REDs in male athletes: 'Suffering in silence' as stigma hides Widespread condition

Doctors warn energy deficiency in male athletes is under-diagnosed despite research showing it affects nearly half of competitors

By LineZotpaper

Published20 October 2026

Read Time3 min

A growing body of evidence suggests that Relative Energy Deficiency in Sport (REDs) is as prevalent in men as in women, yet stigma and a lack of obvious warning signs mean many male athletes suffer in silence. A recent meta-analysis found nearly half of male athletes had low energy availability, a condition that can lead to brittle bones, serious injuries and long-term health problems if left untreated.

Doctors told British long-distance runner Jake Smith his career could be over after his weight dropped to just over eight stone (51kg) and he suffered two stress fractures in four months. His diagnosis: Relative Energy Deficiency in Sport (REDs).

For decades, the mantra "lighter is faster" dominated endurance sports, driving athletes to under-fuel in pursuit of performance. The problem is so pervasive that a meta-analysis published in the Australian journal Sports Medicine last year found 49.4 per cent of male athletes had low energy availability, compared to 44.2 per cent of women.

The condition was originally known as the "Female Athlete Triad" before the International Olympic Committee renamed it in 2014 to reflect the reality that men suffer too. Dr Nicky Keay, a hormone health specialist, said "it's a strange situation because normally it's women's health that is the one being ignored but, in this situation, it's the men who weren't being recognised or represented."

Women have a monthly indicator of hormonal health through their menstrual cycle, described by Dr Keay as a "free monthly medical check". For men, the signs are subtler: a drop in testosterone, reduced libido and fatigue. This makes REDs harder to spot in male athletes until a serious injury forces them to stop.

Triple Olympic medallist Jonny Brownlee told BBC Sport he did not see the importance of fuelling during his triathlon career. "You were seen, culturally, as a bit weak if you were fuelling on the bike," he said. The consequence was stress responses, stress fractures and underperformance in races.

Brownlee believes the culture around fuelling has changed, but a stigma remains. "Men also don't like to talk about under-fuelling because it's just seen as 'you probably should feel better and you should be on top of that'," he said.

Dr Keay's 2019 experiment on male cyclists found that those who continued their usual fuelling habits lost bone mineral density similar to an astronaut in space. The group she advised saw improvements in both bone health and race results. "The good news is that REDs is reversible," she said. "But if you don't take action, it's a decline."

Resources are now available for those seeking help. Former GB runner Pippa Woolven set up Project REDs, and Dr Keay reports a slow but steady increase in men reaching out for support. Tennis player Emma Navarro was the latest high-profile athlete to disclose her diagnosis last month.

Analysis

Why This Matters

REDs affects nearly half of male athletes, yet it remains significantly under-diagnosed compared to in women, placing a large population at risk of serious and long-term health problems.
The stigma around male body image and fuelling within sport prevents athletes from seeking help, endangering careers and long-term well-being.
Increased awareness is critical because the condition is reversible with proper intervention, but only if it is identified early.

Background

REDs was originally known as the 'Female Athlete Triad' before the International Olympic Committee renamed it in 2014 to capture its full range of symptoms and acknowledge it also harms male athletes. The condition occurs when an athlete does not consume enough energy to support their training load, leading to hormonal disruption, loss of bone density and a high risk of stress fractures and underperformance.

Key Perspectives

Dr Nicky Keay: REDs goes undetected longer in men because women have the menstrual cycle as a clear monthly health marker, whereas men experience a subtler drop in testosterone that is often overlooked until serious injury strikes. Jonny Brownlee: There is a persistent stigma attached to fuelling, especially for male athletes, who fear being seen as weak if they prioritise nutrition, making them less likely to speak up or seek help. Traditional Sports Culture: The deep-seated 'lighter is faster' philosophy in endurance sports can act as a barrier to acknowledging the condition, as initial weight loss is perceived to improve performance, masking the underlying health decline.

What to Watch

Whether more male athletes will publicly share REDs diagnoses, following the example of Jake Smith and female athletes like Emma Navarro.
The impact of resources like Project REDs on early detection and shifting cultural attitudes within coaching and sport science communities.
Further research into bone health screening for male athletes as a potential standard part of sports medicine checkups.

Sources

Race, illness, injury, repeat - REDs and why men are suffering in silence · BBC News

Checked

8 claims in this story checked against 1 source: 0 supported.

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Partly supportedDoctors warn that male athletes’ energy deficiency is under-diagnosed, and research shows it affects nearly half of competitors.BBC News: “But men are just as susceptible and due to stigma and lack of obvious warning signs, it can go undetected for longer and means many, like Smith, suffer in silence. ... indicated 44.2% of female athletes and 49.4% of male athletes had low energy availability.”
Partly supportedREDs is a widespread condition in men, as prevalent as in women.BBC News: “But men are just as susceptible and due to stigma and lack of obvious warning signs, it can go undetected for longer ... indicated 44.2% of female athletes and 49.4% of male athletes had low energy availability.”
Partly supportedJake Smith’s weight dropped to just over eight stone (51kg).BBC News: “the 28-year-old returned from a running camp in Uganda weighing just eight stone (51kg) at 5ft 5in (1.7m).”
Partly supportedSmith was told his career could be over after his weight dropped and he suffered two stress fractures in four months.BBC News: “He had such brittle bones that he was told his career could be over. After suffering two stress fractures in the space of four months, Smith sought professional help and was diagnosed with REDs”
Partly supportedFor decades, the “lighter is faster” mantra drove athletes to under-fuel for performance.BBC News: “For decades, it had been an accepted wisdom in sports like endurance running, cycling, climbing, horse riding, dancing and aesthetic sports like diving and gymnastics. And for athletes like Smith, it is how his problems started.”
Partly supportedMale athletes’ subtler signs mean REDs can be harder to spot until a serious injury forces them to stop.BBC News: “In females, there are more obvious signs but in males it can go under the radar a little bit and then it hits you by a really serious injury,”
Partly supportedDr Keay reports a slow but steady increase in men seeking help.BBC News: “Most of her patients are women, but she is starting to see more men reach out for help”
Partly supportedEmma Navarro was the latest high-profile athlete to disclose a REDs diagnosis last month.BBC News: “just last month, tennis player Emma Navarro revealed her diagnosis and subsequent decision to step away from competition until 2027.”

Correction

20 October 2026An earlier version of this story presented altered wording as a direct quote from Jonny Brownlee about under-fuelling. The quote has been corrected to match his words.