Hill N E, Woods D R, Delves S K, Murphy K G, Davison A S, Brett S J, Quinton R, Turner S, Stacey M, Allsopp A J, Fallowfield J L
Royal Centre for Defence Medicine, Birmingham, UK; Imperial College London, London, UK.
Andrology. 2015 Mar;3(2):293-7. doi: 10.1111/andr.308. Epub 2015 Jan 23.
Military training has been associated with changes in the hypothalamic-pituitary-gonadal axis consistent with central hypogonadism. Often such changes have been associated with body mass loss, though sleep deprivation and other psychological stress may also contribute. The effects of deployment in a combat zone on the hypothalamic-pituitary-gonadal axis in military personnel are not known. The objective was to investigate the hypothalamic-pituitary-gonadal axis in male military personnel deployed in Afghanistan. Eighty-nine Royal Marines were investigated pre-deployment, following 3 months in Afghanistan and following 2 weeks mid-tour leave. Testosterone, sex hormone-binding globulin (SHBG), follicle-stimulating hormone (FSH), luteinising hormone (LH), 17-hydroxyprogesterone, androstenedione (AD) and insulin were assayed and body mass recorded. The results showed that body mass (kg) dropped from 83.2 ± 9.2 to 79.2 ± 8.2 kg during the first 3 months of deployment (p < 0.001). Total testosterone did not change, but SHBG increased (30.7 ± 9.7 vs. 42.3 ± 14.1 nmol/L, p < 0.001), resulting in a significant (p < 0.001) fall in calculated free testosterone (435.2 ± 138 vs. 375.1 ± 98 pmol/L). Luteinising hormone and FSH increased by 14.3% (p < 0.001) and 4.9% (p = 0.003) respectively. Free testosterone, SHBG, LH and FSH returned to baseline following 2 weeks of mid-tour leave. Androstenedione (AD) decreased by 14.5% (p = 0.024), and insulin decreased by 26% (p = 0.039), over the course of deployment. In this study of lean Royal Marines, free testosterone decreased during operational deployment to Afghanistan. There was no evidence to suggest major stress-induced central hypogonadism. We postulate that reduced body mass, accompanied by a decrease in insulin and AD synthesis, may have contributed to an elevated SHBG, leading to a decrease in free testosterone.
军事训练与下丘脑 - 垂体 - 性腺轴的变化有关，这种变化与中枢性性腺功能减退一致。通常，此类变化与体重减轻有关，不过睡眠剥夺和其他心理压力也可能起作用。战区部署对军事人员下丘脑 - 垂体 - 性腺轴的影响尚不清楚。目的是调查部署在阿富汗的男性军事人员的下丘脑 - 垂体 - 性腺轴。对89名皇家海军陆战队队员在部署前、在阿富汗服役3个月后以及在中途休假2周后进行了调查。检测了睾酮、性激素结合球蛋白（SHBG）、促卵泡激素（FSH）、促黄体生成素（LH）、17 - 羟孕酮、雄烯二酮（AD）和胰岛素，并记录了体重。结果显示，在部署的前3个月内，体重（千克）从83.2±9.2降至79.2±8.2千克（p<0.001）。总睾酮没有变化，但SHBG升高（30.7±9.7对42.3±14.1纳摩尔/升，p<0.001），导致计算出的游离睾酮显著下降（435.2±138对375.1±98皮摩尔/升，p<0.001）。促黄体生成素和促卵泡激素分别升高了14.3%（p<0.001）和4.9%（p = 0.003）。在中途休假2周后，游离睾酮、SHBG、LH和FSH恢复到基线水平。在部署过程中，雄烯二酮（AD）下降了14.5%（p = 0.024），胰岛素下降了26%（p = 0.039）。在这项对身材偏瘦的皇家海军陆战队队员的研究中，在部署到阿富汗执行任务期间游离睾酮下降。没有证据表明存在重大应激诱导的中枢性性腺功能减退。我们推测，体重减轻，同时胰岛素和AD合成减少，可能导致SHBG升高，进而导致游离睾酮下降。
