Role of Relative Malnutrition in Exercise-Hypogonadal Male Condition

Objective Exercise Hypogonadal Male Condition (EHMC) is a well-recognized condition in women but much less understood in men. The aim of this case report is to highlight exercise induced hypogonadotropic hypogonadism in a male who recovered with lifestyle modifications. Methods We report a case of an adolescent male who developed hypogonadotropic hypogonadism secondary to excessive exercise and malnutrition that was followed up for a year without exogenous testosterone supplementation. Informed consent was obtained from the patient for his information to be used in a manuscript submitted to a journal. Results 18-year-old adolescent male presented to the clinic with symptoms of fatigue and low endurance, low libido and lack of morning erections. At the time of his presentation, he was running about 60 miles per week for school cross-country team in addition to cross training with kick-boxing. Physical examination was remarkable for low BMI (Body mass index) of 19 but was otherwise normal. Biochemical work up confirmed hypogonadotropic hypogonadism and a mild pancytopenia. Other pituitary laboratory values and MRI of the brain were unremarkable. Bone marrow biopsy performed for anemia showed features consistent with malnutrition. With a working diagnosis of EHMC, he was advised to reduce the frequency and intensity of his exercise and increase calorie intake. Cell counts and testosterone levels normalized and his symptoms resolved without any further interventions. Conclusion Significant reversible hypogonadism can develop after intensive and prolonged exercise. One of the mechanisms of hypogonadism in endurance athletes performing intensive exercise could be relative malnutrition. Further studies to evaluate the role of nutrition and BMI in male endurance athletes presenting with hypogonadism are needed to identify the underlying mechanism of this condition. No funding received for this work. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Conflict of Interest: The authors declare that there are no conflicts of interest. © 2018 American College of Sports Medicine

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