Healthy Living: September 3, 2019

By  | 

BANGOR, Maine (WABI) - Just when the next generation of footballers thought it might be safe to get on the gridiron, researchers in the journal 'Neurology' published their results last week on the significant risk that traumatic brain injury can carry for long-term hormone and sexual function in men. In a study of more than 3,000 former football players with a history of head injury, researchers at the Beth Israel Medical Center and the Harvard School of Public Health in Boston demonstrated an association between the number of concussive events with increased risk for erectile disorders and low testosterone in later life.

The publication of these findings could not have been more timely. Just a week previous, the big news in sports was the early retirements of the well-known professional football players Andrew Luck of the Baltimore Colts and the ever popular Rob Gronkowski of the New England Patriots -- both leaving the sport at age 30 after short careers punctuated with significant injuries. Although studies had been previously published demonstrating a link between head injury and subsequent diagnoses of low-testosterone and sexual dysfunction, these had the limitations of small sample size, usually under 100, and did not adequately take into account other factors that these individuals had which could have contributed to these problems such as sleep apnea, opioid abuse, prior use of performance enhancing drugs and obesity. Because x-rays have demonstrated lower pituitary volumes in those with repeated blows to the head such as professional boxers and military veterans with a documented closed-head injury, the proposed mechanism is thought to be shearing forces associated with traumatic brain injury. When this causes damage to the neurons in the pituitary and adjacent regions of the brain, normal hormone regulation can be disrupted.

Between January of 2015 and March of 2017, questionnaires were sent to players who had been in the NFL after 1960, when the adoption of the hard plastic helmet models because widespread. The researchers also collected information on the respondents Body-Mass Index, drug history – prescription or otherwise, other diagnoses such as heart disease, or sleep apnea. They also asked more intimate questions regarding sexual dysfunction including need for medications such as Viagra or testosterone, and psychiatric problems.

Respondents were then asked to quantify how many times they experienced concussive symptoms that include headaches, loss of consciousness, memory problems, unsteadiness when standing, and other symptoms of head injury. Using statistical modeling to account for the potential confounding variables listed above that can also cause these problems, the researchers demonstrated a very convincing 'dose-response' where the increased number of head injuries experienced was correlated with increasing probability of having low testosterone or having ED. Overall 3409 valid responses were obtained and the average age of the responders was 52.5 years. 18% of the players reported the indicators of low-testosterone and 22.7 reported ED. Both of these outcomes are higher for this age in the general population, but more convincingly, the more concussive episodes a person reported, the higher the frequency of these medical problems.

The authors conclude that these findings have implications for players in many sports, with soccer, boxing, mixed-martial arts, and hockey also having substantial risk for head injury. We are at a time in our culture that we cannot ignore these risks, particularly for our children who may want to engage in these pastimes. It is important for sports physiologists to engineer protective gear, but it is also essential that leaders in these sports look at modifying rules to prevent these unnecessary injuries. And last but not least, it is up to parents and the athletes themselves to make the best decisions to allow the next generation of all-stars to live and thrive long after their careers in sports are over.

*doi:10.1001.jamaneurol.2019.2664