The role of a Hormone Doctor

The Role of a Hormonal Health Doctor in RED-D

You might be a dancer, a parent, or a teacher who suspects Relative Energy Deficiency in Dance (RED-D), either in yourself, your child, or a pupil.

RED-D results from an imbalance between nutrition and training load. This can negatively impact both a dancer’s health and their performance. However, RED-D can present with a wide range of symptoms, making it tricky to identify as the root cause. Fatigue, disrupted sleep, recurrent injuries, or menstrual changes (such as delayed onset or stopping of periods in female dancers) may all be signs- but they might also point to other medical issues.

This is why it’s important to consult a fully qualified medical doctor, ideally someone with experience in hormonal health and working with dancers. Their role is to rule out any underlying medical conditions and confirm whether RED-D is the issue. This will typically include a set of blood tests. It's worth noting that medical doctors are the only healthcare professionals qualified to interpret hormonal blood tests accurately.

Some doctors are already familiar with RED-D and have experience working in dance medicine. You can find resources to help locate these professionals on this website, as well as through One Dance UK and IADMS websites.

Preparing for Your Appointment

Once you’ve identified an appropriate doctor to see, it’s helpful to come prepared. Write down the symptoms you’re experiencing. For female dancers, this includes noting:

• The age you started your periods (if applicable)

• Whether your periods have stopped, and for how long

Also prepare a short summary of your typical day- this includes:

• Your training schedule

• What you eat and when

You might also consider completing the PEAQ (Personal Energy Availability Questionnaire) beforehand. This can help guide your doctor during the consultation, the link to the PEAQ questionnaire can be found here.

What Investigations Should You Expect?

Some baseline blood tests you may be offered include:

Reproductive Hormones:

• Follicle-Stimulating Hormone (FSH)

• Luteinising Hormone (LH)

• Prolactin

• Oestradiol (in females)

• Testosterone (in males)

These tests help rule out medical causes for symptoms like missing periods in female dancers or reduced frequency of morning erections in males- both of which can result from RED-D.

Thyroid Function:

• Thyroid-Stimulating Hormone (TSH)

• Thyroxine (T4)

• Triiodothyronine (T3)

• These are used to rule out primary thyroid conditions. Notably, low T3 is a key marker of low energy availability (according to the IOC REDs Clinical Assessment Tool – REDs CAT v2, 2023).

Additional Blood Tests:

• Full blood count

• Vitamin D

• Ferritin

• Vitamin B12

These help assess general health and identify any additional deficiencies.

Bone Health Assessment

A DEXA scan (dual-energy X-ray absorptiometry) may also be recommended to evaluate bone health. This scan measures bone density at two key sites:

• The lumbar spine, which contains trabecular bone and is sensitive to low hormone levels

• The hip (femoral neck), which contains cortical bone and responds to mechanical loading

In dancers with RED, there's often a noticeable difference between the Z-scores at these two sites. A Z-score less than -1 in the lumbar spine is a strong indicator of RED-D (per IOC REDs CAT v2, 2023).

What Next?

Once your hormonal health doctor confirms that you are experiencing RED-D, the next step is to address the energy imbalance. This usually involves adjusting both nutritional intake and training load. Your doctor should work with you to agree on a personalised action plan.

For female dancers whose periods have stopped due to Functional Hypothalamic Amenorrhoea (FHA) and who also have bone health concerns (such as stress fractures or a lumbar spine Z-score below -1), Hormone Replacement Therapy (HRT) may be recommended. This is a temporary measure to protect bone health while you work on restoring your energy balance. Importantly, HRT is not the same as taking the contraceptive pill—which does not have the same protective effect on bone health.

With the right support, including input from a hormonal health specialist, you'll be on the path to better health, sustainable performance, and a thriving dance journey.