I want you all to imagine a place where female athletes could come
and they could get interdisciplinary medical care
and they could get the answers to their questions
so that they could achieve peak performance
throughout their life span.
Where they could get educated
about the physical changes that happen during puberty,
where they could learn how to use their menstrual cycle
to their performance advantage,
where they could get sex-specific injury prevention advice,
where they could get nutritional advice,
mental health support,
where they could learn how to train through pregnancy and postpartum,
where they could learn how to train
through the menopausal transition and beyond.
We know that female sports involvement
correlates with female success.
So isn't it time that we started investing in our female athletes
and giving what they need
so that they can actually get to their full potential?
So I was born in 1972.
(Cheering)
That was a banner year, as we know,
because that was the year of Title IX.
And Title IX was this unbelievable legislation
that required that basically,
there were equal sporting opportunities for girls and women
in federally funded programs.
So it's not really surprising that I would grow up to be an elite athlete,
a sports medicine doctor, and a fierce advocate for women, right?
I mean, check me out.
Here I am crushing it in a three-legged sack race.
(Laughter)
And I started very young doing surgery.
This is me operating on my brother,
using a needle nose pliers to try to remove his appendix.
(Laughter)
Actually, I wasn't that sporty when I was a kid.
I was much more into music and theater,
big hair, big makeup, jazz hands.
(Laughter)
In fact, I didn't even pass
the president's physical fitness test in sixth grade.
(Laughter)
I was too slow at the 50-yard dash.
Poor Mrs. Leonard, she really tried with me.
So no one was more surprised than I was
when I got to college and I discovered rowing.
They just let me walk on.
There were no cuts, and I was not good.
But I loved it and I was determined to figure it out.
And that's where my journey began as a female athlete,
where I learned so many of those lessons that we all learn from sport:
teamwork, perseverance, grit.
I admit, I was a late bloomer,
but I still reap so many of those benefits that girls get from athletic involvement.
I had improved fitness,
overall better health, more confidence.
We know that studies show that sports participation in girls in high school
and women in college
correlates with better GPAs and higher graduation rates.
I lived that statistic.
I got good grades and I found my people.
And eventually I even made the varsity.
And so by the time I graduated, I was hungry for more.
I wanted to see what my potential was.
So I kept rowing, lots of rowing, lots of studying,
and I even made the US national team.
I did that while I was at Johns Hopkins Medical School.
I don't really recommend that combination.
(Laughter)
But my sixth grade gym teacher was really proud.
(Laughter)
And I kept training.
I did want to go to the Olympics, but I wasn't fast enough.
There were only two spots for lightweight women
in the lightweight double.
And so I had to head home in 2000.
I went back to medical school,
and I watched my friends row in Sydney from patient rooms in the hospital,
on the TV.
But I really needed to shift my focus.
I still loved sports, and I had to figure out
how I was going to combine my medical career with women's sports.
And I had learned a lot
from my time at the Olympic Training Center.
We really don't know if I ever reached my potential as an athlete,
but that experience was so good for me.
I experienced a lot, I witnessed a lot.
We had a male coach
who used to make us do a lot of the same workouts as the men.
It didn't matter whether we were lightweights or we were open weights,
whether we were in a single or an eight.
We did do lactate testing,
but we didn't get our blood checked for iron deficiency
or other nutritional deficiencies.
We had body composition testing,
but that was more for our coach to post
and show us where we each could lose more fat.
A lot of the lightweights lost their menstrual cycle.
We just thought that meant we were training hard
and we were working really hard, and we we're nice and lean.
You know, a lot of us developed poor body image.
And at that time, most of us didn't know what the female athlete triad was.
This combination of low energy availability,
where you don't eat enough calories for how much you're expending,
menstrual dysfunction
and poor bone health and stress fractures.
We had a doctor that would come in,
it was usually a different doctor every couple of weeks.
Nobody asked us about our periods, and we definitely didn’t talk about it.
You know, even the open-weight women had issues
where they would get urinary incontinence if they tried to do the track workouts.
So they were always trying to dodge the track workouts.
They'd come up with excuses so they could skip those practices.
And we didn't even know what normal medical care should be.
In rowing, a lot of us experienced rib stress injuries.
So those happen from overtraining, underfueling or a combination.
And so we didn't know if it was appropriate or not
when we went to see the doctor about a rib stress injury
that was off to the side
and he was doing a breast exam on all of us.
He didn't explain what he was doing.
We just didn't really feel comfortable with that.
He obviously wasn't familiar with rowers.
So I loved training with the other women,
but I didn’t really like the environment.
And I thought that female athletes deserved more.
So when I headed back to med school,
I decided to contact the US Olympic Committee,
what's now known as the US Olympic and Paralympic Committee.
And I thought, wow, it would be so great
to talk to the women who've been through all of this.
Do they have a database
of the former female athletes that have been involved in Olympic sports?
They said, "Of course we do.
We have contact information for over 700 people, 700 women."
I thought, awesome.
I would really like to survey them.
I'd like to ask them about their menstrual histories,
about their fertility,
about the different injuries they might have had.
How did they transition out of sport?
What kind of exercise were they doing now?
What were their long-term health issues?
And you know what the USOC said to me?
"Hell, no."
"Why? This is a really good group of people.
What a great group to learn from."
"Because we don't want to know.
It'll look bad for women.
And what are we going to do about it?"
So I did what most women do.
I felt bad and thought it was my fault.
"Well, shoot, I didn't become an Olympian.
So that's why they don't want to share it with me"
or, "I'm not done with med school yet.
That must be why they're not sharing this information."
So then I did the other thing that women often do.
I decided to put my head down
and just get overeducated and overcompensate.
So I finished med school.
I went off and studied biostatistics and epidemiology
at the Harvard School of Public Health.
I went to Penn and did my internal medicine residency.
And then I went back to Harvard and did a sports fellowship
and an endocrine fellowship.
At this point, my family, my friends,
my colleagues thought I was nuts.
They were like, "Will you just get on with it?
Why are you doing all this schooling? What are you afraid of?
And if you're really interested in sports medicine,
why don't you become an orthopedic surgeon?"
Usually sports is just run by orthopedic surgeons.
Well, I liked the OR,
and I liked watching surgeons put bones back together
and repair and reconstruct joints.
But I wanted to do something different with my career.
I was more interested in physiology.
I really thought that sports medicine should be interdisciplinary.
And I cared about endocrine, hormones and cardiovascular systems.
I cared about mental health and nutrition.
So then ...
I was lucky to have a male boss who actually believed in me.
He was a he-for-she,
an orthopedic surgeon who understood what I was saying.
And in 2013, he gave me the opportunity to launch a female athlete program.
That same year,
my friends and I thought it would be really cool
to throw a female athlete conference.
Now, we were scrappy,
but we just wanted to get coaches, athletes, parents,
other medical professionals, all together
so that we could talk about what we need to know about female athletes.
If people knew better, they could do better.
So we wanted to educate people.
We wanted to get the network together.
We wanted to collaborate.
So there were international people coming together
and we were combining resources.
And we wanted to inspire other people to do this work.
Our first conference was at a small school outside of Boston.
They donated the space to us.
Our out-of-town speakers stayed at my house.
But over time, we've grown.
It's now an international biennial female athlete conference.
The last one had people from over 32 countries.
And it’s something we really look forward to every year.
We’ve made huge connections, and we’re doing more research together
because of these connections.
But there's so much more to do.
We know that female athletes lag behind
in terms of their participation in sport
compared to boys.
And this dropout rate really widens as girls go through adolescence.
So we need to be doing more
because we know that sports actually doesn't only help with physical health
and mental health,
but it also helps propel girls into successful careers.
80 percent of female Fortune 500 executives were athletes.
94 percent of the women in C-suites did sports.
But between 2014 and 2020,
when you look at the top sports exercise science journals,
only six percent of the publications,
six percent of the articles, focused solely on women.
We've got to do better.
We can't just apply studies and data from male rats
and male humans to girls and women.
We're different.
So we kept plugging away,
and then 2020 hit.
And the world as we know it came to a screeching halt.
We were taking care of our family, our friends, our patients.
We lost loved ones.
We became depressed and stressed, and our athletes did too.
School was canceled.
Sports were canceled.
The Olympics were postponed.
And yet our female athlete clinic exploded
because our girls were handling the stress
by overexercising, underfueling, worrying about their body image.
They were getting injuries,
and they were getting severe eating disorders.
But two great things happened.
One, in a full-circle moment,
the new and improved US Olympic and Paralympic Committee contacted me
and asked me if I would cochair
a newly-formed Women's Health Task force.
What?
Of course.
(Applause and cheers)
They wanted me to determine the research needs
and develop treatment protocols for their athletes.
This was a new era.
Not only was I getting access to the database,
but they wanted transparency, and they wanted to work together
to help solve the issues.
And the other cool thing that happened
was that I was contacted by the advisor to a philanthropist.
Now, this is new territory for me.
I don’t usually get these kind of cold calls.
But they wanted me to work with five other individuals,
leaders from other institutions,
to help design and launch the Wu Tsai Human Performance Alliance.
They wanted us to work together
to discover principles of peak performance,
translate those to youth athlete development,
athletic excellence,
resiliency and healthy, long life spans.
And they wanted me to lead the female athlete component of that.
OK, So that should be the end of my TED Talk,
woo, and the rest of the world is great.
But this propelled us,
this got us to keep moving.
We were already doing all this international work,
and this gave us more energy and sped up the whole process.
We were already working on sex and menstrual cycle effects
on performance,
there's so much more we need to learn there.
We are working on relative energy deficiency in sport.
We continue our work with learning about pregnancy and postpartum,
psychological resilience,
injury prevention and recovery,
the intersections of race, gender, sexual orientation, class and ability,
as well as the effects of menopause.
I just told you I'm pushing 50.
My teammates and I, we want to know what's coming.
(Laughter)
But this is where you all come in.
Our sports systems, our medical systems,
our cultures are not built for girls and women.
We don't have a one-stop shop,
a physical facility to get all of this work done.
And people are looking to us, the Female Athlete Program,
to build this center.
We really are the ones who are supposed to be taking this deep dive.
But we need to be working together, and we need to have it all under one roof.
Like the vision we talked about.
Having the athletes come to us
and have all this stuff available in one place
and have sports scientists working together with them.
We want to do this so that we can be a model.
We're further along than anywhere else in the world,
but they're looking to us so that we can be the model
to help them build it elsewhere.
And we can collaborate and help let it grow.
We've been trying to launch this vision,
but we cannot just rely on Clara Wu and Joseph Tsai's generosity.
We need to demand more from others.
And so we need you to demand more from others.
We need people to really invest.
I'm talking about the sports companies,
the medical institutions and other foundations.
We don't just want lip service.
There are athletes who are afraid to tell their sponsors
that they want to get pregnant
because they're afraid they'll get dropped.
There are athletes who don't want to speak up when they're injured
because they're afraid they'll lose their sponsorship.
It's not good enough to just hang a shingle,
make a pretty sports bra,
or make a new sneaker.
We need more than that, we need true investment.
We need investment in our girls to let them know that they matter,
particularly in this political climate.
They need to hear it loud and clear.
Now I love the men in my family.
I have a father. I have a brother.
I have a husband and a son.
But this world was built for them.
I owe it to my grandmothers and my mother
and my teammates and my daughters.
And those women 50 years ago
who fought so hard for Title IX,
to keep fighting and keep the mission going.
So my challenge to you
is that I hope that you'll join me
and challenge the way things are.
To encourage the investment in women.
And please do not be afraid
of seeing girls realize their full potential.
Thank you.
(Applause)