Getting Girled: The female athlete triad

In high school, as I lined up along the waterfall start line for the Washington State Championship mile, I noticed something about my competitors. The majority of the girls, clad in skin-tight shorts and singlets, were not only shorter than me; they were far thinner than me. Many of them, despite being juniors and seniors in high school, appeared prepubescent; I felt I raced against a field of twelve-year-olds, which couldn't be fair. Not only were they smaller than me, they were much, much faster than me.

After finishing third to last, 12 seconds off the 4:48 pace, I regretted not taking my race weight more seriously. For weeks, my coaches had urged me to slow my intake of carbs, to avoid fatty foods and to curb my appetite with hydration and while I had done all of that, I wondered how I could have done more to overcompensate for my height and natural size.

As a 16 year old, I had entered into the consuming psychological aspect of the female athlete triad, a condition that has devoured countless talented athletes and promises to continue to damage the bodies and minds of women across all athletic fields. In order to study for this month's column, I dug into several medical journals and have translated the scientific speak into English in order that the condition may be more widely understood and addressed.

The three prongs of the triad are menstrual dysfunction, low energy availability (even without and eating disorder) and decreased bone mineral density. While all three tenets are not required for an athlete to suffer, the three generally come hand in hand.

Pressure to perform causes women to increase their exercise load and strive for low body mass, which in turn delivers low energy intake, causing psychological stress hormones to alter the menstrual cycle, leaving the athlete without the faculty to moderate bone density.

During the industrial revolution, several publications warned of the dangers of the female athlete. They urged men to not let their wives run or jump up and down, for fear that they may damage their reproductive capabilities.

While this is clearly complete bullocks, for an athlete in the triad, its claims are not altogether absurd.

Amongst other things, a triad athlete is more likely to experience reproductive failure, psychological disorder and physical injury than her healthy competitors. A Sports Health journal article states that nearly 69 percent of athletes in sports like running and ballet are affected by the disorder, and those athletes are two to four times more likely to suffer a stress fracture. A decrease in macronutrients causes the body's ability to recover and build muscle to plummet, leaving it no choice but to pull calcium from the bones to compensate.

Unfortunately, much of the triad comes from naive ignorance, as nutritional and emotional education both serve as preventative measures for young athletes. However, as exercise physiologist Karen Birch puts it, "Prevention is better than treatment, but prevention in athletes is made difficult by the nature of the game." The triad can appear in women who do not show signs of psychological eating disorders, but rather suffer from a more subtle, pressure induced anorexia athletica. Athletes are tactical. We're smart; if we can fake it on race day, we can fake it at mealtime.

The most terrifying part of the disorder, to me, is its destruction of the beauty of the sport. To watch a talented young woman begin to hate athletics, and hate herself, is heartbreaking. Athletics are meant to empower, they are meant to enable human beings to compete safely and experience a heightened form of themselves. Instead, many women are being beaten down.

The female athlete triad makes athletics a dangerous game, and it is one of the many barriers that keeps women from remaining in sport and competing for equality. I hope that with the right education and discussion, it, too, may be defeated.


Birch, Karen. ABC of Sports and Exercise Medicine: Female Athlete Triad.

Clinical Review. BMJ Volume 330. 29 January 2005.

Nazem, Taraneh Gharib BA and Ackerman, Kathryn E MD. The Female Athlete Triad. Sports Health. Volume 4. August 2012.


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