"The next station is...Summit."
My eyelids slowly rise, contacts dry and stuck to my eyes. I grab my bag full of sweaty training gear and empty UCAN bottle from that morning's threshold ride at Tailwind Endurance and stand up. Whoa. I feel weak, and now a rush goes through my body as blood begins to circulate more rapidly again. I walk down the steps and off the train feeling terribly sluggish. Of course I do. I got up at 5am this morning, trained my butt off on the bike for an hour and a half, worked a full day and now here I am falling asleep on the train. I have a hill workout tonight that doesn't sound fun right now, but hey, I'll wake up after the first couple of miles of running.
I give Lauren a kiss and run out the door to meet Clyde at the hill, two miles away. My legs feel like jelly but that must just be the sleepiness wearing off. It'll go away like it does every time I do a run in the morning right after waking up. Not this time. I get to the hill and my legs still feel lazy. Weird. I know what will fix it...I'll run hard up this hill for 5 minutes! My heart rate will be north of 180 and that'll definitely wake me up. I hit the button on my Garmin and Clyde and I charge forward; my legs are heavy-feeling but I reach the top at a solid pace and jog back down. Somehow, my legs still feel sluggish though and not just for the first rep, but all five of them. What the heck!? I must just be off today.
But it wasn't just that day. Week after week starting in March 2015, I got off the train feeling lazy, and it continued right through any of the evening workouts I had. I hit the splits fine, but I didn't feel like I had an extra gear. After this persisted for a while, I began moving all of my workouts to the morning when I typically felt less lethargic, even if I had to wake up before 5am. Further to the fatigue was that I often lost interest in using the bed for anything besides sleep for days, or even weeks on end. Now that's weird. I'm 28 years old and I KNOW that's not supposed to happen yet.
This is what it feels like to have low testosterone, as I've had since at least March of last year, due to overtraining / under-recovery. It's terrible, and can affect many aspects of life including energy levels, sleep patterns, mood, sex life, fertility, cognitive ability, bone health and body composition. The symptoms that each person experiences are different; for me, it has been fatigue, low libido, and bone health (see my previous blog called “Update: Bad News, and More Bad News”), but for other people it could be any combination of the other symptoms that I listed.
I write this blog so that you might be aware of the issues that can arise from too much endurance training and perhaps prevent the problems that have wreaked havoc on my health. Life is about balance, and I screwed up my balance. I may look healthy, but I’m not. 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.
If you have low T like me, 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:
- “I try to fit in as much training as my schedule will allow”
- “If I miss a workout, I try to make it up later in the week”
- “I got to bed late, but that 5am swim session is too important to pass up”
- “I know I’m already really lean, but every pound less I am is a pound less I’ll carry during my next race, so I think I’ll lose a few”
- “My wife and kids no longer recognize me”
Tip for the women reading this: it doesn’t just apply to men! Women face similar issues with regards to overtraining and hormone imbalances. Women are actually at a greater risk of bone health problems. I’m not as familiar with the issues as they relate to women, so you should consult your doctor.
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. I’ve been a fan of Ryan’s since I was in high school because he was a senior when I was a freshman. I watched in awe as he, Dathan Ritzenhein and Alan Webb duked it out and shattered records. Ryan went on to race at the marathon distance, running the fastest 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. This 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.
Over the past three weeks, I have been on a fact-finding frenzy. How can I make important decisions about an integral part of my life and future without information? 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.
The prevalence of health issues, particularly at the elite level, is both disheartening and encouraging at the same time. It’s great to know that I’m not alone, that many of these athletes continue to train and compete at a very high level despite these problems, and that some of them have overcome the issues. I must admit though…it’s scary to know how common it is and that it’s likely something I’ll need to manage for as long as I am training at a high level in this sport.
Attitudes toward their hormone issues have varied widely with some accepting it to be a cost of the sport, while others have fought back (and won) through natural measures, like Cody Beals. I choose to fight back.
Matt Bach, A Case Study
Below I will describe what I’ve done over the past five 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 – Competed in my first Ironman at Lake Placid. 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.
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. On one occasion, we had her parents over for dinner and I practically kicked them out at 9pm because I had to get to bed early for a 5am wakeup call the next morning to go on a century ride by myself. Nearly every Saturday for three months, I rode over 100 miles up 9W to Bear Mountain and back, 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 on her birthday. It turns out I had some niggling issues that stopped me from doing much training in between the races, which in hindsight was what allowed me to win my age group at Louisville and qualify for Kona (I was stoked!). 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
2014 – Three Ironmans was a lot to handle. I was mentally shot and I decided to make 2014 a “down year.” I would regroup, hire a coach for the first time, and do just half Ironman events this year. Training under Earl was totally different than how I coached myself…I had extra bandwidth. I had a solid rest day each week, trained fewer hours, yet improved faster. Training was going so well that in June I decided to throw the inaugural Ironman Maryland onto the race schedule in September to try to qualify for Kona for 2015. Between June and early September, training increased marginally to “Ironman training” from “Half-Ironman training” but all of the training was more focused and specific to my goals. I continued to get 7:15 of sleep per night, but without really knowing it, I had taken my first real step in the direction of better training/recovery balance by hiring Earl.
Weekly Average: 14 hours
2015 – Having won Ironman Maryland in 2014 in a massive 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 the symptoms of low testosterone for the first time as described in the intro to this blog, 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 apparently not enough!). 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, which you can read about in the “What I Did Right” section below.
Weekly Average: 13 hours
This is a loaded topic! Weight is a major factor for some people when it comes to having hormone problems, and it may have had something to do with mine. While I’ve always been very lean, my weight actually puts me in range of “normal” on the BMI charts. Just to be safe, I’ve increased my weight since I learned of my low testosterone in 2015. Prior to 2015, I weighed 145 pounds (I’m 6’0”) and if I ever found myself below 140, I would feel like dirt. In 2015, I increased my weight a few pounds to 148. Early this year, I increased it further to 155 and now I’m “chunky” at 163.
Something of note is that 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 140 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! Now it makes sense, 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 was known to have said “you need to be fat in July” to race well in October.
Other Factors & Notes
- I, like many of you reading this, work full time and sit in a chair all day. Top pros don’t do that because it is not conducive to training at the highest levels of the sport. While we are toiling, they are recovering, but we gotta bring home the bacon!
- I trained for 5 years straight at a high level because each success and failure led to new goals to pursue. Even in 2014, when I planned on reducing my training/racing for a year, I ended up doing an Ironman. The low T and bone density problems I have take years to develop, and I never really gave my body a long break.
- “Early season” not light enough. A better plan might be to do moderate but consistent training from January to July then ramp up in August/September for an October race. It’s a long season if you train hard January through October!
- Offseasons – I generally took at least 2 weeks completely off, then had a period of 1-2 months around the holidays where I did just ~25% of my usual volume.
What I Did Right
- Up until 2014, not a lot!
- In 2014, I began Metabolic Efficiency Training with Nicci Schock. At the time, I didn’t know that the principles of MET reconciled so well with the dietary measures one might take to improve testosterone.
- High in healthy fats
- High in protein
- Low in processed foods
- Low in sugar and simple carbs
- Low in alcohol
- In 2015, once I discovered the low T problem and had researched how to “fix it” I:
- Started a vitamin D supplement, which can help with testosterone production
- Started taking Omega-3 fish oil supplement
- Brought the training volume down a bit (just 1-2hrs less per week)
- Cut soy out of my diet because soy encourages estrogen production, which decreases testosterone levels in men
- In 2016, I took more natural measures to raise my T levels:
- Stopped training for several weeks after Kona 2015, then gradually got back into it starting in late December
- Began regular heavy lifting sessions in the gym under the supervision of my physical therapist, Joshua Grahlman of Clutch Physical Therapy, particularly dead lifts
- Increased my sleep from an average of 7:15 to 8:00 per night
- Better work arrangement that allowed me to train in the middle of the day
- Gained 7 pounds
- Doubled my vitamin D supplement to 4000 IU daily
- Began taking a zinc supplement which helps with testosterone production
- Working with Dr. Barry Sears to manage cellular inflammation and improve recovery time through the consumption of large quantities of high quality fish oil
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.
Performance Enhancing Drugs
I won’t take supplemental testosterone, and here’s why:
- It’s banned by the World Anti-Doping Agency (WADA)
- It can cause fertility problems and other side effects
- I don’t like the idea of “slapping a band-aid” on something instead of fixing the root cause
- Even for the short-term, I won’t take it because I don’t want to risk there being an asterisk next to a future result. “Yea, but he took testosterone at one point.”
- Because it can be done without it
It’s been a roller coaster emotionally. Though I typically excel at remaining rational, it’s been hard to keep my head on straight. The journey has brought up tons of questions and has driven me to learn things about myself. Am I doing the right thing for me and Lauren? A future family we might have? Is this a career change I should be pursuing? Will I find the right balance between training and recovery? Will that equilibrium translate into enough training to compete with the best in the sport? Genetically, do I have what it takes? Should I throw in the towel?
Recently, with the help of my coach, I realized that these health issues have only brought more clarity to the question of whether I pursue a career as a professional triathlete. When I ask myself what I should do, the answer is still to go for it. I would regret it for the rest of my life if I didn’t. To be able to say that, even given my new situation, is a powerful indication to me that this is the path I need to follow.
My Path Forward
- Decrease my training to near zero for the time being to allow my testosterone levels to restore to at least the low end of “normal,” targeting 400+
- Begin and progress a strength training regimen to improve testosterone levels, maintain core stability, improve bone density, and limit muscle imbalances
- Continue metabolic efficiency training but maintain a higher body fat %
- Get more sleep! I will be targeting an average of 8-8.5hrs per night
- Gradually introduce more endurance training while continuing to achieve rising testosterone levels and improved bone density
- Continue working with my doctors to assess my blood work and correct some of the abnormalities through (natural and legal) supplementation
- With every upheaval comes opportunity, and the extra time will allow me to work closely with my sponsors in ways other than by giving them exposure through racing. I’ll do more speaking engagements, educational events and blogging.
- Early next year, my goal is to have positioned myself in a way where I can employ a “less is more” approach to my training that will still yield performance improvements. It may involve as little as 6-8 hours of high-quality, intense training per week, similar to the approaches of Sami Inkinen (ridiculously fast age grouper and co-founder of Trulia) and training partner Jared Tootell (husband, father, banker and elite age group Ironman athlete who makes it happen). Professional triathletes Cody Beals and Sarah Piampiano had similar problems with hormone imbalances, and bone density issues. Both have recovered from those, came back even stronger than before, and have gone on to very successful pro careers. I hope to use their success as a model for my own.
A Frog Slowly Cooked
There is a fabled science experiment that a frog can be boiled if the temperature rises slowly enough, but the metaphor is apt so I will use it. A frog is placed in a beaker of water which is placed on a hot plate and slowly heated. If the frog were to be placed in boiling water, it would jump out, but here, the frog remains in the water until it’s literally boiled alive. My doctors have told me that testosterone and bone density don’t change overnight and that my levels have probably been coming down for years. As for the mythical boiled frog, the threat developed gradually and I allowed myself to get cooked.
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 your 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. I can help point you in the right direction.
Keep your priorities straight. Remember what is important in life! We love endurance sports, but your health comes before training and competition, as does family, and if you’re not healthy, you’re not going to be there for them.
Don’t be a frog slowly cooked.