The Male Athlete Triad—A Consensus Statement From the Female and Male Athlete Triad Coalition
Part 1: Definition and Scientific Basis
Authors: Aurelia Nattiv, Mary Jane De Souza, Kristen Koltun, Madhusmita Misra, Andrea Kussman, Nancy Williams, Michelle Barrack, Emily Kraus, Elizabeth Joy, Michael Fredericson
Summary: Introducing The Male Athlete Triad: a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado in 2017. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.
Find Part I Consensus Statement document HERE
The Male Athlete Triad—A Consensus Statement From the Female and Male Athlete Triad Coalition
Part II: Diagnosis, Treatment, and Return-To-Play
Authors: Michael Fredericson, Andrea Kussman, Madhusmita Misra, Michelle Barrack, Mary Jane De Souza, Emily Kraus, Kristen Koltun, Nancy Williams, Elizabeth Joy, Aurelia Nattiv.
Summary: Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.
Find Part II Consensus Statement document HERE
2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad
Authors: Mary Jane De Souza, Aurelia Nattiv, Elizabeth Joy, Madhusmita Misra, Nancy I Williams, Rebecca J Mallinson, Jenna C Gibbs, Marion Olmstead, Marci Goolsby, Gordon Matheson, Expert Panel: Michelle Barrack, Louise Burke, Barbara Drinkwater, Connie Lebrun, Anne B Loucks, Margo Mountjoy, Jeanne Nichols, Jorunn Sundgot-Borgen
Summary: In 2014, the American College of Sports Medicine (ACSM) released an update to the 1997 and 2007 position stands. The revised publication refers to the Female Athlete Triad as defined by the interrelationships among energy availability, menstrual function, and bone mineral density, with each component of the Triad occurring on a spectrum from healthy to unhealthy.
Find the 2014 ACSM Position Stand document HERE
The American College of Sports Medicine (ACSM) position stand. The female athlete triad.
Authors: Aurelia Nattiv, M.D., FACSM (Chair); Anne B.Loucks, Ph.D., FACSM; Melinda M. Manore, Ph.D., R.D., FACSM; Charlotte F. Sanborn, Ph.D., FACSM; Jorunn Sundgot-Borgen, Ph.D.; and Michelle P. Warren, M.D.
Summary: In 2007, the American College of Sports Medicine (ACSM) updated their original position stand on the female athlete triad, first published in 1997. The revised publication refers to the female athlete triad as defined by the interrelationships among energy availability, menstrual function, and bone mineral density, which may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis.
Find the 2007 ACSM Position Stand document HERE.
2009 Joint Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance
Authors: Nancy R. Rodriguez, PhD, RD, CSSD, FACSM; Nancy M. DiMarco, PhD, RD, CSSD, FACSM; Susie Langley, MS, RD, CSSD
Summary: It is the position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine that physical activity, athletic performance, and recovery from exercise are enhanced by optimal nutrition. These organizations recommend appropriate selection of food and fluids, timing of intake, and supplement choices for optimal health and exercise performance.
Download document HERE
2000 Joint Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance
Authors: Melinda Manore PhD, RD, FACSM; Susan I. Barr, PhD, RDN, FACSM; Gail E. Butterfield, PhD, RD, FACSM
Summary: It is the position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine that the performance of, and recovery from, sporting activities are enhanced by well-chosen nutrition strategies. These organizations provide guidelines for the appropriate type, amount, and timing of intake of food, fluids, and supplements to promote optimal health and performance across different scenarios of training and competitive sport
Download document HERE
Managing the Female Athlete Triad
Authors: Developed by Roberta Sherman, Ph.D., FAED, and Ron Thompson, Ph.D., FAED, Co-chairs of the Athlete Special Interest Group of the Academy of Eating Disorders, in conjunction with the NCAA.
Summary: This manual resulted from a recent survey of almost 2,900 NCAA coaches of female athletes that looked at how disordered eating and the Female Athlete Triad are identified and managed. Coaches were surveyed because of their importance to, and their influence with, their studentathletes, and the fact that coaches are in an excellent position to play a significant role in identifying and managing affected athletes. On the survey, coaches were also asked what training or information they needed in this regard.
Based on the findings of that survey, this manual was proposed. The purpose of this manual is to provide coaches with strategies to identify, manage and prevent the Female Athlete Triad, which involves the interrelated problems of disordered eating (DE), amenorrhea (loss of menses) and osteoporosis (loss of bone mineral density). The prevalence of the Triad is unknown, but is believed to be high among female athletes due to the prevalence of eating disorders in young women, the high rate of amenorrhea often found in athletes, and the pressures many athletes feel to be thin or lean in order to perform better athletically or conform to an appearance standard associated with their sport. An athlete with signs or symptoms of any component of the Triad should be evaluated regarding the other two.
Download document HERE.
National Athletic Trainers’ Association Position Statement: Preventing, Detecting, and Managing Disordered Eating in Athletes
Authors: Christine M. Bonci, MS, ATC; Leslie J. Bonci, MPH, RD, LDN, CSSD; Lorita R. Granger, ATC; Craig L. Johnson, PhD; Robert M. Malina, PhD, FACSM; Leslie W. Milne, MD; Randa R. Ryan, PhD; Erin M. Vanderbunt, MS, ATC
Summary: In 2008, the National Athletic Trainers’ Association (NATA) published their position statement in the Journal of Athletic Training, regarding the recommended prevention, detection, and effective management of disordered eating in female athletes.
Download document HERE.
