NYC Physical Therapy and Fitness Training Studio - Custom PT

Moving Beyond the Female Athlete Triad: Signs of RED-S in Men


RED-S (Relative Energy Deficiency in Sport) was a term adopted in 2014 by the International Olympic Committee to describe a situation in which an athlete has insufficient energy intake relative to the demands of their life and their sport.

Prior to the term RED-S (relative energy deficiency in sport), this group of symptoms was referred to as the ‘Female Athlete Triad’. One of the hallmarks of this ‘Triad’ was the disruption of menstruation, an indication of issues with hormones and energy availability. This term was very helpful in highlighting the existence of this phenomenon, but it left out about half of the athletic population – male athletes.

Even since the adoption of the universally applicable term RED-S, this set of symptoms has been misunderstood by the general public to affect primarily women. While there are a number of societal and biological reasons why this phenomenon frequently occurs in female athletes, it is by no means a female-only condition.

The basis of RED-S is the mismatch of energy intake and energy expenditure, known as LEA (Low Energy Availability). Humans have a baseline energy requirement to sustain function, which varies from human to human. Exercise and activity require additional energy.

The body’s total energy requirement is Baseline Function + Activity Usage. The energy needed during activity is used instantaneously, and Baseline Function has to use whatever is left, known as EA (Energy Availability).

If the energy left over after exercise is insufficient to cover the Baseline Function, the body enters a state of Low Energy Availability (LEA). In a state of LEA, some essential functions do not occur, such as tissue repair, the reformation of bone, and the production of hormones. This mismatch of need and availability has nothing to do with gender or age, therefore men are at equal risk to their female counterparts.

In women, one of the baseline functions that gets skipped is menstruation, so this makes for an easy indication of LEA. In men, the warning signs may be more subtle, here is what to look out for:

  • Recurring illness or injury
  • Mood changes
  • Disrupted sleep
  • Excess fatigue
  • Problematic relationship with food or training
  • Performance plateau or deterioration
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