Relative Energy Deficiency in Sport (REDs) in Men: Signs, Risks, and Recovery

Relative energy deficiency in sport is one of the most under diagnosed conditions in male athletics. When an athlete's energy intake consistently falls short of their energy expenditure, the body starts shutting down systems it considers non-essential. This includes hormone production, bone building, and immune defense. This article breaks down what REDs looks like specifically in male athletes, why it gets missed so often, and what recovery actually requires.

Key Takeaways

• Relative energy deficiency in sport occurs when energy intake is below energy expenditure, This results in low energy availability that negative effecting health and performance. REDs affects athletes of all genders, ages, and skill levels, but this article focuses specifically on how it affects male athletes.

• REDs is often missed in men because male athletes lack obvious markers like missed menstrual periods. Instead, they may show low testosterone levels, poor bone health, recurrent stress fractures, and a general decline in athletic performance.

• Common early signs in males include excessive fatigue, plateauing or declining performance, frequent illness, low libido, mood changes, and bone stress injuries. Athletes may experience anxiety around food alongside weight preoccupation.

• Recovery usually requires increasing energy intake, sometimes reducing energy expenditure, addressing disordered eating patterns, and treating hormonal issues such as low testosterone. Management of REDs requires a multidisciplinary approach including medical, nutritional support and therapeutic support.

• Serendipity Counseling Services located in Cherry Hill, NJ offers specialized support for males with REDs, including help with relationship to food, body image, perfectionism, and sport identity.

What Is Relative Energy Deficiency in Sport (REDs)?

REDs occurs when energy intake is less than energy expenditure over a sustained period of days, weeks, or months. In simple terms, athletes using more calories than consumed are at risk for REDs, regardless of how they look or how much they weigh.

The concept centers on energy availability. When that number drops into dangerously low zones, the body begins rationing resources. REDs can lead to decreased energy availability for health and performance across nearly every organ system.

REDs was previously known as the female athlete triad, a model linking disordered eating, menstrual dysfunction, and low bone density. In female athletes, missed menstrual periods are a common symptom of REDs, and amenorrheic athletes have a higher risk of stress fractures than their peers. But the condition impacts more than three areas of health originally described. The International Olympic Committee broadened the framework to REDs, recognizing that it affects both male and female athletes and involves metabolic, immune, cardiovascular, psychological, and endocrine systems.

Energy deficiency in sport is not just about thinness or wanting to lose weight. Men can develop REDs while chasing performance goals, trying to meet weight-class targets, or simply following team culture around leanness. REDs can develop from intentional calorie restriction or eating disorders, but it can also result from unintentional under fueling.

How REDs Shows Up Differently in Men

While the underlying problem, chronic low energy availability, is similar across male and female athletes, the visible signs and social context differ significantly for males. This leads to under diagnosis, with symptoms often mislabeled as "overtraining" or "just stress."

Male athletes lack the menstrual cycle as an obvious warning signal. Menstrual disturbances in female athletes can indicate REDs risk quickly, but men have no equivalent red flag. Instead, key male-specific indicators include low testosterone, reduced morning erections, reduced libido, and fertility issues including impaired sperm production that may not surface until years later.

Where the classic female athlete triad links energy deficiency, irregular periods, and low bone density, the male adaptation substitutes low testosterone for menstrual dysfunction. Males may show more subtle changes:

• gradual loss of muscle mass, despite consistent strength work

• thinning of body or facial hair

• shifts in body composition that do not match training effort

These changes in male features are easy to overlook.

Cultural factors play a powerful role. Male athletes may normalize extreme leanness, very high training loads, or frequent fasting as "discipline." Coaches may praise weight loss, masking emerging REDs. Many men experience mental health symptoms such as, irritability, higher anxiety, obsessional thinking about training or food, that get written off as personality traits rather than flags of energy deficiency.

Causes and Risk Factors for Low Energy Availability in Male Athletes

REDs in men arises when chronic low energy availability persists, either from intentional restriction, unintentional underfueling, or a combination of excessive energy expenditure and inadequate fueling.

High-risk sport contexts include:

• Endurance athletes: distance runners, triathletes, cyclists, rowers

• Weight-sensitive sports: wrestling, powerlifting, lightweight rowing, ski jumping

• Aesthetic or performance-leanness cultures: rock climbing, body building, gymnastics, diving

Overall, there is a major lack of research around REDs in males, making it difficult to see how prevalent it actually is. However, here are some results from research done on male cyclists that might surprise you:

• 67% of males athletes are not satisfied with their weight

• 41% dieted to lose weight

• Others reported using laxatives and excessive exercise to try and control weight

• Intake of calcium, vitamin D, Iron, and vitamin B where all below the recommended amounts

Intentional restriction pathways include dieting to "race weight," following intermittent fasting trends, cutting out entire food groups for body composition changes, and using wearables or apps to chase aggressive calorie deficits. These eating habits are often reinforced by team norms or coaching cultures that equate leanness with performance.

Unintentional under-fueling is equally common. Busy schedules, two-a-day practices, long work or school days, appetite suppression after hard sessions, and simply misunderstanding how many calories heavy training demands can all create a sustained energy deficit without the athlete ever intending to restrict.

Disordered eating patterns and perfectionism in male athletes, rigid food rules, guilt after meals, and compensatory extra workouts, create increased risk of sustained low energy availability. Additional risk factors include starting intense training during adolescence (which can lead to stunted growth), a history of dieting or weight-cutting, chronic stress, inadequate sleep, and poor nutrition education from coaches or teams.

Signs and Symptoms of REDs in Men

In men, REDs symptoms often creep in gradually and may be misattributed to aging, stress, or just "training hard." Here is how they break down by system:

Performance and physical signs:

• Unexplained plateau or decline despite smart training

• "Heavy legs" or flat sessions; loss of explosiveness or power

• Slower recovery between sessions; under-fueled bodies lead to longer recovery times between workouts

• REDs leads to decreased sports performance even in well-conditioned athletes

Hormonal and reproductive signs:

• Low testosterone, reduced sex drive, fewer or absent morning erections

• Erectile difficulties, decreased muscle strength despite training

• Low energy availability can impair hormonal function in athletes at every level

Bone health and injury signs:

• Higher rate of stress fractures

• Low bone density and low bone mineral density on DXA scans

• Low energy availability can lead to long-term osteoporosis and bone loss if left untreated

• Nagging tendon or joint pain that does not fully heal, contributing to recurring sports injuries

Mood, cognition, and psychological signs:

• Irritability, low mood, anxiety about missing workouts

• Obsessive tracking of weight or macros

• Brain fog, difficulty concentrating at work or school

General health and immune signs:

• Frequent colds or infections; low energy states can disrupt immune function, leading to increased illness frequency

• Feeling cold all the time, hair thinning, brittle nails

• Digestive changes (constipation, bloating)

• Sleep disturbances or waking up feeling unrested

How REDs Affects Male Hormones and Testosterone

The male endocrine system is particularly sensitive to energy availability. Chronic energy deficiency in sport suppresses reproductive sex hormones when it senses an energy imbalance resembling starvation.

Specifically, anabolic hormones (ex. testosterone) are impacted, leading to reduced muscle mass and strength, negative impacts on VO2max, blunted training response, and weak bones over time. Males that have low testosterone are more likely to have bone stress injuries.

Blood tests may show low or low-normal total testosterone, low free testosterone, suppressed thyroid markers, and elevated cortisol. A sports clinician can interpret these testosterone levels in the context of training load, energy intake, and overall health. Importantly, hormone therapy or testosterone replacement alone is not a solution if low energy availability persists. The primary treatment for men remains restoring adequate energy balance through nutrition and training adjustments.

Diagnosing REDs in Men: Evaluation and Testing

There is no single "REDs test." Diagnosis in men relies on a combination of careful medical history, physical examination, lab tests, and sometimes imaging for bone health.

Medical history should include:

• Detailed review of training volume, intensity, and exercise habits across the year

• Patterns of energy intake, current eating plan, and past or current disordered eating or eating disorder history

• Weight changes, body weight history, attempts to lose weight for the athlete's sport

• History of stress fractures, mood changes, and sexual health (libido, erections, fertility)

A physical exam focuses on body weight trends, orthostatic vitals, skin and hair changes, and tenderness over common stress injury sites. Healthcare providers should assess the athlete's health comprehensively. Health includes physical and mental well-being.

Common lab tests a clinician might order blood tests for:

• Complete blood count, iron studies, ferritin, vitamin D

• Thyroid panel (TSH, T3, T4)

• Testosterone

• Basic metabolic panel, Magnesium, phosphorus

Orthostatic vitals, along with an EKG are also highly recommended. A DXA scan for bone mineral density may be recommended for male athletes with repeated bone stress injuries or prolonged low energy availability. Ideally, athletes should seek a sports-medicine physician, sports dietitian, and mental health professional familiar with REDs.

Treatment: Restoring Energy Availability and Protecting Long Term Health

The core goal is restoring adequate energy availability by rebalancing energy intake and energy expenditure while addressing hormonal disruption, bone health, and mental health factors. Early intervention is essential to address REDs and restore energy availability before damage becomes entrenched.

Increasing energy intake looks different for everyone. I recommend working with a sports dietitian that works with REDs. Here are a few examples of what you may work on with them:

• Adding regular meals and snacks timed around training sessions

• Prioritizing carbohydrates for endurance athletes; include more fats for hormone production

• Increasing variety of all food groups

• Ensure enough energy to support not just training but overall health, regular exercise, and recovery

Sometimes adjusting energy expenditure is necessary. The amount decrease is dependent on the individual and sport. This could look like adding more complete rest days or periodizing heavy blocks with recovery weeks. The goal is to keep athletes in their sport safely, even if this is modified training during recovery.

Treatment requires a multidisciplinary healthcare team approach: sports dietitians tailor nutrition plans to the athlete's sport, schedule, and preferences. When disordered eating or entrenched diet rules are present, working with a REDs therapist to address perfectionism, body image concerns, and all-or-nothing thinking, is important. The underlying cause of the energy deficit must be identified, whether it is poor nutrition knowledge, an eating disorder, or external pressure (and it may be a little but of everything).

Recovery is gradual and can be an up and down journey. Regular check-ups are essential to monitor treatment progress and ensure the athlete is on track. REDs can impair recovery from training, so patience is non-negotiable.

Preventing REDs in Male Athletes and Teams

Prevention is far easier than rebuilding bone health, endocrine function, and trust in food after years of energy deficiency in sport. It starts with integrating basic sports nutrition education on energy availability, fueling windows, risks of extreme leanness into high school, collegiate, and club programs so that many athletes and coaches understand the health consequences before problems develop.

Practical team policies that help:

• Avoid public weigh ins and stop praising weight loss (actually do not talk about body sizes at all)

• Focus performance feedback on strength, endurance, and skill, not appearance or body size

• Monitor for red flags: unexplained performance decline, multiple stress injuries, repeated illnesses, and signs of disordered eating

• Build an environment where male athletes feel safe disclosing low libido, fatigue, mood changes, or body image pressure without shame

A health condition like REDs does not reflect weakness. It reflects an energy imbalance that affect athletes across every sport and level. Good health and sustained athletic performance come from fueling appropriately, not from consuming fewer calories or more calories arbitrarily, but from matching intake to demand. REDs screening should be a part of physicals needed prior to joining a team.

How Serendipity Counseling Services Supports Males with REDs in Cherry Hill, NJ

Serendipity Counseling Services offers specialized counseling for male athletes dealing with relative energy deficiency in sport, disordered eating, and body-image concerns in New Jersey.

The focus is on men's unique experiences: pressure to be lean and strong, stigma around seeking help, cultural expectations to "tough it out," and how these interact with REDs, low energy availability, and low testosterone symptoms. Individual therapy addresses perfectionism and sport identity, support in challenging harmful diet rules, coordination with sports dietitians and medical providers, and guidance for navigating return to play decisions.

REDs therapy helps athletes separate self-worth from performance metrics, learn sustainable eating habits, and cope with anxiety when increasing energy intake or reducing training load. Serendipity offers in-person REDs therapy in Cherry Hill, NJ, as well as virtual therapy throughout NJ, PA, MD, VT, FL and AZ.

Schedule an initial consultation focused on REDs, disordered eating, or chronic injuries.

About the Author: A REDs Therapist

Kate Ringwood is a REDs therapist with experience in sports mental health, eating disorders, and relative energy deficiency in sport, with a particular focus on working with male athletes. Her approach is evidence-based, compassionate, and centered on integrating performance goals with long-term physical and psychological well-being. Kate is committed to reducing stigma around men seeking help for disordered eating, REDs, and body-image concerns.

Frequently Asked Questions

Can I have REDs even if I am not underweight and still look muscular?

Yes. Many male athletes with REDs are in a "normal" BMI range. REDs is about chronic low energy availability, not just body weight or visible leanness. Men with high muscle mass and high training loads can be in energy deficiency if their energy intake does not match their energy expenditure, leading to low testosterone, fatigue, and poor bone health despite a strong appearance.

How long does it take for testosterone and performance to recover after fixing low energy availability?

Recovery time varies. Some men notice improvements in mood, energy levels, and libido within a few weeks of consistently increasing energy intake and adjusting training. Full hormonal normalization and bone health improvements often take several months to a year or more, depending on how long REDs was present and whether there were stress fractures or other complications.

Is it possible to treat REDs without gaining any weight?

In some men, restoring energy availability can happen with small changes in body weight if they were not severely underweight. In others, weight gain is a necessary and healthy part of recovery. The priority is restoring hormone function, bone health, and performance capacity. Working with a sports dietitian and therapist can help manage fears about weight changes and build an eating plan that supports the athlete's sport and goals.

Should I stop training completely if I think I have REDs?

Not every athlete with REDs must stop all physical activity, but many will need a temporary reduction in training volume or intensity while increasing energy intake and allowing injuries to heal. Individualized guidance from a sports medicine physician or multidisciplinary team is essential rather than self-prescribing drastic changes, especially for competitive athletes who need to safely participate in their sport long term.

How do I talk to my coach or teammates about REDs without feeling weak or ashamed?

Frame REDs as a medical and performance issue similar to any other injury or health problem. Share that you are following professional guidance, and emphasize that addressing it now supports better long term athletic performance. A therapist or counselor, such as at Serendipity Counseling Services, can help you practice these conversations, manage fears about stigma, and build a support network within your sport environment.