When to use this
The moment warning signs stop looking random and start looking like a cluster in one athlete.
- Missed periods, bone pain, or repeated illness is showing up alongside a performance slide.
- You are drafting what to say to the athlete and their family this week.
- The staff needs to agree on who calls whom before the conversation happens.
Advanced lab
The escalation script and referral tree
The public sheet says act on clusters. The gated layer is the exact sequence: what to document, what to say, and who gets called in what order.
RED-S evaluation and any lab work belong with a physician, and recovery fueling belongs with a sports dietitian. The coach's job ends at recognition, referral, and adjusting training load.
Evidence sources
These references support the handout’s general education. Individual medical, supplement, laboratory, or injury questions should be handled by the appropriate qualified clinician.
- Mountjoy M, Sundgot-Borgen JK, Burke LM, et al. (2023) IOC 2023 consensus statement on REDs. British Journal of Sports Medicine, 57:1073-1098.
- De Souza MJ, Nattiv A, Joy E, et al. (2014) 2014 Female Athlete Triad Coalition consensus statement. British Journal of Sports Medicine, 48(4):289.
Where to go next
PrintableKnow the referral thresholdsThe companion sheet on when a concern crosses from coach territory into clinical territory.
ToolRun the referral checklistWork through the flags and generate the referral next step for this specific athlete.
PrintableGet the language rightThese conversations fail fastest on wording — this sheet covers what to say and what to avoid.
