The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes

Abstract

The Female Athlete Triad represents three interrelated conditions of (i) low energy availability (energy deficiency), presenting with or without disordered eating, (ii) menstrual dysfunction, and (iii) poor bone health, each of which can exist along a continuum of severity ranging from mild and moderate subclinical health concerns to severe clinical outcomes, including eating disorders, amenorrhea, and osteoporosis. This review provides a brief overview of the Female Athlete Triad, including updating the current thinking regarding energy availability and how it relates to reproductive function, and sets the stage for an initial working model of a similar syndrome in males that will be based on currently available evidence and will later be defined and referred to as a Male Athlete Triad by the newly re-named Female and Male Athlete Triad Coalition. A primary focus of this paper will be on the physiology of each Triad model with an emphasis on low energy availability and its role in reproductive function, with a brief introduction on its effects on bone health in men. From the data reviewed, (i) a specific threshold of energy availability below which menstrual disturbances are induced is not supported; (ii) it appears that the energetic, reproductive, and bone systems in men are more resilient to the effects of low energy availability compared to those of women, requiring more severe energetic perturbations before alterations are observed; and (iii) it appears that recovery of the hypothalamic pituitary gonadal axis can be observed more quickly in men than in women.