Endocrine Abstracts

Background: Secondary hypogonadism due to intensive exercise and eating disorders are well documented in females. But there very few reports of secondary hypogonadism due to intensive exercise in male patients.

Case presentation: A 34 year old Caucasian male, presented to our clinic with impaired fertility, lack of libido and increased fatigue. On further enquiry, he mentioned that he had starting running 3–4 yrs. ago, and had been running marathons over the last couple of years since, practicing regularly, runningup to 120 miles/week. He had lost weight over this period. Moreover, he had become a vegan six months ago, and since then lost another one stone in weight. No history of any anabolic steroids or other hormonal misuse. On examination, he had adequate secondary sexual characteristics, including male pattern baldness, and testicles were normal in size bilaterally (253 ml). His BMI was 20. Biochemistry results showed hypogonadotropic hypogonadism (with LH 0.7 IU/l, FSH 3.7 IU/l, Testosterone 1.60 mIU/l). Other hormonal results are normal. (9 am Cortisol 453 nmol/l, Free T4 14 pmol/l, TSH 1.51 mIU/l, Prolactin 273 mu/l). MRI scan of Pituitary was normal. Sperm count showed Oligospermia. As fertility was the main concern, in view of above results and with history of intensive training (for Marathons) and also recent dietary change, he was advised to reduce his activity levels, recommended to regain some weight and was also referred to a dietician. At three months review, he had gained 10 kg in weight (and not following Vegan diet) and also reduced the running distance from 120 miles/week to just 40 miles/week and the repeat morning Testosterone has improved to 8.02 nmol/l. After following the same, at 6months review his weight was stable, and still doing only 40 miles/week of running, and the morning Testosterone levels are in normal range at 11. 83 nmol/l. He had mentioned that his Partner is now pregnant. And his libido and erectile dysfunction have improved as well.

Conclusion: Intensive training for Marathon with dietary restriction have caused hypothalamic hypogonadism in this patient, and changes in exercise intensity and duration and weight gain with appropriate dietary changes, has resolved the Hypothalamic amenorrhoea spontaneously.