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The myth of the female athlete triad
  1. L DiPietro,
  2. N S Stachenfeld
  1. The John B Pierce Laboratory, Yale University, New Haven, CT, USA
  1. Correspondence to:
 Dr Di Pietro
 The John B Pierce Laboratory, Yale University, New Haven, CT 06511, USA; ldipietro{at}

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The female athlete triad is defined as a syndrome consisting of three necessary components: (a) disordered eating; (b) amenorrhoea; (c) osteoporosis.1 The American College of Sports Medicine (ACSM) published a Position Stand in 1997,1 and at that time indicated a strong need for more epidemiological, laboratory, and clinical data to support the importance of this syndrome. Currently, the prevalence of regular vigorous activity among adolescent girls remains out of reach of the Year 2010 objectives,2 and the problem of overweight among young people has achieved epidemic proportions in the United States and other industrialised countries.3 Our concern is that triad related data may be misinterpreted and used as justification for setting health and social policies that may ultimately counter the US Public Health Service efforts to promote the benefits of athletic participation and an active lifestyle among children and adolescents.4 Moreover, there are ample historical and medical examples of iatrogenic eating and psychosexual disorders ascribed to otherwise healthy, hard driving, and passionate women in their pursuit of social independence, political power, or athletic excellence.5–8 In fact, until 1972, women were banned from very challenging athletic events such as the marathon, because officials of the Amateur Athletic Union (AAU) believed that such competition would be harmful to female reproductive function.8 Therefore we maintain that, as girls and young women are currently striving to attain the same level of accessibility and achievement in organised sports as their male counterparts, the creation of yet another form of female specific pathology undermines this hard earned success and may have other serious implications for their health and wellbeing. Our purpose in writing this article is to describe the female athlete triad with regard to its epidemiology and physiology and to offer our comments and opinions which challenge …

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  • Competing interests: none declared

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