The Female Athlete Triad has recently been suggested to be a threat to male athletes. This review aims to examine the evidence, and associated effects, of low energy availability (LEA) in male athletes. A comprehensive search of PubMed and SportsDiscus was performed. Three RCT and seven CS studies were included that measured energy availability and included well trained males. Clinical LEA (<30 kcal/kg LBM/ day) or subclinical LEA (36 ± 6 kcal/kg LBM/day) was evident within all CS studies, documenting 25% of middle and long distance runners and race walkers and 70% of cyclists with LEA. Two out of three RCTs and three out of seven CS studies reported disrupted endocrine functioning, particularly reduced testosterone levels, in association with LEA. One CS study reported that up to 40% of cyclists with LEA had low BMD. One CS study assessed metabolic health, reporting those with suppressed levels spent more time in a severe energy deficit. This review highlights that LEA appears prevalent across male athletic populations, in particular endurance and weight class athletes, and is a potentially serious threat to bone, endocrine and metabolic health. Future larger scale longitudinal studies, using appropriate study designs, should be undertaken to confirm these threats.

Evidence suggests that Gaelic football (GF) players do not meet the recommended energy intake (EI) levels and therefore may be at risk of low energy availability (LEA). This study examined energy availability (EA) in 20 elite male GF players. At two stages during a season (2019–2020), repeated measures of EI, exercise energy expenditure (EEE), EA and body composition were performed. Sixty-five percent reported with LEA [<30 kcal.kg Lean Body Mass (LBM)⁻¹.day⁻¹] at pre-season (PRE), with 70% at in-season (IN). Mean daily carbohydrate intake (PRE 3.2 ± 0.82 g.kg; IN 3.4 ± 0.79 g.kg) was below the recommended intake (5–7 g.kg) in 95% at PRE and 100% at IN. All consumed the recommended daily amount of protein (PRE 1.85 ± 0.57 g.kg; IN 1.87 ± 0.48 g.kg) and fat (PRE 1.23 ± 0.4 g.kg; IN 1.02 ± 0.3 g.kg). Significant correlations (P = 0.001) were reported between EA and carbohydrates (PRE r = 0.801; IN r = 0.714); protein (PRE r = 0.675; IN r = 0.769); fat (PRE r = 0.805; IN r = 0.733) and energy intake (PRE r = 0.960; IN r = 0.949). Twenty percent were at risk of disordered eating. This study suggests male elite GF players require education and interventions surrounding nutrition, in particular EA.

Purpose: Despite the introduction of Relative Energy Deficiency in Sport (RED-s) in 2014, there is evidence to suggest that male endurance athletes still present with a high prevalence of low energy availability (LEA). Previous findings suggest that energy availability (EA) status is strongly correlated with impairments in endocrine function such as reduced leptin, triiodothyronine (T₃₎, and insulin, and elevated bone loss. This study aimed to report the current EA status, endocrine function and bone health of highly trained Irish male endurance athletes. Methods: In this cross-sectional study, participants (n = 3 triathletes; n = 10 runners) completed a 7-day testing period during the competition season using lab-based measures, to ascertain EA status, hormone level and rates of bone metabolism. Serum blood samples were obtained to assess hormone levels and markers of bone metabolism. Results: Mean EA was < 30 kcal/kg lean body mass (LBM)/day in 76.9% of athletes. There was a strong association between LEA and low carbohydrate intake, and lower LBM. Mean levels of insulin, IGF-1 and leptin were significantly lower than their reference ranges. Elevated mean concentrations of β-CTX and a mean P1NP: β-CTX ratio < 100, indicated a state of bone resorption. Conclusion: The EA level, carbohydrate intake, hormone status and bone metabolism status of highly trained male endurance athletes are a concern. Based on the findings of this study, more frequent assessment of EA across a season is recommended to monitor the status of male endurance athletes, in conjunction with nutritional education specific to EA and the associated risks.

Relative energy deficiency in sport (REDs) is a syndrome that negatively impacts the health and performance of athletes, due to low energy availability (LEA), resulting in metabolic, cardiovascular, and endocrine function impairments, and an increased risk of injury. An increased emphasis on the coach-athlete relationship may facilitate the knowledge transfer of LEA's negative effects, mitigating the potential of an athlete developing REDs. Yet building on the International Olympic Committee's 2023 REDs statement of articles published between 2018–2022, to also include articles from 2023–2024, it is noted 38,424 participants were recruited to 246 REDs-related studies, with coaching staff only represented ∼3% of the total cohort. This review aims to assess coaches’ and athletes’ perceptions of their respective, as well as each other's roles and experiences in the presence of LEA and REDs. A summary of athlete and coach first-person experiences of REDs-related issues is provided. However first-person REDs experiences are often that of the athlete, while the coach will more often ‘ experience ’ REDs from a second-person perspective, thereby highlighting the need for the development and provision of REDs education targeted to coaching staff which maybe sports-specific, taking into account topics such as appropriate language to use and how/when to discuss an athlete's body, health and/or performance. A better understanding of how athletes experience REDs-related issues may facilitate individual coaching staffs’ evaluation of their role in preventing and/or addressing a potential REDs diagnosis.

Since the introduction of relative energy deficiency in sport (REDs) in 2014, research has primarily focused on athletes’ experiences of REDs symptomatology and consequences, limiting understanding beyond athletes’ perspective. This study assessed the relationship between athletes’ expectations of coaching and support staff in relation to REDs, and staff members’ perceptions of athletes’ REDs experiences. Two interrelated questionnaires were implemented in a mixed-methods cross-sectional study: the Athlete- and Coach-Centric Questionnaires. 101 respondents participated, comprising 56 athletes and 45 coaching and support staff. Awareness of REDs was reported by 31 (55%) athletes and 33 (73%) coaching and support staff. Among athletes, 31 (55%) expected coaches to be aware of REDs symptoms, while 35 (62%) expected awareness of REDs consequences. Only 8 (18%) staff members reported the presence of a REDs assessment, and 10 (22%) a REDs treatment responsibility in their sporting organisation. Qualitative analysis highlighted the importance of the coach-athlete relationship in delivering individualised REDs care. Athletes reported negative coaching practices, and expected to receive limited support, while coaching and support staff highlighted that REDs symptoms were often unreported by athletes. Staff also felt that REDs was under-supported by national governing bodies (NGBs), limiting their potential to positively influence REDs experiences. Further exploration of REDs-specific education for coaching and support staff, athletes, and NGBs is warranted.