Key objectives include improving diagnostic methods and developing effective strategies for addressing testosterone deficiency and relative energy deficiencies. This makes it critical to investigate methods for effective monitoring, such as the athlete's biological passport, which tracks hormonal profiles and therapeutic use exemptions for those with endocrine disorders.This Research Topic aims to further our understanding of hormonal issues faced by athletes and explore innovative therapeutic interventions. NADA Germany is solely responsible for approving the use of prohibited substances or methods in relation to transgender athletes. This rule applies to all athletes, regardless of their testing pool status. These may be for example genetic abnormalities, bilateral testicular trauma or torsion or bilateral orchiectomy, radiation treatment, chemotherapy and genetic abnormalities and pituitary or hypothalamic tumors. For testosterone, dihydrotestosterone is the principle androgenic product; estradiol is the major estrogenic metabolite. Thus, high endogenous concentrations of testosterone may confer both psychological and physiological advantage in sports. Additionally, testosterone has been linked to increased risk-taking in economic domains (Stanton et al., 2011; van Honk et al., 2004, but see also Stanton, Mullette-Gillman et al. 2011) and social domains (Mazur, 1995). Basal testosterone is positively correlated with power motivation in men (Schultheiss et al, 2003; Schultheiss et al, 2005), whereas basal estradiol is positively correlated with power motivation in women (Stanton & Edelstein, 2009; Stanton & Schultheiss, 2007). Perhaps most importantly, it doesn’t really change management of an athlete whose performance has been decreased for some time. The diagnosis of OTS vs NFOR was determined retrospectively, where individuals with OTS had more than a year of reduced performance, and individuals experiencing NFOR recovered. HRV does not reliably map to OTS, and its use in strength athletes is poorly studied. This disconnect has also been shown in resistance training. For example, cortisol levels are normal in at least 75% of people formally diagnosed with OTS.18 T levels also don’t reliably change with exercise. Much of the reason this metric has failed is because both T and C are noisy in response to training. Pubertal effects begin to occur when androgen has been higher than normal adult female levels for months or years. For postnatal effects in both males and females, these are mostly dependent on the levels and duration of circulating free testosterone. The participation policy for transgender student-athletes adopted by the Board of Governors and effective February 6, 2025, does not permit competition by an individual assigned male at birth to compete on a women’s team. Student-athletes assigned male at birth may not receive athletic scholarships that are otherwise designated for women. Foster C. Monitoring training in athletes with reference to overtraining syndrome. Specifically, testosterone levels increased and cortisol levels decreased. Estimates suggest OTS affects roughly 20% of elite endurance athletes, but the methodology behind those numbers is weak enough that the figure should be treated with considerable skepticism.27 It was also small and classified athletes using subjective symptom criteria that overlaps with HPA dysfunction by design, which produces a selection bias and makes causality unclear. With respect to blunted ACTH, when the authors plotted ACTH response values across all subjects, 78.6% of OTS athletes grouped at the low end of the distribution — a pattern the authors described as a cluster of blunted responses. In this study 85% of the OTS athletes produced peak cortisol that was lower than the adrenal insufficiency threshold of 18 μg/dL.18 Of note, 75% of the non-exercising controls showed the same response. Normally, the HPA axis would pump out ACTH and cortisol to restore blood sugar levels. HPA response was measured by Insulin Tolerance Testing (ITT), a highly-specialized test that induces hypoglycemia (low blood sugar) to see how the body responds. Under a chronically high training load, the pituitary can show a reduced ACTH output.18,19 Importantly, the adrenal glands themselves are intact; the regulatory signal upstream from them is what changes. In 1950, sprinter Foekje Dillema was expelled 1950 from the Dutch national team and banned from international competition following a gynecologic exam. Typically, individuals with Turner's or Klinefelter's syndrome are hypogonadal, which is not a competitive advantage in sport. Individuals may have only one sex chromosome (Turner's syndrome), or sometimes three or four Klinefelter's syndrome (XXY) is the most common example; Bojesen and Gravholt (2007). DSD may include alterations in the complement of sex chromosomes, as well as defects in the production, metabolism or binding capacity of sex steroid hormones produced by the gonads. Accordingly, the distinction of male or female sex applies to all animals, but only humans can be said to have gender. Sex is a biologic definition that distinguishes male and female; gender is the sense of one's own self as a man or woman (see Wilson, 2000). DSD is often confused with "intersex", referring to conditions where the external genitalia do not conform to the standards of either male or female (Ritchie et al, 2008). We recommend against shotgun testing, e.g. broad hormone panels ordered without a specific question. For example, iron-deficiency anemia affects nearly half of women, though it remains underdiagnosed. We recommend working with a trusted medical professional to investigate common conditions that overlap with Overtraining Syndrome (OTS), e.g. anemia, thyroid dysfunction, sleep apnea and other parasomnias, depression, and so on.
