In Reply We thank Lopez and Ghuman for their comments about our study demonstrating significant associations between concussion symptoms and self-reported low testosterone levels or erectile dysfunction (ED) among former professional US-style football players.¹

While we agree that the evidence of association between concussion and pituitary dysfunction is sparse, the published literature on this subject does have substantial clinical relevance. At least 2 studies have found pituitary dysfunction to occur in 29% to 38% of patients with mild traumatic brain injury (TBI),^2,3 and 12% to 14% of the patients with mild TBI specifically showed hypogonadism years after injury. The US Centers for Disease Control and Prevention reports that 1.5 million Americans experience a head injury each year and that 75% of those injuries are considered mild (eg, concussion).⁴ Therefore, if these estimates are accurate, every year more than 400 000 and 150 000 Americans are at risk for pituitary dysfunction and hypogonadism, respectively, subsequent to mild TBI.

回复我们感谢 Lopez 和 Ghuman 对我们的研究发表的评论，表明前美国职业足球运动员脑震荡症状与自我报告的低睾酮水平或勃起功能障碍 (ED) 之间存在显着关联。¹

虽然我们同意脑震荡与垂体功能障碍之间关联的证据很少，但关于该主题的已发表文献确实具有实质性的临床相关性。至少有 2 项研究发现，29% 至 38% 的轻度创伤性脑损伤 (TBI) 患者会出现垂体功能障碍，^{2 ,3}和 12% 至 14% 的轻度 TBI 患者在受伤后数年会出现性腺功能减退症。美国疾病控制和预防中心报告说，每年有 150 万美国人遭受头部损伤，其中 75% 的损伤被认为是轻微的（例如脑震荡）。⁴ 因此，如果这些估计是准确的，那么每年有超过 400 000 和 150 000 的美国人在轻度 TBI 之后分别面临垂体功能障碍和性腺机能减退的风险。