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Iron deficiency and testosterone levels in male athletes

Iron deficiency and testosterone levels in male athletes

Chaves PHAshar BGuralnik JMFried Dark chocolate protein bars Looking at the relationship im hemoglobin concentration and prevalent mobility difficulty in older women. Rhoden ELMorgentaler A Risks of testosterone-replacement therapy and recommendations for monitoring. What's more, testosterone plays other important roles in health and disease that may surprise you.

Iron deficiency and testosterone levels in male athletes -

Occasionally, iron levels may be low enough to cause anemia, which is known as iron deficiency anemia IDA. True anemia may have negative effects on immune function, cognitive abilities, and even athletic performance. This is particularly concerning to endurance athletes. A sports medicine physician will be aware of the association between low iron levels and decreased athletic performance, and will perform a thorough history and physical exam.

Lab tests may be ordered, and are particularly important in assessing iron stores in the body. These include tests getting the level of hemoglobin, hematocrit, ferritin, and iron, among others. Routine screening for ID and IDA in female athletes and male endurance athletes is often recommended.

An athlete with low ferritin and iron levels, and normal hemoglobin and hematocrit, is considered to have ID, but not IDA. If the athlete also has low hemoglobin and hematocrit levels, then he or she has IDA.

For athletes with IDA, the evidence is clear that a daily oral iron supplement is beneficial in improving athletic performance. However, there is controversy about whether iron supplementation in athletes with ID alone is helpful. The decision to start iron supplementation in ID should be shared between the athlete, physician, and potentially, a dietician.

Iron supplementation without knowing iron levels is not recommended. Iron is best absorbed in the form of food, as opposed to iron supplements, so increasing the intake of iron-rich foods is important to treating both ID and IDA.

Iron-rich foods include animal protein such as red meat, chicken, and fish, as well as non-animal sources, including iron-enriched cereals and pastas, beans, and dark-green leafy vegetables.

Iron supplement absorption is improved with vitamin C supplementation. Orange juice without calcium is a great option to take with the supplement. Iron supplements should not be taken with milk, coffee or calcium tablets, as these can reduce the absorption of iron.

Finally, iron supplements can cause constipation, so increasing dietary fiber intake and considering a fiber supplement is important. Prevention Eating a healthy diet with foods rich in iron is a good way to help maintain normal iron stores in the body. As meat is a good source of iron, athletes who adhere to a vegetarian or vegan diet should be particularly careful to ensure adequate dietary iron consumption.

Return to Play Athletes with symptoms like weakness, shortness of breath, or heart palpitations will likely have difficulty in competition, and exercise restriction may be considered until the athlete feels better.

As iron levels increase, the athlete will likely experience improved symptoms and expect to return to a normal level of athletic performance. Authors: AMSSM Members Kyle V. Goerl, MD; Cindy J. Chang, MD. Understanding the causes of anemia in older persons is important because anemia in older persons is frequently unexplained 15 and is associated with a high risk of disability and accelerated decline of physical function.

The InCHIANTI study 19 is an epidemiologic study conducted on a representative sample of the population living in the Tuscany region of Italy. Another participants with a history or clinical evidence of cancer or gastric diseases, and 5 undergoing anti-androgen therapy, were excluded from the analysis.

The study population for the cross-sectional analyses included subjects men and women. Of these, 88 had anemia at the baseline evaluation, died before the 3-year follow-up visit, and 80 refused to be reevaluated.

Thus, the study population for the longitudinal analysis included men and women who were not anemic at baseline and were reevaluated after 3 years. The Italian National Institute of Research and Care on Aging institutional review board ratified the study protocol.

Participants consented to participate and to have their blood samples analyzed for scientific purposes. At an initial home interview, participants were provided a plastic container and received detailed instructions for hour urine collection.

Blood samples were obtained from participants after a hour fast, and after a minute rest. Total testosterone level was measured using a radioimmunologic assay Diagnostic Systems Laboratories, Webster, Tex , with a minimum detection limit of 0.

In our research laboratory, intra-assay and interassay coefficients of variation CVs assessed for 3 different concentrations were 9. Sex hormone—binding globulin SHBG concentrations were measured by radioimmunoassay Diagnostic Products Corporation, Los Angeles, Calif , which has a sensitivity of 0.

In our laboratory, interassay and intra-assay CVs for 3 concentrations The serum albumin level was measured with a commercial enzymatic test Roche Diagnostics, GmbH, Mannheim, Germany. Bioavailable testosterone values serum free and albumin-bound testosterone but not SHBG-bound testosterone were calculated using the Vermeulen formula.

Hemoglobin levels were analyzed within 4 hours of blood drawing using the autoanalyzer SYSMEX SE Sysmex Corporation, Kobe, Japan. Erythropoietin EPO was measured in duplicate by Quest Laboratories Baltimore, Md using the Advantage EPO chemiluminescence immunoassay Nichols Institute Diagnostics, San Clemente, Calif , which has a sensitivity of 1.

The mean of the 2 assays was used in the analysis. Folic acid and cyanocobalamin vitamin B 12 levels were measured by a radioimmunologic assay ICN Pharmaceuticals, New York, NY. The minimum detectable concentrations were 0.

Serum ferritin and soluble transferrin receptor sTfr levels were measured in duplicate using chemiluminescent immunoassays Abbott Diagnostics, Abbott Park, Ill, and Nichols Institute Diagnostics.

Serum interleukin 6 IL-6 levels were measured in duplicate by high-sensitivity enzyme-linked immunosorbent assays BIOSOURCE, Camarillo, Calif. The lowest detectable concentration was 0. A clinician ascertained coronary heart disease angina and myocardial infarction , congestive heart failure, stroke, diabetes, hypertension, and chronic obstructive pulmonary disease according to preestablished criteria that combined information from physician diagnoses, pharmacologic treatment, medical records, clinical examinations, and blood test results.

Body mass index BMI , calculated as weight in kilograms divided by the square of height in meters, was based on objective measures. Data are reported as mean ± SD values, medians, and interquartile ranges or percentages. Because of skewed distributions, log-transformed values for EPO and IL-6 levels were used in regression analyses.

Comparisons across subgroups were performed using age-adjusted linear or logistic regression models. The relationships of total and bioavailable testosterone levels with hemoglobin levels is depicted in scatterplots using age-adjusted hemoglobin values, summarized by locally weighted polynomial regression smoothers, 26 and tested in sex-specific linear regression models adjusted for multiple confounders.

Since we found no statistical evidence for such interactions, they were removed from the presented models. The prevalence of anemia across total and bioavailable testosterone quartiles was compared by sex-specific logistic regression models, adjusted for age and multiple confounders.

To capture linear and nonlinear effects, testosterone quartiles were inserted in these models both as dummy using the upper quartile as reference and ordinal variables tests for trend.

We hypothesized that a low testosterone level would be more strongly associated with anemia without a clear clinical cause unexplained anemia than with anemia accompanied by 1 or more potential causes. All analyses were performed using the SAS statistical package, version 9.

Of the men in the study population, 31 7. Of the women, 57 Women with unexplained anemia also had a lower BMI than those without anemia Table 1. Independent of age, total and bioavailable testosterone levels were linearly correlated with hemoglobin levels Figure 1.

However, standardized regression coefficients, which estimate the average difference in hemoglobin associated with a 1-SD change in total and bioavailable testosterone levels, were almost identical in the 2 sexes Table 2. These findings were substantially unchanged after adjusting for age, BMI, smoking, creatinine clearance, diabetes mellitus, hypertension, coronary heart disease, congestive heart failure, stroke, chronic obstructive pulmonary disease, and IL-6 and EPO levels, and after restricting the analysis to male and female participants with normal serum iron levels and no deficiencies of iron, vitamin B 12 , or folate.

After adjusting for multiple confounders, we found that men in the lowest total and bioavailable testosterone level quartiles, compared with men in the highest quartile, were, respectively, 5. Analogously, women in the lowest bioavailable testosterone level quartile were 3.

In women, there was a nonsignificant trend for higher anemia prevalence from the highest to the lowest total testosterone level quartiles from quartile 1 to quartile 4: In adjusted analysis on the restricted sample, the significant trend of higher anemia prevalence across total and bioavailable testosterone level quartiles was still statistically significant for both men and women.

Women in the first and second testosterone level quartiles were at least 4 times significantly more likely to be affected by anemia than those in the highest quartiles. In spite of the significant test for trend, men in the first, second, and third total and bioavailable testosterone level quartiles were not significantly more likely to be anemic compared with those in the highest quartiles, probably because of the small sample size Table 3.

Since none of the men in the highest quartile of bioavailable testosterone level was anemic, to calculate the odds ratios ORs for this specific analysis, we randomly assigned the diagnosis of anemia to 1 male participant in this group.

Therefore, the statistic reported in Table 3 represents a conservative estimate of the true association. Similar findings were obtained for the bioavailable testosterone level data not shown.

The longitudinal analysis was conducted in male and female participants free of anemia at baseline who were reevaluated after 3 years.

Of these, 23 men 8. Adjusting for multiple confounders, we found that men and women in the lowest total testosterone level quartile were, respectively, 1. The risk of developing anemia associated with a low testosterone level became statistically significant relative risk, 2.

The association between low testosterone level and anemia was more robust and highly significant for the bioavailable testosterone level. After adjusting for multiple confounders, we found that men and women in the lowest bioavailable testosterone level quartile were, respectively, 4. We found that older persons with low testosterone levels tend to have lower hemoglobin levels, are more likely to have anemia, and have a higher risk of developing anemia over a 3-year follow-up period.

The risk of anemia associated with a low testosterone level and anemia was similar in the whole study population and in participants with normal serum iron levels and no deficiencies of iron, vitamin B 12 , or folate. Both the cross-sectional and the longitudinal associations of testosterone level with anemia were stronger for bioavailable than for total testosterone level.

To our knowledge, this is the first study that directly addresses the hypothesis that a low testosterone level is a risk factor for anemia in older persons. Our findings are consistent with the frequent development of anemia in patients affected by hypogonadism or those taking anti-androgen drugs 4 - 7 and with the fact that androgen treatment helps correct anemia in patients undergoing hemodialysis and may enhance erythropoiesis even in hypoproliferative anemia where EPO is relatively ineffective.

Although the association between low testosterone level and lowered hemoglobin level was statistically significant, many participants with low testosterone levels were not anemic, and many of those who were anemic had normal testosterone levels.

These findings suggest that a low testosterone level increases the susceptibility to anemia but may not be a sufficient causal factor for anemia, probably because the effect can be counteracted by alternative mechanisms.

Consistent with this hypothesis, we found that the testosterone level was a similar predictor of anemia in the whole study population and in participants free of potential causes of anemia, and there is evidence in the literature that anemia in older persons is multifactorial.

The somewhat stronger association of anemia with a bioavailable rather than with total testosterone level is not surprising. In fact, SHBG and albumin levels, which considerably affect the portion of total testosterone level that is bioactive, are highly variable in older persons.

The mechanism through which testosterone stimulates erythropoiesis is unclear. Testosterone enhances the proliferation of erythroid burst—forming units and colony-forming units by stimulating specific nuclear receptors, and this effect is completely abolished by pretreating marrow cells with cyproterone and flutamide, which selectively block androgen binding to nuclear androgen receptors.

Noteworthy, using standardized regression coefficients, we found the effect of testosterone levels on hemoglobin values in men and women to be almost identical, suggesting that the testosterone-signaling pathway has different settings in men and women.

Also, it has been suggested that testosterone may exert its erythropoietic activity by stimulating EPO. This is consistent with previous findings showing that the erythropoietic activity of androgens is relatively erythropoietin independent.

The main limitation of this study is that the testosterone level was measured only once. Changes in testosterone levels over the 3-year follow-up period may have considerably affected the anemia risk. Information on reticulocytes was also not available, and therefore, whether a low testosterone level is associated with reduced erythropoiesis remains unknown.

Additionally, transient anemia events that occurred and reversed before the 3-year follow-up evaluation were not considered. Finally, we used the World Health Organization definition 22 of anemia to make our study comparable to other studies in the literature, but the validity of using such a definition in older persons has been recently challenged.

We collected information on testosterone levels and other measures that, in the absence of direct assessment of bone marrow, are considered the gold standard for determining the pathophysiologic characteristics of anemia.

The results of this study have opened new questions about the pathophysiologic characteristics of anemia in older patients. We suggest that low testosterone levels could be a susceptibility factor for anemia that has been generally neglected. We suggest that low testosterone levels should be considered a potential cause or cocause of anemia in older men and women, especially when other plausible causes have been excluded, and in patients with nutritional deficiencies in whom nutritional supplementation of iron and vitamins has been ineffective.

However, our findings should be confirmed in larger populations and in other clinical settings before they can be considered for clinical applications. In particular, the interplay between testosterone level and EPO in modulating erythropoiesis in older persons should be better characterized.

Recent studies have established a strong and independent relationship between hemoglobin level and many of the potential targets of testosterone supplementation, including muscle strength, muscle fatty infiltration, bone mineral density, physical performance, and cognition.

This possibility should be carefully considered in evaluating the results of trials of androgen replacement therapy. Correspondence: Luigi Ferrucci, MD, PhD, National Institute on Aging, Longitudinal Studies Section, Clinical Research Branch, ASTRA Unit, Harbor Hospital, Fifth Floor, S Hanover St, Baltimore, MD ferruccilu grc.

Author Contributions: All authors contributed substantially to this work. Drs Ferrucci, Maggio, Bandinelli, Valenti, Guralnik, and Longo conceived, designed, and performed the analysis and directly contributed in the writing of this article.

Dr Basaria participated in the study design and critically reviewed the manuscript, providing essential endocrinologic expertise. Drs Lauretani, Ble, and Ershler participated in the interpretation of the main findings of this analysis and critically revised the manuscripts several times.

Financial Disclosure: Drs Ferrucci and Guralnik sereved as consultants for Ortho Biotech Clinical Affairs, Bridgewater, NJ, during and Role of the Sponsor: The granting institutions did not interfere in any way with the collection, analysis, presentation, or interpretation of the data reported in this article.

full text icon Full Text. Download PDF Top of Article Abstract Methods Results Comment Article Information References. Figure 1. View Large Download. Table 1.

Linear Regression Models for the Relationship of Testosterone Levels With Hemoglobin Levels. Logistic Regression Models for the Likelihood of Anemia. Logistic Regression Models For the Risk of Developing Anemia Associated With Low Testosterone Level in Participants Free of Anemia at Baseline.

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What is ni Iron deficiency and iron Dark chocolate protein bars anemia are important, and occasionally, controversial topics in Tsetosterone Medicine. Iron is used by Building healthy habits Antioxidant supplements for skin rejuvenation atgletes to levelz deliver oxygen all throughout the body. When iron levels are too low, bodily functions are negatively affected. Iron levels in the body can be low for reasons such as a diet deficient in iron, inadequate iron absorption in the stomach and intestines, or by loss of iron, which is a common cause in menstruating women. Iron, specifically low Best body fat calipers of it, is often Antioxidant supplements for skin rejuvenation to feelings deficincy exhaustion and poor recovery. Athleges is a critical Antioxidant supplements for skin rejuvenation athletea for deficciency individuals, but is particularly important for athletes, due to the important role it plays in oxygen transportation to working muscles. Iron is an essential component of hemoglobin, the protein that carries both oxygen and carbon dioxide in the blood. It also plays a key role in the transfer of oxygen in muscle cells. Anemia is very simply a lack of iron in the blood. Iron deficiency and testosterone levels in male athletes

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Here Are The Most Common Causes of Iron Deficiency Anemia in Athletes

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