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Daniels M, Margolis LM, Rood JC, Lieberman HR, Pasiakos SM, Karl JP. Comparative analysis of circulating metabolomic profiles identifies shared metabolic alterations across distinct multistressor military training exercises. Physiol Genomics 2024; 56:457-468. [PMID: 38738316 DOI: 10.1152/physiolgenomics.00008.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/26/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024] Open
Abstract
Military training provides insight into metabolic responses under unique physiological demands that can be comprehensively characterized by global metabolomic profiling to identify potential strategies for improving performance. This study identified shared changes in metabolomic profiles across three distinct military training exercises, varying in magnitude and type of stress. Blood samples collected before and after three real or simulated military training exercises were analyzed using the same untargeted metabolomic profiling platform. Exercises included a 2-wk survival training course (ST, n = 36), a 4-day cross-country ski march arctic training (AT, n = 24), and a 28-day controlled diet- and exercise-induced energy deficit (CED, n = 26). Log2-fold changes of greater than ±1 in 191, 121, and 64 metabolites were identified in the ST, AT, and CED datasets, respectively. Most metabolite changes were within the lipid (57-63%) and amino acid metabolism (18-19%) pathways and changes in 87 were shared across studies. The largest and most consistent increases in shared metabolites were found in the acylcarnitine, fatty acid, ketone, and glutathione metabolism pathways, whereas the largest decreases were in the diacylglycerol and urea cycle metabolism pathways. Multiple shared metabolites were consistently correlated with biomarkers of inflammation, tissue damage, and anabolic hormones across studies. These three studies of real and simulated military training revealed overlapping alterations in metabolomic profiles despite differences in environment and the stressors involved. Consistent changes in metabolites related to lipid metabolism, ketogenesis, and oxidative stress suggest a potential common metabolomic signature associated with inflammation, tissue damage, and suppression of anabolic signaling that may characterize the unique physiological demands of military training.NEW & NOTEWORTHY The extent to which metabolomic responses are shared across diverse military training environments is unknown. Global metabolomic profiling across three distinct military training exercises identified shared metabolic responses with the largest changes observed for metabolites related to fatty acids, acylcarnitines, ketone metabolism, and oxidative stress. These changes also correlated with alterations in markers of tissue damage, inflammation, and anabolic signaling and comprise a potential common metabolomic signature underlying the unique physiological demands of military training.
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Affiliation(s)
- Michael Daniels
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States
| | - Lee M Margolis
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Jennifer C Rood
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States
| | - Harris R Lieberman
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
| | - Stefan M Pasiakos
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, United States
| | - J Philip Karl
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, United States
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Lieberman HR, Caldwell JA, Vartanian O, Carmichael OT, Karl JP, Berryman CE, Gadde KM, Niro PJ, Harris MN, Rood JC, Pasiakos SM. Effects of testosterone enanthate on aggression, risk-taking, competition, mood, and other cognitive domains during 28 days of severe energy deprivation. Psychopharmacology (Berl) 2024; 241:461-478. [PMID: 38038817 PMCID: PMC10884082 DOI: 10.1007/s00213-023-06502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
RATIONALE Behavioral effects of testosterone depend on dose, acute versus sustained formulation, duration of administration, personality, genetics, and endogenous levels of testosterone. There are also considerable differences between effects of endogenous and exogenous testosterone. OBJECTIVES This study was the secondary behavioral arm of a registered clinical trial designed to determine if testosterone protects against loss of lean body mass and lower-body muscle function induced by a severe energy deficit typical of sustained military operations. METHODS Behavioral effects of repeated doses of testosterone on healthy young men whose testosterone was reduced by severe energy deficit were examined. This was a double-blind, placebo-controlled, between-group study. Effects of four weekly intramuscular injections of testosterone enanthate (200 mg/week, N = 24) or matching placebo (N = 26) were evaluated. Determination of sample size was based on changes in lean body mass. Tasks assessing aggression, risk-taking, competition, social cognition, vigilance, memory, executive function, and mood were repeatedly administered. RESULTS During a period of artificially induced, low testosterone levels, consistent behavioral effects of administration of exogenous testosterone were not observed. CONCLUSIONS Exogeneous testosterone enanthate (200 mg/week) during severe energy restriction did not reliably alter the measures of cognition. Study limitations include the relatively small sample size compared to many studies of acute testosterone administration. The findings are specific to healthy males experiencing severe energy deficit and should not be generalized to effects of other doses, formulations, or acute administration of endogenous testosterone or studies conducted with larger samples using tests of cognitive function designed to detect specific effects of testosterone.
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Affiliation(s)
- Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA.
- University of Toronto, Toronto, ON, Canada.
| | - John A Caldwell
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
- Laulima Government Solutions, Frederick, MD, USA
| | - Oshin Vartanian
- University of Toronto, Toronto, ON, Canada
- Defence Research and Development Canada, Toronto, ON, Canada
| | - Owen T Carmichael
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - J Philip Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
| | - Claire E Berryman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kishore M Gadde
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Philip J Niro
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
| | - Melissa N Harris
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Jennifer C Rood
- University of Toronto, Toronto, ON, Canada
- Louisiana State University's Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, 01760-5007, USA
- University of Toronto, Toronto, ON, Canada
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
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Margolis LM, Marlatt KL, Berryman CE, Howard EE, Murphy NE, Carrigan CT, Harris MN, Beyl RA, Ravussin E, Pasiakos SM, Rood JC. Metabolic Adaptations and Substrate Oxidation are Unaffected by Exogenous Testosterone Administration during Energy Deficit in Men. Med Sci Sports Exerc 2023; 55:661-669. [PMID: 36563086 DOI: 10.1249/mss.0000000000003089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION/PURPOSE The effects of testosterone on energy and substrate metabolism during energy deficit are unknown. The objective of this study was to determine the effects of weekly testosterone enanthate (TEST; 200 mg·wk -1 ) injections on energy expenditure, energy substrate oxidation, and related gene expression during 28 d of energy deficit compared with placebo (PLA). METHODS After a 14-d energy balance phase, healthy men were randomly assigned to TEST ( n = 24) or PLA ( n = 26) for a 28-d controlled diet- and exercise-induced energy deficit (55% below total energy needs by reducing energy intake and increasing physical activity). Whole-room indirect calorimetry and 24-h urine collections were used to measure energy expenditure and energy substrate oxidation during balance and deficit. Transcriptional regulation of energy and substrate metabolism was assessed using quantitative reverse transcription-polymerase chain reaction from rested/fasted muscle biopsy samples collected during balance and deficit. RESULTS Per protocol design, 24-h energy expenditure increased ( P < 0.05) and energy intake decreased ( P < 0.05) in TEST and PLA during deficit compared with balance. Carbohydrate oxidation decreased ( P < 0.05), whereas protein and fat oxidation increased ( P < 0.05) in TEST and PLA during deficit compared with balance. Change (∆; deficit minus balance) in 24-h energy expenditure was associated with ∆activity factor ( r = 0.595), but not ∆fat-free mass ( r = 0.147). Energy sensing (PRKAB1 and TP53), mitochondria (TFAM and COXIV), fatty acid metabolism (CD36/FAT, FABP, CPT1b, and ACOX1) and storage (FASN), and amino acid metabolism (BCAT2 and BCKHDA) genes were increased ( P < 0.05) during deficit compared with balance, independent of treatment. CONCLUSIONS These data demonstrate that increased physical activity and not exogenous testosterone administration is the primary determinate of whole-body and skeletal muscle metabolic adaptations during diet- and exercise-induced energy deficit.
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Affiliation(s)
- Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | | | | | - Emily E Howard
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Nancy E Murphy
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Christopher T Carrigan
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | | | - Robbie A Beyl
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Eric Ravussin
- Pennington Biomedical Research Center, Baton Rouge, LA
| | - Stefan M Pasiakos
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA
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Vartanian O, Lam TK, Mandel DR, Ann Saint S, Navarrete G, Carmichael OT, Murray K, Pillai SR, Shankapal P, Caldwell J, Berryman CE, Karl JP, Harris M, Rood JC, Pasiakos SM, Rice E, Duncan M, Lieberman HR. Effect of exogenous testosterone in the context of energy deficit on risky choice: Behavioural and neural evidence from males. Biol Psychol 2023; 176:108468. [PMID: 36481265 DOI: 10.1016/j.biopsycho.2022.108468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Previous research has shown greater risk aversion when people make choices about lives than cash. We tested the hypothesis that compared to placebo, exogenous testosterone administration would lead to riskier choices about cash than lives, given testosterone's association with financial risk-taking and reward sensitivity. A double-blind, placebo-controlled, randomized trial was conducted to test this hypothesis (Clinical Trials Registry: NCT02734238, www.clinicaltrials.gov). We collected functional magnetic resonance imaging (fMRI) data from 50 non-obese males before and shortly after 28 days of severe exercise-and-diet-induced energy deficit, during which testosterone (200 mg testosterone enanthate per week in sesame oil) or placebo (sesame seed oil only) was administered. Because we expected circulating testosterone levels to be reduced due to severe energy deficit, testosterone administration served a restorative function to mitigate the impact of energy deficit on testosterone levels. The fMRI task involved making choices under uncertainty for lives and cash. We also manipulated whether the outcomes were presented as gains or losses. Consistent with prospect theory, we observed the reflection effect such that participants were more risk averse when outcomes were presented as gains than losses. Brain activation in the thalamus covaried with individual differences in exhibiting the reflection effect. Testosterone did not impact choice, but it increased sensitivity to negative feedback following risky choices. These results suggest that exogenous testosterone administration in the context of energy deficit can impact some aspects of risky choice, and that individual differences in the reflection effect engage a brain structure involved in processing emotion, reward and risk.
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Affiliation(s)
- Oshin Vartanian
- Defence Research and Development Canada, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Timothy K Lam
- Defence Research and Development Canada, Toronto, ON, Canada
| | - David R Mandel
- Defence Research and Development Canada, Toronto, ON, Canada
| | - Sidney Ann Saint
- Defence Research and Development Canada, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada
| | - Gorka Navarrete
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | | | - Kori Murray
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | | | - John Caldwell
- Alaka'ina, Frederick, MD, USA; Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA
| | - Claire E Berryman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA
| | - J Philip Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA
| | - Melissa Harris
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | | | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA
| | - Emma Rice
- Defence Research and Development Canada, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada
| | - Matthew Duncan
- Defence Research and Development Canada, Toronto, ON, Canada
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA, USA
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Stein JA, Karl JP, Berryman CE, Harris MN, Rood JC, Pasiakos SM, Lieberman HR. Metabolomics of testosterone enanthate administration during severe-energy deficit. Metabolomics 2022; 18:100. [PMID: 36450940 PMCID: PMC9712311 DOI: 10.1007/s11306-022-01955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 11/03/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Testosterone administration attenuates reductions in total body mass and lean mass during severe energy deficit (SED). OBJECTIVES This study examined the effects of testosterone administration on the serum metabolome during SED. METHODS In a double-blind, placebo-controlled clinical trial, non-obese men were randomized to receive 200-mg testosterone enanthate/wk (TEST) (n = 24) or placebo (PLA) (n = 26) during a 28-d inpatient, severe exercise- and diet-induced energy deficit. This study consisted of three consecutive phases. Participants were free-living and provided a eucaloric diet for 14-d during Phase 1. During Phase 2, participants were admitted to an inpatient unit, randomized to receive testosterone or placebo, and underwent SED for 28-d. During Phase 3, participants returned to their pre-study diet and physical activity habits. Untargeted metabolite profiling was conducted on serum samples collected during each phase. Body composition was measured using dual-energy X-ray absorptiometry after 11-d of Phase 1 and after 25-d of Phase 2 to determine changes in fat and lean mass. RESULTS TEST had higher (Benjamini-Hochberg adjusted, q < 0.05) androgenic steroid and acylcarnitine, and lower (q < 0.05) amino acid metabolites after SED compared to PLA. Metabolomic differences were reversed by Phase 3. Changes in lean mass were associated (Bonferroni-adjusted, p < 0.05) with changes in androgenic steroid metabolites (r = 0.42-0.70), acylcarnitines (r = 0.37-0.44), and amino acid metabolites (r = - 0.36-- 0.37). Changes in fat mass were associated (p < 0.05) with changes in acylcarnitines (r = - 0.46-- 0.49) and changes in urea cycle metabolites (r = 0.60-0.62). CONCLUSION Testosterone administration altered androgenic steroid, acylcarnitine, and amino acid metabolites, which were associated with changes in body composition during SED.
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Affiliation(s)
- Jesse A. Stein
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA USA
| | - J. Philip Karl
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA USA
| | - Claire E. Berryman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA USA
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL USA
| | - Melissa N. Harris
- Louisiana State University’s Pennington Biomedical Research Center, Baton Rouge, LA USA
| | - Jennifer C. Rood
- Louisiana State University’s Pennington Biomedical Research Center, Baton Rouge, LA USA
| | - Stefan M. Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA USA
| | - Harris R. Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA USA
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Emerging evidence of the relationship between fat-free mass and ghrelin, glucagon-like peptide-1, and peptide-YY. Nutrition 2022; 103-104:111815. [DOI: 10.1016/j.nut.2022.111815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/28/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022]
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Howard EE, Shankaran M, Evans WJ, Berryman CE, Margolis LM, Lieberman HR, Karl JP, Young AJ, Montano MA, Matthews MD, Bizieff A, Nyangao E, Mohammed H, Harris MN, Hellerstein MK, Rood JC, Pasiakos SM. Effects of Testosterone on Mixed-Muscle Protein Synthesis and Proteome Dynamics During Energy Deficit. J Clin Endocrinol Metab 2022; 107:e3254-e3263. [PMID: 35532889 DOI: 10.1210/clinem/dgac295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Effects of testosterone on integrated muscle protein metabolism and muscle mass during energy deficit are undetermined. OBJECTIVE The objective was to determine the effects of testosterone on mixed-muscle protein synthesis (MPS), proteome-wide fractional synthesis rates (FSR), and skeletal muscle mass during energy deficit. DESIGN This was a randomized, double-blind, placebo-controlled trial. SETTING The study was conducted at Pennington Biomedical Research Center. PARTICIPANTS Fifty healthy men. INTERVENTION The study consisted of 14 days of weight maintenance, followed by a 28-day 55% energy deficit with 200 mg testosterone enanthate (TEST, n = 24) or placebo (PLA, n = 26) weekly, and up to 42 days of ad libitum recovery feeding. MAIN OUTCOME MEASURES Mixed-MPS and proteome-wide FSR before (Pre), during (Mid), and after (Post) the energy deficit were determined using heavy water (days 1-42) and muscle biopsies. Muscle mass was determined using the D3-creatine dilution method. RESULTS Mixed-MPS was lower than Pre at Mid and Post (P < 0.0005), with no difference between TEST and PLA. The proportion of individual proteins with numerically higher FSR in TEST than PLA was significant by 2-tailed binomial test at Post (52/67; P < 0.05), but not Mid (32/67; P > 0.05). Muscle mass was unchanged during energy deficit but was greater in TEST than PLA during recovery (P < 0.05). CONCLUSIONS The high proportion of individual proteins with greater FSR in TEST than PLA at Post suggests exogenous testosterone exerted a delayed but broad stimulatory effect on synthesis rates across the muscle proteome during energy deficit, resulting in muscle mass accretion during subsequent recovery.
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Affiliation(s)
- Emily E Howard
- Military Nutrit ion Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Willian J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Claire E Berryman
- Military Nutrit ion Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
- Department of Nutrition, Food, and Exercise Sciences, Florida State University, Tallahassee, FL 32306, USA
| | - Lee M Margolis
- Military Nutrit ion Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Harris R Lieberman
- Military Nutrit ion Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - J Philip Karl
- Military Nutrit ion Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Andrew J Young
- Military Nutrit ion Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Monty A Montano
- MyoSyntax Corporation, Worcester, MA 01605, USA
- Harvard Medical School, Boston, MA 02115, USA
- Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Marcy D Matthews
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Alec Bizieff
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Edna Nyangao
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Hussein Mohammed
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Melissa N Harris
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Marc K Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA 94720, USA
| | - Jennifer C Rood
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Stefan M Pasiakos
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
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Varanoske AN, Harris MN, Hebert C, Howard EE, Johannsen NM, Heymsfield SB, Greenway FL, Margolis LM, Lieberman HR, Beyl RA, Church DD, Ferrando AA, Pasiakos SM, Rood JC. Testosterone Undecanoate Administration Prevents Declines in Fat-Free Mass but not Physical Performance During Simulated Multi-Stressor Military Operations. J Appl Physiol (1985) 2022; 133:426-442. [PMID: 35796614 PMCID: PMC9359646 DOI: 10.1152/japplphysiol.00190.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Male military personnel conducting strenuous operations experience reduced testosterone, muscle mass, and performance. Pharmacological restoration of normal testosterone may attenuate performance decrements by mitigating muscle loss. Previously, administering testosterone enanthate (200 mg/week) during energy deficit prompted supraphysiological testosterone concentrations and lean mass gain without preventing isokinetic/isometric deterioration. Whether administering a practical dose of testosterone protects muscle and performance during strenuous operations is undetermined. OBJECTIVE Test the effects of a single dose of testosterone on body composition and military-relevant physical performance during a simulated operation. METHODS After a 7-day baseline phase (P1), 32 males (mean±SD; 77.1±12.3 kg, 26.5±4.4 years) received a single dose of either testosterone undecanoate (750 mg; TEST) or placebo (PLA) before a 20-day simulated military operation (P2), followed by a 23-day recovery (P3). Assessments included body composition and physical performance at the end of each phase and circulating endocrine biomarkers throughout the study. RESULTS Total and free testosterone concentrations in TEST were greater than PLA throughout most of P2 (p<0.05), but returned to P1 values during P3. Fat-free mass (FFM) was maintained from P1 to P2 in TEST (mean±SE; 0.41±0.65 kg, p=0.53), but decreased in PLA (-1.85±0.69 kg, p=0.01) and recovered in P3. Regardless of treatment, total body mass and fat mass decreased from P1 to P2 (p<0.05), but did not fully recover by P3. Physical performance decreased during P2 (p<0.05) and recovered by P3, regardless of treatment. CONCLUSIONS Administering testosterone undecanoate before a simulated military operation protected FFM but did not prevent decrements in physical performance.
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Affiliation(s)
- Alyssa N Varanoske
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Melissa N Harris
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Callie Hebert
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Emily E Howard
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Neil M Johannsen
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Frank L Greenway
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Lee M Margolis
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Robbie A Beyl
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - David D Church
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging and Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Arny A Ferrando
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging and Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Stefan M Pasiakos
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Jennifer C Rood
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
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Kean AC, Saroufim R, Meininger E, Fuqua JS, Fortenberry JD. Cardiovascular Health of Youth During Gender-Affirming Testosterone Treatment: A Review. J Adolesc Health 2021; 69:896-904. [PMID: 34627656 DOI: 10.1016/j.jadohealth.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Many birth-assigned female/transgender male and nonbinary people (identified as masculine spectrum here) begin gender-affirming testosterone therapy by the age of 24 years. Few data inform assessment of cardiovascular health of masculine spectrum youth as a specific subgroup of the 1.5 million transgender people in the United States. The purpose of this review is to help youth-serving practitioners consider, understand, and evaluate cardiovascular health in adolescent and young adult masculine spectrum patients receiving gender-affirming testosterone treatment. METHODS This is a narrative review intended to synthesize a broad body of clinical and research literature. RESULTS Common cardiovascular health changes associated with testosterone include increased red blood cell mass and likely insignificant changes in high-density lipoprotein and low-density lipoprotein levels. Changes in heart mass, heart electrophysiology, and endothelial reactivity are likely, based on extrapolation of data from adults. Testosterone may have indirect effects on cardiovascular health through influences on depression, anxiety, stress, and anorexia nervosa as well as on behaviors such as tobacco use. CONCLUSIONS Testosterone contributes importantly to the cardiovascular health and well-being of masculine spectrum gender-diverse youth. We need to do a better job of supporting these young people with data on cardiovascular health over the life span.
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Affiliation(s)
- Adam C Kean
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rita Saroufim
- Division of Pediatric Endocrinology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Eric Meininger
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - John S Fuqua
- Division of Pediatric Endocrinology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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Grossmann M, Wittert GA. Dysregulation of the Hypothalamic-Pituitary-Testicular Axis due to Energy Deficit. J Clin Endocrinol Metab 2021; 106:e4861-e4871. [PMID: 34264314 DOI: 10.1210/clinem/dgab517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Although gonadal axis dysregulation from energy deficit is well recognized in women, the effects of energy deficit on the male gonadal axis have received much less attention. EVIDENCE ACQUISITION To identify relevant articles, we conducted PubMed searches from inception to May 2021. EVIDENCE SYNTHESIS Case series and mechanistic studies demonstrate that energy deficit (both acutely over days or chronically over months) either from inadequate energy intake and/or excessive energy expenditure can lower serum testosterone concentration as a result of hypothalamic-pituitary-testicular (HPT) axis dysregulation in men. The extent to which this has clinical consequences that can be disentangled from the effects of nutritional insufficiency, concomitant endocrine dysregulation (eg, adrenal and thyroid axis), and coexisting comorbidities (eg, depression and substance abuse) is uncertain. HPT axis dysfunction is primarily the result of loss of GnRH pulsatility resulting from a failure of leptin to induce kisspeptin signaling. The roles of neuroendocrine consequences of depression, hypothalamic-pituitary-adrenal axis activation, proinflammatory cytokines, Ghrelin, and genetic susceptibility remain unclear. In contrast to hypogonadism from organic pathology of the HPT axis, energy deficit-associated HPT dysregulation is functional, and generally reversible by restoring energy balance. CONCLUSIONS The clinical management of such men should aim to restore adequate nutrition and achieve and maintain a healthy body weight. Psychosocial comorbidities must be identified and addressed. There is no evidence that testosterone treatment is beneficial. Many knowledge gaps regarding epidemiology, pathophysiology, and treatment remain and we highlight several areas that require future research.
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Affiliation(s)
- Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Well-being, University of Adelaide, Adelaide, South Australia, Australia
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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11
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Varanoske AN, Harris MN, Hebert C, Howard EE, Johannsen NM, Heymsfield SB, Greenway FL, Margolis LM, Lieberman HR, Church DD, Ferrando AA, Rood JC, Pasiakos SM. Effects of testosterone undecanoate on performance during multi-stressor military operations: A trial protocol for the Optimizing Performance for Soldiers II study. Contemp Clin Trials Commun 2021; 23:100819. [PMID: 34278044 PMCID: PMC8264529 DOI: 10.1016/j.conctc.2021.100819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/15/2021] [Accepted: 07/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background Previously, young males administered 200 mg/week of testosterone enanthate during 28 days of energy deficit (EDef) gained lean mass and lost less total mass than controls (Optimizing Performance for Soldiers I study, OPS I). Despite that benefit, physical performance deteriorated similarly in both groups. However, some experimental limitations may have precluded detection of performance benefits, as performance measures employed lacked military relevance, and the EDef employed did not elicit the magnitude of stress typically experienced by Soldiers conducting operations. Additionally, the testosterone administered required weekly injections, elicited supra-physiological concentrations, and marked suppression of endogenous testosterone upon cessation. Therefore, this follow-on study will address those limitations and examine testosterone's efficacy for preserving Solder performance during strenuous operations. Methods In OPS II, 32 males will participate in a randomized, placebo-controlled, double-blind trial. After baseline testing, participants will be administered either testosterone undecanoate (750 mg) or placebo before completing four consecutive, 5-day cycles simulating a multi-stressor, sustained military operation (SUSOPS). SUSOPS will consist of two low-stress days (1000 kcal/day exercise-induced EDef; 8 h/night sleep), followed by three high-stress days (3000 kcal/day and 4 h/night). A 23-day recovery period will follow SUSOPS. Military relevant physical performance is the primary outcome. Secondary outcomes include 4-comparment body composition, muscle and whole-body protein turnover, intramuscular mechanisms, biochemistries, and cognitive function/mood. Conclusions OPS II will determine if testosterone undecanoate safely enhances performance, while attenuating muscle and total mass loss, without impairing cognitive function, during and in recovery from SUSOPS. Trial Registration ClinicalTrials.gov Identifier: NCT04120363.
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Key Words
- Anabolism
- And hypogonadism
- BIA, bioelectrical impedance analysis
- D2O, deuterium
- DSMB, data and safety monitoring board
- DXA, dual-energy x-ray absorptiometry
- ECW, extracellular water
- EDef, energy deficit
- EIEE, exercise-induced energy expenditure
- Energy deficit
- Exercise
- FBR, fractional breakdown rate
- FFM, fat-free mass
- FSR, fractional synthetic rate
- HR, heart rate
- HRR, heart rate reserve
- ICW, intracellular water
- ID, identification
- IRB, Institutional Review Board
- MRE, Meal
- Optimizing Performance for Soldiers Trial I, OPS II
- Optimizing Performance for Soldiers Trial II, PAR-Q+
- Pennington Biomedical Research Center, PLA
- Physical Activity Readiness Questionnaire+, PB
- Ready-to-Eat, OPS I
- Skeletal muscle
- Sleep deprivation
- TBW, total body water
- TDEE, total daily energy expenditure
- TDEI, total daily energy intake
- TEST, testosterone experimental group
- VO2max, maximal cardiorespiratory fitness
- VO2peak, peak oxygen uptake
- WBGT, wet bulb globe temperature
- placebo experimental group, PS
- protein breakdown, PBRC
- protein synthesis, Q
- ratings of perceived exertion, SUSOPS
- repetition maximum, RNA
- respiratory exchange ratio, RM
- ribonucleic acid, RPE
- sustained, multi-stressor military operations
- whole-body nitrogen flux, RER
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Affiliation(s)
- Alyssa N Varanoske
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Melissa N Harris
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Callie Hebert
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Emily E Howard
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Neil M Johannsen
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Frank L Greenway
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Lee M Margolis
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - David D Church
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging & Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Arny A Ferrando
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging & Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer C Rood
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
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