How triathletes can harness their hormones for optimal performance

Lars Lomholt of Denmark reacts after winning Ironman Portugal Cascais on October 15, 2022 in Lisbon, Portugal. (Credit: Nigel Roddis/Getty Images for Ironman)

Hippocrates, often described as the father of medicine, would have made a very good triathlon coach. He advocated that the “surest way to health” was by giving each individual just the right amount of nutrition and exercise; “not too little and not too much”.

Optimal health is a prerequisite to athletic performance. In other words, personalised training load, fuelling and recovery will mean triathletes can strive to be citius, altius, fortius (faster, higher, stronger)!

The foundation for athletic performance

Although Hippocrates recognised the practical strategies to attain optimal health and therefore performance, he did not know why. We now understand that hormones are the missing link.

Hormones are chemical messengers transmitted in the blood stream. Just one hormone found in both men and women, such as oestradiol (most potent form of oestrogen) or testosterone, has access to all the cells in the body.

On arriving at a cell, the hormone homes in on the DNA in the nucleus to direct gene expression and the production of proteins: the right ones, at the right time and in the right amount for optimal health.

In other words, hormones bring our DNA to life. Hormones work in collaborative teams to support physical and mental health[1].

How athlete behaviours harness hormone action

Hormone action is influenced by our behaviours of exercise, nutrition and sleep. Furthermore, hormones drive the positive adaptations to exercise training.

In order to harness our hormones to gain maximum benefit from triathlon training, it’s important to aim for the optimal balance of training load, nutrition and recovery. Not too little and not too much. Timing is also crucial.

Hormone release runs on internal biological clocks. These hormone clocks can have short daily time scales like cortisol; monthly timing like the hormones of the menstrual cycle; and the longest timescale of all – the lifespan.

The challenge is to synchronise the timing of external athlete behaviours with internal hormone clocks. The optimal combination and timing of these athlete behaviours will depend on the individual characteristics of the athlete, including their starting fitness level, biological sex and age[2].

The hormone ages of a triathlete

The child triathlete

The endocrine system (all the hormone secreting glands and the hormone orchestra) have not fully developed in a child. This is one of the reasons why a child should not be encouraged to train like an adult as the hormone networks can’t deal with high-intensity training.

Not only will this type of training not bring positive adaptations, but also risks early physical and mental burnout. Rather, focusing on enjoyment and technical skills will support nurturing the aspiring young triathlete.

What to do if your child is a talented triathlete

The teenage triathlete

The teenage years see an explosion in hormones! In particular, the sex steroid hormone axes come to life. For young women this means the start of menstrual cycles with oestradiol and progesterone as the protagonist sex steroids.

In young men, puberty sees the increase in testosterone towards adult levels. As hormone networks mature at different times and rates, training load with appropriate nutrition and recovery will need to be personalised according to the stage of hormone ‘maturity’ of the teenage triathlete.

The adult triathlete

Hormone networks should now be working at full potential to support positive adaptations to triathlon training. For female triathletes, understanding and tuning into the fluctuations of hormones that occur during the menstrual cycle can help[3].

This is also the time when there will be many demands outside of triathlon training, such as work and social life. This can lead to imbalances in behaviours which have negative impacts on hormone health.

For example, relative energy deficiency in sport (RED-S) is where there’s a mismatch in energy demand from training and energy intake[4]. This can lead to low energy availability, requiring the body to go into ‘energy saving’ eco mode.

This includes downregulation, or a powering off of the hormone networks. The reproductive hormone axis is one of the first to be switched off to save energy. In women this can result in menstrual disruption, including lack of periods (amenorrhoea).

Triathlon training advice for women

In men, low energy availability will cause reduced levels of testosterone associated with reduced libido and fatigue.

Low levels of hormones put triathletes at risk of underperformance and injury. Fortunately, low energy availability and RED-S is a reversible situation through rebalancing of athlete behaviours around training load, nutrition and recovery to reboot hormone networks.

3 ways to boost your morning routine for hormonal optimisation

The masters triathlete

Hormones start to wind down with advancing age, but modifying athlete behaviours in step with hormone changes can secure continued triathlon performance.

For example, the decline in growth hormone and testosterone in both men and women means that increasing strength training will help support these ‘anabolic’ (tissue building) hormones and maintain good body composition and metabolic health.

For female triathletes, the menopause sees the retirement of the ovarian function and a consequent dramatic reduction in oestradiol and progesterone. Although this change in hormone levels is a natural physiological event, this can present challenges in terms of wellbeing and exercise performance.

I’m actually guiding an increasing number of female masters athletes through this transition, to support women’s continued participation in sport.

How does the postmenopause affect your triathlon training and racing?

Hormone replacement therapy (HRT) is a game changer for many. HRT consists of a combination of oestradiol and progesterone to maintain quality of life, with the added benefit for long term cardiovascular and bone health.

It’s important to mention that testosterone replacement is not permissible for either male or female triathletes under WADA regulations. Fortunately, modification of triathlete behaviours is a legal way to support hormone health throughout a triathlete’s career.

Is there a ‘male menopause’?

Summary

Hormones are vital to a triathlete’s health and performance, for all levels and ages of athlete. Triathletes can harness the power of their hormones by ensuring personal, optimal balance of athlete behaviours around training, nutrition and recovery.

Dr Nicky Keay is the author of ‘Hormones, Health and Human Potential’. Dr Keay offers hormone health advisory appointments for athletes seeking to attain their personal full potential.

References

[1] Keay N. Hormones, Health and Human Potential.
[2] Keay N. Sports Endocrinology – what does it have to do with performance? British Journal Sports Medicine 2017
[3] Keay N. What’s so good about menstrual cycles? British Journal Sports Medicine 2019
[4] www.Health4performance.co.uk British Association of Sport and Exercise Medicine

Top image credit: Nigel Roddis/Getty Images for Ironman

About

Dr Nicky Keay is a sports and dance endocrinologist. As an honorary clinical lecturer in medicine at University College London and previously research fellow in the Department of Sport and Exercise Sciences at Durham University, she conducts clinical research in sports/dance endocrinology. She’s a member of the British Association of Sport and Exercise Medicine and the British Menopause Society, and a speaker on dance endocrinology for the National Institute of Dance Medicine and Science and International Association of Dance Medicine and Science. Dr Nicky is also the author of ‘Hormones, Health and Human Potential: A guide to understanding your hormones to optimise your health and performance’. Dr Nicky Keay studied medicine at Cambridge University, with clinical attachments including sports medicine clinics in Australia and University of Geneva. After gaining membership of the Royal College of Physicians, she gained extensive clinical and research experience in endocrinology and sport/dance and exercise medicine involving elite athletes, professional ballet dancers and young aspiring athletes. As a research fellow at St Thomas’ Hospital Nicky was part of the international medical team working to develop a test to detect athletes doping with growth hormone, supported by the International Olympic Committee. Her other research studies have investigated the effects of training and nutrition on the endocrine system, body composition and bone mineral density, and relative energy deficiency in sports (RED-S) in competitive male cyclists. Nicky wrote the British Association of Sport and Exercise Medicine (BASEM) educational website Health4Performance on RED-S, is the medical advisor to Scottish Ballet, runs a clinic for dancers and athletes, and is chief medical officer of Forth Edge, providing medical interpretation of blood tests to dancers and athletes. Dr Nicky is also an experienced ballet dancer, choreographer and teacher, and has a background in competitive swimming, gymnastics and tennis, together with recreational cycling and windsurfing. Plus, she’s a qualified Pilates foundation teacher.