This paper is the first of two publications comprising a 2025 update to the 2014 Consensus Statement on treatment and return-to-play guidelines on the Female Athlete Triad (Triad), defined as three inter-related components including energy status, reproductive function, and bone health. The Triad is initiated by exposure to varying degrees of energy deficiency with or without disordered eating/eating disorders with primary pathological outcomes to the reproductive and skeletal systems. This first paper includes a detailed update on the scientific underpinnings of the Triad and introduces a new Triad model specific to the adolescent female athlete. Energy deficiency and "metabolic compensation" are added to the energy status continuum to describe adaptations that reflect energy conservation. Ovarian steroid hormone exposure and functional hypothalamic oligo-amenorrhea are added to the reproductive function continuum. Bone stress injury is added to the bone health continuum. Rates of change are depicted for the induction and recovery of clinical outcomes within the adult model. Evidence-based statements are presented throughout the paper and supported by a high number of level A and B grades. Key Points: In this 2025 updated Female Athlete Triad Coalition Consensus Statement, the term "energy deficiency" is used in association with the energy status spectrum instead of "low energy availability." Low energy availability (defined as the difference between energy intake and exercise energy expenditure normalized for fat free mass) is now one of several indicators of energy deficiency in addition to low body weight and/or weight loss, low body mass index, and/or indications of metabolic compensation. "Metabolic compensation" is introduced to refer to factors that reflect adaptive processes to reallocate the body`s energy resources for the purpose of energy conservation. Bone stress injuries are added to the bone health continuum to reflect the well-established data demonstrating that Female Athlete Triad components are consistently associated with an increased risk of a bone stress injury, which often precipitates a stress fracture. Ovarian steroid hormones have been added to the reproductive continuum in light of evidence demonstrating that nutritional interventions that provide increased energy intake not only result in the recovery of menses, but also the recovery of ovarian steroid concentrations and ovulation. It remains questionable whether recovery of bone mineral density is possible following nutritional interventions of increased energy intake.
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