Diagnosed with low testosterone - looking for training advice

Training
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Leading off with a little bit of my backstory and training history as background prior to my diagnosis with low testosterone and in hopes to hear how other people have dealt with similar problems.

I’m a 37 year old male with a 5 year race history and am currently competing in the front half of road races as a cat 2. I have picked up 24 upgrade points for my cat 1 in the past two seasons.

I started following some semblance of serious training in the fall of 2015 and this is my TrainerRoad TSS history since I started training with power

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2012 - 320 hours
2013 - 428 hours
2014 - 440 hours
2015 - 453 hours - peak FTP 340
2016 - 510 hours - peak FTP 364
2017 - 471 hours - peak FTP 380
2018 - 527 hours - peak FTP 364
2019 - 96 hours - peak FTP 360

Obviously the 2019 data is partial but based on past years I’m roughly on track for the 2018 volume numbers

Over the course of this time my weight has generally trended downward. I don’t have great data pre 2018, but I was around 180 in 2012 and gradually decreased down to 165-170 in 2019. At 6’3" this makes me fairly lean. No major shifts in weight - it has been a gradual slimming down process. My diet is mostly whole foods that I prepare myself (I can post more details about this if people think it matters - but I eat a ton of fruits, vegetables, and lean protein from a variety of sources and the fat I’ve recently added to my diet was avocados, olive oil, and eggs)

From fall of 2016 onwards I have followed high volume TrainerRoad plans with a fairly high degree of adherence to the plan. I succeed in most of the plans - both in adherence to the schedule and completion of the intervals. I might fail at 5-7 total workouts in build and specialty in a typical season. I typically follow plans and structure from October-April and then racing and outdoor riding swings up and I spend less time indoors but maintain roughly the same volume and schedule

As you can see from the FTP data above - I had a strong response to the training and was able to focus on the icing of my fitness such that I could maintain a high FTP while focusing on limiters in certain races such as my 60 second repeatable power.

In the fall of 2018 I went in for a (long overdue) regular check-up with my GP. In the course of the normal blood work everything looked fantastic except for some of my hormone levels, most notably my testosterone level which was below the lower limit. At the time of the blood test I was in week 8 of SSB High Volume - so coming off a fairly high block of training.

My FTP and sensations on the bike were fairly typical for me at this point, so despite a serious conversation with my doctor we decided not to change anything about my prep for my A race and I started General Build High Volume the following week. I slightly modified my diet at this point by adding in some more fat calories but still staying at a relatively low fat diet

I went back in for a follow-up blood draw at the start of week 5 of General Build which confirmed my testosterone levels from five weeks prior. I went back in for a third blood draw after a full rest week (after my A race, which was derailed for completely separate reasons) and after a week off the bike my number was significantly better, but still below the lower range. Throughout both build and specialty I was able to complete high volume with a few workout failures, but mostly as expected (Spanish Needle +2, Striped +1, South Twin +6) based on my strengths and weaknesses on the bike.

I am now starting another build, feeling fine on the bike and able to complete challenging workouts but unable to push my FTP to the heights it was at two years ago. Granted - I’m on the wrong end of the age curve, so I expect decreases, but being 20 watts lower than two years ago is frustrating.

Unfortunately, I’m not the best at getting into my doctor so my last prior blood draw is from 2013 when I was in the upper half of the testosterone range - as expected for someone with my lifestyle, age, etc.

Based on my overall health, diet, and activity level my doctor’s theory is that my hormones are out of whack due to training volume. If his theory is correct, I suspect that I actually started down this road sometime during the second half of the 2017 season and then have been digging this hole for myself over the end of 2017 until now.

My doctor proposes I cut down on my training such that instead of following a typical high volume training schedule (hard three days a week, easy three days a week) I take the easy days all the way off and cut to only four days on the bike (Tuesday, Thursday, Saturday, Sunday being the standards, with adjustments based on my race schedule). I started following this plan two weeks ago when I started training again and will be getting monthly blood tests to monitor how my hormones respond to this.

I’m open to his plan as I have a fairly strong base and think that cutting these easy rides should have a relatively low impact on my fitness for this season. I’m not sure how sustainable it will be over time as eventually I’ll struggle to maintain the fitness for the longer races that I usually perform best at.

I will be monitoring my hormone levels and my fitness based on the above workout schedule to see if things improve (theoretically if my testosterone levels come up my fitness will improve even with the lower volume).

Request one of what I’m hoping for is experiences others have had with this problem, potential causes that I’m missing, as well as suggestions for how to maintain my fitness with a lower training volume. In case it isn’t clear, I’m racing sanctioned events and am not interested in any solutions that don’t fit within the doping regulations and really anything approaching gray areas is not of interest to me either.

Request two of what I’m hoping for is how to best train while maintaining a schedule like I’ve laid out above as well as potential modifications to that schedule/plan that may have a bigger impact on returning my hormone levels to a more normal range. Decreasing to three days? Dropping weekly TSS further?

Here is a sample of what I’ve built out for training for a few weeks moving forward

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Essentially I’m cherry picking workouts from General Build mid and high volume and dropping the Wednesday/Friday workouts. I’ll end up doing an increasing amount of these workouts outdoors as the weather improves

Also as a final thought - throughout the six-ish months since the original diagnosis I’ve felt no different on the bike other than the inability to push my FTP to past heights and have not had anything happen that would’ve made me go seek medical treatment for something like this.

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Check out this article from a former D1 College swimmer turned strength coach and MD

and some podcasts

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Have a look at episode 167 around 27:40

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Thanks - just read through it. Mostly lines up with the other research I’ve done in the causes and treatment options. Unfortunately the only proposed resolutions and medications I cannot take and continue to compete. His analysis (and most things I’ve found when doing my research) is focused on medical remedies and isn’t around how to reduce the impact of significant endurance training

I’ll check out the podcast link you sent later today when I have some more free time

Thanks - I’ve listened previously but will circle back and listen to this one again

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A few things I’m curious about:

#1. With the exception of your FTP, are you having any other underlying health problems? (other than the lung thing you mentioned in another thread?)

I think most endurance athletes end up having low T when they are training regularly just by nature of the type of work we do, but the question is whether it’s actually a problem for you? (or your home life)

#2. It looks like you’ve only take 1 week off the bike per year and otherwise have a really high training load. You might want to consider extending that to two weeks or considering a mid-season break. There is some solid evidence to support this and it would benefit your T levels.

#3. How much lifting do you do? Or just general body strength? Both of these can help maintain testosterone levels especially in combination with some dietary modifications.

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Nope - none of the various indicators have been an issue for me. FWIW my doctor says the lung problem is not related

Yeah - I notice that when I look at my charts as well. I do a few true bike vacations, but they are few and far between. I think this is a good point, but the way I understand the rebound and day to day variability of testosterone it seems that this would help, but not make a long-term difference. It seems that my week to week volume is the thing that needs to change

I do body weight based core work 3-4 times a week and that’s about it. I will, at times, introduce swimming into my training, but otherwise the rest is all all on the bike. I have seem a lot of stuff about the weight lifting though, so that is on my list of future steps to take

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I’m a year older than you and I’m on the low end of the T spectrum as well. I don’t think I’d focus on that as the limiter though.

Looking at your history, you’ve not made much change in overall training volume or TSS over the past few years. If you’ve been primarily following TR plans year after year at your weight and FTP I don’t think I’d be expecting too much more. You might just be at a plateau, and it’s an impressive one for the amount of training you’re doing.

I’m in no way saying TR plans won’t get you to a high level, but I doubt you’ll see many folks getting to Cat 1 without putting in serious extra hours and probably shifting the intensity/volume balance unless they’re very physically gifted. I noticed Jarret Oldham who did the Redlands race report and is at the pointy end of the Pro/1 field is doing over 14hrs/week including rest weeks so not exactly an off the shelf TR plan. And that’s low volume for his level.

Given that you feel “normal” otherwise maybe T isn’t the real issue and it’s just time for some new training stimulus?

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This is where you need to focus, in my experience. As someone that gets regular check-ups related to hormonal issues, my testosterone can be all over the place. Looking at your TSS chart of the last 3 years of training, you never take more than a week off. My testosterone went up 85 ng/dL from a mid-season check-up to one after 3 weeks of low intensity off-season goofing off. It’s still right at the low threshold for my age, but the swing is like that every time. Never backing off your training stress for more than a week is going to keep your testosterone chronically low.

PS. Make sure you get your bone density checked. Low testosterone, loads of cycling, and an uber-low fat diet are three commonalities with me a couple years ago, and I have osteoporosis-level bone density. And I’m only slightly older than you.

PPS. Thank you for adhering to anti-doping rules. Seriously. Many would quietly use this as an excuse to “get on the program.”

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I appreciate the opinion here. I’m ‘only’ doing around 10 hours/week over the course of the year (530 hours last year) so that includes rest, recovery, travel, etc.

I think the type of stimulus could be very germane. I’ve done substantially different types of training, but I can’t reasonably increase the time beyond what I’m currently doing - work and life just take up the rest of the time.

What specifically would you recommend as a modification? Polarized? Bigger on days?

Haven’t had that done yet, but it’s on the list of tests over the next six months

Do you think it is more meaningful to take a sustained (2-3 week) break, or to find a more sustainable cadence for training during the rest of the time? The literature I’ve read seems to say that hormone levels can vary greatly in short periods of time, so my thinking was that a rest would be a good way to reset, but if I go back to doing the same things I’ll very quickly drop my levels back to a point where it is (potentially) limiting my performance.

I’m open to adding in some mid-season and end of season breaks, but if I can find a way to train and get things close(r) to normal ranges that would be my preference so I’m curious if you think there are meaningful long-term hormone shifts you would see only from introducing the larger rest periods.

Thanks - I know many masters athletes take the other path, but if I can’t get a result without medical aids then I don’t think I’ve really gotten anything

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If you’re maxed out on time I’d consider bigger on big days for sure and maybe less intensity. Ive been just adding hrs whenever I can and not stressing the structure as much and seen a big jump from lots of SS work, sometimes over 2.5hrs in zone for a ride. I can handle a lot of quality SS work and even threshold if I’m keeping VO2 work and above to one session per week. I also respond to intensity very quickly and don’t see the need for months of top end intervals if you’ve got a strong aerobic base. YMMV but I’d bet that changing up the progression of your training blocks would make a difference.

I’m definitely not polarized and don’t see the benefit for someone on a limited (<15hrs) training schedule. I do however feel that everyone has an ideal balance of volume vs intensity and it’s important to find yours and then understand how to adjust it during the year and for your goals.

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I’m not saying you necessarily need to train less. I am saying that taking a meaningful break and getting tested at the end of that will likely yield different measured testosterone levels. In my case, I welcome the break at the end of a racing season so it happens on its own. If you’re not suffering any ill-effects of low testosterone, you might as well carry on. You mention lower FTP, but that may or may not be related to your testosterone levels. I’m obviously not a Dr., I’m just speaking from my own experience.

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One thing you haven’t mentioned, and hasn’t been brought up in the thread so far, is the amount of sleep you get?

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Thanks - I might give that a shot over the coming months. I also respond quickly to VO2 and threshold work and can sustain a huge amount (for me anyway) of TSS at SS or endurance paces

I’ve always thought of this the same as you - never seriously considered it due to my 10-12 hour weekly volume

This is, honestly, my gut reaction to all of this. Carry on and make sure I’m resting more regularly. My doctor doesn’t think sustaining this level of hormonal imbalance for 10 months a year is a good idea and will heavily limit my ability to recover and eventually my muscle strength

I get between 7-8.5 hours a night every night. I didn’t think to mention it in my original post because I ruled it out myself but this is a fair question as it is often related. I wake up without an alarm every morning and have few major sleep disruptions. Occasionally work and life stress bleeds through and I’ll have a restless night but I would say around 95% of my nights I get 7.5+ hours of solid sleep

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Does your doctor work with a lot of endurance athletes or are you the rarity to them? If it’s the latter, it’s also worth getting a second opinion from a doctor who is more experienced with high level athletes. Not saying that your doctor isn’t right btw, because the second opinion could confirm it.

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Also, for reference, I looked around from all the various pros who mentioned their off-season in various articles and it looks very similar to the following:

  • Two weeks completely off the bike (but doing other activities if they want, swimming, hiking, etc)
  • Two weeks completely easy, unstructured, just spinning around as much or as little as they feel like
  • A 5-10 day transition period where they start to reintroduce structure

I’ve also seen a lot of pros doing a mid-season break of 5-14 days where there is a period of 3-5 days completely off the bike with some easy riding.

A good read here: Planning Your Off Season: When To Take A Break - Wattbike

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I don’t have any training advice, but some experience.
I got diagnosed with very low T. After meeting with a fertility doctor, he concluded (after blood results) that my brain just stopped producing test, so there was either the option to take test shots/gel for the rest of my life or get it started naturally. I was put on clomiphene to “kickstart” my test production, I’m currently week 10 of a 16 week treatment taking 50mg each day. The first blood test after 8 weeks showed I started producing test again.

I don’t compete myself but I’m pretty sure you can get a exemption from doping agencies on clomiphene, as it only helps produce test and not elevate it over natural levels.

My low test was probably caused by a low fat diet (like 15g or less a day).

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Besides getting the BBQ lit up because of STEAK and moving around some iron in the gym (Starting Strength)?
There are some good post on their forum regarding cycling plus strength. Note that you can’t be good at both. So make a choice if a high T count is important for you.

Regarding T, there is a good series of articles on the art of manliness. I suggest to read that and than look at your test results again. My question would be when that baseline was established…

Also maybe getting rid of all the soy products (estrogen content) if you take any (watch the labels).

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I appreciate that you don’t race so it is not an issue but Clomifene is banned at all times under WADA rules:

https://www.wada-ama.org/en/content/what-is-prohibited/prohibited-at-all-times/hormone-and-metabolic-modulators

I don’t know if you are able to get a TUE or not though as I’ve never had reason to look into this process!

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Get luck getting that particular TUE.

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He does not - I have been trying to find someone more specialized but have had no luck finding anyone thus far. Any suggestions on what to search for? I’ve done all the common-sense type wordings and have found nothing thus far

I’ve been missing this in particular - think it might make a big difference in my mental energy if nothing else, thank you

I appreciate you posting your experience, but I’d strongly prefer to stay away from anything that even starts to approach a TUE. Mostly because I don’t want to go down that path, but also my understanding is that it is nearly impossible to get a TUE for anything testosterone related (exceptions being from birth type conditions).

I do not get a significant amount of soy in my diet currently. Nearly all of my calories are home prepared and I don’t use soy