Advice on Talking to Your Doctor

Perhaps the only thing more frustrating than experiencing a REDs related issue is trying to describe it to your doctor, or anyone else for that matter.

Even if you know something’s not quite right, your regular practitioner probably doesn't have the time or resources to explore the underlying reasons why. Despite the fact that REDs is a worryingly common issue among an exercising population, athletes (i.e. anyone who trains regularly) still represent a relatively small subset of society and many doctors won’t see patients with REDs very often.

Females

For females, one big REDs flag is a missing or abnormal menstrual cycle. If you’re using a form of hormonal birth control, this can be tricky to identify, since hormonal contraceptives typically work by suppressing the hormones within the natural ovarian cycle. 

Using hormonal contraceptives to ‘treat’ a missing or abnormal menstrual cycle, or being told it is fine to experience this, is akin to putting a piece of tape over a big red flashing indicator light on your car dashboard. Instead, we need to look under the hood to investigate and address the underlying engine problem.

Males

Unfortunately (depending on which way you look at it), males lack the obvious metric of a menstrual cycle in which to determine their likelihood of experiencing REDs, though there are other signs to look out for. These include:

• Reduced frequency of morning erections and lower libido (a key hormonal indicator)

• Persistent fatigue and low energy levels

• Trouble gaining strength or recovering from workouts

• Frequent or persistent illnesses or injuries

• Mood swings or feelings of depression or anxiety

• Weight changes or difficulty maintaining weight

• Obsessive food restriction or exercise dependance

No matter your age, gender, or situation, there is no better time to become an active participant in understanding your own health. Just knowing there is a strong possibility that REDs won't be looked into should help you prepare for ensuring that it is.

So here’s some athlete-to-athlete advice on how to get the most out of an initial appointment.  

1. Prepare in advance. It can help to pull together a concise overview of your history, including training regularity/intensity, nutrition, and any illnesses or injuries you’ve experienced. You might want to ask for input from your partner, parent, coach, physio, or anyone else who might be able to identify patterns or changes over the recent months/years. Denial can (but doesn't always!) play a part in REDs cases and it can help to have some input from someone you trust.

2. Take some information with you. Since the chances of your doctor having heard of REDs are slim, the sooner you can present them with the details, the better. You could take a copy of the REDs clinical assessment tool, or your own version of this example letter, to your appointment. If they aren't willing to read it or learn more, it's always worth seeking a second opinion from someone who is.

3. Consider going privately. If you're able to afford an appointment with a private specialist with knowledge and experience of REDs, we've recommended some resources here. We know it's not an option for everyone, but if it is possible, then even one appointment should be a worthwhile investment in your long-term health.

4. Make the most of what you've got. If you aren't able to go privately and your doctor doesn't have the capacity to look into your case further, ask to be referred to a sports medicine physician who is far more likely to a) know what REDs is, or, b) explore it with you if they don't.

5. Bone health. If you’ve experienced any bone related injuries (i.e. stress fractures), ask for DEXA scan (measuring hip and spine density) to look for signs of low bone density or osteopenia. This is a crucial indicator of REDs and it's essential to treat it early. While your doctor might seem sceptical as to whether you need one, a scan should be available to anyone considered by their GP to be at risk of developing osteoporosis. 

6. Remember that ‘normal’ isn’t always 'normal for athletes'. Standard test reference ranges are designed for the general population, not for people who train regularly or intensely. For example, dietary iron recommendations are 1.3 to 1.7 times higher for athletes than non-athletes and 1.8 times higher for vegetarians than meat eaters (source). So even if your results fall within the “normal” range, it’s worth asking for the actual numbers and reviewing them with a specialist who understands athlete health.

Similarly, while your weight might sit within a “normal” range, REDs is not limited to athletes with low body weight. It can affect anyone, at any size, at any time. Relying on weight alone as a marker of health can be misleading and delay the identification of REDs.

7. Tell the truth. It’s essential to be honest with your doctor (and yourself) about your relationship with food and exercise. If you don't think you display any disordered eating or exercise behaviours (like those described here) it helps to be open to the possibility that you're unintentionally under-fueling. If you’re anxious about eating too much or gaining weight to the detriment of your sports performance, then mention it. If you’re not sure whether you eat enough to sustain your training load or hormone levels, then tell them. And, if you think you might have a full blown eating disorder or exercise addiction then be try to be honest about it (we understand this can be hard).

You should never ever feel ashamed or embarrassed while talking to your doctor. They'll have seen and heard far worse things than whatever you’ll come out with, so this is your opportunity to have a judgement-free conversation with someone who can help. Seize it."

8. Trust your instincts. If you’re willing to seek support, then arm yourself with as much understanding of your own health picture as possible and don’t give up if you don’t get everything you need from your first appointment. Chances are, you’re an athlete who would be willing to push through most things if it meant continuing your training. But please trust us here and don't try to push through this.

You might find that your doctor is a lot more helpful than you’d expected, if you just know what to ask.” - Period Repair Manual by Lara Briden