SHM Converge Scientific Abstract ePoster Gallery-Its a Red Flag; Relative Energy Deficit in Sport-"Red-S"

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This case describes an 18-year-old male wrestler with one year of low libido, fatigue, muscle weakness, and erectile dysfunction. He trained intensely for two hours daily and ate a very restricted diet. Exam showed low blood pressure, bradycardia, delayed pubertal development, and small testicular volume. Labs revealed suppressed LH/FSH and very low testosterone, while pituitary, thyroid, adrenal, prolactin, IGF-1 testing, MRI, and drug screening were normal. He was diagnosed with Relative Energy Deficit in Sport (RED-S), a condition caused by insufficient calorie intake relative to exercise expenditure, leading to suppression of the gonadal axis.<br /><br />Management focused on restoring energy balance by increasing carbohydrate intake and reducing exercise. Over two months he gained weight and began noticing improved erections and libido. By six months, he had gained 14 pounds, his energy and sexual function normalized, and testicular size increased. Repeat labs showed normalization of LH, FSH, and testosterone.<br /><br />The discussion emphasizes that RED-S is not limited to female athletes; men are also affected and may present subtly, without obvious reproductive symptoms like amenorrhea. Diagnosis requires careful attention to diet, training volume, and symptoms of low energy availability. The mechanism is thought to involve central suppression of reproductive hormones, possibly influenced by low leptin, stress hormones, and inflammatory cytokines. Treatment is primarily nutritional rehabilitation and reduction of excessive exercise, with recovery indicating that the hypogonadism is functional and reversible.<br /><br />Key point: in athletes, especially those with high training loads and restricted intake, RED-S should be considered as a cause of hypogonadism and included in routine screening.

Asset Subtitle

Zaineb Viqas

Meta Tag

Author List Felina Dass MD, Soumya Nadella, Zaineb Viqas

Category Clinical Vignettes

Concept Relative Energy Deficit in Sport

Concept Energy Deficit

Concept Hypogonadotropic Hypogonadism

Concept Energy Availability

Concept Androgen

Distinguished Non-Finalist

Presenter Organization St Luke's Hospital

Presenting Author Zaineb Viqas

Track Adult

Keywords

Relative Energy Deficit in Sport

RED-S

male athlete hypogonadism

low testosterone

suppressed LH FSH

energy deficiency

restricted diet

intense exercise

delayed puberty

reversible functional hypogonadism

Relative Energy Deficit in Sport

Energy Deficit

Hypogonadotropic Hypogonadism

Energy Availability

Androgen