Your doctor has told you that you need to go on birth control to treat your RED-S / REDs (Relative Energy Deficiency in Sport), specifically the harm it does to your bones. But you’re afraid of the side effects. What should you do?

Dr. Jennifer Guadiani is a strong proponent of body choice, and says that ultimately the decision is up to you. However, you want to be sure that you’re making an informed choice. She shares what you should take into consideration, what some possible compromises might be, and when you need to be aware that anorexia could be a factor.


Read the transcript

[Tina]  I don’t want to go on birth control for the side effects that I’ve been told, or it says that it has, but my doctor has told me that’s the only way of helping my situation. What would you say? 

[Jen]  So first of all, you get to choose for your body. I am a profound believer in body choice, so if you choose not to go on a particular medicine, that is your right. I just want to make sure that you’re choosing that within a framework of really understanding the pros and cons, so that when you make a choice, it is a choice that is an educated one and there’s no surprises later on. 

Assuming that a really good, thoughtful pros and cons discussion has been had, you know you still get to make a choice. So you might say, “I really don’t want to go on any form of estrogen” and it might not just be for some of the theoretical risks that people share that can be a little sort of body dysmorphia-oriented. It might also be for reasons like, “I have a history of breast cancer” or “I have a history of a blood clotting disorder, and I cannot go on those.” There are reasons. Everybody gets to decide what their own personal balance of risk and benefit is.

 So, I would say that if you’re purely in the camp of, “I once had a friend whose boobs got really big when they went on estrogen, and they gained a bunch of weight, and I’m terrified of that happening to me,” talk through it. Talk through it; maybe talk through it with a therapist, maybe with friends. If you feel that your bones are really not in good shape and you’re not psychologically or practically in a place to promptly shift how you’re nourishing and how you’re resting, balance what the negatives are going to be as far as the risk to your bones in the near future and whether you might be able to make a change within the next two months, for instance, in your behaviors and taking care of yourself. If you’re not, again we’ve got to start thinking about is this more on the anorexia side, in which case we need a different sort of specialized team and take it really, really seriously. 

Then we need to think, “I could try. I could try the patch,” or “I could ask my GP, ‘Could I go in a half dose of the patch? I’m just a little nervous. I wouldn’t mind just going on a little lower dose and seeing how my body responds.'” Because whatever experiences you’re gonna have on these hormones, they’re immediately reversible as soon as you go off them. You don’t need to live in fear. So if you wanted to try to go on a half dose, or try a full dose for a month or two, maybe the fears, which can sometimes be tangled up with OCD, maybe they’re just proven not to exist. Or maybe you’re like, “Oh no, when I go on estrogen, my mood gets terrible” or “I get awful headaches” or whatever it might be. In which case, great, you tried. Now we really need to focus, since we don’t have that to fall back on. We know that behavior change is a must. We know now it is a must, and it’s just a matter of sort of personal reconciling of risks and benefits, and making sure you’ve really become an educated owner of your body. 

 [Tina] Thank you so much.

check it out

Recovering from RED-S is hard. It’s even harder if you’re working through it alone. Even if you have professional support, they’re not available 24-7, and that can lead to going down search engine rabbit holes that have the potential to derail everything.

Our online resource, RED-S: Realize. Reflect. Recover, will answer all those questions swimming around in your head about recovery. It will give you the opportunity to connect with the experts you’ve come to know here, and to surround  yourself with a community of others who are going through it too. THANK YOU! to Athletic Greens and Tracksmith for supporting this YouTube series and RED-S: Realize. Reflect. Recover.

Go to to get five free travel packs of AG1 and a free one year’s supply of vitamin D3+K2 with your subscription!

When you go to and use the code TINA15 at checkout, you’ll get free shipping and Tracksmith will donate 5% of your order to Rising Hearts, the Indigenous-led nonprofit founded by Jordan Marie Daniels.

more about Dr G:

Dr. Jennifer Gaudiani, CEDS-S, FAED, is an internist who specializes in eating disorders. She practices from a deeply anti-diet, weight-inclusive perspective and partners with therapists and dietitians around the country to ameliorate medical roadblocks in patients’ recovery journeys. Her book, “Sick Enough: A Guide to the Medical Complications of Eating Disorders,” is for patients, families, and practitioners. You can find Jen at

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