GLOSSARY

Female Athlete Triad Table

REDs and Female Athlete Triad assessment require an appropriate clinical process; do not invent a score from a few glossary indicators.

RED-S Assessment An integrated clinical evaluation of possible RED-S, including relevant signs, exposure history and alternative explanations.

Relative energy deficiency in sport describes impaired health or function associated with problematic low energy availability and can affect female and male athletes. The duration, severity and individual context matter. No isolated body weight, symptom, hormone value or calculated energy-availability threshold can diagnose every case. Clinical assessment integrates history, signs, measurements and alternative explanations. The IOC assessment framework supports trained clinicians; it is not a self-scoring clearance tool. Management addresses energy supply and training while considering psychological support and the athlete's overall safety.

Energy availability describes dietary energy remaining after exercise expenditure, expressed relative to fat-free mass over a defined period. It differs from whole-day energy balance and from body-fat percentage. Calculations are sensitive to errors in food records, exercise expenditure and body-composition estimates. No single threshold or short observation establishes a diagnosis for every athlete. Persistent fatigue, impaired recovery or other concerning changes warrant assessment in the broader health and training context rather than a conclusion from one calculated value.

Menstrual dysfunction is a clinical signal with several possible causes, including pregnancy, endocrine disorders, medication and inadequate energy availability. Functional hypothalamic amenorrhea is diagnosed after appropriate evaluation, not from training volume alone. Missing periods should not be normalized as an inevitable sign of serious training. Withdrawal bleeding on hormonal contraception does not establish recovery of spontaneous menstrual function. A qualified team should assess the history, energy supply, bone health and other causes while coordinating nutrition, medical care and training decisions.

For example, repeated injury, reduced recovery and restrictive eating can justify a coordinated assessment even when body weight is stable. Look for alternative causes and assess the whole pattern. Correcting a calculated energy figure alone does not establish recovery; health, behavior and safe training participation also need review.

Bone stress injury develops when repeated loading exceeds the bone's capacity to tolerate and repair it. It spans changes such as stress reaction through stress fracture; location and severity affect management. Nutrition assessment considers energy availability, calcium, vitamin D and other relevant factors alongside training, biomechanics and medical history. A bone-density result is only part of the picture. Persistent focal bone pain warrants assessment rather than being treated solely with a supplement or continued training until a fracture becomes visible.

Male athletes can experience underfueling, disordered eating and bone-health problems even when body mass appears stable. Low testosterone has several possible explanations and requires assessment in its sampling and clinical context. A single result cannot establish a sport-related endocrine condition or justify hormone use. The male athlete triad connects low energy availability, reproductive suppression and impaired bone health. Nutrition care supports adequate energy and nutrient supply while the medical team evaluates other causes and determines appropriate monitoring and training participation.

Disordered eating spans harmful patterns that may or may not meet criteria for a specific eating disorder. Eating disorders can occur at any body size and in any sex or sport. Restriction, recurrent bingeing, compensatory behaviors and marked distress deserve sensitive assessment; a scale reading alone cannot determine severity. Support should coordinate medical, nutrition and mental-health care when indicated. Avoid prescribing further restriction or praising rapid weight loss when the person's eating behavior or health is deteriorating.

Table references: bjsm.bmj.com · 1 · DOI · 2