Matt Bach is a storied Age Group Athlete that has a long list of victories, including Ironman Maryland. He has the experience of balancing a normal work life and setting sights on a World Championship title. Along the way though Matt started to notice signs that were not normal to endurance training. Matt couldn't shake the constant fatigue, and he struggled to find any enjoyment in racing or training. Matt, similar to me, suffered from chronic overtraining which lead to some severe low testosterone. Matt dives into his experience and his new found knowledge about low testosterone in this guest blog. You might recognize the name from his appearance on ENDURANCE PLANET podcast, TRS Radio, as well as Slowtwitch and The Wall Street Journal.
Overtraining and Low Testosterone
What it is, how to prevent it, and how to get back into balance
I may look healthy, but I’m not. I am a triathlete suffering from fatigue, low libido and osteoporosis. I have the bones of a 73 year old. I’m 29.
I write this blog so that you might be aware of the issues that can arise from too much endurance training, but also to inform you that it is preventable and reversible. Life is about balance, and I screwed up my balance and my health. You may like what you see in the mirror, but you may not be healthy either. I am a case study for what NOT TO DO, and I hope you will learn from my mistakes.
Symptoms of Low T (<300ng/dL)
It has been shown in numerous studies since the 1980’s that overtraining in endurance sports can cause reduced testosterone levels. The most common symptoms include fatigue, low libido and impaired performance, but low T can impact many aspects of life including energy levels, sleep patterns, mood, sex life, fertility, cognitive ability, frequent illness, bone health and body composition. The symptoms that each person experiences are different; for me, it was fatigue, low libido, and impaired bone health (osteoporosis at age 29), but for other people it could be any combination of the other symptoms that I listed.
Careful! Most people, including myself, write off their fatigue and lack of desire to the rigors of their training, but in many cases, it is something deeper.
If you have low T like I did, know that we are not alone. It is a very common thing for triathletes, and if you have the type A, overly-disciplined personality that so many of us triathletes have (and many take pride in), then you are at high risk for suffering from low T. If any of the below apply to you, then you might be driving yourself into a hole:
It’s not just triathletes that suffer from hormone issues, but other endurance athletes too. Many of you may be aware of Ryan Hall’s story, which has helped to bring the low testosterone issue into the limelight. Ryan ran the fastest marathon time ever by an American in the 2011 Boston Marathon, 2:04:58. He also broke the American record in the half marathon running a blistering 59:43. Last year, he retired from the sport, at the young age of 33, struggling to run just 12 easy miles per week because of the devastating effects of low testosterone.
Soon after I discovered I had low testosterone, I went on a fact-finding frenzy. I wanted to see how common low testosterone is in endurance athletes, and ask them what they’ve done to manage it. I chose to focus on elite endurance athletes, about half professional and half elite amateurs, because they typically take on higher volumes of training, which I’ve come to understand is the biggest factor leading to low T. I polled 22 elite triathletes and an astonishing 13 of them have had diagnosed hormone issues due to endurance training. Out of the remaining 9 people, 6 of them have experienced symptoms of low testosterone but have not been formally diagnosed. Just 3 out of the 22 elite triathletes I polled claim to have never experienced hormone issues! Further, at least 6 from the list have also had low bone density due to hormone imbalances, and bone stress injuries like I have.
Finally, a researcher in the area of exercise-induced low testosterone has informed me that a study will be published soon that reports low testosterone in approximately 50% of male Kona athletes.
Matt Bach, A Case StudY
Below I will describe what I’ve done over the past six years to cause such devastation to my health. I do this so that you might have a better understanding of what it took for me, and you can compare to yourself. We are all different though, and some of our bodies can sustain a lot more stress than others before they break down. Note that you may be training far less than I, and may be getting more rest, but still could experience issues. On the flip side, you might be training far more and sleeping 5 hours a night, yet haven’t experienced any problems health-wise. Lucky you!
How I Dug My Hellth Hole
Overtraining / Under-recovery
2010 – The year my wife and I began triathlon. Spinning classes, some running, practically drowning in the pool, and some killer abs classes at the gym. This was not when I began overtraining.
Weekly Average: 6 hours
2011 – Met a group of tremendously dedicated triathletes in Hoboken while I was living in Jersey City. Saw their knowledge and company as a way to get good quickly, and I was right! Upped my training and they showed me the ropes. I did 3 half Ironman events that year, along with some shorter triathlons and running events. I was self-coached and partook in “leech training” where I would join in on my training partners’ workouts, usually created by their coaches.
Weekly Average: 12 hours
2012 – My body seemed to be able to cope with more training, so I gave it more training, as I was still self-coached. I saw improvements in fitness over the past couple of years simply by increasing volume, so I, like so many others in our sport, figured improvement must be linearly correlated with volume. My attitude drifted in the direction of trying to fit in as much training as possible given my work and sleep schedule. I noticed that if I got under an average of 7:15 sleep per night, I would get sick, so determined that 7:15 was the right amount. While it was not my goal, I missed qualifying for Kona by 1 slot in my debut Ironman going 9:59 at Ironman Lake Placid.
Weekly Average: 16 hours
2013 – Seeing how close I was to qualifying for Kona, I was determined to get there. I remained self-coached, increased my training even further, and fit in as much training as possible. In fact, I stretched the limits of what was possible to put into my schedule. I rarely saw my wife during the week, and spent only a handful of hours with her each weekend. Nearly every Saturday for three months, I rode a century+ then tacked on a run afterwards. For a five week period before tapering for Placid, I had not given myself a single rest day. I ended up having a terrible race at Placid, missed Kona by 1 slot again and went 9:58. Frustrated but knowing the fitness was there, my wife allowed me to sign up to race Ironman Louisville four weeks later where I succeeded in qualifying for Kona by winning my age group. Another factor was that Jared Tootell, a training partner and friend of mine, informally coached me after Placid, and taught me the value of the trainer and quality vs. quantity. This was my first foray into “less is more” and likely saved me from digging myself even further into this hellth hole. I competed in Kona 7 weeks later to complete my 3rd Ironman in as many months. This year was the peak of my overtraining / under-recovery, and when my life balance was most out of whack.
Weekly Average: 17 hours
2015 – Having won Ironman Maryland in 2014 in a 51 minute PR of 8:51 on what felt like “light” training, the prospect of going pro became real. I felt compelled to train more this time and see how big of a ripple I could make in Kona, targeting the top amateur spot. A great result there would put me in a good position to go pro either in 2016 or 2017. My volume stretched again and I felt as though some of that extra bandwidth was gone. Then in March, I noticed two symptoms of low testosterone, unusual fatigue and low libido, for the first time, but I didn’t know that’s what my issue was until August when I was first diagnosed. I had total testosterone of 153 vs the “normal” range of 300-1000. By then it was too close to Kona to just stop training, especially when the only things I noticed were fatigue and low libido, and I was continuing to improve performance-wise. In fact, I had a number of massive breakthroughs in training last year and was top amateur at Eagleman 70.3 by over 5 minutes. I kept the testosterone issue in mind, but decided to continue training at a high level through Kona, and then I would address the issue. I placed 72nd overall in Kona, failing to execute the race I knew I was capable of, and then took time off. After 2 weeks, my testosterone levels had already risen to 256, more than a 100 point increase over my known low point, though still not in the range of “normal.” Several more weeks off would help, and learning more about what could be done to improve my levels naturally would set me up well for 2016.
Weekly Average: 16 hours
2016 – This is when I finally started doing a lot of the right things, though it turns out it was too little too late. I developed a stress reaction in my right femoral neck in May due to having low bone density, the low bone density being a result of low testosterone and underfueling. I slashed my training to near zero and after gathering tons of info from doctors, studies, google, Cody Beals, and ancient cave paintings, I decided to pursue a smattering of natural methods to improve my testosterone levels. By September, my testosterone levels had climbed to 599ng/dL, just shy of the “average” T level for 30 year old males of 625ng/dL. I gradually resumed and increased my training throughout the remainder of the year.
Weekly Average: 13 hours until injury, then 0 building to 8 hours by the end of the year
2017 – I was running ~10 miles at a time, or about 20-25 miles per week when I suffered a recurrence of the stress reaction in my right femur. While my testosterone levels were back to normal, my bone density levels were still very low (it takes a lot of time to regrow bone and bone loss is partially irreversible). I stopped training again, then resumed swimming, then had my first child on April 7th.
Weekly Average: 5 hours until injury and baby, then 1
In early 2015, one of the experiments I ran on myself was to see how low I could go before losing muscle mass or feeling like dirt. I had begun employing metabolic efficiency training in 2014, so thought that maybe with my new nutrition regimen, I could go lower than 140lbs and still feel strong. Every pound less I weigh is one pound less I have to carry for 138.2 miles (the swim doesn’t count) through the lava fields right? Right, but it’s not sustainable! My body rebelled and I couldn’t even drop below 145. I pushed and pushed and just couldn’t do it. It turns out that your body’s response to having low testosterone is to retain body fat. Also, by not giving the body enough fuel, it goes into survival mode and begins to draw from other resources in the body (i.e. your reproductive system, your bones, etc). Note that in females, this biological mechanism results in a loss of their period (amenorrhea), but it’s not so obvious for men. It all makes sense now, but I am fairly certain I did some damage during those months.
I’ve always wondered why professional triathletes are all heavier than me, even if they are shorter. I think I now understand the reason why. I think I also understand why Mark Allen said “be fat in July to race well in October.”
Time for a little side story! After Kona 2015 when I was determined to get a handle on my testosterone levels, I met with an endocrinologist. I thought I had a good idea of how the meeting would go…I’d explain that I have low testosterone, and that I thought it was because of overtraining. The doc would say, ok, we’ll slap this testosterone patch on you and you’ll be good to go. I’ll say “no, doc, I can’t do that because I’m an athlete and it’s against the anti-doping rules” and then the doc would say “ok, then let’s take natural measures to remedy this.” Doc would then list a bunch of natural ways to do it that would probably overlap quite a bit with the methods I had already learned from Cody Beals. Maybe I’d learn a thing or two, and would consider the appointment a success. NOPE! We didn’t even get past the first part. I explained that I have low testosterone due to endurance training, and the endocrinologist, someone who is an expert in hormones, wasn’t even aware that the link exists! Needless to say, I walked out and never saw that doc again.
The point I am making with this anecdote is that while hormone imbalance is prevalent, it is hardly spoken about. Barely anyone understands the problem or how to fix it, even among the medical community. In order to help the multitude of athletes dealing with this, I’ve begun offering consultations to help them get their health and performance back on track. You can email me at email@example.com to request my Athlete Questionnaire, which you would fill out and send back to me in order to get started.
Performance Enhancing Drugs
I won’t take supplemental testosterone, and here’s why:
Natural Remedies for Endurance Athletes with Low T
These last couple of years have been a roller coaster emotionally. Though I typically excel at remaining rational, it’s been hard to keep my head on straight. At one point I was on the verge of turning professional in the sport, but have since been nearly driven out of the sport altogether due to health issues that I never even knew could arise because of a sport that I thought was healthy. Am I doing the right thing for me, my wife and my newborn daughter? Should I be trying to be competitive at this sport, at a pro or age group level, if it’s going to be a detriment to my health? Will I find the right balance between training and recovery? Will that equilibrium translate into enough training to compete at a high level? Or should I just throw in the towel?
While I’ve wavered periodically between the two extremes, quitting the sport and pursuing triathlon at a pro level, and everything in between, the place I seem to be settling is that I will do what I can to restore my health and to return to the sport. Whether I am able to compete again or not, though, will not impact my desire to help those suffering from low testosterone due to endurance training. Let’s all raise awareness of this problem so that others can prevent the hellth hole I’ve fallen into, and so that those who are facing the debilitating effects of low testosterone or low bone density can recover. Preserving your health and being competitive at the sport is possible.
What I Hope For You
Get blood work done. It’s either free, or nearly free (just a co-pay) and really easy to get. Simply talk to you primary care physician about your level of exercise and concern that it may be affecting your hormone levels. Routine blood work does not typically call for testosterone measurement, so be sure to have your doctor request it specifically.
If you think you have experienced symptoms of hormone imbalance, do not hesitate to email me at firstname.lastname@example.org and I will send you my Athlete Questionnaire.
Also, if you meet the following criteria, and want to be considered for a research study will be starting in the coming months, then email me. The study will be over the course of a year and will assess endurance training’s impact on testosterone, general health, and performance for endurance athletes.
1.) Male endurance athlete
2.) Average 10+ hours of aerobic activity per week
3.) Have either:
a.) qualified for Kona (or have come close) or 70.3 worlds, with an overall placement that would be considered "elite" (i.e. a 75 year old man who qualifies for Kona, while very respectable, would not be eligible unless he were capable of being in the top ~third of the overall field)
b.) run a marathon under 2:50
c.) raced competitively in 3+ sanctioned cycling events
d.) or have achieved something in an endurance sport that would be considered "elite"
4.) Can commit to testing once every 2 months for 1 year at either Rutgers University (New Brunswick, NJ), Ohio State University (Columbus, OH) or Armstrong University (Savannah, GA)
If you are interested, you can subscribe to my blog by entering your email address in the upper right hand corner of my website (www.ironmattbach.com) and you can follow me at @IronMattBach on Facebook, Instagram and Twitter
Keep your priorities straight. Remember what is important in life! We love endurance sports, but your health comes before training and competition, as does your family, and if you’re not healthy, you’re not going to be there for them.