Every case of RED-S is complex and unique, yet there are a number of signs and symptoms to look out for. The RED-S CAT™ Clinical Assessment Tool (CAT) can be a useful resource for exploring these further, ideally with a medical professional.
Physical symptoms
Strategies to identify and monitor symptoms
Physical signs
Unexplained fatigue/low energy
Recurrent or persistent injuries (including bone and soft tissue injuries)
Recurrent or persistent illness
Decreased training adaptation
Stagnation or decline in performance
Strategies to identify and monitor symptoms
Note down anything you’ve been experiencing: illnesses, injuries, niggles, inconsistencies in training, fatigue, changes in mood, difficulty adapting to training or generally poor performances
Consider keeping a training diary that includes your daily training, energy levels, mood, and sleep quality
Consider discussing your nutrition and exercise habits with a registered dietitian to assess whether your intake is sufficient relative to your body's needs
If you've experienced a bone-related injury (or multiple) and haven’t already had a DEXA scan, try to do so via your GP or sports doctor (head here for guidance)
Physical signs
Secondary amenorrhea - missing or irregular periods when a regular cycle had previously been present
Strategies to identify and monitor symptoms
Consider whether you’ve missed any periods or showed subtle signs of menstrual disturbance, such as a longer length of time between periods. Tracking your cycle and symptoms via an app like FitrWoman can be really helpful. Be aware that a withdrawal bleed from hormonal contraceptives, such as the oral contraceptive pill is not the same as a natural period.
Physical signs
Primary amenorrhea in females – menstrual cycle has not begun by the age of 15
Strategies to identify and monitor symptoms
If you're over 15 years old and haven't had your first period, it is essential to see a doctor who can investigate possible causes, including RED-S
Physical signs
Low libido (in males and females)
Strategies to identify and monitor symptoms
Keep tabs on your sex drive (if you're of the age to have one) to check for signs of hormonal disruption. Make a note on whether it’s been lower than usual or absent completely. For males, experiencing fewer than 3 morning erections per week is a sign that your endocrine system is lacking the energy for 'non-essential' functions.
Physical signs
Iron deficiency
Strategies to identify and monitor symptoms
Ask your medical practitioner to check your ferritin levels and ask to view the result - note that the optimal range for athletes differs from the ‘normal range’ identified in the lab. More advice on this here.
Physical signs
Scoring low on an energy availability scale
Strategies to identify and monitor symptoms
Head here for more details
Psychological symptoms
Try to answer these questions as accurately and honestly as possible
Psychological signs
Increased irritability, poor concentration, depression
Unwillingness to take rest days, including continuing to train when in pain or unusually fatigued
Anxiety around meal times or avoidance of eating certain food groups such as carbohydrates or fats
An irrational fear of weight gain
Feeling the need to ‘earn' food
Body dissatisfaction: negative thoughts about one's body or an untrue belief that changing its size/shape will result in performing better or feeling happier
Body dysmorphia: believing that one's body does not fit the ideal for your sport
Try to answer these questions as accurately and honestly as possible
How do you feel about your weight and body?
Are you trying to lose or gain weight?
Do you believe that losing weight could improve your performance?
Are there certain foods you try to avoid or eliminate from your diet?
Do you feel a need to exercise to ‘earn’ food, or to eat less on rest days than you would on training days?
Do you try to avoid rest days from training or feel an urge to make them ‘active’ rest days?
What percentage of the time do you spend thinking about food?
Do you find it hard to sit down and truly rest?
Do you find yourself sticking rigidly to exercise plans, even if it means ignoring your body's signals, like fatigue or pain?
Do you think you might have an eating disorder?
Would some of your eating behaviours be considered disordered?