The balance of hormones is essential for all aspects of human health and the same plays true for athletes. Whether you are a beginner working on getting into shape and losing weight, or a seasoned veteran with many competitions under your belt, understanding your hormones and how they change with intense exercise is essential to getting as much as possible out of your training. ZRT Laboratory is launching 2 new kits that will enable athletes to track their hormones and help them better understand the changes happening to their body. In my previous blog, I spoke about why laboratory testing is important for hormone tracking to prevent injury and achieve optimal performance. Here, I am going to introduce ZRT Laboratory’s new kits and explain why these particular biomarkers were selected and how they tie into each other.
Fitness Metrics Profile
Our first kit, designed more for the beginner athlete, is called the Fitness Metrics profile. This profile is designed to measure the levels of the 4 main sex steroid hormones estradiol, progesterone, testosterone, and DHEA-S, plus cortisol, from a small amount of fingerstick blood dried on a filter card (dried blood spot – DBS). Both estradiol and testosterone can be useful tools in diagnosing overtraining syndrome (OTS) . During exercise, testosterone levels are depleted, but generally rebound after a good night’s rest. However, if testosterone (and estradiol in women) stay low, an athlete’s susceptibility to injury increases.
DHEA is an important marker as it decreases with age and is viewed as the anti-aging hormone. DHEA helps reduce recovery time, protects joints and bones, and increases stamina . DHEA also reduces bad cholesterol, increases good cholesterol, and neutralizes the effects of cortisol, the stress hormone. In this kit we look at the sulfate form of DHEA, DHEA-S, which is the form in which the body stores DHEA. Progesterone doesn’t fluctuate in response to activity like the other hormones, but is still important to track, especially for female athletes. If your progesterone levels are low, this can have negative effects on your health and wellbeing such as anxiety and poor moods, increased susceptibility to PMS, and the possibility of irregular periods, decreased fertility, poor sleep, and less muscular development.
This kit also tests for cortisol, discussed in my previous blog. Cortisol is the stress hormone, released as the end-product of HPA axis activity as it regulates the stress response, and is important for shunting resources where they are needed in stressful situations. The fluctuations in cortisol tend to be limited to short bursts but with increased stress or increased physical activity, these bursts can last longer and longer, making the body less sensitive to these small changes and causing long-term effects. These long-term effects of too much cortisol can reduce protein synthesis, increase abdominal fat, suppress levels of anabolic hormones like growth hormone, estradiol, progesterone, testosterone, and DHEA-S, affecting fertility and libido, and can lessen glucose usage predisposing to diabetes. This kit takes only one cortisol measurement in the morning about 30 minutes after awakening, when the level should normally be at the peak of the cortisol awakening response, which helps you get out of bed each day. If this level is elevated, it could mean your overall cortisol is high throughout the day and your sleep cycles are not enough to lower it properly. If cortisol is low shortly after awakening your energy level will likely be low and it may have significant effects on your athletic performance. (To get a better understanding of the effects on cortisol, a 4 time point circadian reading gives more information).
The final piece of the puzzle that is important when analyzing steroid hormones in blood, is sex hormone binding globulin (SHBG). SHBG binds free steroids in the blood and keeps them bound and soluble allowing for transport through the blood vasculature. If sex steroid levels are decreasing while SHBG is increasing, this can be a sign of OTS and should be monitored closely .
Moving on from the sex steroids, we also look at thyroid-stimulating hormone (TSH). TSH is an important indicator of thyroid health. Thyroid hormones regulate the size and performance of muscles. To boost thyroid hormone levels during exercise, the thyroid needs to be working properly. Over-exercising can increase catabolic hormones like cortisol and adrenaline (epinephrine), and reduce the thyroid’s capacity to make thyroid hormone, making daily tasks such as focusing and remembering things more difficult. Underactive thyroid in athletes can reduce blood volume pumped by the heart, decrease fat consumption during muscle contraction, reduce insulin sensitivity, interfere with bone metabolism, and slow down muscle recovery . Thyroid health becomes especially important after sustaining an injury; doctors recommend measuring thyroid levels before resuming activity. Monitoring thyroid hormone levels is critical in endurance athletes as most thyroid hormone levels increase right after an event and can take 1-4 days to return to normal afterwards.
Blood lipids are another important set of biomarkers tested in this profile. Blood lipids are useful in understanding cardiovascular disease risk and how it can be improved by fitness training and diet. Aerobic exercise has been shown to increase HDL cholesterol, the “good” cholesterol, and decrease triglyceride levels. Being able to set a baseline and see your blood lipid levels improve can be an effective strategy for starting and keeping a workout routine.
The final standard test of this profile and probably one of the most important, especially during the COVID-19 pandemic, is vitamin D. Vitamin D is important in immune regulation, protein synthesis, inflammatory response, cell growth, and skeletal muscle strength and function. Surprisingly, vitamin D deficiency is not uncommon in athletes due to the body’s utilization of vitamin D for muscle repair and recovery. Many studies have shown a link between hospitalization from COVID-19 and vitamin D levels . While vitamin D can’t prevent you from getting COVID-19, it may help decrease symptomatology and hopefully prevent a hospital stay.
There are a few add-ons available to the fitness metrics kit that can round out the health picture. These include free T3, free T4 (thyroxine), and thyroid peroxidase antibodies (TPOab), completing the thyroid picture; insulin and hemoglobin A1c (HbA1c), giving insight into insulin resistance and predisposition to diabetes; C-reactive protein (hsCRP), an indicator of inflammation; and luteinizing hormone (LH). LH plays an important role in the production of estrogens and androgens by stimulating their production. LH steadily declines over time in athletes under an intense training regimen but can rebound quickly during periods of rest and recovery.
Elite Athlete Metrics
The second new kit offered by ZRT is the Elite Athlete Metrics profile. This is very similar to the Fitness Metrics profile, but adds a 4-point saliva collection in addition to the DBS and offers a few extra goodies. The reason we chose to assess sex hormones and cortisol in saliva rather than blood for this profile is that it gives a better picture of the bioavailable hormones, those not tied up by SHBG and available to be utilized by the target cells. Another benefit of measuring hormones in saliva is that samples can be collected throughout the day non-invasively, so we can make sure that cortisol is following a normal circadian pattern. Looking at cortisol levels throughout the day in this manner allows for a better understanding of whether cortisol patterns are normal after vigorous physical activity to allow for optimal recovery to take place.
This profile also includes all the thyroid hormones together to give a full picture of how the thyroid system is performing. Thyroid levels will increase as a response to training increase and should recover to normal levels once this new training level is stabilized. Just remember that the more you push yourself, the harder your thyroid has to work, so it is important to understand the state of your thyroid health both before beginning a training regimen as well as once fully ensconced in one.
Similarly to the Fitness Metrics profile, this profile provides Vitamin D measurements, which are vital to overall health, especially with winter fast approaching, and allows for the add-on of the blood lipids (which are included as standard in the Fitness Metrics profile) as an option.
Which Profile do I choose?
Choosing the right kit and testing frequency can be tough. I will throw in my 2 cents here as to how I envision this information being used, but you may also consult with your training coach or physical therapist as well to see if they have any insight.
As an athlete that trains year-round, it may be difficult to find a time to establish a baseline. This is best done during a time of prolonged rest, preferably 2 weeks or more. As for myself, I have had very few periods of no activity in the last year that amounts to 2 weeks or more, but it is important to have this baseline established. It can help diagnose injuries before they occur as well allow you to get more out of your training in the future, so it is time well invested. For the baseline test, especially for seasoned athletes, I recommend the Elite Athlete profile. If you are a seasoned athlete you probably don’t need the add-on blood lipids, but if you are just beginning your journey or working to shed some weight, then I would recommend the add-ons. If you are new to training, the Fitness Metrics profile will also work well, but make sure to get all the add-ons. The add-ons will help you track your progress toward health and give you the ability to see progress you may not be seeing in the mirror.
As for frequency, I would recommend retesting every 3 months at a minimum. After having established a baseline, it is less imperative to get all the add-ons if you are an elite athlete. I would either recommend the basic Elite Athlete Metrics profile or the basic Fitness Metrics profile for these “maintenance” measurements. These are more to ensure everything is still in line and nothing is slowly getting out of whack. If you are a beginner looking more to increase your overall health and lose weight, I would recommend the Fitness Metrics, which includes the blood lipids. This will allow you to track your progress to help keep the motivation there. For any type of athlete, if there were areas of concern with the baseline test, I would recommend making sure those hormones are tested again at the next 3 month “maintenance” test. Once everything is in the healthy range, it is ok to only do the basic tests every 3 months. However, if you are injured or a feeling like you are hitting a wall and can’t seem to break through with your training, it may be good to get your testing done more frequently. This will enable you to see why exactly you are hitting a wall and hopefully help prevent any injuries. If you are injured, it would be good to do a “maintenance” test before resuming your activities to make sure you are back to baseline and may want to do the “maintenance” testing a little more frequently thereafter. Finally, if you are coming up on a competition, it could be helpful to get an idea of the state of your hormones to determine the amount of rest that may be needed to perform optimally at the competition. I would suggest testing yourself at least 2 weeks prior to competition so you have adequate time to rest and recover as needed before the competition.
So, whether you are a beginner or a seasoned athlete, hormone testing can be a useful tool to help you achieve your goals and continue to be the best you. Contact a customer service representative at ZRT today to find out how to get started tracking your hormones today!
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- Urhausen A, et al. Blood hormones as markers of training stress and overtraining. Sport Med. 1995;20:251-76.
- Hernández JL, et al. Vitamin D status in hospitalized patients with SARS-CoV-2 infection. 2020. J Clin Endocrinol Metab. 2020 Oct 27:dgaa733 [Epub ahead of print].