Do I Have RED-S? A Self-Screener

If you train hard and you've ever quietly wondered whether something's off (your period went missing, the stress fractures keep coming, your sleep got weird, your libido tanked, your race times are going the wrong direction), you're probably wanting some answers.

Relative Energy Deficiency in Sport (now technically called REDs in the 2023 IOC consensus statement, but everyone still says RED-S) is what happens when your body chronically doesn't get enough energy to cover both your training and basic biology.

If you want a longer explanation of why this is showing up so often in Austin specifically, I wrote about that here.

What this screener is (and isn't)

What it is:

• A self-report screening tool built on validated risk domains

• A useful structured prompt to take to your physician, dietitian, or care team

• A way to see if the constellation of small things you've been ignoring actually adds up

What it isn't:

• A diagnosis. Diagnosis requires labs, exam, history, and clinical judgment. No questionnaire can replace that.

• A substitute for medical care. If you have ongoing symptoms, please see a clinician.

• The full IOC REDs CAT2 assessment. That tool requires a clinician and access to your medical data.

How the scoring works

You'll answer about 15 to 18 questions depending on your branching path. Heavier clinical indicators (stress fractures, missed periods, recurrent injuries) are weighted more than lighter signals (occasional cold intolerance, mild fatigue). The total gives you one of three risk levels, modeled on the traffic-light framework the IOC uses:

• Green: Few or no warning indicators. Keep paying attention; this isn't a forever-clear stamp.

• Yellow: Several signals worth taking seriously. Worth an assessment.

• Red: Significant clinical indicators present. Strongly recommend a real evaluation.

Take it honestly. You're not being graded!

RED-S Risk Screener

Built on validated risk indicators from the LEAF-Q (Melin et al., 2014) and the IOC REDs Clinical Assessment Tool (Mountjoy et al., 2023). This is a screening tool, not a diagnosis.

About You

Sex assigned at birth

Female

Male

Non-binary / Prefer not to say

Are you currently menstruating naturally?

Regular cycles

Irregular or missing

On hormonal contraception

Postmenopausal / N/A

Hours per week of moderate-to-vigorous training

<3

3–6

7–10

11–15

16+

Energy & Fueling Patterns

In the past 12 months, have you intentionally restricted calories, carbs, or specific food groups?

Yes

Sometimes

No

Do you regularly skip meals or train fasted for sessions longer than 60 minutes?

Yes

Sometimes

No

Do you frequently feel cold even in normal temperatures?

Yes

Sometimes

No

Do you feel like your food intake hasn't kept up with your training load?

Yes

Sometimes

No

Bone & Injury History

Have you had a stress fracture or stress reaction in the past 24 months?

Yes

No

Have you had more than one stress fracture or stress reaction in your lifetime?

Yes

No

Do soft tissue injuries (tendinopathy, muscle strains) recur or heal more slowly than they used to?

Yes

Sometimes

No

GI Symptoms

Do you experience bloating, constipation, or diarrhea during or after training?

Yes

Sometimes

No

Do you experience persistent nausea or appetite loss after exercise?

Yes

Sometimes

No

Menstrual Function

Have you missed your period for 3 or more consecutive months in the past year (not due to pregnancy or hormonal contraception)?

Yes

No

Is your cycle irregular, varying by more than 7 days month to month?

Yes

No

Did your first period start later than age 15?

Yes

No

Don't know

Endocrine Indicators

Have you noticed a decrease in libido in the past 6 months?

Yes

Some

No

Have you noticed reduced morning erections compared to your baseline?

Yes

Some

No

General Health & Performance

Do you get sick more often than you used to (more than 3 colds or URIs per year)?

Yes

Sometimes

No

Have you experienced mood changes, persistent irritability, or a drop in motivation?

Yes

Sometimes

No

Is your sleep poor despite training hard (trouble falling asleep, staying asleep, or feeling unrested)?

Yes

Sometimes

No

Has your performance plateaued or declined despite consistent training?

Yes

Sometimes

No

Please answer all visible questions to see your result.

See my result

This screener is built on validated risk indicators from the LEAF-Q (Melin et al., 2014) and the IOC REDs Clinical Assessment Tool (Mountjoy et al., 2023). It is a screening tool only and does not constitute medical diagnosis. If you are concerned about disordered eating, you can reach the National Alliance for Eating Disorders helpline at 1-866-662-1235.

If you scored low risk

That doesn't mean you're done thinking about fueling. It means the major red flags aren't currently present in the constellation we screened for. If you're an endurance athlete in Austin, the smart move is still to know your sweat rate, fuel long sessions with intent, and pay attention if anything on the screener changes in the next 6 to 12 months. Most cases of RED-S start as low-risk profiles that slowly drifted.

If you scored moderate risk

This is the group I see most. Several real signals, often a few years of "I'm probably fine" running in the background. The right next step is a proper assessment. That usually means:

• Labs (CBC, ferritin, vitamin D, hormones appropriate to your situation, electrolytes, sometimes thyroid and lipids)

• A real fueling assessment, including training-day intake against training load

• A clinical conversation about menstrual history, bone health, mood, sleep, libido, and injury history

If you'd like to do that with a sports-trained, in-network dietitian, we offer that at Khan RD.

If you scored high risk

You have multiple significant indicators present. This isn't an emergency in most cases, but it isn't something to keep watching from the sidelines either. The strongest move is:

1. Schedule with a sports medicine physician for a workup (DXA scan if indicated, full lab panel, full history).

2. Schedule with a sports-trained dietitian for fueling assessment and a real plan.

3. If there are concurrent eating disorder concerns, bring a therapist into the picture too. RED-S and eating disorders overlap significantly, and treating one without the other typically doesn't hold.

Underfueling does not resolve on its own. It tends to compound. Acting on a high-risk score in your twenties or thirties is dramatically easier than acting on the consequences in your forties.

What working on this actually looks like

Recovery from RED-S, at any risk level, follows a similar structure:

• Restore energy availability first. Fueling adequacy is the lever, not body composition.

• More frequent eating windows around training, not bigger single meals.

• Real carb intake for the sessions that need it.

• Repair the post-session window, where most underfueling happens in Austin specifically.

• Coordinate with your physician on labs, bones, hormones, and iron.

• Eventually re-introduce performance goals once your body can actually adapt to training again.

You can't mentally out-train a deficit, and you can't recover from one on a diet.

• Is this screener actually validated?

  The individual risk domains are. The screener itself is not a published, peer-reviewed instrument; it's a self-assessment built on the indicators those instruments use. The LEAF-Q (validated for female athletes) and the IOC REDs CAT2 (the current clinician-administered standard) are the underlying sources. Use this as a starting point, not a final answer.

• Can men use this screener?

  Yes. The screener includes male-specific clinical indicators (libido, morning erections) that have been validated as endocrine markers of low energy availability in male athletes. The picture for men is less well-studied than for women, but the indicators are real.

• What if I'm on hormonal contraception?

  Hormonal contraception masks one of the most useful clinical signals (menstrual function), so the menstrual-specific questions don't apply. The rest of the screener still works. If you're on hormonal contraception and you suspect RED-S, the right move is a real clinical workup, because the easiest signal is hidden.

• What if I'm postmenopausal or don't have a menstrual cycle for other reasons?

  The menstrual section won't apply, and the rest of the screener still functions. Bone health, GI, energy, and mood indicators are still meaningful regardless of menstrual status.

• Does Khan RD work with athletes on RED-S?

  Yes. Sports nutrition and RED-S recovery are core to the practice. We're in-network with Aetna, BCBS, and UnitedHealthcare, and we work with athletes in person in Austin and virtually across Texas.

• Should I show my doctor this result?

  Yes, if it's helpful. The screener is structured around the indicators most clinicians know. Bringing a moderate or high-risk result to a sports medicine appointment can speed up the assessment process meaningfully.

At Khan RD, we work with Austin endurance athletes on RED-S recovery, fueling, and sustainable performance nutrition. In-network with Aetna, BCBS, and UnitedHealthcare.

The content of this blog does not serve as medical advice.