What is the evidence for a Triad-like syndrome in exercising men?

Recently, an expert panel under the leadership of the Female and Male Athlete Triad Coalition (Coalition) convened and determined that there was sufficient evidence to date to warrant an official consensus statement and naming of a Triad-like condition in exercising men which will be published in 2019. Our understanding of a Triad-like condition in men will be developed using an evidence-based medicine approach to ensure the accuracy of the component conditions and their physiological relationships, and with the understanding that it is clinically diagnosable and treatable. This review will present the current evidence on low energy availability, reproductive function, and bone health in exercising men to provide an overview of an initial working model of a similar Triad-like syndrome in male athletes. In male athletes, it appears that both the hypothalamic gonadal axis and the skeletal system are impacted by low energy availability and energy deficiency. The impact of energy deficiency on bone in male athletes appears to occur frequently with a relatively high incidence of bone stress injuries presenting in the presence of low bone mineral density, and the impact to the hypothalamic gonadal axis seems to be translated to both spermatogenesis and androgenic hormonogenesis with both oligospermia and low testosterone concentrations observed. Lastly, men appear to be robust and more resilient to the effects of low energy availability compared to women, requiring more severe energetic perturbations before alterations are observed and are more quickly reversible in men than in women.