Recurring injuries, chronic fatigue and decreased performance are all telltale signs that you might be experiencing Relative Energy Deficiency in Sport – known as RED-S. But there’s another red flag that might take you by surprise: fewer or absent morning erections.
The condition affects pro and recreational athletes alike, and is caused by low energy availability, either through under-fuelling or over-exercising. Essentially, you don’t have enough energy in the tank to complete daily life and training.
Your hormones take a hit when you have RED-S. So don’t be alarmed if your physio asks about your morning erections when working towards a diagnosis.
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‘It’s not intrusive. It’s a useful health signal,’ according to running physiotherapist Sophie Vecchione, who posted an Instagram reel on the topic. ‘Changes here can reflect disrupted hormone function, often linked to high training load, poor recovery, stress, or under-fuelling,’ she continues in the caption. ‘In male endurance athletes, this can be part of REDs (Relative Energy Deficiency in Sport).’
The reel features physiotherapist Luke Vanderfeen, who emphasises the importance of having this conversation with your healthcare provider if RED-S is a risk.
‘Some people might find it a little bit awkward talking to their physios about erections. Some of you might find it even more awkward talking to a female physio about it,’ Vecchione says in the video. ‘So, I’ve brought in my male colleague, Luke, to help explain why we might talk to you about your erections.’
‘One of the main reasons we’re going to ask questions like this is we know that hormonal changes can be one of the first signs of RED-S,’ Vanderfeen explains. ‘And, in guys, we start to see that a change in morning stiffness can indicate that our body is starting to preserve energy.’
How do you know what’s normal and what’s not? ‘’Normal’ in research looks between 5-7 times per week,’ Vanderfeen says. However, the biggest indicator that something’s off is if there are changes to your personal pattern.
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When there’s a limited energy supply, the body deprioritises non-essential systems. This results in a reduction in – or complete loss of – morning erections. A dip in testosterone can cause libido to plummet too.
Additional symptoms of RED-S in men include:
- Recurring illness
- Reduced muscle mass
- Poor recovery
- Decreased performance
- Low mood
- Recurring injuries, including stress fractures
- Irritability
- Brain fog
- Insomnia
- Digestive and gut health issues
RED-S is resolved with increased energy intake and reduced training load. Often, support from a GP, dietitian, psychologist or sports doctor is needed. ‘If you’ve noticed a change, tell your physio,’ Vecchione urges in the reel caption. ‘It helps us look beyond the injury and address the real drivers, with referral on when needed.’
This article by Abbi Henderson was originally published in Men’s Health UK
