Former National Football League players who experienced more concussions during their careers reported more erectile dysfunction and low testosterone in retirement than those who had experienced fewer concussions, according to findings published in JAMA Neurology.
“This study is important because it connects the dots between the two types of studies that are currently published on this topic,” Rachel Grashow, PhD, MS, a research scientist for the Football Players Health Study at Harvard University and a research associate in the department of environmental health at Harvard T.H. Chan School of Public Health, told Endocrine Today. “Because the study is so large, we were able to control for other factors that contribute to [erectile dysfunction] that other smaller studies didn't have the statistical power to explore. We also feel this study is important because it gets the message to former players that if they are suffering from [erectile dysfunction], it may be directly connected to their playing history, not some sort of personal failure.”
Grashow and colleagues distributed questionnaires by mail to 3,506 former NFL players (mean age, 52.5 years; mean playing career length, 6.8 seasons). The questionnaires assessed concussion history and current sexual function and testosterone level and were completed between January 2015 and March 2017.
Participants self-reported how often they experienced concussion symptoms during their playing career. The researchers calculated a concussion symptom score based on these responses, with quartiles for severity. The first quartile was made up of participants with the fewest symptoms and scores between 0 and 10.5. The second quartile was made up of participants with scores between 10.5 and 23. The third quartile was made up of participants with scores between 23.5 and 43.5. The fourth quartile was made up of participants with the most symptoms and scores between 43.5 and 130.
Former National Football League players who experienced more concussions during their careers reported more erectile dysfunction and low testosterone in retirement than those who had experienced fewer concussions.
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Self-reported receipt of prescriptions or suggestions from medical professionals for medications to treat erectile dysfunction or low testosterone were used to determine whether a participant had either condition. Based on these criteria, 22.7% of the study population said they had erectile dysfunction, 18.3% said they had low testosterone and 9.8% said they had both conditions. The researchers found that medication for erectile dysfunction was used by 50.2% of the participants who met criteria for the condition, and medication for low testosterone was used by 39.8% of the participants who met the criteria for that condition.
In models adjusted for current health factors, those who reported the most concussion symptoms were more than twice as likely to self-report low testosterone (OR = 2.39; 95% CI, 1.79-3.19) and also more likely to report erectile dysfunction (OR = 1.72; 95% CI, 1.3-2.27) compared with those with the fewest concussion symptoms. The researchers also noted that, compared with participants in the first quartile of concussion score, participants in even the second quartile were 1.41 times more likely to self-report low testosterone (OR = 1.41; 95% CI, 1.05-1.89).
These findings included adjustments for “current health factors” as well as which position the participant played, how long they played and present-day BMI (higher present-day measures equated to higher risk), among other factors. In addition, according to the researchers, analyzing data only from those taking medications, those younger than 50 years and those who played at least 2 decades before the study did not significantly change the findings.
"Since both erectile dysfunction and low testosterone are treatable, we hope that players or anyone with a single head injury experiencing symptoms of low testosterone or erectile dysfunction will speak to their clinician about these conditions,” Grashow said. “Furthermore, since erectile dysfunction can be a sign of systemic disease, we hope that individuals suffering with erectile dysfunction will speak to their doctors or health care providers. We also believe that these results should motivate neurologists and endocrinologists to proactively speak to their patients about sexual and hormonal dysfunction if a head injury has occurred.” – by Phil Neuffer
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Rachel Grashow, PhD, MS, can be reached at firstname.lastname@example.org.
Disclosures: Grashow reports she has received grants from the NFL Players Association. Please see the study for all other authors’ relevant financial disclosures.