Energy deficits are a serious and ongoing problem in the female athletic population. Deficits in energy intake may be acquired through excessive energy expenditure or insufficient caloric consumption. Two separate but interrelated conceptualizations and models of energy deficiency exist in the female athlete population. The seminal model, the female athlete triad, is defined as the interrelationships among energy availability, menstrual function, and bone density. A novel conceptualization, the relative energy deficiency in sport (RED-S), expands on the female athlete triad (energy availability, menstrual function, and bone density) by broadening our understanding of the impact of low energy in female athletes to factors such as psychological, immunological, endocrine, metabolic, gastrointestinal, cardiovascular, and growth and development factors. In both models, these dynamic components may transcend various clinical manifestations, including eating disorders, functional hypothalamic amenorrhea, and osteoporosis. This chapter will serve to review the two models and discuss the implications of each for the female athlete, including health and performance outcomes.
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