Drugs - A View That You Might Share

Wednesday, April 5, 2017 - 15:45

The View

I had a doctor's appointment last Thursday that prompted me to learn about myself and better articulate what it is that makes me against drugs. I thought I'd share this because I suspect a lot of people have the same view and that it might be helpful for anyone else debating whether to take a pharmaceutical or not.

When the topic comes up, I typically just say "I don't like to take drugs" and that I prefer natural solutions, however, that's an oversimplification of what I really mean, which is that I don't like the things drugs typically stand for. These three things in particular:

1.) They don't solve the root problem, often "slapping a band-aid" on the situation by masking symptoms
2.) They have side effects and it's often a chemical completely foreign to the body
3.) The patient often becomes dependent on the drug (i.e. needing to take it for the rest of their life)
If a doctor is recommending that you take a pharmaceutical for a non-immediately-life-threatening condition, pause for a moment, and consider the above three points. If these three things come up as "not applicable" then congrats! You may have found yourself one of those rare drugs that will help you without screwing up the balance that the human body has so miraculously achieved through eons of evolution. Unfortunately, nearly all pharmaceuticals fail to meet all three of these criteria, and that is why I have felt so comfortable saying "I don't like drugs" as a blanket statement.
I should take a step back...we should FIRST be considering natural ways to fix things, because then there is no chance of 1, 2, or 3 being applicable. By taking drugs, we introduce risks, whether they be known (like the side effects you see listed on Warning labels), or unknown risks. Former US Secretary of Defense Donald Rumsfeld made famous the phrase "unknown unknowns" in a speech about Iraq in 2002 - there are unknown unknowns when it comes to drugs too, because the body is so incredibly complex that we don't know the full extent of what we are doing to it when we add something unnatural. The body is capable of some amazing things, so before you add something unnatural, we should use food, habits, natural supplements, exercise, etc to fix our problems where possible.

A Real Life Example

Mine. It serves as an example, but also an update to those following along in my recovery.
That doctor appointment I had last week was with a bone density specialist in Manhattan named Dr. Joseph Lane. The two doctors I've worked with in the past, Dr. Sylvia Hesse (Orthopedic) and Dr. Ruth Johnson (Internist), have both been fantastic, but there are a few questions that they were unable to fully answer:
1.) Will my bone density ever be back to normal?
2.) How fast should I expect it to get better?
3.) Is there anything else I can be doing to make it better?
Dr. Lane was quickly able to answer number 1. His answer...my bone density will never be back to normal. The bone loss I've experienced is partially irreversible. If I take the natural route, I can expect to get from -2.0 standard deviations below the mean (where I am now, at the border of osteoporosis) to about -1.7, or -1.5 at best. At that level, he thinks I'd be able to resume normal daily living, but won't be able to train at a high level. Then he went to say that he thinks I could get back to -1.0, but only with drugs.
I knew he was going to say that.
He's a conventional doctor after all and the pharmaceutical companies have big bucks.
But I listened. He said that at -1.0, I would not be back to where I was before this mess (because "there are consequences [for what you've done]"), but that I could train at a high level again as long as I didn't do anything stupid (like have low testosterone or undereat).
Trying not to be skeptical, I prompted "so tell me about the drug." And what he said surprised me. He described a drug called Forteo that is almost identical to a hormone that our bodies already produce that prompts your osteoblasts to make bone faster, therefore outpacing your osteoclasts (which break down bone), thereby increasing bone density. I would take it for 2 years and then stop, supposedly keeping the bone density I've gained.
Ok, so that meets criteria number 1 because it actually fixes the problem, which is low bone density. It meets number 2 because it's not foreign to the body and has minimal side effects, and it meets number 3 because you don't become dependent on the drug. I didn't expect to seriously be considering any drug, but this one had me thinking.
Then the bad news. The drug is extremely expensive and not often covered by insurance. I could get 1-2 months covered, but after that no guarantees, and if I paid for it all out-of-pocket it would cost $3000 per month! That's completely unaffordable and not happening.
So then they told me about a second drug called Prolia, which is covered by insurance. It's completely foreign to the body and comes with a host of potentially serious side effects. It checks off numbers 1 and 3, but fails completely to meet number 2. That's out.
I went home with a lot to think about. The first thing I had to do was determine the validity of what he was saying with regards to bone loss being (mostly) permanent. I combed through the literature and asked favors of a number of my friends in the medical field to search as well. We found 2-3 case studies of women in their 20s who had lost their bone density due to the Female Athlete Triad, and then restored it using natural methods (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761891/ and https://www.ncbi.nlm.nih.gov/pubmed/16177598), but we didn't find a single case study of a ~30 year old male who has been able to do it.
Favor: if anyone knows of any case studies where this has been done, please let me know!
Then I had a number of conversations with Lauren, my family, other athletes, friends, researchers and medical professionals, so that I could a.) hear their feedback and b.) have them act as a sounding board for me. To those who have helped me in that way, thank you!

My Plan

I never thought I'd say it, but I'm going to take a drug. I'm going to see how much Forteo I can get covered by insurance and take it, even if it's for only 2 months. For those wondering, it's not banned by WADA. After that, I'll maximize the bone density gains I can make naturally and hopefully get to a place where my bone density doesn't affect my life and those around me, including our baby daughter who will born any day now!
I continue to reach out to bone density specialists so that I might discover something new to help me, but if Dr. Lane is correct that it's mostly irreversible, then I hope at least my story will convince others to take care of themselves. Check in on your hormone levels (both men and women!) and eat right, before it's too late. If you don't know how to keep your hormone levels strong, I may be able to help: http://www.ironmattbach.com/consultations and if you don't know what "eating right" means, then reach out to Nicci Schock: http://elevatebynicci.com/
Drugs have their place. Modern medicine has saved countless lives and should continue to be used in emergency situations, in situations where there is no natural fix, and when the drug meets all three of the criteria I outlined. That's my view. What's yours?

The Road Bach #5 - Set Back

Friday, February 3, 2017 - 10:45

Ugh. It was all going so smoothly, but here I am facing some hefty bumps in the road. My bone density has barely moved, and I've given myself another stress reaction. What happened?!? Here's the scoop:

My health was returning, so I jumped, ran and lifted heavy weights. No problems! It had been 4 months since I had the initial stress reaction and I stopped training, my hormone levels are back to normal, and my hips were feeling fine. No evidence of any bone injury. I had come to believe that my bone density must be coming back nicely, but I wanted to check it out and make sure before ramping up my training more, so I scheduled a DEXA bone scan.

The result: low bone density!

My reaction: "What?!?!? I only gained 9.7% in my spine?!? And I lost 4.0% in my femur!?!? I thought I was on the right track!"

The problem: There are lots of them. First, my expectations weren't set properly. I was under the assumption that I could gain tens of percents in my bone density within a year. My fault. I should have known, by asking my doctors or doing some Googling, that bone density improves really really slowly...to the tune of 10% per year if you're doing well. Second, there is a margin of error of +/- 5% for these tests. Third, the two datapoints, 7 months apart, don't tell the whole story. I was very disappointed at first, but after giving it some thought, talking to my doctors, and looking at the evidence, this is actually a pretty good result. Yes, even the loss of 4% isn't so bad. My first DEXA was done in May 2016, but that probably wasn't my low point. I was injured and had low testosterone, both of which were further hurting my bone density. Further evidence comes from a bone resorption test that I did (it shows how much bone you're breaking down) in late June that showed I was breaking it down pretty quickly. I had another bone resorption test in November that showed a dramatic decrease in the amount of bone I was breaking down. Therefore, the story is likely that my bone density continued downward till a low around July, but then necessarily must have rebounded in order to arrive back at the "nearly unchanged" numbers we see in January 2017. This would suggest that I've actually been progressing since mid-summer, and that I need to just keep doing what I'm doing. Great. So my priorities are: 1.) I'm still susceptible, so don't get a stress fracture 2.) keep hormone levels normal, which is of utmost importance for healthy bones and 3.) keep lifting heavy weights to encourage bone growth

Fastforward three days. I go for a 9 mile run with a few short pickups. It's nothing out of the ordinary as I've been doing pickups recently and have run up to 10.5 miles at a time without issue. Two hours after the run, though, my hip starts aching ever so slightly. It's the same feeling as when I first had the stress reaction. My first thought..."this must just be in my head. I got the disappointing bone density result and bone stress injuries are fresh in my mind. Plus, I've been doing runs like this, and throwing heavy weights around, and jumping and I haven't had any problems, so why would this run-of-the-mill 9 mile run affect me? Are you becoming a hypochondriac? Matt!? Are you!?" Then I ran on Thursday morning, an easy 6 miles. The ever-so-slight achiness returned...hmmm...then I lifted heavy that same day and the achiness moved into the range of undeniability. It felt like soreness deep in my hip area, but only on my right side, the same exact feeling I had back in May 2016. I immediately contacted my doctor to set up an MRI, which I did the very next day. Well I got the result on Tuesday and WHAM! I've got a stress reaction. It's in the same exact spot as before and looks to be approximately the same intensity.

What does this mean? For the short term, it means I won't be running anytime soon, I won't be doing any heavy lifting, and I can't do any hard bike workouts. Chances are slim to none that I will be doing Puerto Rico 70.3 frown. I'm lucky to still be walking without crutches. I can, for now, still bike easy and swim, but if that aggravates it, then I won't be able to do those either. For the longer term, maybe this is God's way of telling me to put this mission aside. "Here, I'm giving you something more important to worry about, a daughter!"

My new priorities: 1.) get ready for the arrival of our little one 2.) heal my stress reaction 3.) maintain hormone levels 4.) restore bone density to levels where I can run without reinjuring myself

I write about this topic so that others will be aware of the health debacle that can occur if you overtrain. So many articles write about overtraining and how it's not good for you, but they don't get into the nitty gritty. What actually happens to your biology? Why does performance suffer? Why do you become more injury prone? Why do you feel tired and why don't you want to have sex?! It's much deeper than "I'm tired from training," and I feel I have a duty to spread that word. I'll be doing a speech on this topic in 2 weeks at a Sports Medicine conference in Greenville, SC, I'm working with a researcher named Dr. David Hooper on a study assessing overtraining in endurance athletes, and I offer consultations to those who are in a hole and need help. To be clear, my point isn't to diminish enthusiasm about training for endurance sports, but just that we need to be smart about it! There is a balance that can be found in each person's life situation that will allow them to fully enjoy triathlon and become better athletes, all while remaining healthy. I encourage you to find your balance!


Train happy, train healthy,


The Road Bach #4 - Progress!

Thursday, November 17, 2016 - 16:15

BOOM! My testosterone levels are way up and I'm feeling great. I'm making major progress down my road to recovery - the crazy fatigue I was feeling is all but gone, my libido is way back, and my body recovers from workouts and injury faster than last year. In even bigger news, we're having a baby!!! Those of you who listen to Endurance Planet will already know that from our latest episode. The pic on this blog is how we announced publicly (because once it's on Facebook, it's official?).

Her name will be Summer Elizabeth Bach and we're very excited to be bringing her into our lives after trying for a year (and having two early miscarriages). As you might expect, her arrival will affect my athletic plans, but I'll get to that in a bit.


I've been meaning to write this one for a couple of weeks now but things kept getting in the way, things that dudes with a lot of testosterone do...like lift heavy things, scarf down steaks, build things, start bar brawls, and women (well...woman in my case. Hi Lauren smiley). I'm only sort of joking.


I've been feeling better and better, but then the blood work proved it. My latest number came back at 599!? Here's an updated chart of my testosterone levels with reference numbers so you know what it all means:

Here's what I've done to get these huge results (all done naturally, careful not to have or do anything banned by USADA):

- Decrease my endurance training load from ~15hrs per week of fairly intense training to ~7hrs of mostly aerobic, not-so-intense training

- More sleep! I used to get 7.5ish hours per night while training a lot. Now I'm getting 8-9 hours per night training less. Big swing.

- Increase my strength training from 1-2 sessions per week to 3-4 sessions of fairly intense lifting, including CrossFit twice per week.

- Supplements. I've been taking a host of all-natural supplements since May when I learned how unhealthy I was. These include Omega-3 fish oil (Zone OmegaRx, very pure), zinc, pregnenolone, Mitocore Multivitamin (also helps with my bone density), CoQ10, magnesium, and adaptogenic herbs that help with HPA axis regulation (calming and sleep).

- Being more relaxed, sometimes through meditation and breathing.

- Keeping an eye on nutrition and fueling needs to be sure I'm not causing my body any undue stress (we get enough of it from training and everyday life right!?)

- Packing on some body weight/fat. I'm not sure if it played a role in my hormone issues or not, but just to be safe, I now weigh 163lbs, and strangely still feel lean.


You might ask..."is it all worth it? You've sacrificed fitness, training and races, but what do you really have to show for it? Will you ever be able to go back to heavier training loads?" They're good questions and I don't fully know the answers, but I believe it will all be worth it. Yes, I've sacrificed performance to the tune of 15% by decreasing my training, but what I've gained back is my health. With good health as my foundation, I hope to raise that fitness again without sacrificing what I've earned. That's the part that remains to be seen, but pioneers like Cody Beals and Sarah Piampiano have showed me that it's possible, so I am hopeful.

In other news, I've been able to run a whopping 5 miles at a time, outdoors, full body-weight, without any issues with my bones (like recurrences of bone stress injuries) or my Achilles, which had been chronic problems. This is thanks to routine adjustments and therapy by Dr. Todd at All-Pro Health and Josh Grahlman at Clutch Physical Therapy. I highly recommend both of them as they have helped me to keep my body together over the years.


Finally, here's a little update on my plan going forward. It's hard to really plan because there is so much uncertainty around the birth of our first child and with the pace of my recovery, but here's what I've got:

Between now and the end of the year: Swimming 4x per week, strength 4x per week (including CrossFit), run 2x per week and get it back up to 10+ miles at once, bike 1-2x per week. Get back some base fitness so that in...

January - March 2017: Build off of that foundation and get into "fighting shape" for Puerto Rico 70.3, my anticipated return to the sport!

April - June 2017: Babytime! No focused training, just caring for my wife and our little one, and getting in what training I can.

July onward: ???Late summer or fall racing??? Only God knows at this point, but I am excited that maybe, just maybe, I'll be Bach.


Train Health, Train Happy,




The Road Bach #1 - Time for a Quick Update

Wednesday, July 13, 2016 - 10:30

I've been working as hard on my recovery as I did in my training, and it's paying off! Catch up on my health debacle by reading my first blog here then read this update below.

Bone Stress Injury

I am officially off the crutches after using them for 4 weeks and weening off of them for an additional 2 weeks. I can walk around without any achiness returning in my hip, which I haven't felt in over 4 weeks. I can even ride my bike again! I did two rides, one in Lake Placid where I went for a "training camp," and one with the Mapso Tri Club near where I live, that were pretty hard and both over 50 miles. I'm happy to be off the crutches even though they did give me an opportunity to drop some jaws...I could walk without pain and without a limp, so sometimes I would be crutching down a sidewalk, and suddenly pick up the crutches and walk completely normally. Onlookers were shocked and it made me a little bit happy.

You may ask why I needed the crutches if I didn't have any pain. The simple answer is that my doctor said so. The more robust answer is that my bone stress injury is in a place of "high risk" and continued stress on the area, especially since I have osteoporosis, could lead to avascular necrosis, where the bone essentially dies and requires surgery. Not ideal! To play it safe, we kept me on the crutches longer than many would consider necessary for a standard "low risk" stress reaction. I have also begun pushing off the wall in the pool, which is allowing me to keep up with my old lane! I still can't run because the force your joints must withstand is approximately 4-5x your body weight when running, far greater than the ~1.4x your body weight when walking. I'm hoping to return to the Alter-G at Dr Todd's and then hopefully return to the roads soon thereafter.


I had blood work done last week and the result came back at 308 ng/dL, a 41 point increase from one month ago. I'm pleased! Though I would have loved to see it jump faster than that, this new number puts me in the range of "normal" (albeit at the low end). The symptoms of low T have abated dramatically since I stopped training. The fatigue that I used to experience on the train after work is all but gone, and I'm almost back to my old self in the bedroom. This jives surprisingly well with my doctor's comment that most men experience symptoms of low T if it is under 300. She also mentioned that men feel the full benefits of this hormone at around 600, so I still have work to do if I want to situate myself in the best way possible for triathlon performance.

Another interesting thing I learned about testosterone (from a smart friend of mine) is that a discovery has been made linking certain gene mutations with low testosterone. We've known that one's natural testosterone levels are influenced by genetics, but now we know which genes have the highest correlation with those levels. The men studied had somewhere between 0 and 4 genetic mutations termed "risk alleles" and those with 3 or 4 mutations had a far greater chance of testosterone under 300 ng/dL (30%) than those with 2 mutations (15%), 1 mutation (12%) or 0 mutations (5%). We all have access to whether we have these risk alleles by doing genetic testing through 23andMe, which I will do soon. I'm mainly interested because it will educate me on whether I had a compromised starting point or not, which is something I don't know right now because I never had baseline testosterone measurement done before I began training for Ironman.

Bone Density

My bone density is going to take some time to return, many months to be more specific, but in order to monitor the progress, my doctor gave me a test kit that would tell us whether I'm creating or breaking down bone. It was a urine test that I did about two weeks ago and I should be receiving the results any day now. I am optimistic that the trend has been reversed, partly because of my higher testosterone levels, and partly because my blood work revealed an interesting genetic mutation that makes me susceptible to low bone density. I have a double mutation in the MTHFR gene, specifically in the C677T variant, that means my body isn't very good at converting inactive folic acid and B12 to their active forms. I'm 10% as efficient at creating the enzyme that does the conversion as compared to a person with no mutations in that gene. It's actually a fairly common thing to have at one, or even two, mutations and the good news is that it is easily treatable. Just take methylated (activated) forms of folic acid and B12 so your body doesn't have to do the conversion. I've been taking that for about a month now as part of a special multivitamin I'm taking.

I'm also doing a few other things to help strengthen my bones...I take magnesium and strontium and will be doing weight-bearing strength work that will encourage my body to develop greater bone density (not yet though because I still need to be careful with my bone stress injury).


I'll be "racing" this weekend in honor of my brother, Justin, who died of cancer in 2008, at the Lake Waramaug Sprint Triathlon in Connecticut. I'll likely do just the swim and bike, and then drop out before the run to avoid re-injuring my femur. Each year, we do an event like this one, and raise money from family and friends for St Jude's in his name. Please read our one page letter and consider a donation! We are grateful for any amount!

Happy Training!

A Frog Slowly Cooked

Friday, June 17, 2016 - 14:00

"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 also describe how I discovered that I had low testosterone in Episode 2 of a podcast series following my journey to “go pro” called “So You Wanna Go Pro?” on Endurance Planet.

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 matthew.j.bach@gmail.com. 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.

Update: Bad News, and more Bad News

Wednesday, June 8, 2016 - 14:30

I received this custom Tri Kit in the mail a couple of days ago. I LOVE IT! and can't wait to race in it, but yesterday I learned that I will not be racing Ironman Lake Placid. Many of you may have noticed that I did not race Raleigh 70.3 last weekend. I won't be racing Eagleman 70.3 this upcoming weekend either. My season is up in flames and I'm working on accepting the facts of my situation and choosing the best path forward.

As any of you who have listened to the podcast series about my journey to "go pro" on Endurance Planet will know, it started with what I thought was inflammation in my hip, but I've discovered that it's much more than that. The "hip" injury is actually a stress reaction in my right femoral head where it meets the femoral neck, according to an MRI I had done a couple of weeks ago. The good news is that it's not a stress fracture, but only a stress reaction, because I was smart enough to stop running on it when the pain appeared. The bad news is that the stress reaction is in a bad place, a place of tension, where weight that I apply to that leg tends to put more strain on the affected area which makes it susceptible to reinjury. In fact, if I continue to aggravate the area, I could actually kill the bone. I was put on crutches and immediately knew I would not be racing Raleigh 70.3 or Eagleman 70.3. I won't be running anytime soon, can only do light cycling, and can swim but can't push off the wall. In my meeting with Dr. Sylvia Hesse, a fantastic orthopedic doctor in Manhattan, I mentioned that I've had issues with low testosterone due to overtraining. Hmmmm...are the two linked?? I hadn't thought to ask that question, but Dr. Hesse did. She had me do a bone scan and the results were terrifying. I have osteopenia in my hips and osteoporosis in my spine. To summarize...Overtraining led to low testosterone, which over prolonged periods can lead to low bone density, which led to the stress reaction I have today. I'm a mess.

Yesterday, at a follow-up meeting with Dr. Hesse, she assessed my progress and didn't like it. I still have a subtle dull ache in my hip area on the right side, indicating that I'm still injured. I had been on crutches for 2 1/2 weeks already, but was told that I will be on them for another 2 weeks. I also won't be able to race Ironman Lake Placid. The risk is too high that I will reinjure myself, or even cause another injury somewhere else due to my low bone density. My health is the priority so I will be focusing on restoring it for the rest of 2016, and though the racing season is up in flames, I may be able to take a page out of the phoenix's book and rise from the ashes next year.

I will continue to blog and speak about the health issues - I want you all to know of the problems that endurance training can cause so you can be careful in your own training approach. Stay tuned for my blog about low testosterone, why it happens, and what you can (naturally) do about it. I'll use my own story as a case study so that you might prevent or repair your own issues with low testosterone. It's more common than you think.

Until I can get back to health again, the Tri Kit will hang in my room waiting for me to return.

Be healthy, and train happy.

An Experiment for 2016 - Fish Oil

Wednesday, May 4, 2016 - 13:15

Each year, I pick a handful of things to experiment with, and one of them for 2016 is high dose, high quality fish oil. People's diets often lead to high levels of inflammation, particularly in the U.S., and as an athlete, we choose to inflame our bodies daily through our training. Dr. Barry Sears has pioneered the use of Omega-3 fish oil in order to keep that inflammation under control and optimize recovery. Something that I've learned lately is that inflammation is about balance, like so many other things in life. Too much inflammation and your body destroys its own tissue leading to injury and minimal performance gains. Too little inflammation, and your body doesn't know what to repair. Inflammation is your body's signal to heal itself, which it does in a supercompensatory way leading to you being stronger, which leads to performance gains. Woah! Isn't that what we are looking for as athletes!?


So how do we measure inflammation? A blood test. I did a blood test before starting the fish oil consumption to measure my AA (Arachidonic Acid) and EPA (Eicosapentaenoic Acid) levels, which are used to calculate the AA/EPA ratio. Dr. Sears' research has concluded that 1.5-3.0 is a good range with 1.5 being ideal. My original test on February 3rd came back at 5.1 (8.96% AA / 1.76% EPA), and after taking 10 capsules per day for a bit less than 3 months, my ratio is now 1.5 (8.2% AA / 5.6% EPA), spot on with the ideal number! I guess Dr Barry Sears knows what he's talking about when it comes to dosage recommendations! Not only did my second test number reflect a better ratio, but both my AA and my EPA numbers improved, particularly my EPA percentage. The ideal range is >4% of total fatty acids, a number I failed to meet by far in my first test. After taking more fish oil, I've achieved it and then some, meaning I have a lot of "good" fatty acids in my system now. This totally jives with the fact that I've been taking a ton more fish oil under Dr. Barry Sears' guidance, and not just any fish oil, but the highest quality fish oil there is on the market, OmegaRx fish oil.


So the science proves there's been a theoretical improvement, but how do I feel?


The quick answer is that I've been feeling great! I have been recovering like Wolverine from my workouts, soreness is minimal, I feel sharp-minded, and the symptoms from having low testosterone last year have abated (listen to the recent podcast on Endurance Planet, Episode 2 of "So You Wanna Go Pro?" where I talk about my testosterone issues: http://www.enduranceplanet.com/ep-2-so-you-wanna-go-pro-the-boston-marathon-special-and-athletes-facing-low-t/).


The longer answer is that I've been feeling great, but it's hard to tell that it's directly due to the fish oil. There are so many factors in life and in training that could affect my ability to recover, or my testosterone levels, that it's hard to say for certain that it is high dose, high quality fish oil making the impact. However, given the fact that my health has made a turn for the better this year is a good sign that it has been beneficial to me. All of the things that are supposed to improve because of an ideal AA/EPA ratio, have improved. Another way I could try to test whether the fish oil is helping me is by stopping consumption of it and seeing if I feel worse. I don't want to though! There's a good chance that it is helping my health and performance, so I'm going to continue taking it as long as I continue to feel as great as I do.


Feel free to comment or message me directly if you have stories of your own regarding the impact of fish oil on your health. I'm interested to hear!



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