Estrogen and the Male Athlete

       Estrogen is always a popular topic in the sports and fitness crowd. As usual I see mostly misinformation when I read about this topic in the media or see it discussed. People know it as the primary female sex hormone, but seem not to know much about what else it does. They don't seem to know quite what to make of it and what difference it makes to a male anyway. That's a shame because this hormone does a lot of interesting things.  Before we start, let's note that this isn't the final word on estrogen. Endocrinology is a massive and constantly evolving field. We know much more this year than we did last year, and next year we'll know even more, but we have just scratched the surface. There is much more we don't know, aren't sure of, or can't prove. Yet. Always remember science is fluid. So let's talk about estrogen and what effect it has on you as a male athlete.

       There are three primary types of estrogen - which is a steroid hormone just like it's counterpart testosterone - in production in the human body. Estrone is the most prevalent form in aged women, who are in or have experienced menopause. Estriol, the weakest form in terms of potency, plays a major role in pregnancy (as does a fourth estrogen, estetrol, which is only produced during pregnancy). Estradiol, the beta form of estrogen, is both the strongest estrogen in terms of potency and the dominant form for the bulk of a woman's reproductive years. It is this form that concerns us today, as this is the dominant form in men as well.

       First, we'll briefly summarize why you need estradiol. In addition to it's role as a sex hormone, there are many roles of estradiol in the male system as well. It exerts effects on the development of brain, lung, reproductive, and vascular tissues; supports immune function; regulates mood and libido; interacts with other anabolic processes to regulate tissue accretion (fat, muscle, wound healing); and confers some protective benifits to the cardiovasular system. Note that physiologically normal amounts of estrogen are being discussed here. In normal men, normal levels of estrogen carry on the functions above. Problems arise when levels are outside the accepted normal range of ten to forty picograms per millileter of blood.

       Significant elevations of estradiol are known to be risk factors in a variety of conditions. Rather than explain each condition and how estradiol is involved I'll make a simple list of conditions with proven links to estradiol elevations. For further reading I can provide interested parties with references.

• Stroke: Data suggest increases in stroke risk with elevated estradiol levels. In elderly men risk can double. (Abbott RD, Launer LJ, Rodriguez BL, et al. "Serum Estradiol and Risk of Stroke in Elderly Men." Neurology. Feb 2007)
• Heart Attack and Coronary Artery Disease: Data going all the way back to the 1970's indicate elevations in serum estrogen are risk factors for heart attack in men. Subsequent studies have confirmed this countless times. If you search for "estradiol and myocardial infarction" in any database, you'll get page after page of nearly identical studies. This is among the most replicated results in literature that I'm aware of. (Phillips, "Evidence for Hyperestrogenemia as a Risk Factor for Myocardial Infarction in Men." The Lancet. July 1976; Mohammad et al. "Serum Levels of Sex Hormones in Men with Acute Myocardial Infarction." Neuroendocrinology Letters. 2007; etc) Estradiol is also seen as a risk factor for vascular throboses, or blood clots. (Philips, Pinkernell, and Jing. "The Association of Hyperestrogenemia with Coronary Throbosis in Men." Arteriosclerosis, Thrombosis, and Vascular Biology.)
• Atherosclerosis: Estrone has been implicated here as well. (Dunajska K, Milewicz A, Szymczak J, et al. "Evaluation of Sex Hormone Levels and Some Metabolic Factors in Men with Coronary Atherosclerosis." Aging Male. Sept 2004) Estradiol remains a risk factor in the data as well though. At this point it's effect isn't clear, and we can't say for sure estradiol is a direct influence or an indirect one, affecting atherosclerotic processes via lipid changes. But high estradiol correlates with risk certainly. And more needs to be done to elucidate its role.
•  Peripheral Artery Disease: High circulating levels of estradiol are associated with increased instance of PAD as men age. (Tivesten A, Mellstrom D, Jutberger H, et al. "Low Serum Testosterone and High Serum Estradiol Associate with Lower Extremity Peripheral Arterial Disease in elderly men." Journal of the American College of Cardiology. Sep 2007) 
• Chronic Inflammatory Issues: there are alot of these, and high estradiol shows up regularly in the blood work for male autoimmune patients and those with other inflammatory diseases. Rheumatoid arthritis springs to mind, as does Crohn's disease. Here is one example: "estradiol correlated strongly and positively with all measured indices of inflammation." (Tengstrand et al. "Abnormal Levels of Serum DHEA, Estrone, and Estradiol in Men with Rheumatoid Arthritis: High Correlation Between Serum Estradiol and Current Degree of Inflammation." Journal of Rheumatology. 2003)
• Prostate Cancer: Estradiol is emerging more and more as a risk factor here. See my post about Testosterone for more reading in this area.
• Psychological/Neural/Mental Issues: as estrogen affects the brain and is strongly involved in mood, libido, and spatial reasoning, elevations can have a variety of effects in these areas. Mood swings, altered tolerance to stress, suppressed libido, and difficulty with spatial reasoning have all been noted in the literature or reported in case studies. One of the more studied effects is depression. This just about sums it up: "Depression in men is accompanied by a high production of estradiol..." (Vogel et al. "Roles of the Gonadal Steroid Hormones in Psychiatric Depression in Men and Women." Progress in Neuropsychopharmacology, Issue 4, Volume 2. 1978.)
• Metabolic Syndrome: This is pretty well known. Elevated estradiol correlates strongly with obesity, and can modify fat accretion rates and patterns. Obesity itself correlates strongly with increases in aromatase and thus even more estradiol production. Nifty little vicious cycle huh? While most data indicates little or no direct effect of estradiol on insulin sensitivity, this cyclic action has been described in numerous instances as an adipose promoting chain of events. Insulin action can be indirectly affected in this way. There is still much to learn in this area, but it is crucial that we recognize estradiol and it's relationship to other hormones as a part of the increasingly complex foundation of metabolic syndrome. (Cohen. "Obesity in Men: The Hypogonadal-estrogen Receptor Relationship and its Effect on Glucose Metabolism." Medical Hypotheses, Volume 70, Issue 2. 2008.)
• Gynecomastia: This is another one most people are already familiar with. Elevations in estradiol can lead to growth of breast tissue in men, as the hormone interacts strongly with receptors in the mammary glands.
• Hypogonadism: The last one on the list is yet another commonly discussed issue. Estrogen is highly suppressive to the Hypothalamic Testicular Pituitary Axis, and elevations can lead to decreases in the production of testicular hormones. In men using hormone drugs, suppression is already an issue, but estradiol elevations make it worse, and may contribute to difficulties in recovering when ceasing use of the drugs.  

       Considering that, many men who look into estrogen-related issues, especially those concerned about increases due to steroid use, become somewhat obsessed with estrogen. It is common to find individuals in these groups who are actively trying to eliminate estrogen or reduce it as much as possible. This is not a solution. Low estradiol carries its own set of problems. Remember it is needed for normal processes to carry on. Bear in mind also that physiologically appropriate levels correlate with increased health in many ways, including neuroprotection (up to and including Alzheimer's patients) and enhanced bone regeneration. It should go without saying that eliminating or heavily suppressing a hormone with such important tasks can cause all kind of issues. Here is a list of the more commonly reported issues related to low estradiol. I won't go into the studies as much here, as symptoms vary strongly, and the data is mostly case-studies.

• Low libido
• Aching joints
• Bone mineral loss
• Low immunity
• Itching and increases in allergy activity
• Altered mood
• Altered sleep patterns
• Short-term memory difficulty and general "brain fog"

        Since both elevations and dramatic decreases in estradiol are problematic, the logical solution is to maintain appropriate levels within the physiological range. If you use hormone drugs for performance enhancement purposes or for hormone replacement therapy, it is important to keep an eye on your bloodwork to ensure everything is ok. Always communicate with your healthcare providers to ensure an understanding of needs and risks exists. And always be aware of how your lifestyle and related factors may be affecting your body. Stay safe everyone.

      
      

Gains are fun! Training isn't always.

       Today I don't have any hard science for you. That's coming soon, so check back regularly if you are waiting on an explanation of the controversial Thoracolumbar Sling (it's not controversial to biomechanists and strength coaches - just to the internet and its crew of pseudo-intellectual semiscientists - but we'll get into that later). Today we're talking about work and fun.

     A thread in a facebook group I'm in got me thinking about the need to base training on performance needs rather than how enjoyable the training is. There is an idea held dear in some circles that everyone who works out should be having fun first and foremost and that discipline and results should take a back seat to enjoyment. This has bled heavily into the field of nutrition as well as dietary flexibility has become the cause du jour. But it's the wrong attitude if you expect success in sports.

     Don't take this as an attempt at machismo or stoicism. I'm not against fun at all. In fact, I love what I do. I love my sport and my job and can't think of a better way to grind through life than by hanging out with fantastic athletes and lifting heavy things over and over. But I'm flabbergasted by the idea that if your training isn't always fun it's missing something. Articles abound extolling the benefits of this or that exercise, imploring you to add more and more variety to your ever-expanding exercise selection. This, supposedly, will keep things fun and fresh while covering all your needs more effectively than a less varied routine can. After all, seeing how many movements you can gain proficiency in and constantly changing training elements is more exciting than slogging through another session of heavy competition drills. If you exercise for general health and have no specific goals then this may be for you. As far as non-athletes are concerned there is something to be said for covering the work with a bit of light fun. Moving and exercising is the end goal rather than the performance adaptation being held paramount. Simply going to the gym and doing some work is beneficial to health, and enjoying it might make casual exercisers more likely to stay with it.

     But I'll be very clear to the athletes in the audience. If you try this as a way to stay sport-ready, you will fail. Not a little bit. Miserably. You will get crushed into oblivion by a competitor who wants nothing more than to beat you. This individual would rather succeed than get an "epic training sesh, bruh." Fun in training hasn't been considered. It's all about the present competition and whether preparation has been adequately undertaken. Athletes who can't achieve this mindset don't tend to fare well. As my coach and mentor is fond of saying, "step up or get stepped on."

     The fact is that searching for variety and requiring fun, regardless of the intent, are great ways to avoid the hard and repetitive training that actually makes you better. You can get wrapped up enough in recreation that you become lax in the overall discipline and specificity of your training. It's the job of your coach to call you out on this bullshit and make sure the work you do has purpose. Let me know when they add lateral raise dropsets with band tension and a 20 degree lateral lean to the powerlifting total. And we can do all the circuits you want when they add a CrossFit round to pre-judging at bodybuilding shows. Until then, you're better off spending your time and effort on things that are relevant, even if they don't leave you ecstatic. Let's forget the nonsense. We came to the gym to get better. If that means a workout is difficult and unpleasant, so be it. If that means additions or subtractions to training, make it happen. If it means training more or less, do it. If it means selecting different movements to train with... you get it.

     Those of you who read my training logs know how mind-numbingly boring some of my workouts are. I do what's needed and no more. I follow this rule for all my athletes. Training doesn't have to be exciting. It has to lead to improvement. There's nothing wrong with training in a recreational fashion if if meets your needs and wants but if you have any serious athletic aspirations you need to divorce yourself from the idea that it's just for fun. It's a tool. A means to an end. A way to achieve a goal. And sometimes it isn't fun. But you know what is fun? Setting a personal record, achieving the best shape of your life, placing or winning at a competition, losing the weight, fixing the health issues, or getting the girl/guy. Have fun - yes have fun! - but remember what you're in the gym for and do what you need to do to make it happen. I can guarantee the way forward lies in the work and discipline shown by the successful competitors -not in the fun you'll have in a workout you won't even remember next week.