RED-S / REDS (Relative Energy Deficiency in Sport) has left you with weakened bones. Dr. Jennifer Guadiani details what the results from your DEXA scan mean, and what you can do to try to improve your bone health as much as possible, which might include hormonal support.


Read the transcript

[Tina]  I’ve been diagnosed with osteopenia or osteoporosis. What should I do?

[Jen] So interestingly, the term “osteopenia” is actually overused from an official sense.

Osteopenia doesn’t exist in any one under 50 years old, but I used to lecture on that inappropriately and incorrectly. Those over 50 may have osteopenia, which is early bone density loss, or osteoporosis, which is formal full bone density loss based on their T scores on their DEXA scan. 

Those who have some bone density loss under 50, and here again, the International Olympic Committee has designated that a T score less than negative one, not less than negative two, which is what the radiologic society says has bone density loss. Because athletes should have particularly superb bones, because we know that weight-bearing exercise creates a stimulation along the bone due to the bearing of force that says, “Hey, you’re being needed right now. Get stronger, because we’ve got things to do.” So athletes should have particularly fine bones, and by “fine,” I mean “excellent,” not brittle. And as a result, somebody who has a Z-score of less than negative one and who has a diagnosis of hypothalamic amenorrhea or absent period, due, for instance, to RED-S, that person formally has osteoporosis.

 It’s not going to be named on the report, because the radiologist doesn’t have access to your full clinical history. But that combination actually means osteoporosis, because less than negative one is low bone density for age, and then if you add a secondary cause like absent period, the combination means osteoporosis. I frequently up regulate people’s diagnoses when I actually put pieces together, and it can be quite shocking and a little alarming. But, it’s better to know, because then you know your body really needs you to make change.

So if you get one of those diagnoses and you’re like,  “Oh, my gosh,” it’s time to really think, “What resource do I have to access expert support so that I can care for myself and improve this as much as possible, if not completely reverse it?  What do I need to do in terms of my sport, in terms of my nourishment, in terms of my rest days?  How do I help my body best? Do I need patch estrogen to get me through?” 

For those who are assigned male at birth and who identify as male, they will need testosterone patches.  It works the same way as the estrogen patch. Now of course, if they’re athletes who are competing, that’s going to be a no-no. So guys who have osteoporosis, and actually they get it younger and at a faster level than the women interestingly, they need to be really on top of it. But they’re often missed completely, because they don’t have periods to set off alarm bells. And a lean male athlete, nobody gives too much worry about, because they’re like, “Oh yeah, that’s just their sport,” but they should be having bone density tests done, as well. And they need to have the same reset about, “What do I need to give my body and where do I need hormonal support, if that’s legal for what I’m doing.”  

[Tina]  Thank you so much. Such an important one.

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

more you might like…


Related Posts