The purpose of this review is to present a different perspective of the relative energy deficiency syndrome, to improve understanding of associated endocrine alterations, and to highlight the need for further research in this area. The term “female athlete triad” was coined over 25 years ago to describe three interrelated components: disordered eating, menstrual dysfunction, and low bone mass. The syndrome’s etiology is attributed to energy intake deficiency relative to energy expenditure required for health, function, and daily living. Recently, it became clear that there was a need to broaden the term, as the disorder is not an issue of only three interrelated problems but of a whole spectrum of insults resulting from low energy availability (LEA; i.e., insufficient energy availability to cover basic physiological demands) that can potentially affect any exerciser, irrespective of gender. The new model, termed relative energy deficiency in sport (RED-S), has received greater scrutiny in sports medicine due to its effects on both health and performance in athletes of both sexes. RED-S results from low-energy diets (intentional or unintentional) and/or excessive exercise. Energy deficiency reduces hypothalamic pulsatile release of gonadotropin-releasing hormone, this impairing anterior pituitary release of gonadotropins. In women, reduced FSH and LH pulsatility produces hypoestrogenism, causing functional hypothalamic amenorrhea and decreased bone mass. In men, it reduces testosterone and negatively affects bone health. Moreover, LEA alters other hormonal pathways, causing physiological consequences, such as alteration of the thyroid hormone signaling pathways, leptin levels, carbohydrate metabolism, the growth hormone/insulin-like growth factor-1 axis, and sympathetic/parasympathetic tone. This review explains and clarifies the effects of RED-S in both sexes.

本综述的目的是提出相对能量缺乏综合征的不同视角，提高对相关内分泌改变的理解，并强调在该领域进一步研究的必要性。“女运动员三联征”一词是在 25 多年前创造的，用来描述三个相互关联的组成部分：饮食失调、月经功能障碍和低骨量。该综合征的病因归因于相对于健康、功能和日常生活所需的能量消耗而言的能量摄入不足。最近，很明显有必要扩大这个术语，因为这种障碍不仅仅是三个相互关联的问题，而是由低能量可用性（LEA；即，能量供应不足以满足基本生理需求），这可能会影响任何锻炼者，无论性别如何。新模型被称为运动中的相对能量缺乏 (RED-S)，由于它对男女运动员的健康和表现都有影响，因此在运动医学中受到了更严格的审查。RED-S 源于低能量饮食（有意或无意）和/或过度运动。能量缺乏会降低促性腺激素释放激素的下丘脑脉动释放，这会损害垂体前叶促性腺激素的释放。在女性中，FSH 和 LH 搏动减少会导致雌激素不足，导致功能性下丘脑闭经和骨量减少。在男性中，它会降低睾丸激素并对骨骼健康产生负面影响。此外，LEA 改变其他激素途径，导致生理后果，例如甲状腺激素信号通路、瘦素水平、碳水化合物代谢、生长激素/胰岛素样生长因子-1 轴和交感神经/副交感神经张力的改变。这篇综述解释并阐明了 RED-S 对两性的影响。