Girls really are different than boys, especially when it comes to sports. This trivial statement is even more significant in the realm of sports, where ignoring the differences between the sexes can lead to harm, especially for the female athlete. Sex differences do not make the female athlete less important. In fact, these differences make them more important and in need of special care to meet their physical and psychological needs as athletes.

The failure to recognize these issues has led to the emergence of a syndrome among female athletes commonly called the ìFemale Triad. This condition consists of three physical consequences that can emerge when female athletes are treated the same as their male counterparts. When females are subjected to conditioning and training for a sport, the subsequent physical changes can make the female athlete prone to the following medical problems:

Amenorrhea: This condition involves either the complete loss of menses, or irregular menstrual cycles created by an excessively low percentage of body fat. In most women, 18% body fat is necessary to store the hormones made by the body to regulate the menstrual cycle. When the desire to be quicker and faster requires a drop in body weight, the female athlete is at risk for developing this condition.

Osteoporosis: The emphasis on low body weight can often result in lowering dietary fat intake. Restricting the intake of dairy products like milk, cheese, ice cream etc. to reduce fat intake eliminates a vital source of calcium for the female athlete. Low intakes of calcium in the diet can result in bone loss, exacerbated by the increased calcium needs of an exercising adolescent.

Anorexia: The average girl will need to eat less than the average boy to maintain their body weight. This is true regardless of age and is based on the greater muscle mass in males due to higher testosterone levels. Lowering body size to make playing weight requires the female to eat less and less over time. By starting at a lower need at onset, lowering weight can cause the need for excessive calorie restrictions in female athletes, resulting in an abnormal relationship to food, poor nutrition, and an eating disorder.

Orthopedic and psychological differences between the sexes add to the importance of treating females different than males. The hip to knee structural relationship can subject the female athlete to increased risk for knee injury. There are specific sets of exercises that can be done to strengthen the knees, a program that is called ìThe Cincinnati Jump Program (see The psychological needs of adolescent females are not the same as males. Adolescent girls are typically more emotionally developed than boys. At that stage of life, girls spend time developing relationships based on emotional exchanges while boys relationships are based more on parallel play. As a result, the social importance of close relationships to coaches and teammates is usually higher and different for females than males.

I learned this fact from the coach of an elite and undefeated soccer team that coached one of my daughters. This no-nonsense coach was very demanding on the players. They trained often and hard, and were well schooled in the skills of soccer. However, on game day, the coach would be completely different. He allowed the girls to have fun on the sideline when they weren’t playing. They would braid each others hair, play the harmonica, or rough house with each other during the game. He rarely told them to stop, often much to the dismay of the parents who were concerned that the players were being distracted. Yet, when it was their turn to play, they turned on the switch, and were highly focused and intense, over and over again. Maybe there really is something to women being able to multi-task better than men!

The following recommendations are to be considered to address the special needs of the female athlete: A female athlete should start any conditioning without knowledge of their percent body fat.

If the female has a history of weight fluctuation, an Energy Study consisting of a resting metabolic rate (RMR) test should be considered to determine daily energy requirements to determine proper calorie intakes to accommodate training and metabolic energy requirements.

A female athlete needs to maintain proper nutrition and hydration, including special emphasis on calcium and iron needs.

A special conditioning program should be considered to strengthen knees and reduce risk of injury.

Consideration should be given to the athlete’s social needs when selecting teams and coaches.