"I wish I knew five years ago that overtraining could lead to low testosterone and the myriad of other health problems I’m facing."

When low testosterone and training clash, the effects can be devastating.

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. And I’m 29.

Hi, my name is Matt Bach and I won an Ironman. I’m also a case study for what can happen if you don’t recover properly from too much endurance training. I have developed low testosterone and have discovered that it is shockingly prevalent in the male endurance community. Pro runner Ryan Hall, for instance, cited low T and extreme fatigue as the driving factor behind his retirement from running at 33 years old. Most people—even doctors—don’t know you can wreck your hormone profile by training too much, leading to symptoms like mine. But if you can identify the warning signs, you can prevent or even reverse negative effects. Here’s what you need to know about low T.

Symptoms

The most common symptoms include fatigue and low libido. You may experience difficulty building lean muscle mass and slower recovery, leading to reduced physical performance. Having low T for a prolonged period can lead to fertility problems, bone density abnormalities and insomnia. You may also be more anxious or depressed—something your significant other may notice first. Take note if you experience any of these symptoms, as most people, including myself, write off fatigue and lack of desire to the rigors of training, but in many cases, it stems from a deeper issue.

Causes

You are probably aware that as you age, your testosterone levels gradually decline. Medications such as statins (Lipitor), antihistamines (Benadryl), pain killers (codeine) and chemotherapy drugs can suppress T levels, and tumors might also be to blame, but a less well-known cause of low testosterone is overtraining.

Proper recovery—especially sleep—is hard to come by for triathletes with careers and families, but it is imperative for hormone health. As you might expect, genetics also play a role, and scientists’ understanding of which genes affect testosterone is growing.

Weight can also be a factor. Dropping your body fat too low in search of performance benefits can lead to serious problems, including hormone imbalance. The American Council on Exercise recommends that men keep their body fat above 6 percent, and women above 14. The International Olympic Committee coined the term “relative energy deficiency in sport,” or RED-S, to address inadequate caloric consumption relative to training. The IOC applies the term to both men and women, as women can face similar symptoms when low bodyweight and overtraining lead to imbalances in hormones including estrogen, luteinizing hormone and progesterone.

Prevention and treatment

“Early detection of low testosterone should be a priority before serious symptoms, such as low bone density—with increased risk of stress fractures—develop,” says Dr. Sylvia Hesse, a non-surgical orthopedist in New York City. So gather information. If you’re experiencing any of the symptoms listed above, get blood work done to test your testosterone levels (this is usually covered by insurance).

Should you find you do have low T, one option to raise it is testosterone supplementation. But that comes with a host of side effects including disqualification from competition unless you obtain a therapeutic use exemption beforehand. Athletes who prefer a more natural approach can follow these steps doctors, including my own, commonly prescribe for endurance athletes:

Remember that your testosterone levels take months to decrease, so you should also give your body months to fully restore it. Your symptoms, such as fatigue and low libido, should abate over the course of a few weeks or months, though bone density will take many months to restore fully. Have blood work done regularly to see if the steps you are taking are working. If you are recovering from low T, doctors recommend blood work every four to six weeks. If you’re an athlete with normal and stable levels of testosterone, then a checkup every six months is adequate. If you don’t think you’re at risk for low testosterone, it’s still helpful to get your testosterone measured at your next doctor’s appointment so you know what your baseline is for future reference.

I wish I knew five years ago that overtraining could lead to low testosterone and the myriad of other health problems I’m facing, but at least I’m getting back on track now that I’ve learned how to fix it. After three months of reducing my endurance exercise by 70 percent, increasing my sleep from 7.5 to 8.5 hours per night, and following the other steps I listed for three months, I am feeling like a new person. My symptoms have abated, my testosterone numbers have rebounded, and I’m ready to train again—this time with fresh perspective on how to get the best out of myself while keeping my health too.

Reduce your training volume and intensity. Depending on the severity of your case and how much volume you were doing, you may need to reduce volume by anywhere from 20 to 80 percent to reverse declining testosterone. Do away with intense workouts for at least a few weeks as intensity adds additional training stress to the equation that could delay your recovery.

Focus on recovery, especially sleep. Fatigue is OK if it’s short-term but not if it’s chronic. Athletes stress themselves more than most people and thus require more sleep to properly recover. Everyone’s sleep needs are different, but I target 8 to 9 hours per night.

Eat clean. Include more healthy fats and cholesterol in your diet. Limit alcohol, sugar and soy.

Pack on some pounds,
if you need to.

Supplement. Consult your doctor first. Studies show zinc, vitamin D and omega-3 fish oil may help combat low-T symptoms.

Matt Bach (@IronMattBach) is the winner of the 2014 Ironman Maryland.