Female hyperandrogenism and elite sport

Hyperandrogenaemia, polycystic ovary syndrome, and physical fitness in women-a Northern Finland birth cohort study

OBJECTIVE

To investigate the independent associations of hyperandrogenaemia (HA) and polycystic ovary syndrome (PCOS) with physical fitness in women among the general population.

DESIGN

A population-based birth cohort study including 5889 women.

METHODS

Longitudinal associations of serum testosterone (T), free androgen index (FAI), and PCOS with cardiorespiratory fitness (CRF) (measured by heart rate after a submaximal exercise test) and grip strength over the 31 to 46 years of age timespan were examined using multivariable linear mixed models adjusted for time, body mass index, homeostatic model assessment of insulin resistance, physical activity and smoking. The results are reported as regression coefficients (β) with corresponding 95% confidence intervals [95% CI].

RESULTS

The third and fourth T and FAI quartiles were associated positively with higher heart rate after the submaximal exercise test in multivariable models indicating poorer CRF compared with women in Q1 of T and FAI (Q3: β of T = 1.58 [95% CI: 0.21 to 2.96], β of FAI = 1.97 [0.54 to 3.39]; Q4: β of T = 1.88 [0.46 to 3.30], β of FAI = 2.70 [1.15 to 4.25]). The second, third, and fourth quartiles of FAI were associated with higher grip strength in multivariable models compared with women in Q1 (Q2: β = 0.59 [0.04 to 1.14], Q3: β = 0.74 [0.16 to 1.30], Q4: β = 0.68 [0.06 to 1.27]). Excluding women with PCOS did not alter these results, while PCOS itself was not associated with CRF or grip strength.

CONCLUSION

Hyperandrogenaemia in premenopausal women was associated with poorer CRF but better grip strength, independently of PCOS, which suggests that HA, rather than PCOS, has an independent and complex association with physical fitness in premenopausal women.

The role of androgens and global and tissue-specific androgen receptor expression on body composition, exercise adaptation, and performance

Gonadal testosterone stimulates skeletal muscle anabolism and contributes to sexually differentiated adipose distribution through incompletely understood mechanisms. Observations in humans and animal models have indicated a major role for androgen receptor (AR) in mediating sex differences in body composition throughout the lifespan. Traditional surgical, genetic and pharmacological studies have tested systemic actions of circulating androgens, and more recent transgenic approaches have allowed for tests of AR gene function in specific androgen responsive niches contributing to body composition, including: skeletal muscle and surrounding interstitial cells, white and brown adipose, as well as trabecular and cortical bone. Less well understood is how these functions of gonadal androgens interact with exercise. Here, we summarize the understood mechanisms of action of AR and its interactions with exercise, specifically on outcomes of body composition and muscle function, and the global- and tissue-specific role of AR in regulating skeletal muscle, adipose, and bone morphology. Additionally, we describe the known effects of androgen and AR manipulation on female body composition, muscle morphology, and sport performance, while highlighting a need for greater inclusion of female subjects in human and animal muscle physiology and endocrinology research.

Testosterone mediates life-history trade-offs in female mammals

Hormones mediate life-history trade-offs. In female mammals, such trade-offs have been studied predominantly in the contexts of oestrogen, progesterone and prolactin. We evaluate the hypothesis that prenatal and postnatal testosterone levels structure and regulate trade-offs in females involving components of reproduction and survival. This hypothesis is predicated on the observation that testosterone confers competition-related and survival-related benefits, but also reproduction-related costs, to female mammals. The hypothesis is supported by field and laboratory data from diverse non-human animals, and data from healthy women. Most broadly, relatively low testosterone level in females has been associated with earlier, faster and higher offspring production, greater attractiveness to males, and reduced dominance or competitiveness, whereas higher testosterone level is associated with delayed and reduced reproduction but increased dominance, status, aggression, and resource accrual. The magnitude of testosterone-mediated trade-offs is expected to depend upon the strength of female-female competition, which represents some function of species-specific ecology, behaviour and mating system. Testosterone-associated trade-offs have, until now, been virtually ignored in studies of female life history, reproductive physiology, evolutionary endocrinology, and female-limited disease, probably due to researcher biases towards conceptualizing androgens as hormones with effects mainly restricted to males.

The Comparative Effects of High-Intensity Interval Training and Traditional Resistance Training on Hormonal Responses in Young Women: A 10-Week Intervention Study

BACKGROUND

Hormonal levels in women are influenced by exercise intensity and modality.

METHODS

This 10-week study compared high-intensity interval training (HIIT) and traditional resistance training (TRT) in 72 young women. Hormonal levels (estrogen, testosterone, FSH, prolactin, and LH) were measured pre- and post-intervention.

RESULTS

Both groups showed significant increases in estrogen (HIIT: 150%; TRT: 72.3%) and decreases in testosterone (HIIT: 58%; TRT: 49%), FSH (HIIT: 6%; TRT: 7.7%), and PL (HIIT: 5%; TRT: 2.1%). There are no significant changes in LH.

CONCLUSIONS

HIIT and TRT effectively modulate hormonal profiles, potentially benefiting reproductive and metabolic health.

Frequency of polycystic ovarian morphology and other ultrasonographic findings in Iranian female athletes

OBJECTIVES

Polycystic ovary morphology and ovarian cysts are frequent and usually asymptomatic in young female individuals. The present study is the first to examine ovarian sonographic findings in asymptomatic female athletes from Iran. This study aimed to evaluate the frequency of such sonographic findings in healthy female athletes on a screening basis.

METHODS

In this cross-sectional observational study, 455 females from 16 provinces of Iran were evaluated by trans-abdominal sonography during their routine pre-participation medical evaluation.

RESULTS

The mean age of participants was 21.8 years (SD 5.3). The mean age at the beginning of exercise was 14.20 years (SD = 4.25). Menarche occurred at 11-20 years with a mean of 13.5 years (SD 1.5). Judokas had the lowest (12.1 years), and football players had the highest menarche age (14.6 years; as compared to 12.8 years in the Iranian female population). In 87.5 % of participants, the sonographic findings were within normal limits. 4.8 % of all examinations revealed polycystic ovary morphology (PCOM), 5.7 % of participants had a simple cyst(s), and 20.8 % of cysts had diameters >49 mm. In those athletes who began regular performance-oriented training before menarche, PCOM was found in only 2.4 %. There was a significant positive linear association between BMI groups and PCOM (p = 0.003), but not for simple cysts. Frequency of PCOM (p < 0.001) as well as ovarian cysts (p = 0.012) were significantly different among studied sport types. There was a significant positive correlation between delayed menarche status and PCOM (p = 0.017). However, no such relationship was found for simple cysts.

CONCLUSIONS

Maintaining a healthy body mass index and beginning regular exercise before menarche may have a preventative effect for polycystic ovary morphology in female athletes.

Gender Differences and Performance Changes in Sprinting and Long Jump Among Young Athletes

This research aimed to examine the dynamics of changes in sprint and long jump performance and the age of gender divergence in well-trained young athletes specialising in athletics. Data were collected from 1249 male and 1497 female athletes aged 10 to 15 years who participated in the final round of the annual national athletics tournament "Shipovka Yunykh" from 2017 to 2019. The top 50 results in each age group for the 60-metre sprint and long jump were analysed. Boys showed significantly higher performance than girls in both events from ages 11 and 12. Significant performance improvements were noted between ages 12 and 13 for boys in the long jump and 10-11 in the sprint. Girls showed significant improvements between ages 12 and 13 in the long jump and 11-12 in the sprint. Gender divergence in sprint and long jump performance occurs around age 11. The dynamics of performance changes are influenced by the timing of the growth spurt, highlighting the need for age-specific competition categories in athletics.

Association Between Female Androgen Levels, Metabolic Syndrome, and Cardiovascular Disease: An NHANES Analysis (2013-2016)

Background

The impact of androgens on metabolic diseases, cardiovascular diseases (CVD), and long-term mortality in the general female population remains poorly understood. This study, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database managed by the Centers for Disease Control and Prevention, seeks to elucidate the relationship between androgen levels and metabolic syndrome (MS), CVD, and mortality in adult women.

Methods

After excluding ineligible individuals, descriptive analyses were conducted on demographic characteristics, metabolic-related indicators, and disease prevalence, based on the presence of high androgenemia and androgen quartile grouping. Logistic regression models were developed to assess the associations of androgen markers, including total testosterone (TT), Free Androgen Index (FAI), with MS, CVD, and cox regression models were used to explore the relationships with mortality.

Results

Our results show that, even without adjustment for age, age at menarche, marital status, and smoking status, both in patients with hyperandrogenemia and across the general population stratified by quartiles of FAI, higher androgen levels are associated with increased waist circumference, weight, Body Mass Index, fasting insulin, and the monocyte/high-density lipoprotein cholesterol ratio. In adjusted correlational analysis, MS remained positively correlated with FAI, even after controlling for age, tobacco use, and alcohol consumption. As FAI quartiles increased, the correlation strengthened, achieving an odds ratio (OR) of 1.45 (95% CI 1.04 to 2.02, P=0.03) in the highest quartile. This indicates that androgen levels are strongly associated with metabolic syndrome, with FAI proving more sensitive than TT.

Conclusion

The greater sensitivity of FAI may be attributed to its ability to reflect bioavailable testosterone more accurately than TT, underscoring its potential utility in clinical assessments of metabolic risk. This study found no significant correlation between androgen levels and CVD or mortality.

Exercise in the management of polycystic ovary syndrome: A position statement from Exercise and Sports Science Australia

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition amongst females of reproductive age, leading to lifelong cardiometabolic, reproductive, psychological, and dermatologic symptoms as well as a reduced quality of life. Lifestyle interventions, which can include structured exercise programmes delivered by appropriately trained exercise professionals such as clinical exercise physiologists, are considered first-line strategies in PCOS management due to their therapeutic effects on various health outcomes and quality of life. This position statement builds on the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS and describes the role of the exercise professional in the context of the multidisciplinary care team which includes physicians and allied health professionals. This position statement aims to equip exercise professionals with a broad understanding of the pathophysiology of PCOS, how it is diagnosed and managed in clinical practice, and evidence- and consensus-based recommendations for physical activity and exercise in PCOS management. In line with the physical activity recommendations for the general public, individuals with PCOS should aim to undertake between 150 to 300min of moderate-intensity or 75 to 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week. Additionally, muscle-strengthening activities on two non-consecutive days per week are recommended to maintain health and prevent weight gain. For further health benefits and to achieve modest weight loss, individuals with PCOS should aim for a minimum of 250min of moderate-intensity or 150min of vigorous-intensity aerobic activity per week, or an equivalent combination of both spread throughout the week, plus muscle-strengthening activities on two non-consecutive days per week. Adolescents with PCOS should aim for a minimum of 60min moderate- to vigorous-intensity activity each day, incorporating muscle- and bone-strengthening activities three times per week. Finally, exercise professionals should consider the significant psychological burden, including weight stigma, and the high prevalence of comorbidities amongst individuals with PCOS and take appropriate measures to deliver safe and efficacious exercise interventions.

The evolutionary basis of elevated testosterone in women with polycystic ovary syndrome: an overview of systematic reviews of the evidence

Polycystic ovary syndrome (PCOS) exhibits high prevalence and heritability despite causing negative impacts on fertility and fecundity. Previous hypotheses have postulated that some PCOS-associated traits, especially above-average levels of testosterone, were associated with benefits in ancestral environments. As such, PCOS would represent, in part, a maladaptive extreme of adaptations related to relatively high testosterone. To evaluate this hypothesis, we conducted a series of systematic literature reviews on the associations of testosterone levels, and prenatal testosterone metrics, with measures of strength, robustness, muscularity, and athleticism in females. We also systematically reviewed the literature on associations of testosterone with dominance in females and reviewed archaeological evidence concerning female strength and muscularity and its correlates. The main findings were fivefold: (1) elevated testosterone levels were generally associated with higher strength, muscularity and athleticism in females; (2) females with PCOS showed notable evidence of increased strength, muscularity, and athleticism compared to controls; (3) females with higher testosterone levels exhibited clear evidence of high dominance, (4) despite evidence that higher testosterone is linked with higher bone mineral density in healthy females, PCOS was not clearly associated with this phenotype; and (5) archaeological evidence from osteology, and data from some current small-scale societies, indicated that females often exhibit substantial levels of muscularity. Overall, the hypothesis that relatively high levels of testosterone are associated with benefits to females in some contexts was largely supported. These results provide evidence for the "maladaptive extremes of adaptation" model, with implications for treatment of females with PCOS and for future research.

Is There a Relative Age Effect among the Most Successful Track and Field Athletes?

The prevalence of the Relative Age Effect (RAE) was studied among medalists from the World Athletics Championships at U18, U20 and Senior age groups and from the Olympic Games from 2000 to 2022. The specific events examined were the 100, 200, 400, 800, 1500, and 3000/5000 m, the long jump, the triple jump, the high jump and the pole vault. Dates of birth from 1,858 outdoor track and field athletes were analysed and further divided into four groups according to the quartile of birth. The RAE was found to be widespread among athletes of both sexes in U18 and U20 age groups in all examined disciplines. There was no difference between the most successful U18 and U20 athletes (p = 0.52). Among senior athletes of both sexes, this effect was not detected and the number of "late-born" athletes in this age group was higher than athletes born in the first three quarters. The prevalence of the RAE across the four groups of events was found in U18 and U20 age groups. Additionally, within each age group, the difference among events was statistically significant. In most successful track and field athletes, the RAE is only significant in U18 and U20 age groups. In senior athletes, the number of "late-born" athletes is significant while RAE disappears. These data may be considered when assessing the athletic potential of an individual athlete.

Androgenic steroid excess in women

Excessive use of anabolic-androgenic steroids (AAS) in sport occurs among professional athletes but increasingly also in amateurs. Prevalence of steroid use has been on the rise for a number of years. While the practice involves mostly men, it also occurs in women with an estimated prevalence of 1.6%. Since 2014, a 'steroid passport' has operated for sports people in competition that is based on longitudinal urinary and blood steroid levels, measured by liquid chromatography and mass spectrometry. Androgen excess stimulates muscle growth and improves muscle performance. However, their consumption carries numerous side effects, including myocardial hypertrophy; altered lipid metabolism and pro-thrombotic effects. The excess of AAS is associated with increased risk of atherosclerosis and cardiovascular events. Data for their effects in women is lacking. Perturbations of the menstrual cycle are common in female athletes, with spaniomenorrhea and even amenorrhea. This can be a consequence of gonadotropin insufficiency due to negative caloric balance, but may also be due to endogenous or exogenous hyperandrogenism. The use of AAS is probably underestimated as a public health issue, particularly in women, and thus presents a prevention challenge for healthcare professionals.

The relationship of testosterone levels with sprint performance in young professional track and field athletes

Evidence suggests that higher testosterone levels may provide an athletic advantage. Therefore, it is of practical interest to examine the association between testosterone levels and power- and strength-related traits in young professional track and field athletes, and to consider the factors that determine testosterone levels. The study involved 68 young professional athletes (45 females, 17.3 ± 2.6 years; 23 males, 18.2 ± 1.9 years). Testosterone levels were assessed via liquid chromatography-mass spectrometry. All subjects performed two 20 m and two 30 m sprint trials, and countermovement jump without arm-swing. A bioimpedance analysis of body composition was carried out and biological maturity was examined using the Khamis-Roche method. The average testosterone levels were 26.4 ± 9.6 nmol/l and 1.5 ± 0.7 nmol/l in males and females, respectively. In female athletes, testosterone levels did not correlate with any of traits. Males with the highest testosterone levels were significantly faster in the 20 m (p = 0.033) and 30 m (p = 0.014) sprint trials compared to males with lower testosterone levels. Testosterone levels in males were positively associated with fat mass (p = 0.027), and degree of biological maturation (p = 0.003). In conclusion, we found a positive relationship between testosterone levels and sprint performance in young male athletes.

Sex differences and athletic performance. Where do trans individuals fit into sports and athletics based on current research?

There are well known sex differences in parameters of physical fitness/performance due to changes occurring during sexual development. Thus, many sport and athletic events have regulations separating male and female participants. However, the inclusion or exclusion of transgender individuals in athletics has recently received outsized attention despite relatively few cases of transgender athletes. When determining which athletic gender category trans individuals should be permitted to compete in, it is important to understand the level of physical fitness/performance these individuals possess relative to their cisgender counterparts. Unfortunately, there are few studies investigating this topic, and several complications that confound this research. The current review seeks to discuss sex and gender as concepts, review sex differences in fitness/performance and how they develop, and then, consider how current evidence suggests that trans individuals compare to cis individuals. Finally, this review seeks to offer considerations for whether trans individuals should be excluded from sports and athletics, and how future research should proceed to better understand this marginalized population.

Impact of Sex on Cardiovascular Adaptations to Exercise: JACC Review Topic of the Week

Routine exercise leads to cardiovascular adaptations that differ based on sex. Use of cardiac testing to screen athletes has driven research to define how these sex-based adaptations manifest on the electrocardiogram and cardiac imaging. Importantly, sex-based differences in cardiovascular structure and outcomes in athletes often parallel findings in the general population, underscoring the importance of understanding their mechanisms. Substantial gaps exist in the understanding of why cardiovascular adaptations and outcomes related to exercise differ by sex because of underrepresentation of female participants in research. As female sports participation rates have increased dramatically over several decades, it also remains unknown if differences observed in older athletes reflect biological mechanisms vs less lifetime access to sports in females. In this review, we will assess the effect of sex on cardiovascular adaptations and outcomes related to exercise, identify the impact of sex hormones on exercise performance, and highlight key areas for future research.

Exercise Metabolome: Insights for Health and Performance

Exercise has many benefits for physical and mental well-being. Metabolomics research has allowed scientists to study the impact of exercise on the body by analyzing metabolites released by tissues such as skeletal muscle, bone, and the liver. Endurance training increases mitochondrial content and oxidative enzymes, while resistance training increases muscle fiber and glycolytic enzymes. Acute endurance exercise affects amino acid metabolism, fat metabolism, cellular energy metabolism, and cofactor and vitamin metabolism. Subacute endurance exercise alters amino acid metabolism, lipid metabolism, and nucleotide metabolism. Chronic endurance exercise improves lipid metabolism and changes amino acid metabolism. Acute resistance exercise changes several metabolic pathways, including anaerobic processes and muscular strength. Chronic resistance exercise affects metabolic pathways, resulting in skeletal muscle adaptations. Combined endurance-resistance exercise alters lipid metabolism, carbohydrate metabolism, and amino acid metabolism, increasing anaerobic metabolic capacity and fatigue resistance. Studying exercise-induced metabolites is a growing field, and further research can uncover the underlying metabolic mechanisms and help tailor exercise programs for optimal health and performance.

Clinical Concerns on Sex Steroids Variability in Cisgender and Transgender Women Athletes

In the female athletic community, there are several endogenous and exogenous variables that influence the status of the hypothalamus-pituitary-ovarian axis and serum sex steroid hormones concentrations (e. g., 17β-estradiol, progesterone, androgens) and their effects. Moreover, female athletes with different sex chromosome abnormalities exist (e. g., 46XX, 46XY, and mosaicism). Due to the high variability of sex steroid hormones serum concentrations and responsiveness, female athletes may have different intra- and inter-individual biological and functional characteristics, health conditions, and sports-related health risks that can influence sports performance and eligibility. Consequently, biological, functional, and/or sex steroid differences may exist in the same and in between 46XX female athletes (e. g., ovarian rhythms, treated or untreated hypogonadism and hyperandrogenism), between 46XX and 46XY female athletes (e. g., treated or untreated hyperandrogenism/disorders of sexual differentiation), and between transgender women and eugonadal cisgender athletes. From a healthcare perspective, dedicated physicians need awareness, knowledge, and an understanding of sex steroid hormones' variability and related health concerns in female athletes to support physiologically healthy, safe, fair, and inclusive sports participation. In this narrative overview, we focus on the main clinical relationships between hypothalamus-pituitary-ovarian axis function, endogenous sex steroids and health status, health risks, and sports performance in the heterogeneous female athletic community.

Comparing metabolic profiles between female endurance athletes and non-athletes reveals differences in androgen and corticosteroid levels

Endurance training is associated with physiological changes in elite athletes, but little is known about female-specific effects of endurance training. Despite the significant rise in female sports participation, findings from studies performed on male athletes are largely extrapolated to females without taking into consideration sex-specific differences in metabolism. Subsequently, this study aimed to investigate the steroid hormone profiles of elite female endurance athletes in comparison with their non-athletic counterparts. Untargeted metabolomics-based mass spectroscopy combined with ultra-high-performance liquid chromatography was performed on serum samples from 51 elite female endurance athletes and 197 non-athletic females. The results showed that, compared to non-athletic females, certain androgen, pregnenolone, and progestin steroid hormones were reduced in elite female endurance athletes, while corticosteroids were elevated. The most significantly altered steroid hormones were 5alpha-androstan-3alpha,17alpha-diol monosulfate (FDR = 1.90 × 10^-05), androstenediol (3alpha, 17alpha) monosulfate (FDR = 2.93 × 10^-04), and cortisol (FDR = 2.93 × 10^-04). Conclusively, the present study suggests that elite female endurance athletes have a unique steroid hormone profile with implications on their general health and performance.

Sex Differences in VO2max and the Impact on Endurance-Exercise Performance

It was not until 1984 that women were permitted to compete in the Olympic marathon. Today, more women than men participate in road racing in all distances except the marathon where participation is near equal. From the period of 1985 to 2004, the women’s marathon record improved at a rate three times greater than men’s. This has led many to question whether women are capable of surpassing men despite the fact that there remains a 10–12% performance gap in all distance events. The progressive developments in sports performance research and training, beginning with A.V. Hill’s establishment of the concept of VO_2max, have allowed endurance athletes to continue performance feats previously thought to be impossible. However, even today women are significantly underrepresented in sports performance research. By focusing more research on the female physiology and sex differences between men and women, we can better define how women differ from men in adapting to training and potentially use this information to improve endurance-exercise performance in women. The male advantage in endurance-exercise performance has commonly been attributed to their higher VO_2max, even when expressed as mL/kg/min. It is widely known that oxygen delivery is the primary limiting factor in elite athletes when it comes to improving VO_2max, but little research has explored the sex differences in oxygen delivery. Thus, the purpose of this review is to highlight what is known about the sex differences in the physiological factors contributing to VO_2max, more specifically oxygen delivery, and the impacts on performance.

Multi-omics research in sarcopenia: Current progress and future prospects

Sarcopenia is a systemic disease with progressive and generalized skeletal muscle dysfunction defined by age-related low muscle mass, high content of muscle slow fibers, and low muscle function. Muscle phenotypes and sarcopenia risk are heritable; however, the genetic architecture and molecular mechanisms underlying sarcopenia remain largely unclear. In recent years, significant progress has been made in determining susceptibility loci using genome-wide association studies. In addition, recent advances in omics techniques, including genomics, epigenomics, transcriptomics, proteomics, and metabolomics, offer new opportunities to identify novel targets to help us understand the pathophysiology of sarcopenia. However, each individual technology cannot capture the entire view of the biological complexity of this disorder, while integrative multi-omics analyses may be able to reveal new insights. Here, we review the latest findings of multi-omics studies for sarcopenia and provide an in-depth summary of our current understanding of sarcopenia pathogenesis. Leveraging multi-omics data could give us a holistic understanding of sarcopenia etiology that may lead to new clinical applications. This review offers guidance and recommendations for fundamental research, innovative perspectives, and preventative and therapeutic interventions for sarcopenia.

Endocrine disorders and fertility and pregnancy: An update

It is estimated that more and more couples suffer from fertility and pregnancy maintenance disorders. It is associated with impaired androgen secretion, which is influenced by many factors, ranging from genetic to environmental. It is also important to remember that fertility disorders can also result from abnormal anatomy of the reproductive male and female organ (congenital uterine anomalies - septate, unicornuate, bicornuate uterus; acquired defects of the uterus structure - fibroids, polyps, hypertrophy), disturbed hormonal cycle and obstruction of the fallopian tubes resulting from the presence of adhesions due to inflammation, endometriosis, and surgery, abnormal rhythm of menstrual bleeding, the abnormal concentration of hormones. There are many relationships between the endocrine organs, leading to a chain reaction when one of them fails to function properly. Conditions in which the immune system is involved, including infections and autoimmune diseases, also affect fertility. The form of treatment depends on infertility duration and the patient's age. It includes ovulation stimulation with clomiphene citrate or gonadotropins, metformin use, and weight loss interventions. Since so many different factors affect fertility, it is important to correctly diagnose what is causing the problem and to modify the treatment regimen if necessary. This review describes disturbances in the hormone secretion of individual endocrine organs in the context of fertility and the maintenance of pregnancy.

Female Hyperandrogenism in Elite Sports and the Athletic Triad

Essential hyperandrogenism seems to be overrepresented in female elite athletes. This applies to mild forms such as polycystic ovary syndrome, as well as rare differences/disorders of sex development (DSD). The reason is likely a selection bias since there is increasing evidence that androgens are beneficial for athletic performance by potent anabolic effects on muscle mass and bone mass, and stimulation of erythropoiesis. XY DSD may cause a greatly increased production of testosterone in the male range, that is, 10 to 20 times higher than the normal female range. The established regulations concerning the eligibility of female athletes with severe hyperandrogenism to compete in the female classification remain controversial. The most common cause of menstrual disorders in female athletes, however, is probably an acquired functional hypothalamic disturbance due to energy deficiency in relation to energy expenditure, which could lead to low bone mineral density and increased risk of injury. This condition is particularly common in endurance and esthetic sports, where a lean body composition is considered an advantage for physical performance. It is important to carefully evaluate endocrine disturbances and menstrual disorders in athletes since the management should be specific according to the underlying cause.

Influence of Female Sex Hormones on Ultra-Running Performance and Post-Race Recovery: Role of Testosterone

In recent years, increasing numbers of women have participated in extremely long races. In adult males, there is a clear association between physiological levels of endogenous sex hormones and physical performance. However, the influence of plasmatic sex hormones and the effects of different types of hormonal contraception (HC) on the modulation of physical performance in adult females remain to be fully clarified. Eighteen female ultra-endurance athletes were recruited to participate in the study. Different variables were studied, including hematological parameters, body mass index, and body composition. Strength measurements were obtained using the squat-jump and hand-grip test. A repeated-measures analysis demonstrated significant differences in hematological values of CK and LDH pre-race as compared to immediately post-race and after 24/48 h. Furthermore, statistical differences were found in squat-jump and hand-grip test results after the ultramarathon. Testosterone, estradiol, and the testosterone/estrogen ratio were significantly correlated with muscle fatigue and were found to be indirect markers of muscle damage. A multivariate analysis demonstrated the protective role of testosterone against muscle damage and severe fatigue. Fluctuations in endogenous testosterone levels were correlated with greater fatigability and muscle damage after the competition. Adjusting the menstrual cycle with HC would not provide any further benefit to the athlete's competitive capacity.

Enhanced Skeletal Muscle Oxidative Capacity and Capillary-to-Fiber Ratio Following Moderately Increased Testosterone Exposure in Young Healthy Women

Background: Recently, it was shown that exogenously administered testosterone enhances endurance capacity in women. In this study, our understanding on the effects of exogenous testosterone on key determinants of oxygen transport and utilization in skeletal muscle is expanded.

Methods: In a double-blinded, randomized, placebo-controlled trial, 48 healthy active women were randomized to 10 weeks of daily application of 10 mg of testosterone cream or placebo. Before and after the intervention, VO₂ max, body composition, total hemoglobin (Hb) mass and blood volumes were assessed. Biopsies from the vastus lateralis muscle were obtained before and after the intervention to assess mitochondrial protein abundance, capillary density, capillary-to-fiber (C/F) ratio, and skeletal muscle oxidative capacity.

Results: Maximal oxygen consumption per muscle mass, Hb mass, blood, plasma and red blood cell volumes, capillary density, and the abundance of mitochondrial protein levels (i.e., citrate synthase, complexes I, II, III, IV-subunit 2, IV-subunit 4, and V) were unchanged by the intervention. However, the C/F ratio, specific mitochondrial respiratory flux activating complex I and linked complex I and II, uncoupled respiration and electron transport system capacity, but not leak respiration or fat respiration, were significantly increased following testosterone administration compared to placebo.

Conclusion: This study provides novel insights into physiological actions of increased testosterone exposure on key determinants of oxygen diffusion and utilization in skeletal muscle of women. Our findings show that higher skeletal muscle oxidative capacity coupled to higher C/F ratio could be major contributing factors that improve endurance performance following moderately increased testosterone exposure.

Development and validation of an UHPLC–MS/MS method for extended serum steroid profiling in female populations

Aim: Quantitative endogenous steroid profiling in blood appears as a complementary approach to the urinary module of the World Anti-Doping Agency's Athlete Biological Passport Steroidal Module for the detection of testosterone doping. To refine this approach further, a UHPLC–MS/MS method was developed for the simultaneous determination of 14 free and 14 conjugated steroids in serum. Results: The method was validated for quantitative purposes with satisfactory results in terms of selectivity, linearity range, trueness, precision and combined uncertainty (<20%). The validated method was then applied to serum samples from both healthy women and women diagnosed with mild hyperandrogenism. Conclusion: The UHPLC–MS/MS method showed promising capability in quantifying free and conjugated steroids in serum and determining variations of their concentration/distribution within serum samples from different populations.