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9/6/23 blog post

when to be concerned about REDS

tired female basketball player

in this article:

REDS is a condition that affects thousands of male and female athletes, but it’s likely you haven’t heard of it. However, it’s important that athletes and their families understand REDS and its symptoms because if left untreated, it can lead to irreparable, lifelong damage to an athlete’s body. We asked Lora Scott, MD, chief of sports medicine at Dayton Children’s, to help us understand what REDS is, the common causes of REDS and when to seek medical attention for your child.

what is REDS?

Relative Energy Deficiency in Sports (formerly known as Female Athlete Triad) is a condition that happens when the body begins to break down from not getting enough energy (food) to support exercise. It is not the same thing as an eating disorder, such as anorexia or bulimia, and often needs a different approach to treatment. While REDS is more common in female athletes, male athletes are also at risk, especially athletes who participate in sports with frequent weigh-ins, like wrestling, or endurance activities, like running.

what are the symptoms of REDS?

REDS can affect every system in the body, but the three most noticeable findings are: decreased energy intake, decreased reproductive hormones, and bone loss.

  • Not enough energy (food). An athlete may eat enough to support normal life, but not enough to support their training schedule. Symptoms may include fatigue, exercise intolerance, changes in sports performance, and weight loss.
  • Decreased hormone levels. When lack of energy becomes the body’s ‘normal’ state, it begins to shutdown the ‘optional’ systems. The reproductive system usually shuts off. This is more noticeable in females, who may have irregular periods, lighter periods or stop having periods entirely. It is more difficult to monitor in male athletes. Early studies show that they have a similar change in hormones, but without any noticeable outward signs that there is a problem.
  • Bone health. As the body begins to shut down systems from lack of energy, athletes lose bone mass. The body has peak bone growth during the teen years. Losing bone mass, (or not building enough bone mass) during this time can cause lifelong problems. It also increases the chance that an athlete has an overuse injury, either now or later.

how is REDS diagnosed?

REDS is diagnosed after a thorough look at an athlete’s medical history and a physical exam from a medical provider. The provider will ask about recent symptoms they have been experiencing, especially fatigue, weakness or irregular menstruation. The exam may also include bloodwork or a test to look at bone density.







how is REDS treated?

The goal of treatment is to eat more and train less. That sounds simple, but it can take a team of professionals to get the balance right. A registered dietitian can ensure an athlete is getting the nutrition needed for their sport. Behavioral health can help an athlete with any worries about how these changes in nutrition and exercise could affect sports performance. Sports medicine can monitor hormones, vitamins, minerals, and bone density, as well as treat injuries and prescribe needed medications. These professionals can communicate with coaches, school athletic trainers, and other staff about short-term changes to training or eating schedules. Depending on severity, other specialists may also be involved. These could include adolescent medicine, gynecology, endocrinology or orthopedics.

If your athlete is experiencing symptoms of REDS, you can schedule an appointment online with one of Dayton Children’s sports medicine physicians by visiting

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Lora Scott, MD

division chief sports medicine
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