Naessens G, De Slypere J P, Dijs H, Driessens M
Department of Physical Medicine and Rehabilitation, University Hospital Antwerp, Edegem, Belgium.
Int J Sports Med. 1995 Aug;16(6):413-7. doi: 10.1055/s-2007-973030.
Hypogonadotropic hypogonadism is a well known entity in highly trained female athletes. In male sportsmen, resting testosterone levels may be lowered especially in well endurance trained athletes and during high intensity training periods, frequently in combination with excessive weight reduction. However, only few reports illustrate a clinical pathology related to this state. In this report, where we present a case of a high level soccer player with recurrent muscle injuries over several years, hypogonadism was caused by sports activity together with an impaired testicular function (cryptorchidy). Clinical findings included testicular maldevelopment, decreased libido, infertility and a high incidence of muscle strains and delayed post-exercise soreness in mainly eccentric exercised muscle groups. Laboratory findings showed abnormally lowered resting testosterone values, most prominent during training periods, and an unfavourable testosterone/cortisol ratio during recuperation after exercise. With respect to treatment of the problem, neither any form of physical therapy nor rehabilitation program could give long lasting benefit. Using tamoxifen, an anti-oestrogenic drug, which stimulates LH and FSH production, we not only observed normal physiological resting testosterone values and a restoration of the testosterone/cortisol ratio after exercise, but our patient also experienced a higher sexual drive, well being and a spectacular decrease in the muscle injury rate. Although this patient was not a highly endurance trained athlete, we assume that a chronic anabolic/catabolic hormone imbalance may be of greater clinical importance in sports activity based on eccentric and explosive muscle work.
低促性腺激素性性腺功能减退在高水平训练的女性运动员中是一种众所周知的情况。在男性运动员中，静息睾酮水平可能会降低，尤其是在耐力良好的训练有素的运动员中以及高强度训练期间，且常与过度减重同时出现。然而，仅有少数报告阐述了与这种状态相关的临床病理情况。在本报告中，我们呈现了一名高水平足球运动员的病例，该运动员数年来反复出现肌肉损伤，其性腺功能减退是由体育活动以及睾丸功能受损（隐睾症）所致。临床发现包括睾丸发育不良、性欲减退、不育，以及主要在离心运动的肌肉群中肌肉拉伤和运动后延迟性肌肉酸痛的发生率较高。实验室检查结果显示静息睾酮值异常降低，在训练期间最为显著，且运动恢复期间睾酮/皮质醇比值不利。关于该问题的治疗，任何形式的物理治疗或康复计划都未能带来持久益处。使用他莫昔芬（一种抗雌激素药物，可刺激促黄体生成素和促卵泡生成素的分泌）后，我们不仅观察到静息睾酮值恢复到正常生理水平，且运动后睾酮/皮质醇比值也恢复正常，而且我们的患者还出现了性欲增强、感觉良好以及肌肉损伤率显著降低的情况。尽管该患者并非耐力良好的训练有素的运动员，但我们认为基于离心和爆发性肌肉运动的体育活动中，慢性合成代谢/分解代谢激素失衡可能具有更大的临床重要性。
