure, which could lead to low bone mineral density and increased risk of injury. This condition is particularly common in endurance and esthetic sports, where a lean body composition is considered an advantage for physical performance. It is important to carefully evaluate endocrine disturbances and menstrual disorders in athletes since the management should be specific according to the underlying cause.
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Affiliation(s)
- Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
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Caballero-Guzmán A, Lafaurie-Villamil MM. Nadar con la menstruación: un estudio cualitativo en nadadoras de élite. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n3.76135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La menstruación en atletas es un fenómeno poco explorado desde una mirada cualitativa.Objetivo. Describir la experiencia de nadadoras de élite de una liga deportiva de Bogotá D.C. en relación con la menstruación y su práctica deportiva.Materiales y métodos. Estudio cualitativo descriptivo basado en entrevistas a profundidad. Participaron 9 nadadoras entre 18 y 29 años de las modalidades natación carreras, waterpolo y natación en aguas abiertas. Las entrevistas se transcribieron y se procesaron con el programa NVivoPro®.Resultados. Todas las participantes reportaron nadar durante su menstruación. Para ellas, la menstruación representa un serio problema que afecta su bienestar en la práctica de este deporte. Las principales dificultades descritas fueron la necesidad de ocultarla y restringirla; los síntomas psicológicos como la depresión y físicos como los cólicos; la poca empatía de algunos entrenadores; la escasa información que reciben por parte del personal de salud sobre la fisiología y manejo de la higiene menstrual, y el desconocimiento de métodos alternativos de manejo como la copa menstrual. Como aspecto positivo se reportó el apoyo de sus pares y entrenadoras, lo que hace que se sientan comprendidas en su condición de mujeres.Conclusiones. La menstruación es una condición que afecta el bienestar y desempeño de las nadadoras de élite, por lo tanto es necesario que sus implicaciones fisiológicas, psicológicas y sociales sean reconocidas en escenarios de alto rendimiento deportivo para brindar un mejor apoyo a estas atletas, lo que contribuirá a mejorar su calidad de vida y salud integral en general.
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Abstract
Emerging evidence indicates that testosterone, which can increase muscle mass and strength, stimulates erythropoiesis, promotes competitive behaviour, and enhances the physical performance of women. Indeed, the levels of testosterone within the normal female range are related to muscle mass and athletic performance in female athletes. Furthermore, among these athletes, the prevalence of hyperandrogenic conditions, including both polycystic ovary syndrome and rare differences/disorders of sex development (DSD), which may greatly increase testosterone production, are elevated. Thus, if the androgen receptors of an individual with XY DSD are functional, her muscle mass will develop like that of a man. These findings have led to the proposal that essential hyperandrogenism is beneficial for athletic performance and plays a role in the choice by women to compete in athletic activities. Moreover, a recent randomized controlled trial demonstrated a significant increase in the lean mass and aerobic performance by young exercising women when their testosterone levels were enhanced moderately. Circulating testosterone is considered the strongest factor to explain the male advantage in sport performance, ranging between 10 and 20%. It appears to be unfair to allow female athletes with endogenous testosterone levels in the male range (i.e. 10-20 times higher than normal) to compete against those with normal female androgen levels. In 2012, this consideration led international organizations to establish eligibility regulations for the female classification in order to ensure fair and meaningful competition, but the regulations are controversial and have been challenged in court.
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Affiliation(s)
- Angelica Lindén Hirschberg
- Division of Obstetrics and Gynaecology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
- Correspondence should be addressed to A L Hirschberg:
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Hirschberg AL, Elings Knutsson J, Helge T, Godhe M, Ekblom M, Bermon S, Ekblom B. Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study. Br J Sports Med 2019; 54:599-604. [DOI: 10.1136/bjsports-2018-100525] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2019] [Indexed: 11/03/2022]
Abstract
ObjectiveTo investigate the effects of a moderate increase in serum testosterone on physical performance in young, physically active, healthy women.MethodsA double blind, randomised, placebo controlled trial was conducted between May 2017 and June 2018 (ClinicalTrials.gov ID: NCT03210558). 48 healthy, physically active women aged 18–35 years were randomised to 10 weeks of treatment with 10 mg of testosterone cream daily or placebo (1:1). All participants completed the study. The primary outcome measure was aerobic performance measured by running time to exhaustion (TTE). Secondary outcomes were anaerobic performance (Wingate test) and muscle strength (squat jump (SJ), counter movement jump (CMJ) and knee extension peak torque). Hormone levels were analysed and body composition assessed by dual energy X-ray absorptiometry.ResultsSerum levels of testosterone increased from 0.9 (0.4) nmol/L to 4.3 (2.8) nmol/L in the testosterone supplemented group. TTE increased significantly by 21.17 s (8.5%) in the testosterone group compared with the placebo group (mean difference 15.5 s; P=0.045). Wingate average power, which increased by 15.2 W in the testosterone group compared with 3.2 W in the placebo group, was not significantly different between the groups (P=0.084). There were no significant changes in CMJ, SJ and knee extension. Mean change from baseline in total lean mass was 923 g for the testosterone group and 135 g for the placebo group (P=0.040). Mean change in lean mass in the lower limbs was 398 g and 91 g, respectively (P=0.041).ConclusionThe study supports a causal effect of testosterone in the increase in aerobic running time as well as lean mass in young, physically active women.
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La Vignera S, Condorelli RA, Cannarella R, Duca Y, Calogero AE. Sport, doping and female fertility. Reprod Biol Endocrinol 2018; 16:108. [PMID: 30449281 PMCID: PMC6241032 DOI: 10.1186/s12958-018-0437-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 10/24/2018] [Indexed: 01/02/2023] Open
Abstract
This article is a review that addresses the following topics, divided by paragraphs. The first paragraph investigates the effects of physical activity on ovarian function, analyzing in particular the changes concerning the serum concentrations of follicle-stimulating hormone, luteinizing hormone, prolactin, growth hormone, thyroid hormones, leptin, ghrelin, neuropeptide Y. The second paragraph analyzes the effects of doping on the hypothalamic-pituitary-ovarian axis. Finally, the last paragraph analyzes the PCOS category, evaluating the effects of hyperandrogenism in relation to athletic performance.
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Affiliation(s)
- Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy.
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
| | - Ylenia Duca
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", via S. Sofia 78, 95123, Catania, Italy
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Amenorrhoea in adolescent female athletes. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:677-688. [DOI: 10.1016/s2352-4642(18)30145-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/28/2018] [Accepted: 05/02/2018] [Indexed: 12/16/2022]
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Maïmoun L, Paris F, Coste O, Sultan C. [Intensive training and menstrual disorders in young female: Impact on bone mass]. ACTA ACUST UNITED AC 2016; 44:659-663. [PMID: 27751748 DOI: 10.1016/j.gyobfe.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Abstract
Participation in recreational physical activity is widely acknowledged to provide significant health benefits. Conversely, intense training imposes several constraints, such as intermittent or chronic metabolic and psychogenic training stressors and maintenance of very low body fat to maximize performance. Adolescent and adult athletic women are therefore at risk of overtraining and/or poor dietary intake, which may have several consequences for endocrine function particularly on hypothalamic-pituitary-gonadal axis. Female athletes, particularly those participating in sports needing leanness or low body weight, present a high prevalence of menstrual disorders with clinical manifestations ranging from delayed menarche, oligomenorrhea to primary and secondary amenorrhea. A high degree of variability according to the type of sport and the intensity of the practice is however observed. Exercise-related reproductive dysfunction may have some consequences for growth velocity and peak bone mass acquisition during adolescence and bone pathologies in adults. Recent findings highlight the endocrine role of adipose tissue and energy balance in the regulation of homeostasis and reproductive function. A better understanding of the mechanisms whereby intense training affects the endocrine systems may orient research to develop innovative strategies probably based on individualized nutritional approach to improve the medical care of these female athletes and protect their reproductive function.
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Affiliation(s)
- L Maïmoun
- Service de médecine nucléaire, hôpital Lapeyronie, université de Montpellier 1 (UM1), CHRU de Montpellier, 34295 Montpellier, France; PhyMedExp, University of Montpellier, Inserm U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - F Paris
- Unité d'endocrinologie et gynécologie pédiatrique, département de pédiatrie, hôpital A.-de-Villeneuve, UMI, CHRU de Montpellier, 34295 Montpellier, France
| | - O Coste
- Direction régionale de la jeunesse, des sports et de la cohésion sociale Languedoc Roussillon/Midi-Pyrénées, France
| | - C Sultan
- Unité d'endocrinologie et gynécologie pédiatrique, département de pédiatrie, hôpital A.-de-Villeneuve, UMI, CHRU de Montpellier, 34295 Montpellier, France
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Łagowska K, Kapczuk K. Testosterone concentrations in female athletes and ballet dancers with menstrual disorders. Eur J Sport Sci 2015; 16:490-7. [PMID: 25951882 DOI: 10.1080/17461391.2015.1034786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Menstrual disorders are common among female athletes and ballet dancers. Endocrine changes, such as high testosterone (HT) levels and high luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratios, may suggest functional ovarian hyperandrogenism which may induce such dysfunction. The aim of this study was therefore to evaluate endocrine status in female athletes and ballet dancers with menstrual disorders. Their nutritional status and dietary habits were analysed in relation to the testosterone levels. In a cross-sectional approach, 31 female athletes (18.1 ± 2.6 years) and 21 ballerinas (17.1 ± 0.9) with menstrual disorders participated in the study. The levels of serum LH, FSH, progesterone (P), estradiol (E2), prolactin (PRL), thyroid-stimulating hormone, testosterone (T) and sex hormone-binding globulinwere measured to assess hormonal status. In addition, the free androgen index (FAI) was calculated. Nutritional status, total daily energy expenditure and nutritional habits were evaluated. Girls were assigned to one of the following groups: low testosterone (LT) level, normal testosterone level or HT level. There were significant differences between ballerinas and other female athletes in terms of testosterone levels, FAI, age at the beginning of training, length of training period and age at menarche. The PRL level was lowest in the LT group while the FAI index was highest in the HT group. Daily energy and carbohydrate intakes were significantly lower in the HT group. T levels in the study subjects were found to be associated with nutritional factors, energy availability, age at the beginning of training and frequency of training. This is the first report of HT levels being associated with the status of a female ballet dancer, the age of menarche and the length of the training history. Further research is necessary to confirm the results in a larger study group.
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Affiliation(s)
- Karolina Łagowska
- a Department of Human Nutrition and Hygiene, Dietetic Division , Poznan University of Life Sciences , Poznań , Poland
| | - Karina Kapczuk
- b Department of Perinatology and Gynecology, Division of Gynecology , Karol Marcinkowski University of Medical Sciences , Poznań , Poland
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Maïmoun L, Georgopoulos NA, Sultan C. Endocrine disorders in adolescent and young female athletes: impact on growth, menstrual cycles, and bone mass acquisition. J Clin Endocrinol Metab 2014; 99:4037-50. [PMID: 24601725 DOI: 10.1210/jc.2013-3030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Puberty is a crucial period of dramatic hormonal changes, accelerated growth, attainment of reproductive capacity, and acquisition of peak bone mass. Participation in recreational physical activity is widely acknowledged to provide significant health benefits in this period. Conversely, intense training imposes several constraints, such as training stress and maintenance of very low body fat to maximize performance. Adolescent female athletes are therefore at risk of overtraining and/or poor dietary intake, which may have several consequences for endocrine function. The "adaptive" changes in the hypothalamic-pituitary-gonadal, -adrenal, and somatotropic axes and the secretory role of the adipose tissue are reviewed, as are their effects on growth, menstrual cycles, and bone mass acquisition. DESIGN A systematic search on Medline between 1990 and 2013 was conducted using the following terms: "intense training," "physical activity," or "exercise" combined with "hormone," "endocrine," and "girls," "women," or "elite female athletes." All articles reporting on the endocrine changes related to intense training and their potential implications for growth, menstrual cycles, and bone mass acquisition were considered. RESULTS AND CONCLUSION Young female athletes present a high prevalence of menstrual disorders, including delayed menarche, oligomenorrhea, and amenorrhea, characterized by a high degree of variability according to the type of sport. Exercise-related reproductive dysfunction may have consequences for growth velocity and peak bone mass acquisition. Recent findings highlight the endocrine role of adipose tissue and energy balance in the regulation of homeostasis and reproductive function. A better understanding of the mechanisms whereby intense training affects the endocrine system may orient research to develop innovative strategies (ie, based on nutritional or pharmacological approaches and individualized modalities of training and competition) to improve the medical care of these adolescents and protect their reproductive function.
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Affiliation(s)
- Laurent Maïmoun
- Service de Médecine Nucléaire (L.M.), Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) de Montpellier and Université Montpellier 1 (UM1), 34295 Montpellier, France; Département d'Hormonologie (L.M., C.S.), Hôpital Lapeyronie, CHRU Montpellier, 34295 Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles (L.M.), INSERM Unité 1046, Université Montpellier 1 (UM1) and Université Montpellier 2 (UM2), 34295 Montpellier, France; Division of Reproductive Endocrinology (N.A.G.), Department of Obstetrics and Gynecology, University of Patras Medical School, University Hospital, Patras 265 04, Greece; and Unité d'Endocrinologie et Gynécologie Pédiatrique (C.S.), Département de Pédiatrie, Hôpital Arnaud de Villeneuve, CHRU Montpellier et UM1, 34295 Montpellier, France
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2012; 19:520-4. [PMID: 23128577 DOI: 10.1097/med.0b013e32835af23e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maïmoun L, Coste O, Philibert P, Briot K, Mura T, Galtier F, Castes-de-Paulet B, Mariano-Goulart D, Sultan C, Paris F. Testosterone secretion in elite adolescent swimmers does not modify bone mass acquisition: a 1-year follow-up study. Fertil Steril 2012; 99:270-278. [PMID: 23084566 DOI: 10.1016/j.fertnstert.2012.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 08/03/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate whether high plasma testosterone (T) levels affect areal bone mineral density (aBMD), bone geometry, and bone remodeling in young elite female swimmers (SW). DESIGN Cross-sectional and 1-year follow-up study. SETTING Pediatric endocrinology and gynecology units. PARTICIPANT(S) Twenty-five SW and 21 control subjects (CON) with breast stages IV or V (mean age 15.3 ± 1.3 y). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Clinical and biologic parameters, aBMD, and bone geometry. RESULT(S) Two groups of SW were constituted on the basis of total T level. High T level SW (HSW; n = 15) presented higher T than SW with normal T (NSW; n = 10) and CON (0.63 ± 0.17; 0.36 ± 0.07, and 0.38 ± 0.14 ng/mL, respectively). The SHBG level (62.1 ± 18.7 vs. 43.3 ± 19.8 nmol/L) and the LH/FSH ratio (1.7 ± 1.1 vs. 0.9 ± 0.5) were higher, and menstrual disorders (60% vs. 23.8%) were more frequent in HSW than CON, and no difference was observed between the three groups for other sex hormones and insulin-like growth factor (IGF) 1 or IGF-binding protein 3. SW presented lower fat mass in the whole body and higher lean mass in the upper limbs only. aBMD was only modestly increased in the upper limbs in the SW groups, but no other bone-specific differences (aBMD, bone geometry, bone turnover markers) were demonstrated between SW and CON at baseline or for aBMD after 1 year in a subgroup of participants. CONCLUSION(S) High plasma T levels have no detectable effect on bone mass and bone geometry in SW during the period of peak bone mass acquisition.
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Affiliation(s)
- Laurent Maïmoun
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France
| | - Olivier Coste
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France; Direction Régionale de la Jeunesse, des Sports et de la Cohésion Sociale, Montpellier, France
| | - Pascal Philibert
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France
| | - Karine Briot
- Service de Rhumatologie, Hôpital Cochin, APHP Paris, France
| | - Thibault Mura
- Centre d'Investigation Clinique et Département d'information Médicale, CHRU Montpellier, Montpellier, France; CIC 1001, INSERM, Montpellier, France
| | - Florence Galtier
- CIC 1001, INSERM, Montpellier, France; Centre d'Investigation Clinique et Département des Maladies Endocriniennes, CHRU Montpellier, Montpellier, France
| | | | - Denis Mariano-Goulart
- Service de Médecine Nucléaire, Hôpital Lapeyronie, CHRU Montpellier, Montpellier, France
| | - Charles Sultan
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France; Unité d'Endocrinologie et Gynécologie Pédiatrique, Hôpital A. de Villeneuve, CHRU Montpellier et UMI, Montpellier, France.
| | - Françoise Paris
- Département d'Hormonologie, Hôpital Lapeyronie, CHRU Montpellier et UMI, Montpellier, France; Unité d'Endocrinologie et Gynécologie Pédiatrique, Hôpital A. de Villeneuve, CHRU Montpellier et UMI, Montpellier, France
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Current world literature. Curr Opin Obstet Gynecol 2012; 24:355-60. [PMID: 22954767 DOI: 10.1097/gco.0b013e3283585f41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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