The Female Athlete Triad and Relative Energy Deficiency in Sport

We recently finished another round of our increasingly popular Volunteer Orientation Course. As part of the final assignment members were tasked to write an original piece of work to share with the profession, the contributions were of the highest quality. Below is the great piece of work written by  Janine Rose.

Since 1997 the term Female Athlete Triad has been used to officially describe a syndrome which was thought to pertain exclusively to females (De Souza et al, 2014). The persons affected were those who were heavily involved in athletic endeavours. This syndrome resulted in disordered eating, amenorrhea and osteoporosis. In 2007 ACSM changed the terms used and introduced the term energy availability (De Souza et al, 2014). In recent times however, the thinking is that it is not only females who are affected. In 2014 the International Olympic Committee (IOC) published a Consensus Statement entitled “Beyond the Female Athlete Triad-Relative Energy Deficiency in Sport (RED-S.” The purpose of the paper was to raise an awareness among those in the sports medicine community that in this regard we now had to pay attention to male athletes. “RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency’’ (Mountjoy et al 2014).

It is therefore important that those who are involved in the rehabilitation of athletes be aware of this. A lack of awareness could result in male athletes not getting the necessary attention that they need. While physical therapists do not have the level of training the dietician does, in this regard, it is important for them to recognize RED-S. The care of the athlete requires a multidisciplinary approach. The athlete can be referred to the relevant practitioner once a problem is noted.

To assist the sports medicine clinician, the IOC developed a RED-S Clinical Assessment Tool (RED-S CAT). The purpose of this tool is to aid in screening athletes who may be at risk and also to aid in the decision making process where return to play is concerned. I believe those of us in the sports medicine arena should make ourselves familiar with these changes. It will enable us to serve our athletes better, both males and females.

Check out more of Janine’s work here and on LinkedIn.


  1. De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, Gibbs JC, Olmsted M, Goolsby M, Matheson G. 2014 Female Athlete Triad Coalition Consensus Statement on treatment and return to play of the female athlete triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med. 2014 Feb 1;48(4):289.
  2. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A. The IOC consensus statement: beyond the female athlete triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med. 2014 Apr 1;48(7):491-7.
  3. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, Ljungqvist A. The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT). Br J Sports Med. 2015 Apr 20;49 (1354).