ArticlePDF Available

Endurance Exercise Training and Male Sexual Libido

February 2017
Medicine and Science in Sports and Exercise 49(7):1

DOI: 10.1249/MSS.0000000000001235

Project: "Exercise Hypogonadal Male Condition", RED-S, Female Athlete Triad and Reproductive Dysfunctions in Endurance Athletes

Authors:

Anthony C. Hackney

University of North Carolina at Chapel Hill

Amy Lane

University of North Carolina at Chapel Hill

Colin O'Leary

University of North Carolina at Chapel Hill

Purpose: To study the associations between aspects of endurance exercise training and the sexual libido in healthy men using a cross-sectional online survey study design. Methods: A developed online survey questionnaire was utilized. The questionnaire was based upon pre-existing validated questionnaires and use to assess elements of physical characteristics, exercise training-habits and libido of participants (n=1077). Three evidence-based categories were created for the primary outcome of total libido score and low, normal, and high response categories set. The high and normal categories were combined to form a high/normal score group and the low category formed a low score group. Odds ratios (OR) were calculated to examine group categorization. Results: Age, training intensity, and training duration of participants had significant (p<0.02) univariate relationships, with libido scores and were thus included in the multivariate model. In the multivariate model, training intensity (p<0.0001) and duration (p<0.002) components were the most significantly associated with libido group designation (high/normal vs. low). Participants with the lowest (OR: 6.9; 95% CI: 2.6-17.9) and mid-range training intensities (OR: 2.8; 95% CI: 1.4-5.3) had greater odds of high/normal libido state than those with the highest training intensity. Participants with the shorter (OR: 4.1; 95% CI: 1.6-10.0) and mid-range training durations (OR: 2.5; 95% CI: 1.3-4.8) at their current intensity also had greater odds of high/normal libido score than those with a greatest duration. Conclusion: Exposure to higher levels of chronic intense and greater durations of endurance training on a regular basis are significantly associated with a decreased libido scores in men. Clinicians who treat male patients for sexual disorders and, or council couples on infertility issues should consider the degree of endurance exercise training a man is performing as a potential complicating factor.

. Summary of key responses from survey on aspects of exercise training characteristics and elements. Associations * = statistically significant association with libido groups (Low vs.

…

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Endurance Exercise Training and Male Sexual Libido

Anthony C. Hackney1,2, Amy R. Lane1, Johna Register-Mihalik1 1

1Department of Exercise & Sport Science and 2Department of Nutrition, Gillings School of

Global Public Health, University of North Carolina, Chapel Hill, NC

Accepted for Publication: 9 February 2017

. . . Published ahead of Print

Endurance Exercise Training and Male Sexual Libido

, Johna Register

Mihalik

Department of Nutrition, Gillings School of

Global Public Health, University of North Carolina, Chapel Hill, NC

Accepted for Publication: 9 February 2017

Endurance Exercise Training and Male Sexual Libido

Anthony C. Hackney1,2, Amy R. Lane1, Johna Register-Mihalik1, and 1

1Department of Exercise & Sport Science and 2Department of Nutrition, Gillings School of

Global Public Health, University of North Carolina, Chapel Hill, NC

Running title: Exercise and Libido

Address correspondence to:

A.C. Hackney, Ph.D., D.Sc., University of North Carolina, CB # 8700 Fetzer Hall UNC-CH,

Chapel Hill, NC 27599, USA

Email: ach@email.unc.edu Fax: 919-962-0489 Tel: 919-962-0334

There was no internal or external funding in support of this project. The authors acknowledge

there are not Conflicts of Interests relative to this work. Also, the results are presented clearly,

honestly, and without fabrication, falsification, or inappropriate data manipulation, and the

present study do not constitute endorsement by ACSM.

Medicine & Science in Sports & Exercise, Publish Ahead of Print

DOI: 10.1249/MSS.0000000000001235

Department of Nutrition

Gillings

School of

, Chapel Hill, NC

Ph.D., D.Sc.,

University of North Carolina,

Chapel Hill, NC 27599, USA

ach@email.unc.edu

Fax: 919

962

There was no internal or external funding in support of this project. The authors acknowledge

there are not Conflicts of Interests relative to this work. Also, the

honestly, and without fabrication, falsification, or inappropriate data manipulation, and the

ABSTRACT

Purpose: To study the associations between aspects of endurance exercise training and the sexual

libido in healthy men using a cross-sectional online survey study design. Methods: A developed

online survey questionnaire was utilized. The questionnaire was based upon pre-existing

validated questionnaires and use to assess elements of physical characteristics, exercise training-

habits and libido of participants (n=1077). Three evidence-based categories were created for the

primary outcome of total libido score and low, normal, and high response categories set. The

high and normal categories were combined to form a high/normal score group and the low

category formed a low score group. Odds ratios (OR) were calculated to examine group

categorization. Results: Age, training intensity, and training duration of participants had

significant (p<0.02) univariate relationships, with libido scores and were thus included in the

multivariate model. In the multivariate model, training intensity (p<0.0001) and duration

(p<0.002) components were the most significantly associated with libido group designation

(high/normal vs. low). Participants with the lowest (OR: 6.9; 95% CI: 2.6-17.9) and mid-range

training intensities (OR: 2.8; 95% CI: 1.4-5.3) had greater odds of high/normal libido state than

those with the highest training intensity. Participants with the shorter (OR: 4.1; 95% CI: 1.6-

10.0) and mid-range training durations (OR: 2.5; 95% CI: 1.3-4.8) at their current intensity also

had greater odds of high/normal libido score than those with a greatest duration. Conclusion:

Exposure to higher levels of chronic intense and greater durations of endurance training on a

regular basis are significantly associated with a decreased libido scores in men. Clinicians who

treat male patients for sexual disorders and, or council couples on infertility issues should

based up

on preon pre

to assess elements of physical characteristics, exercise training

based categories were created for the

w, normal, and high response categories set. The

high and normal categories were combined to form a high/normal score group and the low

Odds ratios (OR) were calculated

Age, training intensity, and training duration of pa

significant (p<0.02) univariate relationships, with libido scores and were thus included in the

multivariate model. In the multivariate model,

training intensity (p<0.000

were

the most

significantly associated with libido group designation

(high/normal vs. low). Participants with the lowest (OR: 6.9; 95% CI: 2.6

training intensities (OR: 2.8; 95% CI: 1.4

those with the highest training intensity. Participant

10.0) and mid

range training durations (OR: 2.5; 95% CI: 1.3

had greater

odds of high/normal libido

Exposure to h

igher levels of chronic intense and greater durations of endurance training on a

consider the degree of endurance exercise training a man is performing as a potential

complicating factor.

Key Words: hypogonadism, testosterone, sex drive, stress, health

Introduction

The Centers for Disease Control and Prevention reports that 1.5 million women in the US

(6%) are infertile (National Survey of Family Growth) and, the American Society for

Reproductive Medicine affirms that infertility affects men and women equally (2,29). Moreover,

in approximately 40% of infertile couples, the male partner is either the sole cause or a key

contributing cause of infertility (2). One of the factors influencing fertility in males is a low

sexual desire; i.e., decreased libido (2). Clinically decreased libido can manifest as Male

Hypoactive Sexual Desire Disorder (MHSDD - Diagnostic and Statistical Manual of Mental

Disorders [DSM-V]); which affects approximately 16-18% of the adult male population (8).

It is well known women who are involved with high levels of intensive exercise training

have an elevated risk for developing menstrual dysfunctions and potential infertility, especially if

the menorrhea as a result of hypothalamic-pituitary-gonadal (HPG) axis

disruption (31). Evidence indicates that exercising men develop a similar corollary HPG axis

ypogonadal Male Condition (EHMC) (16). In the male

condition a quasi-hypogonadotropic hypogonadism exists as testosterone and luteinizing

hormone levels are both suppressed; and, abnormal sperm characteristics are sometimes

manifested (3,14). Current evidence links the development of EHMC to the combining effects of

the volume and intensity of endurance exercise training in these men (3,14,16).

Testosterone is associated with many androgenic-anabolic processes in the male, and

while not universally accepted, it is thought to play a key role in male sexual libido (6). Being

more physically active has been shown to be beneficial reproductively for men who are

sedentary (or have a very low physical activity levels) as it results in improved testosterone

levels and libido (11,32). Conversely, there are many reports in the popular literature and on the

in approximately 40% of infertile couples, the male partner is either the sole cause or a

One of the factors influencing fertility in males is

a a

Clinically decreased libido can manifest as

Male

and Statistical Manual of

8% of the adult male

population (

omen who are involved with high levels of intensive exercise training

have an elevated risk for developing menstrual dysfunctions and potential infertility, especially if

as a result of

hypothalamic

Evidence indicates

that that

exercising men exercising men

ypo

gonadal M

hypogonadotropic

hypogonadi

levels are

both

suppressed

;

manifested

(

3,14

). ).

Current eviden

ce links the development of

volume and intensity

endurance

Testosterone is associated with

ile not universally accepted, it is

internet suggesting that men who participate in large amounts of endurance exercise training

(e.g., marathon running) can have suppressed testosterone and libido (3,5). An examination of

available peer-reviewed research literature, however, reveals the issue of libido status in males

engaged in endurance exercise has not been systematically or empirically studied. To this end,

we studied the associations between aspects of endurance exercise training and the libido status

in healthy men using a cross-sectional online survey study design.

METHODS

Development of the Survey Instrument

An online survey questionnaire was developed to assess elements of physical

characteristics, exercise training-habits and sexual libido of male participants. The questions

concerning exercise training-habits were based on the International Physical Activity

Questionnaire (IPAQ) and the Baecke Questionnaire; and followed recommendations of the

American Heart Association (1,4,12). The libido related questions were based on items within

the Androgen Deficiency in the Aging Male Questionnaire (ADAM), Sexual Desire Inventory

(SDI-2) and the Aging Male Symptoms (AMS) Scale (18,19,23,27). The IPAQ, Baecke, ADAM,

SDI-2 questionnaires and the AMS Scale are commonly used in research-clinical settings and the

validity of each has been assessed and reported elsewhere (

10,18,19,20,24,27). The completed online survey was reviewed by an exercise physiologist and a

fertility specialist who were not involved with the study to insure legitimacy of selected question

items (i.e., content validity). The completed questionnaire and procedures for distribution were

reviewed and approved by the University of North Carolina Institutional Review Board.

Participant consent was obtained via their online access to the questionnaire; and, in which they

xercise training and the libido status

online survey questionnaire was developed to assess elements of physical

habits and sexual

libido

ts were

based on

Baecke

Questionnaire

; and followed recommendations of the

Association

(

1,4,1

The libido related questions were based on

Androgen Deficiency in the Aging Male

and the Aging Male Symptoms (AMS) Scale

questionnaire

the

AMS Scale

validity

of each has

been assessed and reported

,18,19,20,24,2

)

The completed online survey was reviewed by an

fertility specialist who were not involved with the study to insure legitimacy of selected question

also indicated they were healthy and free of endocrine-related medical disorders and prescription

medication usage.

Survey Sample - Administration

The completed survey questionnaire was formatted into the Qualtrics (Quatrics, 2014)

online survey platform and made accessible through a specific world-wide web link

(https://jfe.qualtrics.com/form/SV_eWESbBdaONSuUPb). Subsequent to establishment of the

web link, a series of email notifications were sent to sports clubs, national sports organizations,

university athletic departments, and sporting magazines publicizing the existence of the survey

and the web link site for access (~300 club/organizations were contacted). These emails

requested announcement of the survey and encouragement of participation by individuals

associated with the group/organization. The target population was adult males (>18 years old)

involved with sporting activities (e.g., walking, running, bicycling, swimming) on a recreational

and competitive basis in North America. However, clubs and organizations associated with

endurance based activities (e.g., running, triathlons, bicycling) were predominately targeted since

EHMC is more prevalent in men engaged in such activities (3,14,16). The survey administration

period was January 2014 to January 2015. Approximately every four months reminder emails

were sent to prior contacts to encourage them to continue to promote and distribute information

about the survey.

Dependent measures

The survey was constructed in three parts. The first section addressed elements of the

participant involvement (e.g., gender, medical status) and physical

(Quatrics, 2014)

orld

wide web link

. Subsequent

to establishment of

clubs, national sports organizations,

sporting magazines

publicizing

the existence of the survey

club/organizations

were contacted)

requested announcement of the survey and encouragement of participation

associated with the group/organization

The target

opulation was

(e.g., walking, running, bicycling, swimming)

and competitive basis in North America.

However,

(e.g., running, triathlons,

more prevalent in men

engaged in

period was January 2014 to January 2015.

were sent to prior contacts

to encourage

about the survey.

characteristics/demographic information. The second part focused on exercise habits and history

of regular frequency of exercise (days/week), intensity of training effort (number of light,

moderate, hard sessions per week), duration of exercise (hours/session; total hours/week),

primary and secondary types-forms of exercise engagement, endurance sports competition

participation (type and number of events), years in training, stability of training (i.e., our intent

injury, tapering or overreaching), focus of

training (recreation, health, sporting competition), and physical activity requirements at work

(level of activity, minutes/day). Approximate oxygen uptake (VO2) percentages for respective

recommendations of Bouchard et al. (6). The third part of the survey addressed questions on

libido, targeting such issues as sexual activity, arousal, desire, attraction, fantasy, appetite,

fulfillment, needs for intimacy, and infertility issues or confounders (i.e., concussions, children

sired).

Parts one and two of the survey allowed participants to click on predetermined answer

button options, which provided appropriate ranges for each particular question and parameter

being assessed. Part three (libido) involved a three category format structure to the answer

options where participants clicked answer buttons of Yes, Maybe, No; and, based on answers

some follow-up questions were presented. Answers to part three were scaled and scored in a

Likert- ; answers were assigned plus or minus

values towards final libido score depending on the nature of the specific question. All libido

questions (15 in total) were scored and an aggregate total libido score computed (i.e., > score = >

libido).

stability of training

(i.e., (i.e.,

our

tapering or overreaching)

focus

activity

requirements

at work

Approximate oxygen uptake (VO

) percent

ages

for respective

The third part

of the survey

addressed questions on

activity,

arousal, desire, attraction,

fulfillment, needs for intimacy, and infertility issues

or confounders (i.e., concussions

of the survey

allowed participants to c

which provided appropriate ranges for each particular question and parameter

. Part three

(libido)

involved a involved a

where participant

s clicked answer

some follow

up questions w

Likert

values towards final l

Statistical analysis

All statistical analyses were conducted using IBM® SPSS ® v19 (2010). Frequencies

and missing data checks were conducted to confirm data integrity (i.e., relative to missing data).

Specific variables of interest included age categories, elements of exercise training intensity and

exercise training duration (see above) at the current levels of training; but all response variables

were included in initial analyses. Additionally, several exercise training variables were computed

in which elements of frequency, intensity and, duration relative to time (hour per week and years

of training) were integrated into composite scores to estimate overall dose of exercise effects.

Tertiles categories were created for the variables of interest listed above and three evidence-

based categories were created for the primary outcome of total libido score (30). The cut-points

representing the libido score categories were as follows: Low 7, normal 8-14, high 15. The

high and normal categories were combined to form a single high/normal score group and the low

category formed the low score group. Combining high/normal score groups was utilized since

the focus of the study was on the presence and occurrence of lower libido in relation to

endurance exercise training.

Demographic, exercise training, and libido characteristics of the participants were

summarized with the use of means, standard deviations, and percentages. Demographic and

exercise training outcomes potentially related to our primary outcome of libido score were

analyzed using univariate statistics (Chi-Square analyses and t-tests). Subsequently,

multivariable logistic regression (entry method) was utilized to determine adjusted odds ratios

(OR) and 95% confidence intervals (CI) for libido score (i.e., placement in high/normal vs. low

score group) for the factors with significant univariate relationships to libido score categories.

Alpha level for all analyses was set to 0.05 a priori.

; but all response variables

everal exercise training variables were computed

time (

hour per week and hour per week and

to estimate overall dose of exercise effects

for the variables of interest

listed abovelisted above

and

primary outcome of t

otal libido score

categories were

as follows: Low

7, normal 8

combined to form a single

high/normal

score group

ombining high/normal score groups

the focus of the study was on the presence and occurrence of low

endurance exercise training.

Demographic,

exercise

training, and libido characteristics of the participants were

summarized with the use of means, standard deviations, and percentages. Demographic and

exercise

training outcomes potentially related to our

analyzed using

univariate statistics (Chi

multivariable

logistic regression

RESULTS

A total of 1366 individuals responded to the survey. Only respondents meeting all study

criteria (n=1077; healthy male and 18 years or older, complete surveys ) were included in

the analyses. The mean (±SD) physical characteristics and demographic outcomes of the

participants are reported in Table 1.

Age, exercise training intensity, and training duration components of participants had

significant univariate relationships (p<0.02; Table 2) with libido scores and were thus included in

the multivariate model. In the multivariate model, training intensity (p<0.0001) and

duration (p<0.002) were significantly associated with libido score group designation

(high/normal vs. low). Total intensity was a computed variable representative of number of

training sessions at a low, moderate, hard intensity times the hours of each per week (~oxygen

uptake (VO2) percent for respective intensities were; and high

) (see Methods). Chronic duration was a computed value representative of hours per

week training times the number of years training (at current level).

Specifically, participants with the greatest amount of low intensity training (OR: 6.9;

95% CI: 2.6-17.9) and moderate amount training (OR: 2.8; 95% CI: 1.4-5.3) had greater odds of

being in the high/normal libido score group than those participants with a greater amounts of

high intensity training (Table 3).

Likewise, participants with lower duration amounts to their training (OR: 4.1; 95% CI:

1.6-10.0) and moderate duration amounts of training (OR: 2.5; 95% CI: 1.3-4.8) also had greater

odds of high/normal libido state than those with a greatest amounts of training duration (Table

3).

components

of participants of participants

had

scores

and were and were

thus thus

included in

the multivariate model. In the multivariate model, training

intensity

(p<

0.000

(p<0.002) were significantly associated with libido

score score

group designation

Total intensity was a computed variable representative o

a low, moderate, hard intensity

times

the

hours

of each

percent for respective intensities were;

. Chronic duration was a computed value representative of hours per

the number of year

s training (

Specifically, p

articipants with the

greatest amount

17.9) and

moderate

amountamount

being in the

high/normal libido s

intensity

training training

(

Table 3)

Likewise, participants with

10.0) and

moderate

Age was also a

OR: 1.9, 95% CI: 1.0-3.9) and those in the mid-age category (41-55 yr; OR: 1.9, 95% CI: 0.9-41)

were more likely to be in the high/normal libido score group than those participants in the oldest

age- 56 yr).

Cronbach alpha values within the current survey ranged from 0.64 to 0.88. These were

slightly lower than the values originally reported from the survey/questionnaires on which the

current one was based (see Methods).

DISCUSSION

In this cross-sectional survey study we found that an inverse relationship exists between

endurance exercise training factors and male libido scores. Specifically, higher amounts of

intensive training or training involving greater amounts of duration within the endurance

program were associated with lower libido scores. When comparing the OR responses among

libido score classifications, participants in the low score group were approximately 64.5 to

85.5% ([1-[1/OR]] x 100) more likely to fall in that category since they did greater amounts of

higher intensity exercise. Also the low libido score group were 60.0 to 75.6% more likely to fall

into that category since they were doing greater amounts of longer duration exercise training

(28). Conversely, the effect of low - moderate intensity and shorter - moderate duration exercise

training seemed highly comparable in clearly influencing the libido scores of the participants in a

positive fashion which is in support of prior published work (32).

To our knowledge this is the first scientific, research-based study to examine the issue of

male libido and endurance exercise training. Several surveys on sexual habits and exercise

training have been conducted previously by sporting magazines (e.g., Runners World) and

0.64 to 0.88. These

slightly lower than the values originally reported from the survey/questionnaires on which the

sectional survey study we found

that an inverse that an inverse

relationship exist

and male libido scores

Specifically,

intensive training or training involving greater amounts of duration within the endurance

lower

libido libido

scores

hen comparing the OR responses among

do score classifications, participants in the low

100)

more likely to fall in t

higher intensity exercise

. Also the low libido score group were

into that category since they were

Conversely

, t

he effect of

training seemed

highly comparable in

positive fashion

which is in support of prior

sporting goods manufacturers (e.g., Brooks Sports Inc., Seattle, WA, USA). However, the

constructs of the questions presented in those surveys were not based upon clinical assessment

instruments used in sexual behaviors and fertility research. Furthermore, the statistical

approaches employed with these surveys tended to be descriptive in nature and not analytical-

inferential.

Several recent laboratory studies have examined issues of sexual satisfaction and libido

with exercise, but the generalizability applicability (to the current study) of the findings are

hampered by the small sample sizes utilized (n < 20) and a focus on female participants (17,22).

The findings of these latter studies did suggest that an acute exercise session enhances sexual

arousal-desire via activation of the sympathetic nervous system (SNS), enhanced SNS activity is

a common response to a single bout of exercise (9). It is unclear if these aforementioned studies

used habitual exercisers (such as within the current study). This last point is an important

consideration as it is well established that exercise training improves the sensitivity of tissue

responses to the SNS via enhanced receptor actions, resulting in substantially lower overall

sympathetic autonomic neural tone following chronic training (9,15).

Our focus was to establish whether an association between libido and endurance training

characteristics exists. As noted an inverse relationship between the duration/intensity

characteristics of endurance training and libido was identified. However, why increasing

duration and, or intensity of exercise training reduces a male s libido score cannot be ascertained

from the data obtained in this study. This study was not designed to explore a potential

mechanism. As mentioned earlier, the presence of EHMC is more prevalent in endurance-trained

men and the condition is associated with lowered basal testosterone, which can be linked to

reduced libido. But, currently the only means of detecting the existence of EHMC is through

have examined issues of sexual satisfaction a

nd libido

applicability (to the current study)

of the findings are

and a focus on female participants

an acute

exercise

session

via activation of the sympathetic nervous system (SNS)

exercise

(

)

t is unclear if these

used habitual exercisers (such as within the current study)

it is well established that exercise training improves the sensitivity of tissue

via enhanced receptor actions,

neural

tone

following chronic training

Our focus was to establish whether an association between libi

characteristics

exists. A

s noted a

characteristics of endurance training and libido

duration

and

, ,

or or

ntensity of

from the data obtained in this

measurement of reproductive hormonal levels within the blood or saliva. The present study did

not ascertain hormonal profiles of the respondents. Hence, we cannot state whether EHMC was a

direct factor in our participants with lower libido scores. Likewise, select medication use (e.g.,

performance enhancing drugs [PED]), existing psychological disorders (i.e., depression), and/or

chronic low caloric intakes are well established factors associated with suppression of

testosterone and reduced libido (13,14,26). For participation, we asked our males if they were

healthy and not under medical supervision, thus we feel the likelihood of these factors

confounding our outcomes is unlikely -

adherence and must acknowledge these were potential confounders in our data.

Increased volumes of intensive exercise training may also result in greater levels of

physical and mental fatigue in an individual, which could

motivation towards sex. In the current survey, we did not ask participants to report on their

overall level of general fatigue or lethargy. Typically with excessive physical fatigue,

experienced exercising individuals reduce their training loads to allow recovery (25). Our

participants reported they were in a stable period of consistent training for a number of months at

the time of the survey. This last fact also suggests that they were not overreaching / overtraining

which is associated with the development of the Overtraining Syndrome, which is linked to

sexual dysfunction (15). Nonetheless, the influential aspects of general exercise fatigue from

chronic exercise training as a possible causative mediator of reduced libido scores seems a

logical likelihood and needs to be pursued in future research.

It was expected the age of the participants would be associated with libido score

categorization. We found the two younger age groups participants had a greater likelihood of

placement in the high/normal libido score group than the oldest age group. Evidence indicates

are well established factors associated with

suppression of suppression of

For participation, we asked our males

if they

were

healthy and not under medical supervision, thus we feel the likelihood of these facto

potential confounder

in our data

ncreased volumes of intensive exercise training

may

also result

physical and mental fatigue in an individual, which

could

In the current survey, w

e did not ask participants to report on their

level of general fatigue

or lethargy

pically with excessive

exercising individuals reduce their training loads to allo

participants reported they

were in a stable period of

the time of the survey

This last fact also suggests

which is associated with the

development of the

sexual

dysfunction

(

)

Nonetheless, the influential aspects of

chronic exercise training

logical likelihood and

that male libido does decrease with aging (13), and one could argue this was a factor influencing

membership in the low libido score group. However, Lindau and Gavrilova (21) report that

medically healthy men of this age group (i.e., 56 yr) have active sexual desires and not until

70-85 years of age may there be sizable declines; being ~50-80% less than that observed 20-40

years earlier in life. Relative to this last point, the odds ratio observed for the influence of

exercise training intensity and duration were of a significantly larger magnitude than that of age

alone.

We acknowledge our sample was one of convenience, with potential response bias and

hence is a limitation. We also asked our subjects to complete the questionnaire only once, but

with multiple reminded notices sent to organizations it is possible some duplication occurred.

Another aspect of our study which limits the interpretation and generalizability of the findings is

our reliance upon self-reports and recall from our respondents. As a result of these factors, our

findings should be viewed as preliminary in nature and more work on this topic is needed.

To conclude, this systematic study using an online survey approach suggests men

engaged in higher intensities and greater durations of endurance training on a chronic basis (i.e.,

years) are significantly associated with decreased libido scores. Although our findings are

preliminary, the results suggest that clinicians who treat male patients with regard to Male

Hypoactive Sexual Desire Disorder and/or council couples on infertility issues should take into

account the degree of endurance exercise training a man is performing as a potential

complicating factor.

for the influence of

larger magnitude than that of

age

ur sample was one of convenience, with potential response bias

We also asked our subjects to complete the questionnaire only once, but

to organizations it is possible some duplication occurred.

the interpretation and gen

eral

and recall from our respondents.

viewed as preliminary in nature

and more work on this topic is

, this systematic study using an online survey approach

igher intensities and greater

durations of

are significantly associate

d withd with

preliminary,

the

results

suggest that clinic

poactive Sexual Desire Disorder

account the degree of

complicating

factor.

Acknowledgements

There was no internal or external funding in support of this project. The authors acknowledge

there are not Conflicts of Interests relative to this work. Also, the results are presented clearly,

honestly, and without fabrication, falsification, or inappropriate data manipulation, and the

present study do not constitute endorsement by ACSM. The authors wish to acknowledge the

support of all the different sports clubs and organizations that aided in the distribution of our

questionnaire.

The authors wish to acknowledge the

support of all the different sports clubs and organizations that aided in

the

distribution of our

References

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Table 1. The physical and exercise training characteristics of the participants. *Mean and SD for

categorical rating of measurement (Age: 1: < 18 years = not included in analysis; 2: 18-25; 3: 26-

40; 4: 41-

Measurement

Minimum Maximum Mean SD

Age Group

(category)

2.0 5.0 3.39* 0.96

Weight

(kg)

51.8 159.0 76.4 12.3

Height

(m)

1.42 2.29 1.79 0.08

BMI*

(kg/m2)

16.0 35.0 23.63 3.06

12.3

0.080.08

23.63

3.06

Table 2. Summary of key responses from survey on aspects of exercise training characteristics

and elements. Associations * = statistically significant association with libido groups (Low vs.

Normal/High). Abbreviations: Med = medium (tertile), yr = year, IS = intensity sessions/week (#

low, # moderate, # high), T = tertile, hr = hour, hr/wk = hours per week, VO2% = approximated

VO2%/ IS (# low [ 35%], # moderate [50%], # high [ 70%]) (7). = rounding of numbers to

0.1 decimal (i.e., affects overall percentage totals).

Characteristic

Libido Score Group

Total X

Low

% (count)

Normal/High

% (count)

Age*

(year)

33.3 (20)

18.8 (191)

19.6 (211)

0.000

13.3 (8)

38.5 (392)

37.1 (400)

25.0 (15)

28.8 (293)

28.6 (308)

> 56

28.3 (17)

13.9 (141)

14.7 (158)

Frequency

exercise (per

week)*

1.7 (1)

9.3 (94)

8.9 (95)

0.000

21.7 (13)

58.3 (589)

56.2 (602)

30.0 (18)

25.8 (261)

26.1 (279)

> 10

46.7 (28)

6.6 (67)

8.9 (95)

Hours of

exercise

(per week)*

1.7 (1)

9.6 (98)

9.2 (99)

0.000

10.0 (6)

33.1 (336)

31.8 (342)

23.3 (14)

35.0 (356)

34.4 (370)

> 10

65.0 (39)

22.2 (226)

24.6 (265)

Primary exercise

mode

Walking

1.7 (1)

1.9 (19)

1.9 (20)

0.711

Running

88.3 (53)

79.9 (812)

80.4 (865)

Biking

5.0 (3)

9.4 (95)

9.1 (98)

Swimming

0.0 (0)

1.0 (11)

Weightlifting

3.3 (2)

5.5 (56)

5.4 (58)

Other

1.7 (1)

2.3 (23)

2.2 (24)

Other exercise

modes regularly

performed*

Walking

63.3 (38)

70.8 (720)

70.4 (758)

0.219

Walking

yes

36.7 (22)

29.2 (297)

29.6 (319)

Running

81.7 (49)

73.3 (745)

73.7 (794)

0.150

Running

yes

18.3 (11)

26.7 (272)

26.3 (283)

Biking

71.7 (43)

68.1 (693)

68.3 (736)

0.568

Biking

yes

28.3 (17)

31.9 (324)

31.7 (341)

Swimming

90.0 (54)

85.2 (866)

85.4 (920)

0.301

Swimming

yes

10.0 (6)

14.8 (151)

14.6 (157)

*Wt. Lift

80.0 (48)

57.6 (586)

58.9 (634)

0.001

*Wt. Lift

yes

20.0

(12)

42.4 (431)

41.1 (443)

rounding of numbers to

Total

Normal/High

% (count)

18.8 (191)

19.6 (211)

0.000

38.5 (392)

37.1 (400)37.1 (400)

28.8 (293)

28.6 (308)

28.3 (17)

13.9 (141)

14.7 (158)

1.7 (1)

9.3 (94)9.3 (94)

8.9 (95)

21.7 (13)

58.3 (589)

30.0 (18)30.0 (18)

25.8 (261)

46.7 (28)46.7 (28)

6.6 (67)

1.7 (1)1.7 (1)

9.6 (98)

10.0 (6)

33.1 (336)

23.3 (14)

65.0 (39)

Walking

1.7 (1)

Running

88.3 (53)

Biking

Swimming

WeightliftingWeightlifting

Other

Other exercise

modes regularly

performed*

Walking

Other

81.7 (49)

72.4 (736)

72.9 (785)

0.115

Other

yes

18.3 (11)

27.6 (281)

27.1 (292)

Compete

regularly*

28.3 (17)

47.8 (485)

46.7 (502)

0.003

Yes

71.7 (43)

52.2 (529)

53.3 (572)

Reason for

exercise training

*Wt. Loss

63.3 (38)

39.0 (397)

40.4 (435)

0.000

*Wt. Loss

yes

36.7 (22)

61.0 (620)

59.6 (642)

Stress Relief

40.0 (24)

30.1 (306)

30.6 (330)

0.106

Stress Relief

yes

60.0 (36)

69.9 (711)

69.4 (747)

*Enjoyment

50.0 (30)

14.5 (147)

16.4 (177)

0.000

*Enjoyment

yes

50.0 (30)

85.5 (870)

83.6 (900)

*Strength/Fit

70.0 (42)

34.9 (355)

36.9 (397)

0.000

*Strength/Fit

yes

30.0 (18)

65.1 (662)

63.1 (680)

*Competition

20.0 (12)

35.8 (364)

34.9 (376)

0.013

*Competition

yes

80.0 (48)

64.2 (653)

65.1 (701)

Physical activity

at work (per day)

< 30 minutes

58.3 (35)

66.9 (679)

66.4 (714)

0.121

60 minutes

28.3 (17)

16.7 (170)

17.4 (187)

hours

10.0 (6)

10.0 (102)

10.0 (108)

> 3 hours

3.3 (2)

6.3 (64)

6.1 (66)

Completed a

marathon*

31.7 (19)

45.6 (463)

44.8 (482)

0.035

Yes

68.3 (41)

54.4 (553)

55.2 (594)

Number of

marathons

completed*

19.5 (8)

43.8 (242)

42.1

(250)

0.001

7.3 (3)

12.1 (67)

11.8 (70)

73.2 (30)

44.1 (244)

46.1 (274)

Completed a

triathlon*

61.7 (37)

75.6 (769)

74.8 (806)

0.016

Yes

38.3 (23)

24.4 (248)

25.2 (271)

Number of

triathlons

completed

52.2 (12)

48.6 (120)

48.9 (132)

0.799

13.0 (3)

10.1 (25)

10.4 (28)

34.8 (8)

41.3 (102)

40.7 (110)

Concussions

76.7 (46)

75.1 (763)

75.2 (809)

0.785

Yes

23.3 (14)

24.9 (253)

24.8 (267)

Number of

Concussions*

84.6 (11)

50.2

(127)

51.9 (138)

0.044

15.4 (2)

31.6 (80)

30.8 (82)

0.0 (0)

18.2 (46)

17.3 (46)

Years exercise

training at

current level

(year)*

< 1

3.3 (2)

6.4 (65)

6.2 (67)

0.002

8.3 (5)

20.6 (210)

20.0 (215)

20.0 (12)

31.0

(315)

30.4 (327)

20.0 (12)

14.9 (152)

15.2 (164)

> 10

48.3 (29)

27.0 (275)

28.2 (304)

Chronic i

ntensity

(T; IS x yr)*

Low (0

1100)

13.8 (8)

34.9 (324)

33.7 (332)

0.000

Med (1140

2480)

19.0 (11)

33.2 (308)

32.4 (319)

High

(2500

10000)

67.2 (39)

31.9 (296)

34.0 (335)

Exercise at

current level (T;

Low (< 1

11.7 (7)

27.0 (275)

26.2 (282)

0.001

Med (3

10)

40.0 (24)

45.9 (467)

45.6 (491)

0.106

0.0000.000

0.000

83.6 (900)

36.9 (397)

0.000

63.1 (680)

34.9 (376)34.9 (376)

0.013

65.1 (701)65.1 (701)

66.9 (679)

66.4 (714)

0.121

16.7 (170)

17.4 (187)

10.0 (102)

10.0 (108)10.0 (108)

6.3 (64)

6.1 (66)

31.7 (19)

45.6 (463)

44.8 (482)

68.3 (41)

54.4 (553)

55.2 (594)

19.5 (8)

43.8 (242)

7.3 (3)7.3 (3)

12.1 (67)

73.2 (30)

44.1 (244)

61.7 (37)

75.6 (769)

38.3 (23)

24.4 (248)

52.2 (12)52.2 (12)

13.0 (3)

34.8 (8)

Yes

Number of

Concussions*

Years exercise

training at

current level

< 1< 1

r)*

High (> 10)

48.3 (29)

27.0 (275)

28.2 (304)

Training hours

per week (T; hr)*

Low (1

11.7 (7)

42.7 (434)

41.0 (441)

0.000

Med (7

10)

23.3 (14)

35.0 (356)

34.4 (370)

High (> 10)

65.0 (39)

22.2 (226)

24.6 (265)

Total intensity

(T; IS x hr/wk x

VO2%)*

Low (0

305)

8.6 (5)

33.9 (315)

32.5 (320)

0.000

Med (310

405)

22.4 (13)

33.0 (306)

32.4 (319)

High (410

1000)

69.0 (40)

33.1 (307)

35.2 (347)

Chronic Duration

(T; hr/wk x yr)*

Low (1

16)

11.7 (7)

31.0 (315)

29.9 (322)

0.000

Med (20

40)

21.7 (13)

34.9 (355)

34.2 (368)

High (50

100)

66.7 (40)

34.1 (346)

35.9 (386)

0.000

35.9 (386)

Table 3. Multivariate (logistic regression) model with adjusted odds ratios for libido score

group. Only significant clinical and biological factors noted.

Investigative

Variable

omparison

Between Tertiles

Odds Ratio

(placement in

high/normal

Vs. low)

CI (95%)

Chronic

Duration

Low

Low vs. High

4.0

1.6

10.0

Med

ium

Med

ium

vs. High

2.5

1.3

4.8

High

Total

ntensity

Low

Low vs. High

6.9

2.6

17.9

Med

ium

Med

ium

vs. High

2.8

1.4

5.3

High

Age

(years)

Low vs. High

1.9

1.0

3.9

Med

ium

(41

55)

Med

ium

vs. High

1.9

0.9

4.1

1.6 1.6

1.3

4.8

6.96.9

2.6

17.9

2.8

1.4

Low vs. High

1.91.9

vs. High

1.9

Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q

Article

Full-text available

Apr 2022

A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.

The Male Athlete Triad—A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis

Article

Full-text available

Jun 2021
CLIN J SPORT MED

The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.

Reducing energy availability in male endurance athletes: a randomized trial with a three-step energy reduction

Article

Full-text available

May 2022
Sports Nutr Rev J

Background: Low energy availability (EA) can be detrimental for athlete health. Currently, it is not known what the threshold for low EA in men is, and what effects it may have on performance. Methods: This study was set to determine potential effects of low EA by modulating male participants' exercise energy expenditure and controlling energy intake and consequently manipulating EA in three progressive stages (reducing EA by 25%%, and 75 %). Performance was measured with three specific tests for explosive power, endurance, and agility. Blood was drawn, resting energy expenditure was monitored and two questionnaires were repetitively used to address any changes in eating behaviors and well-being. Results: Repeated measured design showed poorer performance (power output 391.82 ± 29.60 vs. 402.5 ± 40.03 W, p = 0.001; relative power output 5.53 ± 0.47 vs. 5.60 ± 0.47 W/kg, p = 0.018; explosive power 0.28 ± 0.04 vs. 0.32 ± 0.05 m, p = 0.0001, lactate concentration 7.59 ± 2.29 vs 10.80 ± 2.46 mmol/L, p = 0.001). the quartile range for testosterone was lower (2.33 ± 1.08 vs. 2.67 ± 0.78, p = 0.026) and there was a tendency for lower triiodothyronine (4.15 ± 0.61 vs. 4.46 ± 0.54 pmol/L, p = 0.072). Eating behaviors and well-being were worse (46.64 ± 7.55 vs. 24.58 ± 7.13, p = 0.011 and 15.18 ± 2.44 vs. 17.83 ± 3.54, p = 0.002). The intervention also resulted in lower body fat (8.44 ± 3.15 vs. 10.2 ± 2.5%, p = 0.013). Conclusions: Analysis showed that most of the negative effects occurred in the range of 9-25 kCal·kg∙FFM·d-1. This is the range where we suggest a threshold for LEA in men could be. Reducing EA impaired explosive power first, then endurance. It was associated with a reduction in testosterone, triiodothyronine and there was a tendency for reduced IGF-1, but hormones were more resilient to changes in EA. Psychological assessment of eating behaviors and well-being proved to be very useful, whereas monitoring resting energy expenditure did not.

Influence Factors of Sexual Intercourse Frequency in Infertile Couples without Sexual Dysfunction in Southwest China: A Retrospective Study

Article

Full-text available

May 2021
UROL INT

Introduction: The aim of this study was to investigate the sexual intercourse frequency (SIF) of infertile couples without sexual dysfunction and analyze its related influencing factors. Materials and methods: We retrospectively analyzed the data of a total number of 4,923 infertile couples without sexual dysfunction who received treatment in our assisted reproductive center from October 2016 to October 2018. Both partners of couples were inquired about their information of demographic statistics, occupations, lifestyles, education backgrounds, psychological characteristics, and testostrone levels of male patients. The multivariable linear regression analysis was applied to evaluate the influence of various variables on SIF. Results: The median (interquartile range) SIF of infertile couples without sexual dysfunction was 7 (6.5-8) times per month. Lower academic qualification and younger age were predictive of increased SIF in both partners. The SIF of Chinese Han women and Chinese Zang women is higher than that of other ethnic groups. Men with lower testosterone (<10 nmol/L) were associated with lower SIF. The BMI, occupation, alcohol consumption, races of both partners of couples, and smoking status of males were not associated with SIF. Multivariable linear regression analysis indicated that only the age and the education level of men played an important role in SIF, and educational level of men had the greatest impact, followed by men's age. Conclusion: In our study, we analyzed demographics data, occupational characteristics, and lifestyle behaviors of both partners, as well as men's testosterone levels; we also reported the related SIF. According to our research, men's education level was the most important factor in predicting SIF, followed by men's age. Testosterone levels of men do not appear to play a substantial role in predicting SIF in infertile couples.

Maintenance of Sexual Activity Following Androgen Deprivation in Males

Article

Jul 2020
CRIT REV ONCOL HEMAT

Androgen deprivation therapy (ADT) is a common treatment for men with systemic prostate cancer. However, ADT leads to sexual dysfunction, causing >80% of couples to cease sexual activity completely. Here, we use a biopsychosocial framework to review factors that may influence the ability of patients on ADT to remain sexually active. We address sexual factors prior to ADT, neurobiological factors, intermittent ADT, sex aids, exercise, sleep, partner factors, masculinity, non-penetrative intimacy, depressive symptoms, and access to counselling or patient education programs. We make suggestions for future research in order to extend our understanding in this field with the goal of improving evidence-based treatment protocols and practice. Importantly, we suggest that clinicians should discuss options for sexual intimacy after ADT with both patients and their partners, as sexual inactivity is not inevitable for most, and strategies are available for helping maintain sexual intimacy.

Activité physique dans les rhumatismes inflammatoires chroniques: trajectoires de santé et promotion de l’AP

Article

Feb 2023

Marathon Running and Sexual Libido in Adult Men: Exercise Training and Racing Effects

Article

Full-text available

Aug 2022

We examined whether endurance training for a standard marathon (42.2 km) had a greater influence on male libido than more generalized endurance exercise training. We surveyed adult men (>1000) who regularly engaged in endurance running to evaluate exercise training histories-patterns and libido characteristics. Our participants were primarily recruited from North America and Europe. Results indicate men conducting marathon training had lower libido scores (p<0.05; ~20%, d=0.44) than those not doing such specific training. Factors most related to libido were: 1) the number of years of training, and 2) the proportion of high-intensity effort conducted in training (inverse relationships); regardless of whether marathon training was performed or not. Our survey approach did not allow us to determine the cause of the reduced libido, but we speculate it could relate to: 1) chronic physical fatigue from high volumes of exercise training, 2) behavioral accommodations in energy expenditure, or else 'Relative Energy Deficiency in Sport' (RED-S) syndrome, and/ or 3) endocrinological adaptations as a result of the exercise training (i.e., low testosterone). From a practical perspective, we recommend couples attempting conception should inform their healthcare providers of the male partner's exercise habits concerning endurance running as this may be a factor relative to potential infertility.

Relative energy deficiency in sport: modern approaches to diagnostics, treatment and prevention

Article

May 2022

In recent years, close attention has been paid to energy deficiency in professional athletes. More and more studies confirm the widespread prevalence of relative energy deficiency syndrome in sports and its relationship with various pathological conditions that lead to a decrease in the level of athletic performance. Nowadays the possibilities of early diagnosis and treatment of this syndrome are being carefully studied, and clinical protocols are being actively developed to facilitate the early detection of energy deficiency. The aim of the study was to summarize the modern data on the influence of the syndrome of relative energy deficiency in sports on the health and performance of athletes, as well as to consider effective methods for the diagnosis, treatment and prevention of this syndrome. Material and methods. The search was carried out using the Google Academy engine and electronic databases PubMed, MEDLINE, EMBASE, Scopus, Web of Science, eLIBRARY for the period from 2017 to 2021. For the search, we used keywords and their combinations: "relative energy deficit in sports", "female athlete triad", "menstrual dysfunction", "osteoporosis". Results. Based on our analysis, we can conclude that the syndrome of relative energy deficit in sports has a multicomponent negative effect on the athlete's organism and negatively affects his performance, well-being and sports results. Diagnosis of this condition is challenging due to the nonspecificity and variety of symptoms. Key diagnostic methods include physical examination, anamnesis gaining, dual energy X-ray absorptiometry, bioimpedance body composition analysis, and hormonal profile studies. Additional methods include: electrocardiography, study of the basal metabolic rate, hematological examination (hemoglobin, ferritin, etc.), determining the level of energy consumption using diaries of food and physical activity, determining blood vitamin level, etc. To facilitate the screening, diagnosis and follow-up of athletes, it is possible to use specially developed clinical protocols. Non-drug nutritional correction and optimal training plan are the main methods of treatment and prevention of energy deficiency. If this type of treatment is ineffective, hormone therapy should be considered. It is recommended to use transdermal estrogen therapy in combination with shortterm progestin therapy. In some cases, when very low bone mineral density or delayed fracture consolidation is detected, it is possible to use recombinant parathyroid hormone. Conclusion. Due to the relatively high prevalence of relative energy deficiency syndrome in athletes of both sexes and its long-term negative impact on athlete health and performance, further research is needed to improve the effectiveness of early diagnosis, prevention and treatment of pathological conditions associated with malnutrition.

Age and training intensity differently affect male runners' endocrine and sexual parameters

Article

Jan 2022
CHINESE J PHYSIOL

Physical activity is widely recognized to improve health and its inclusion in daily life at all ages is highly recommended. Gonadal hormones are known to be affected by physical activity. The exercise-induced effects on male runners of different ages were investigated by dividing 31 runners by age (Young, Y, 30-55 years; Old, O, 56-70 years) and amount of training (Light, L, <50 km/week; Heavy, H, 50 or more km/week). To test the somatic, sexual, and psychological health aspects, the Aging Male's Symptoms Scale (AMS) and the International Index of Erectile Function-6 (IIEF-6) questionnaires were administered and blood samples were drawn for adrenocorticotropic hormone, testosterone (Total-TT), free testosterone (Free-T), cortisol (C), dihydrotestosterone (DHT), estradiol, and sex hormone-binding globulin determinations. Clinical evaluations and questionnaire results showed the presence in all groups of some subclinical symptoms and "Light" dysfunctions. TT in the old-heavy (OH) group was significantly lower than in the OL group (2.38 ± 0.18 ng/mL vs. 3.36 ± 0.44 ng/ml, P = 0.05). The TT/DHT ratio was significantly higher in YH than in OH (3.64 ± 0.16 vs. 2.92 ± 0.23, P < 0.05). TT was positively correlated with AMS sexual subscale and negatively correlated with IIEF-6. Physical activity can significantly affect andrological health and testosterone levels in runners at all ages. Thus, due to the important testosterone-mediated vital functions in men, the evaluation of these parameters would be indicated in old as well as in young subjects.

Sex therapy

Chapter

Jan 2021

Kleinplatz and her research team (Kleinplatz et al., 2009) set out to study what the “sex of our dreams” consists of. They interviewed 67 participants who were in relationships for at least 25 years and identified their sex as “great.” They were aged, on average, 66 years (ranging from 60 to 82), and described various components to their great sexuality: •Optimal sex requires that the participants be completely present, focused, embodied, and immersed in the experience. •Partners have a sense of connection, being in sync, and losing of self with one another. •Deep erotic intimacy is characterized by deep mutual respect, caring, genuine acceptance, and admiration. •Interpersonal risk-taking through exploration is viewed as fun. Sex is perceived as an adventure, an exploration that expands sexual boundaries together with humor and laughter. •Participants feel free, during sex, to be themselves, authentic, genuine, uninhibited, and totally free to express their wishes. •Great sex requires “letting go,” allowing oneself to be vulnerable, reveling in the sensation, and completely surrendering to their partners. •These sexual experiences are often characterized by a sense of peace, bliss, and a feeling of utter timelessness, growth enhancing and healing, similar to what Maslow (1971) called peak experiences.

Stress and the neuroendocrine system: The role of exercise as a stressor and modifier of stress

Article

Full-text available

Nov 2006

Anthony C. Hackney

In this article, the physiological impact of one form of stress - physical exercise - on the neuroendocrine system will be discussed. The specific intent of the review is to present an overview of stress endocrinology, the conceptual models associated with this area of study, and a discourse on the dual role of exercise as both a stressor and a modifier of stress within the neuroendocrine system. These points are addressed with respect to the current research literature dealing with exercise endocrinology in an adult population.

Sex, health, and years of sexually active life gained due to good health: Evidence from two US population based cross sectional surveys of ageing

Article

Full-text available

Mar 2010
Br Med J

To examine the relation between health and several dimensions of sexuality and to estimate years of sexually active life across sex and health groups in middle aged and older adults. Cross sectional study. Two samples representative of the US population: MIDUS (the national survey of midlife development in the United States, 1995-6) and NSHAP (the national social life, health and ageing project, 2005-6). 3032 adults aged 25 to 74 (1561 women, 1471 men) from the midlife cohort (MIDUS) and 3005 adults aged 57 to 85 (1550 women, 1455 men) from the later life cohort (NSHAP). Sexual activity, quality of sexual life, interest in sex, and average remaining years of sexually active life, referred to as sexually active life expectancy. Overall, men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex. These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex. Men and women reporting very good or excellent health were more likely to be sexually active compared with their peers in poor or fair health: age adjusted odds ratio 2.2 (P<0.01) for men and 1.6 (P<0.05) for women in the midlife study and 4.6 (P<0.001) for men and 2.8 (P<0.001) for women in the later life study. Among sexually active people, good health was also significantly associated with frequent sex (once or more weekly) in men (adjusted odds ratio 1.6 to 2.1), with a good quality sex life among men and women in the midlife cohort (adjusted odds ratio 1.7), and with interest in sex. People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55. This gender disparity attenuated for people with a spouse or other intimate partner. At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health. Sexual activity, good quality sexual life, and interest in sex were higher for men than for women and this gender gap widened with age. Sexual activity, quality of sexual life, and interest in sex were positively associated with health in middle age and later life. Sexually active life expectancy was longer for men, but men lost more years of sexually active life as a result of poor health than women.

A short questionnaire for the measurement of habitual physical activity in epidemiological studies

Article

Nov 1982

The construct validity and the test-retest reliability of a self-administered questionnaire about habitual physical activity were investigated in young males (n = 139) and females (n = 167) in three age groups (20 to 22, 25 to 27, and 30 to 32 yr) in a Dutch population. By principal components analysis three conceptually meaningful factors were distinguished. They were interpreted as: 1) physical activity at work; 2) sport during leisure time; and 3) physical activity during leisure time excluding sport. Test-retest showed that the reliability of the three indices constructed from these factors was adequate. Further, it was found that level of education was inversely related to the work index, and positively related to the leisure-time index in both sexes. The subjective experience of work load was not related to the work index, but was inversely related to the sport index, and the leisure-time index in both sexes. The lean body mass was positively related to the work index, and the sport index in males, but was not related to the leisure-time index in either sex. These differences in the relationships support the subdivision of habitual physical activity into the three components mentioned above.

Drug that cause sexual dysfunction

Article

Mar 2007
Psychiatry

Shubulade Smith

Sexual dysfunction is a common and distressing side effect of many drugs, both prescribed and otherwise. In this brief overview, the normal biology of sexual function is outlined, together with the central and peripheral underlying chemical mechanisms. Knowledge of the normal biology of sexual function, along with knowledge of the mechanism of action of different drugs, helps one to predict whether a medication might cause sexual problems. Psychotropic drugs in particular can have both short- and long-term effects on sexual function, depending on length of exposure to an individual agent. This contribution provides an overview of those drugs which are most likely to be associated with sexual dysfunction, including not only prescribed medication but also recreational drugs and those commonly used by patients with mental health problems. The contribution ends with an outline of the management of drug-induced sexual side effects.

Fertility of men and women aged 15-44 years in the United States: National Survey of Family Growth, 2006-2010

Article

Apr 2012

This report presents national estimates of the fertility of men and women aged 15-44 years in the United States in 2006-2010 based on the National Survey of Family Growth (NSFG). Data are compared with similar measures for 2002. Descriptive tables of numbers, percentages, and means are presented and discussed. Data were collected through in-person interviews of a nationally representative sample of the household population aged 15-44 years in the United States between July 2006 and June 2010. The 2006-2010 NSFG sample is comprised of 22,682 respondents including 10,403 men and 12,279 women. The overall response rate for the 2006-2010 NSFG was 77%, 75% for men and 78% for women. Many of the fertility measures among men and women aged 15-44 based on the 2006-2010 NSFG were generally similar to those reported based on the 2002 NSFG. The mean age at first child's birth for women was 23 and the mean age at first child's birth for men was 25. One-half of first births to women were in their 20s and two-thirds of first births were fathered by men who were in their 20s. On average, women aged 15-44 have 1.3 children as of the time of the interview. By age 40, 85% of women had had a birth, and 76% of men had fathered a child. In 2006-2010, 22% of first births to women occurred within cohabiting unions, up from 12% in 2002. These measures differed by Hispanic origin and race and other demographic characteristics.

The Comparison of the Aging Male Symptoms (AMS) Scale and Androgen Deficiency in the Aging Male (ADAM) Questionnaire to Detect Androgen Deficiency in Middle-Aged Men

Article

Jan 2012

The prevalence of androgen deficiency in men increases with aging. Two common instruments, the Aging Male Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire, are often used to screen for androgen deficiency in clinical practice. The aim of this study is to compare the capability of the AMS scale and the ADAM questionnaire to detect androgen deficiency in middle-aged Taiwanese men. In April 2008, a free health screening was conducted by Kaohsiung Medical University Hospital. All participants completed a health questionnaire and had blood samples drawn between 8:00 am and noon. Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms associated with androgen deficiency were screened by using the AMS scale and ADAM questionnaire. Androgen deficiency was defined as TT < 300 ng/dL or both TT < 300 ng/dL and FT< 5 ng/dL. In total, 339 men were included in the final analysis, with the mean age of 54.6 ± 4.9 years (range, 47-65 years). Androgen deficiency was found in 75 men (22.1%) based on the criteria of TT < 300 ng/dL, and in 54 men (15.9%) based on the criteria of TT < 300 ng/dL and FT < 5 ng/dL. When detecting participants with both TT < 300 ng/dL and FT < 5 ng/dL, the sensitivity and specificity of the AMS scale were 57.4% and 48.1%, compared with 66.7% and 25.6% for the ADAM questionnaire. In a sample of middle-aged Taiwanese men, neither the AMS scale nor the ADAM questionnaire had sufficient sensitivity and specificity to detect androgen deficiency. In addition to using those 2 screening instruments, a thorough physical and biochemical workup should still be conducted in patients at risk or suspected of androgen deficiency.

Explaining Odds Ratio

Article

Aug 2010

Magdalena Szumilas

Effects of endurance exercise on the reproductive system of men: The “exercise-hypogonadal male condition”

Article

Nov 2008
J ENDOCRINOL INVEST

Anthony C. Hackney

An increasing number of investigative research studies point to participation in endurance exercise training as having significant detrimental effects upon reproductive hormonal profiles in men. Specifically, men chronically exposed to this type of exercise training exhibit persistently reduced basal (resting-state) free and total testosterone concentrations without concurrent LH elevations. Men displaying these symptoms have been deemed to exhibit the "exercise-hypogonadal male condition". The exact physiological mechanism inducing the reduction of testosterone in these men is currently unclear, but is postulated to be a dysfunction (or perhaps a readjustment) within the hypothalamic-pituitary-testicular regulatory axis. The potential exists for the reduced testosterone concentrations within exercise-hypogonadal men to be disruptive and detrimental to some anabolic-androgenic testosterone- dependent physiological processes. Findings on this point are limited, but do suggest spermatogenesis problems may exist in some cases. Alternatively, reductions in circulating testosterone concentrations could have cardiovascular protective effects and thus be beneficial to the health of these men. Present evidence suggests the exercise-hypogonadal condition is limited to men who have been persistently involved in chronic endurance exercise training for an extended period time (i.e., years), and it is not a highly prevalent occurrence (although, a thorough epidemiological investigation on the topic is lacking in the literature). Many questions regarding the male reproductive endocrine adaptive process to exercise training still remain unanswered, necessitating the need for much further investigation on the topic, especially with respect to the exercise-hypogonadal condition.

Enhanced sexual behavior in exercising men

Article

Jul 1990

The effects of 9 months of aerobic exercise on aerobic work capacity (physical fitness), coronary heart disease risk factors, and sexuality were studied in 78 sedentary but healthy men (mean age, 48 years). The men exercised in supervised groups 60 min per day, 3.5 days per week on average. Peak sustained exercise intensity was targeted at 75-80% of maximum aerobic working capacity. A control group of 17 men (mean age, 44 years) participated in organized walking at a moderate pace 60 min per day, 4.1 days per week on average. Each subject maintained a daily diary of exercise, diet, smoking, and sexuality during the first and last months of the program. Beneficial effects of chronic, vigorous exercise on fitness and coronary heart disease risk factors were obtained in close agreement with prior studies. Analysis of diary entries revealed significantly greater sexuality enhancements in the exercise group (frequency of various intimate activities, reliability of adequate functioning during sex, percentage of satisfying orgasms, etc.). Moreover, the degree of sexuality enhancement among exercisers was correlated with the degree of their individual improvement in fitness.

A short questionnaire for the measurement of habitual physical activity in epidemiological studies

Article

Dec 1982

The construct validity and the test-retest reliability of a self-administered questionnaire about habitual physical activity were investigated in young males (n = 139) and females (n = 167) in three age groups (20 to 22, 25 to 27, and 30 to 32 yr) in a Dutch population. By principal components analysis three conceptually meaningful factors were distinguished. They were interpreted as: 1) physical activity at work; 2) sport during leisure time; and 3) physical activity during leisure time excluding sport. Test-retest showed that the reliability of the three indices constructed from these factors was adequate. Further, it was found that level of education was inversely related to the work index, and positively related to the leisure-time index in both sexes. The subjective experience of work load was not related to the work index, but was inversely related to the sport index, and the leisure-time index in both sexes. The lean body mass was positively related the the work index, and the sport index in males, but was not related to the leisure-time index in either sex. These differences in the relationships support the subdivision of habitual physical activity into the three components mentioned above.

Endurance Exercise Training and Male Sexual Libido

Abstract and Figures

Recommendations

"Exercise Hypogonadal Male Condition", RED-S, Female Athlete Triad and Reproductive Dysfunctions in Endurance Athletes

Nervous system changes across the menstrual cycle

Exercise, training, endocrine

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