Page 100 - JSOM Spring 2020

Effect of Special Operations Training on Testosterone,
Lean Body Mass, and Strength and the Potential for
Therapeutic Testosterone Replacement

A Review of the Literature

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Jon K. Linderman, PhD, FACSM *; Reginald B. O’Hara, PhD, ACSM-CEP ;
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Jason Ordway, MS ; John Ayala, MS 4
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ABSTRACT
Objective: Due to physical demands, Special Operations FIGURE 1 PRISMA Flowchart.
Forces (SOF) endure changes in body composition, work ca-
pacity, and endocrine function. These changes result in energy
deficits and sleep deprivation, where sleep averaged 3 hours/ Records identified through Additional records identified
day, independently known to decrease testosterone levels. The Identification database searching through other sources
(n = 69)
(n = 2)
use of exogenous testosterone shows increases in lean body
mass (LBM) and muscle function in healthy males and reverses
cachexia in diseased populations. Therefore, the review’s pri-
mary purpose is to summarize and contrast literature in both Records after duplicates removed
SOF and nonmilitary personnel regarding the correlation (n = 71)
between negative energy balance, sleep deprivation, and de-
creased testosterone. The secondary purpose summarizes the Screening
effects of exogenous testosterone therapy in healthy males Records screened Records excluded
as well as reversing the effects of muscle wasting diseases. (n = 71) (n = 25)
Methods: An online literary search from 1975 to 2015 iden-
tified 46 of 71 sources addressing both purposes, and data
were summarized into tables providing mean observations. Full-text articles Full-text articles excluded,
Conclusions: SOF training results in decreased testosterone Eligibility assessed for eligibility with reasons
(n = 9)
(–6.3%), LBM (–4.6%), and strength (–11.7%), tied to en- (n = 46)
ergy deficits (–3,351 kcal/day) and sleep deprivation (3 hours/ (n = 3) Not subject related
(n = 6) Not directly related
day). Exogenous testosterone therapy increases LBM (6.2%), to population groups
strength (7.9–14.8%), reverses cachexia (2.0%) and increases
strength (12.7%) in those with chronic diseases. Therefore,
Studies included in
testosterone supplementation in SOF may attenuate changes Included qualitative synthesis
in body composition and muscle function during training and (n = 37)
sustained Special Operations (SUSOPS).
Keywords: androgenic; anabolic; cachexia; fatigue; Special
Operations; military As reviewed previously, Special Operations Forces (SOF) are
routinely exposed to prolonged and physically demanding
training evolutions that may result in significant changes in
body composition, work capacity, and endocrine function.
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Introduction
Researchers have suggested that the factors influencing these
A systematic review of the primate scientific literature was physiological changes are likely attributed to (1) the high
conducted using PRISMA for this review. A total of 71 full-test physical demand placed upon SOF during both training and
articles were screened from 1975–2015. Twenty-five articles mission operations that necessitates high energy expenditure
were excluded based on established eligibility; the PRISMA (EE), (2) a lower energy intake (EI), (3) a negative energy bal-
flowchart is given in Figure 1. ance (EI – EE), and, last, (4) sleep deprivation. For example,
*Correspondence to Jon K. Linderman, PhD, FACSM, 300 College Park, Dayton, OH 45469-2968 or jonlinderman@udayton.edu
1 Dr Linderman is a tenured professor of exercise physiology at the University of Dayton, Dayton, OH. He is both a Fellow of the American
College of Sports Medicine (FACSM) and a board-certified exercise physiologist with the American Society of Exercise Physiologists. He has
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worked as an NRC Fellow for NASA and consulted for the US Air Force. Dr O’Hara is a certified exercise physiologist with the American
College of Sports Medicine and affiliated with the United States Army, Center for the Intrepid, Department of Rehabilitation Medicine, Brooke
Army Medical Center, JBSA Fort Sam Houston, TX. He has 19 years of experience working with SOF personnel in a variety of settings. His last
assignment was in the Republic of Korea where he worked with US Air Force and Army Special Forces personnel. Mr Ordway has a master of
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science degree in exercise physiology and is presently affiliated with the Athletic Department at the University of Dayton. GySgt/Ayala, USMC,
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is a master of science in exercise science (performance enhancement and injury prevention) candidate and is interning through the US Marine
Corps’ Wounded Warrior Program at the Center for the Intrepid, Brooke Army Medical Center.
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