Hormones, Heart Attacks, and Helmets, Oh My!: The Biology of a Football Fan

SQ Blog | Kaya Moss

There’s lots of talk about the biological risks of football: broken bones, pulled muscles, concussions, chronic traumatic encephalopathy (CTE), and the whole slew of injuries that come from playing a sport at a professional level. But what’s the biology of a football fan like? How does watching sports affect hormone levels and brain activity? And is it really true that emergency rooms are rife with heart attack cases each Super Bowl Sunday?


Hormonal Activity 

One important biological mechanism that shapes fan behavior is hormonal activity. For fans, two particular hormones are of interest: testosterone and cortisol. Testosterone is typically thought of as the male sex hormone due to the role it plays in the development of both primary and secondary male characteristics, but it also plays an important role in women’s health by contributing to ovarian function. Cortisol is a hormone produced by the adrenal glands that is involved with stress, metabolism, blood pressure, and blood sugar. Most relevant to the football fan, however, is the fact that increased testosterone levels are associated with maintaining social status and self-esteem. For example, during competition, testosterone levels are higher, and the studies discussed later on in this section extend this observation to spectators. In addition, the stress associated with cortisol also plays a role in the intensity of a big game. When stressed, cortisol levels are elevated, leading to that feeling of a racing heart, sweaty palms, and a stomach full of butterflies—a sensation that’s likely familiar to sports fans. While we watch our favorite teams, testosterone and cortisol are hard at work, leading to these responses. 

But how exactly does watching a game affect these hormone levels? One study tracked testosterone and cortisol levels in soccer fans watching the FIFA World Cup, the avid soccer fan’s Super Bowl equivalent. Saliva samples were taken before, during, and after the game to measure hormone levels. The samples showed that on average, testosterone levels were 29% higher during the match than during a period of less stressful, controlled activity and cortisol levels were 52% higher. Gender, age, and level of soccer fandom all impacted these numbers, with younger male fans experiencing the greatest increase in testosterone and cortisol levels. This is partially due to the fact that men generally reported higher levels of fandom than women. When comparing people of different genders with similar levels of fandom, this difference largely leveled off. 

Another study observed college basketball and the World Cup, “testosterone levels increased among fans of winning teams and decreased among fans of losing teams,” which is consistent with previous research suggesting winners of various contests (in everything from wrestling to chess) experience an increase in testosterone levels, while the losers experience a drop. This shows that in addition to the obvious changes in mood that result from a big game, there’s also a physiological response. For example, a missed goal could cause stress and release cortisol, perhaps manifesting as an anxious fan screaming at the TV, as well as physiological symptoms like increased heart rate or blood pressure. This study had a limited sample size—only 37 participants across two studies—so it’s not certain that this could be extended to the broader world of sports fandom. However, it does propose an interesting theory, one that joins social cognition with observed biological phenomena. One tenant of this theory states that the performance of others can be tied to our own self-esteem. Considering that higher testosterone correlates with higher self-esteem, as testosterone boosts competitive and aggressive behaviors, this poses many interesting research questions regarding hormones, sports, and social phenomena. One theorist, for example, suggests that success leads to increased testosterone, which makes future success more viable. The researchers conducting the above study suggest that the perceived closeness of fans to players may warrant a psychological response. The researchers, however, note that this picture is incomplete, as they determined that sports have an impact on spectator’s testosterone levels but are uncertain about how changed testosterone levels impact individuals. The researchers pose questions about how aggressive behavior and other displays of dominance change in response to testosterone changes and press the boundaries of this research by suggesting further studies to extend their findings to individual health and behavior.


Brains and Stress

Hormones are just one piece of this puzzle though. While testosterone and cortisol run their course, your brain is hard at work, helping you process and react to every play, touchdown, and (gasp) fumble.

Our brains contain mirror neurons, neurons responsible for understanding and simulating other people’s behavior. In the context of sports, this feature of our brains allows us to put ourselves in our favorite football players’ shoes (cleats?), making the game’s stakes that much higher. In addition, as mentioned before, cortisol is released in the brain during these high-stress situations. Your body and brain work in tandem, and your body reacts to this hormone by showing symptoms of anxiety, like sweating or an elevated heart rate. This can also lead to an increase in adrenaline, which can manifest as what’s called an “excitatory state”, or an elevated state of exhilaration. This stress is further explored in the next section. 

Anyone who’s ever been to a live sporting event knows that win or lose, strong emotions are prevalent throughout the crowd. In a study examining brain activity in participants watching “winning” and “losing” sports scenes, researchers found neural correlates of these emotions. The occipital lobe, an area of the brain responsible for processing visual stimuli and known to increase activity when watching emotional visual stimuli, predictably lit up while watching winning scenes. Other areas of the brain associated with amusement and joy were also involved, like the temporal lobe, which is responsible for emotional processing, among other functions. For losing scenes, activity was shown in the right frontal lobe, which is responsible for high-level cognitive functions like short-term memory, and the right limbic lobe, which handles emotion and memory. This restriction to the right hemisphere poses an interesting example of valence theory, which states that “positive emotion is an approach-related emotion and mainly activates the left hemisphere [and] negative emotion is a withdrawal-related emotion and mainly activates the right hemisphere,” (Park). Interestingly, the study also found that while watching winning scenes and experiencing amusement, brain activity was higher than while watching losing scenes and experiencing sadness. 


Super Bowl Heart Attacks

Given that there’s extremely intense activity happening in the brain and body when we watch sports, is there truth to the claim that Super Bowl Sunday is a hotspot for heart attacks? To figure this out, let’s first look at the risk factors for heart attacks. According to the CDC, three major risk factors for heart attacks are high cholesterol, high blood pressure, and smoking. 

Another piece of the puzzle is heart attack trigger events. Regarding these events, you might imagine a small child scaring her grandmother, who clutches her chest dramatically, shouting “You almost gave me a heart attack!” In the case of the Super Bowl, an at-risk fan may be like that grandmother, and the Super Bowl might be like the anxiety-inducing grandchild. If one is already at risk (say they have diabetes, are overweight, and have high blood pressure), it’s possible that the stress of the Super Bowl could be the thing that triggers a heart attack—the straw that broke the camel’s back, so to speak. This phenomenon has been observed in other high-stress situations, like earthquakes, hot weather, or holidays. Furthermore, stress isn’t the only Super Bowl related factor that increases one’s heart attack risk. While watching the Super Bowl, fans might smoke, consume alcohol, or become dehydrated, all of which can increase the risk of a cardiovascular event. 

So, if we know stress can trigger a heart attack, to what extent can Super Bowl stress trigger this? To answer this question, one study examined cardiovascular deaths surrounding two high-intensity Super Bowls: New York Giants v. New England Patriots in 2008 and Pittsburgh Steelers v. Arizona Cardinals in 2009. After the Patriots lost in 2008, it was found that circulatory deaths increased by 20%, and ischemic heart disease deaths increased by 24% in the eight-day period following Super Bowl Sunday, relative to a comparable non-Super Bowl period. This paints a fascinating picture of the impact of stressful events on cardiovascular death. 

Regardless of whether or not Super Bowl heart attacks are a tried and true phenomenon, it’s known in the field of cardiovascular medicine that cardiovascular event triggers are an important aspect of heart health. It’s possible that the Super Bowl can be one such trigger, as shown by the symphony of activity going on with fans’ hormones and brains. But whether the trigger for a given heart attack comes from Super Bowl stress or elsewhere, the more important issue is what one does to mitigate the chances of a cardiovascular event. Reduce smoking, minimize fatty foods and alcohol, and practice stress management. By watching your risk factors, a trip to the stadium hopefully won’t turn into a trip to the emergency room.