Page 105 - JSOM Spring 2020

Sleep Deprivation or antisocial behavior in males is linked to higher levels of tes-
Sleep deprivation is commonly cited as a factor associated tosterone. Further, evidence to support concepts such as “roid
45
with difficulties experienced during SOF training and SU- rage” from the use of testosterone or AAS is often complicated
SOPS. Daily sleep has been estimated to be 2–4 hours during by the use of additional drugs, whether licit or illicit, and re-
SOF training (Table 1). Sleep deprivation may also include ported incidences of criminal or antisocial behavior.
psychological stresses such as realistic battlefield simulations
and captivity. It is clear that both sleep deprivation and de- Although days of demanding SOF training may result in re-
creased HPG function occur at least temporally during SOF duced testosterone that arguably contributes to decreased
training and likely during SUSOPS. A modest reduction in LBM, at present little data exist on the effects of short-term
normal sleep volume, from 8 to 5 hours daily, reduces testos- testosterone therapy on LBM and strength. A majority of stud-
terone levels after 1 week in healthy young males, suggesting ies supplementing testosterone or AAS with or without resis-
14
that the significant sleep deprivation experienced during SOF tance training treated subjects well in excess of 6 weeks. It is
training is a key factor in the reduction of testosterone. unknown whether days of testosterone therapy would reverse
or attenuate the anthropometric and functional changes asso-
Testosterone Therapy ciated with SOF training.
Data clearly demonstrate the additive effects of testosterone or
AAS to increase LBM and strength when combined with resis- One of the most glaring limitations of exogenous testoster-
tance training (Table 3). However, testosterone independent one therapy in SOF would be its use in females entering SOF.
of resistance training has been reported to increase LBM and The androgenic effects of testosterone in female candidates
strength (Table 2). More importantly, in diseased populations entering SOF training would likely be an unwelcome risk, par-
(e.g., COPD, HIV) exhibiting cachexia, low LBM, and fatigue, ticularly in terms of disrupting the normal female HPG axis
the use of testosterone or AAS reportedly increases LBM and and the potential for the development of male secondary sex
strength. Therefore, the use of exogenous testosterone or AAS characteristics in females. This limitation is unavoidable and
may reverse or attenuate cachexia and diminished muscle should not discount the potential benefit of short-term exoge-
function in SOF during or following SUSOPS. nous testosterone to assist the combat performance of males in
SOF. Data specific to changes in females during SOF training
Although data show positive results in diseased and SOF pop- and SUSOPS need to be gathered and strategies developed to
ulations, the occurrence of adverse reactions in therapy should attenuate losses in LBM and strength in female SOF.
not be disregarded. There is a risk for prostate cancer and
worsening symptoms of benign prostatic hypertrophy, liver Acknowledgments
toxicity, and tumor and worsening symptoms of sleep apnea The views expressed in this article are those of the authors and
and congestive heart failure, gynecomastia, infertility, and do not necessarily reflect the official policy or position of the
skin diseases. Without proper dosage and close monitoring Air Force, the Department of Defense, or the US Government.
46
of vital endocrine systems, these negative effects can become
quickly exacerbated. Disclosure
The authors have no financial relationships relevant to this
Recommendations article to disclose.
Data support the relationship between altered HPG function
and decreases in LBM and functional capacity during SOF
training. Further, it appears that reductions in testosterone pre- References
cede alterations in body composition or muscle function. High 1. O’Hara R, Henry A, Serres J, et al. Operational stressors on phys-
physical demand, negative energy balance, and sleep depri- ical performance in Special Operators and countermeasures to im-
vation all appear to affect testosterone levels. However, the prove performance: a review of the literature. J Spec Oper Med.
2014;14(1):67–78.
seeming inevitability of a large negative energy balance during 2. Nindl BC, Barnes BR, Alemany JA, et al. Physiological conse-
SOF training indicates that investigations incorporating a neg- quences of U.S. Army Ranger training. Med Sci Sports Exerc.
ative energy balance and testosterone therapy are warranted 2007;39(8):1380–1387.
in both experimental animal models and human subjects. In 3. Nindl BC, Leone CD, Tharion WJ, et al. Physical performance re-
animal models, caloric restriction can be used to create a neg- sponses during 72 h of military operational stress. Med Sci Sports
Exerc. 2002;34(11):1814–1822.
ative energy balance, whereas studies in human models should 4. Gomez-Merino D, Chennaoui M, Burnatt P, et al. Immune and
use both an increase in EE and a reduction in EI to create a hormonal changes following intense military training. Mil Med.
caloric deficit. Reduced sleep can also be incorporated into 2003;168(12):1034–1038.
these studies to ascertain the additive nature of caloric deficit 5. Vaara JP, Kalliomaa R, Hynninen P, et al. Physical fitness and
and sleep deprivation on LBM and strength. hormonal profile during an 11-week paratroop training period. J
Strength Cond Res. 2015;29(suppl 11):S163–S167.
6. Aakvaag A, Bentdal Ø, Quigstad K, et al. Testosterone and testos-
Limitations terone binding globulin (TeBG) in young men during prolonged
The use of exogenous testosterone or AAS has been linked to stress. Int J Androl. 1978;1(1–6):22–31.
a number of sporting scandals including Canadian 100-meter 7. Welsh TT, Alemany JA, Montain SJ, et al. Effects of intensified
champion Ben Johnson in the 1988 Olympics. The effects of military field training on jumping performance. Int J Sports Med.
43
testosterone and AAS to increase LBM and strength are well 2007;29(1):45–52.
known, and in the 1990s, the US Congress passed the Anabolic 8. Morgan CA 3rd, Wang S, Mason J, et al. Hormone profiles in
Steroid Control Act, classifying both testosterone and AAS as humans experiencing military survival training. Biol Psychiatry.
2000;47(10):891–901.
controlled substances. A direct relationship between testos- 9. Kyröläinen H, Karinkanta J, Santtila M, et al. Hormonal responses
44
terone levels and aggressive or criminal behavior is not well during a prolonged military field exercise with variable exercise
founded. Studies do not conclusively support that aggressive intensity. Eur J Appl Physiol. 2007;102(5):539–546.
Testosterone, Lean Body Mass, and Strength | 99