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Women have always trained hard. The science surrounding how they fuel, recover, build bone, and respond to training has had a lot of catching up to do.

In this episode of The Ready State Podcast, Kelly and Juliet sit down with Dr. Kate Ackerman, a triple-boarded physician, former elite lightweight rower, and co-founder and president of the Women’s Health, Sports & Performance Institute (WHSP), to explore what changes when female physiology becomes part of the research question from the beginning.

Kate traces her work back to her own experience making weight as an athlete, then unpacks the evolution from the Female Athlete Triad to Relative Energy Deficiency in Sport (RED-S), including how underfueling can affect hormones, bone, cardiovascular health, injury risk, and performance. She explains why bone health begins much earlier than most people realize, how iron status should be evaluated in athletes, and why RED-S deserves attention in postmenopausal women, too.

They also dig into menopause research, strength training, GLP-1s, and WHSP’s mission to answer the questions women themselves say matter to their health and performance.

• How low energy availability and RED-S can affect bone, hormones, cardiovascular health, injury risk, and athletic performance and why RED-S can occur in both men and women.
• Why adolescence represents such an important window for building bone density, with roughly 90% of peak bone mass accrued by age 18.
• What athletes, parents, and coaches should understand about iron and ferritin, including why one lab value rarely tells the whole story.
• Why RED-S can matter after menopause, even when menstrual-cycle changes can no longer serve as a warning sign.
• How WHSP is approaching unanswered questions around female athletes across the lifespan, from adolescent health and pregnancy to menopause, strength training, hormone therapy, and performance.

(00:00) Intro: Dr. Kate Ackerman & the Future of Female Athlete Health

(04:35) Kate’s journey from collegiate rowing to lightweight competition

(06:04) Making weight, underfueling & Crystal Light cereal

(09:30) Extreme weight-cutting tactics in lightweight rowing

(12:05) When losing your menstrual cycle was a “badge of honor”

(12:44) The Female Athlete Triad & Kate’s experience with menstrual loss

(15:43) Kate’s unconventional path into sports medicine

(16:33) Becoming triple-boarded in internal medicine, sports medicine & endocrinology

(20:50) Understanding the Female Athlete Triad & RED-S

(21:10) Why Kate calls osteoporosis a “childhood disease”

(23:01) How low energy availability affects health & performance

(24:49) RED-S warning signs for parents, coaches & athletes

(29:16) Why WHSP was created & the research gap in female athletes

(30:26) Building a one-stop medical model around the female athlete

(33:33) Moving from reactive healthcare toward prevention & performance

(39:06) Iron deficiency, ferritin & what athletes should know about their labs

(41:26) Why ferritin alone doesn’t tell the whole story

(43:53) WHSP’s research across the female lifespan

(44:51) Menopause, hormone therapy & the questions we still need to answer

(47:16) Strength training, bone health & better markers for RED-S recovery

(48:47) What the Boston Marathon study revealed about underfueling & performance

(53:06) What female athletes say they actually want researchers to study

(55:10) RED-S in postmenopausal women

(56:43) What RED-S can look like without a menstrual cycle as a marker

(58:26) GLP-1s, underfueling & muscle loss

(1:01:02) Strength training research for postmenopausal women

(1:02:16) Kate’s vision for the future of female athlete health

(1:05:34) Infinite Shelf: Ted Lasso & The Nightingale

Huge thanks to our sponsors, BEDGEAR, Momentous, and LMNT.