Sports Medicine

, Volume 46, Issue 2, pp 171–182 | Cite as

Parallels with the Female Athlete Triad in Male Athletes

  • Adam S. Tenforde
  • Michelle T. Barrack
  • Aurelia Nattiv
  • Michael FredericsonEmail author
Review Article


Participation in sports offers many health benefits to athletes of both sexes. However, subsets of both female and male athletes are at increased risk of impaired bone health and bone stress injuries. The Female Athlete Triad (Triad) is defined as the interrelationship of low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. The Triad may result in health consequences, including bone stress injuries. Our review presents evidence that an analogous process may occur in male athletes. Our review of the available literature indicates that a subset of male athletes may experience adverse health issues that parallel those associated with the Triad, including low energy availability (with or without disordered eating), hypogonadotropic hypogonadism, and low bone mineral density. Consequently, male athletes may be predisposed to developing bone stress injuries, and these injuries can be the first presenting feature of associated Triad conditions. We discuss the evidence for impaired nutrition, hormonal dysfunction, and low bone mineral density in a subset of male athletes, and how these health issues may parallel those of the Triad. With further research into the mechanisms and outcomes of these health concerns in active and athletic men, evidence-based guidelines can be developed that result in best practice.


Bone Mineral Density Anorexia Nervosa Female Athlete Sport Participation Male Athlete 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethical Standards

Conflict of interest and study funding

Adam Tenforde, Aurelia Nattiv, Michelle Barrack, and Michael Fredericson declare they have no conflicts of interest to report related to this work. The authors thank Dr. Mary Jane De Souza for her review of our manuscript. No financial support was received for the preparation of this manuscript.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Adam S. Tenforde
    • 1
  • Michelle T. Barrack
    • 2
  • Aurelia Nattiv
    • 3
  • Michael Fredericson
    • 4
    Email author
  1. 1.Department of Physical Medicine and RehabilitationSpaulding Rehabilitation Hospital, Harvard UniversityCambridgeUSA
  2. 2.Department of Family and Consumer SciencesCalifornia State UniversityLong BeachUSA
  3. 3.Department of Family Medicine and Department of Orthopaedic Surgery, Division of Sports Medicine and Nonoperative OrthopaedicsUniversity of CaliforniaLos AngelesUSA
  4. 4.Department of Orthopaedic SurgeryDivision of Physical Medicine and Rehabilitation Organization Stanford UniversityRedwood CityUSA

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