Hyperandrogenism controversy in elite women’s sport: an examination and critique of recent evidence

Sönksen, Peter H.; Bavington, L. Dawn; Boehning, Tan; Cowan, David; Guha, Nishan; Holt, Richard; Karkazis, Katrina; Ferguson‐Smith, Malcolm A.; Mircetic, Jovan; Böhning, Dankmar

doi:10.1136/bjsports-2017-098446

Cited by 33 publications

(20 citation statements)

References 7 publications

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“…Furthermore, doping was excluded by doping tests. Sönksen et al note from our study that the athletes had comparable serum levels of testosterone with the controls and that there was no correlation between testosterone and physical performance in the athletes 3. However, they ignore the fact that we found increased serum levels of several precursor androgens including dehydroepiandrosterone (DHEA) in the athletes, compared with the controls.…”

Section: Eklund Et Al Studycontrasting

confidence: 51%

“…The main criticisms expressed about the data used and our statistical analysis were (1) our ‘concentration’ on free testosterone (fT) rather than total testosterone (T)3 (presumably because the T results were only presented in the Internet version of the paper), (2) the fact that 17.3% of the athletes were sampled at both World Championships (Daegu and Moscow),3 (3) the fact that no correlation analysis was performed other than comparison of fT or T tertiles,3 (4) the absence of statistical comparison between a group with high T levels and a group with normal T levels4 and (5) the lack of adjustment for multiple comparisons (suggesting that the significant differences observed in our study could have happened by chance) 5…”

Section: Bermon and Garnier Studymentioning

confidence: 99%

“…The Eklund et al study2 was criticised by Sönksen et al 3 due to its cross-sectional design of 106 female Olympic athletes and 117 sedentary controls. We agree that an intervention study is preferable to answer the question whether there is a causal effect of testosterone on physical performance in women.…”

Section: Eklund Et Al Studymentioning

confidence: 99%

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Serum androgen levels are positively correlated with athletic performance and competition results in elite female athletes

Bermon¹,

Hirschberg

Kowalski

et al. 2018

Br J Sports Med

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We thank our colleagues for their constructive comments that relate to our two articles in the July 2017 issue of BJSM. Bermon and Garnier StudyThe main criticisms expressed about the data used and our statistical analysis were (1) our 'concentration' on free testosterone (fT) rather than total testosterone (T) 3 (presumably because the T results were only presented in the Internet version of the paper), (2) the fact that 17.3% of the athletes were sampled at both World Championships (Daegu and Moscow), 3 (3) the fact that no correlation analysis was performed other than comparison of fT or T tertiles, 3 (4) the absence of statistical comparison between a group with high T levels and a group with normal T levels 4 and (5) the lack of adjustment for multiple comparisons (suggesting that the significant differences observed in our study could have happened by chance). 5Taking this last criticism first, we note that we presented an exploratory study, without no attempt to claim confirmatory results. In fact, the exploratory evidence presented in the study is strong, and correction for multiplicity may be too conservative. But we agree that the results should be put into context. At the type 1 error level of 0.05, we could expect 1 of 20 hypotheses tested to be significant merely by chance, that is, p <0.05. In this study, we have observed significant correlations at the 0.05 level in five events, out of 21 events in total. Therefore, it is very unlikely that all these findings are caused by chance. Moreover, the five flagged events were showing similar findings in both fT and T, which indicates that the evidence and findings are robust.Franklin et al report that, using Fisher's combination test, they were unable to reject the hypothesis that the p values calculated from the published data were not inconsistent with there being no advantage to high fT women in any of the five events, 5 but they do not explain their analysis in any detail or support their conclusion with any evidence. Their suggestion to conduct one single test of correlation across all 21 events combined is inappropriate because the hypothesis is that elevated testosterone levels enhance performance in certain events but not others. Combining results from the events of long sprint to middle-distance running shows with additional statistical calculation a p value of 0.003 for the correlation between testosterone levels and competition results, which is very strong statistical evidence for a true correlation not caused by chance. additional SenSitivity analySeSTo address the other criticisms, we have now performed a sensitivity analysis using a modified data set in which (1) observations from athletes who participated in both World Championships were only counted once, that is, the first observed value, and (2) only T concentrations were used (not fT). As for aggregating results, we used running events from 400 m up to 1 mile, on the basis that that is where T produces its greatest performance-enhancing effects (by increasing lean body mass and the...

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Section: Eklund Et Al Studycontrasting

confidence: 51%

Section: Bermon and Garnier Studymentioning

confidence: 99%

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Serum androgen levels are positively correlated with athletic performance and competition results in elite female athletes

Bermon¹,

Hirschberg

Kowalski

et al. 2018

Br J Sports Med

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“…While the new policy gave its rationale for this new upper limit in the final "End Notes" section, using testosterone as the singular determinant of sex categorization is inconsistent with medical practices, which use a multitude of markers to do so, such as internal/external genitals, gonads, and chromosomes (Karkazis, 2008;Pieper, 2016). Moreover, several scholars have pointed out irrefutable problems with the research methods, analysis of data, and conclusions drawn from the Bermon and Garnier (2017) study, thus invalidating the study, and calling into question the ethicality of the new 2018 IAAF policy (Franklin, Betancurt, & Camporesi, 2018;Karkazis & Carpenter, 2018;Menier, 2018;Pielke, 2018;Posbergh, 2018;Sönksen et al, 2018).…”

Section: The Newest 2018 Iaaf Policymentioning

confidence: 99%

Same Tricks, New Name: The IAAF’s New 2018 Testosterone Regulation Policy for Female Athletes

Posbergh

2019

IJIDI

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On April 26, 2018, the International Association of Athletics Federations (IAAF) released its updated version of its policy on athletes with hyperandrogenism, in a discriminatory attempt to define the term female through specified levels of testosterone, and to thereby provide asolution to the problem of athletes who fell outside of their socially constructed gender binary. The IAAF’s attempts to uphold this outdated binary system is a reflection of normalized scientific discourse which creates accepted, supposedly normal, behaviors and bodies at the expense of and resulting in the oppression of those who challenge these dominant regimes of knowledge (Foucault, 1978). Certainly, the prioritization of scientific knowledge is nothing new for the intersex community, given the history of irreversible genital surgery on newborns and young children with genitalia that is incongruent with current sex standards to make them fit societal gender ideals (Davis, 2015; Karkazis, 2008). In this paper, I trouble the IAAF’s supposed solution to intersex athletes through a Foucauldian understanding of biopower and science-based constructions of knowledge and truths, with particular attention to the perpetuation of health disparities within the intersex community. More specifically, I examine the site and role of female athletes’ bodies, such as Caster Semenya, whose rights to equitable and just treatment were cast aside in order to uphold artificially constructed and societally accepted ideas of male and female. I use Semenya’s narrative, coupled with the scientific discourse in the IAAF’s decision, to explore the subsequent, but unsurprisingly repetitive, reproduction of the hierarchical power relations between governing sports bodies and athletes, especially female athletes.

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“…Some have critiqued the study’s methodology, highly selective sample size (which seemingly included female athletes who had doped), and statistical processing [65-67]. Chand is unable to challenge the policy as she competes in the 100- and 200-m races, events not included in the new rules.…”

Section: Athletes and Hyperandrogenemiamentioning

confidence: 99%

The Interconnected Histories of Endocrinology and Eligibility in Women’s Sport

Rogol

Pieper

2018

Horm Res Paediatr

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This report illustrates the links between history, sport, endocrinology, and genetics to show the ways in which historical context is key to understanding the current conversations and controversies about who may compete in the female category in elite sport. The International Association of Athletics Federations (IAAF) introduced hyperandrogenemia regulations for women’s competitions in 2011, followed by the International Olympic Committee (IOC) for the 2012 Olympics. The policies concern female athletes who naturally produce higher-than-average levels of testosterone and want to compete in the women’s category. Hyperandrogenemia guidelines are the current effort in a long series of attempts to determine women’s eligibility scientifically. Scientific endeavors to control who may participate as a woman illustrate the impossibility of neatly classifying competitors by sex and discriminate against women with differences of sex development (also called intersex by some).

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Hyperandrogenism controversy in elite women’s sport: an examination and critique of recent evidence

Cited by 33 publications

References 7 publications

Serum androgen levels are positively correlated with athletic performance and competition results in elite female athletes

Serum androgen levels are positively correlated with athletic performance and competition results in elite female athletes

Same Tricks, New Name: The IAAF’s New 2018 Testosterone Regulation Policy for Female Athletes

The Interconnected Histories of Endocrinology and Eligibility in Women’s Sport

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