Endocrine Responses to Sport-Related Brain Injury in Female Athletes: A Narrative Review and a Call for Action
Abstract
:1. Introduction
2. The Need for Sex-Specific Brain Injury Research
3. Sex-Specific Differences in SRBI
4. Hypopituitarism
5. Progesterone
6. Estrogen
7. SRBI and the Menstrual Cycle
8. Future Directions: A Call to Action
- Repetitive head trauma, sometimes referred to as sub-concussive trauma, needs to be examined in female athletes in both the short and long term. Repetitive head trauma (or sub-concussive head trauma) does not result in diagnosable symptoms (i.e., dizziness, imbalance), making it extremely difficult to detect and diagnose. Researchers believe that longitudinal, repetitive head trauma can have serious, detrimental effects on physical and cognitive health [67,68,69,70]. Stern and colleagues at Boston University are extensively studying repetitive head trauma (sub-concussive trauma) in former male National Football League (NFL) players and have determined that repetitive head trauma from sport participation is a risk factor for later life neurocognitive and neuropsychiatric disease [67,68,69,70]. In the United States and around the world, female athletes are participating in sports where repetitive head trauma is a part of the sporting environment. Currently, in the United States, it is estimated that there are around 4000 female tackle football players, participating in two different leagues, where one league has a 10+ year participation history. The female tackle football players play by a mix of NFL and National Collegiate Athletic Association (NCAA) rules. Often, we are asked by female football players, “If I continue to play, will have the same issues as the former NFL players?”, to which we answer, “We do not know. Yet. We do not yet know if we will see the same prevalence and severity of head injuries in female football players as have previously been seen in the NFL.”
- Some research [11,12] suggests that there are immediate endocrine-based responses when a female athlete experiences a SRBI. In this review, we identified this concept as NED. Given the vast responsibilities of the pituitary gland and hypothalamus in the production and regulation of female sex hormones, it is critical that future research examines the acute changes in female sex hormones in response to SRBI. While this review has focused on estrogen and progesterone, it is critical to point out that there are several other important HPG axis hormones that are vital for the maintenance of proper menstrual cycle function and reproductive health (i.e., GnRH, LH, FSH) and little to no research exists on these other hormones. Thus, the menstrual cycle should be considered a vital sign for females [71] and abrupt changes in menstrual cycle function should never be ignored in female athletes.
- The ability to identify novel biomarkers that could be used to detect and/or diagnose pituitary hormone deficiencies that occur in the acute phase following SRBI requires studies to elucidate the nuanced changes that occur in both structure and function of various brain regions and the hormonal alterations that result from these changes. These novel biomarkers may also help to determine the time course of hormonal deficiencies that develop as the brain transitions from the acute to the chronic phase of SRBI. Ultimately, the culmination of these efforts would inform better rehabilitation and recovery interventions for female athletes.
- Longitudinal research is critical for understanding the chronic outcomes related to SRBI in female athletes. What we know about chronic outcomes for SRBI is based solely on the experiences of male athletes, specifically former NFL players and boxers, which is problematic given the sex-based differences outlined in this article. Therefore, it is critical that future research efforts not only track head injury exposure, but also the long-term physiological and psychological outcomes of such head injuries, which are likely to impact quality of life in these female athletes.
- Even though it is “messy,” the menstrual cycle must be accounted for in biologically based female athlete research. Research has highlighted that a SRBI disrupts the menstrual cycle and can lead to irregular menstrual cycles. Importantly, irregular menstruation can lead to an increased risk for chronic disease and premature mortality among females. Although the first steps forward in this relatively new area of research requires assessment of clinically overt impacts on menstrual cycle function, it is critical to point out that many disruptions in ‘normative’ menstrual cycle function are not clinically observable. For instance, normative menstrual cycles (i.e., occurring every 26–32 days), are not necessarily indicative of ovulatory cycles. Equally important is the notion that luteal phase defects can result in reproductive issues even when ovulatory cycles occur [72]. Nuanced changes in sex-steroid profiles over time may not produce overt menstrual cycle disruptions and thus, seemingly normal variations may obfuscate underlying reproductive issues.
- Given the acute, immediate hormonal response that occurs when a female athlete experiences a brain injury, future research should investigate how the hormonal response to brain injury may cause, contribute to, mask, or exacerbate other female-related performance disorders (i.e., the Female Athlete Triad, REDS).
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Duffy, D.; Elliott-Sale, K.J.; Gardner, H.; Goldenstein, S.; Wideman, L. Endocrine Responses to Sport-Related Brain Injury in Female Athletes: A Narrative Review and a Call for Action. Endocrines 2021, 2, 99-108. https://doi.org/10.3390/endocrines2020010
Duffy D, Elliott-Sale KJ, Gardner H, Goldenstein S, Wideman L. Endocrine Responses to Sport-Related Brain Injury in Female Athletes: A Narrative Review and a Call for Action. Endocrines. 2021; 2(2):99-108. https://doi.org/10.3390/endocrines2020010
Chicago/Turabian StyleDuffy, Donna, Kirsty J. Elliott-Sale, Hanna Gardner, Samantha Goldenstein, and Laurie Wideman. 2021. "Endocrine Responses to Sport-Related Brain Injury in Female Athletes: A Narrative Review and a Call for Action" Endocrines 2, no. 2: 99-108. https://doi.org/10.3390/endocrines2020010
APA StyleDuffy, D., Elliott-Sale, K. J., Gardner, H., Goldenstein, S., & Wideman, L. (2021). Endocrine Responses to Sport-Related Brain Injury in Female Athletes: A Narrative Review and a Call for Action. Endocrines, 2(2), 99-108. https://doi.org/10.3390/endocrines2020010