Medical and Ethical Concerns Regarding Women With Hyperandrogenism and Elite Sport

Sönksen, Peter H.; Ferguson‐Smith, Malcolm A.; Bavington, L. Dawn; Holt, Richard; Cowan, David; Catlin, Don H.; Kidd, Bruce; Davis, Georgiann; Davis, Paul; Edwards, Lisa; Tamar-Mattis, Anne

doi:10.1210/jc.2014-3206

Cited by 28 publications

(14 citation statements)

References 9 publications

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“…42 The rationale for this is unclear, and establishment of any firm cut-off has been suspended pending further data and discussion, regarding acceptable levels of testosterone in female athletes. [42][43][44] The distinct ranges of serum testosterone levels presented in these studies should inform the discussion of cut-offs between males and females.…”

Section: Discussionmentioning

confidence: 96%

Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex‐specific competition in sports, a narrative review

Clark

Wald²,

Swerdloff

et al. 2018

Clinical Endocrinology

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Section: Discussionmentioning

confidence: 96%

Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex‐specific competition in sports, a narrative review

Clark

Wald²,

Swerdloff

et al. 2018

Clinical Endocrinology

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“…However, an exception is CAIS, since in this case the individual cannot respond to testosterone although she has testosterone in the male range. These rules, designed to preserve the safety, fairness and integrity of women's competition, and in no way to determine sex or gender, have been subjected to debate and criticism (63,64,65,66,67,68).…”

Section: Regulations Concerning the Eligibility To Compete As A Womanmentioning

confidence: 99%

Female hyperandrogenism and elite sport

Hirschberg

2020

Endocrine Connections

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Emerging evidence indicates that testosterone, which can increase muscle mass and strength, stimulates erythropoiesis, promotes competitive behaviour, and enhances the physical performance of women. Indeed, the levels of testosterone within the normal female range are related to muscle mass and athletic performance in female athletes. Furthermore, among these athletes, the prevalence of hyperandrogenic conditions, including both polycystic ovary syndrome and rare differences/disorders of sex development (DSD), which may greatly increase testosterone production, are elevated. Thus, if the androgen receptors of an individual with XY DSD are functional, her muscle mass will develop like that of a man. These findings have led to the proposal that essential hyperandrogenism is beneficial for athletic performance and plays a role in the choice by women to compete in athletic activities. Moreover, a recent randomized controlled trial demonstrated a significant increase in the lean mass and aerobic performance by young exercising women when their testosterone levels were enhanced moderately. Circulating testosterone is considered the strongest factor to explain the male advantage in sport performance, ranging between 10 and 20%. It appears to be unfair to allow female athletes with endogenous testosterone levels in the male range (i.e. 10–20 times higher than normal) to compete against those with normal female androgen levels. In 2012, this consideration led international organizations to establish eligibility regulations for the female classification in order to ensure fair and meaningful competition, but the regulations are controversial and have been challenged in court.

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“…This new language stating that surgical changes are not required is likely in response to criticism of an IAAF study that revealed that four women aged 18-21 from Brural and mountainous regions of developing countries,^ (Fénichel et al 2013 had been subjected to medically unnecessary surgery, including gonadectomy, in order to comply with prior regulations (Jordan-Young, Sönksen, and Karkazis 2014;Sönksen et al 2015). The IAAF identified the athletes through various means and had sent them to the IAAF-approved specialist reference centre in France for assessment (Fénichel et al 2013.…”

Section: Bwhat Else the Athlete Must Do To Qualify^: Medically Unnecementioning

confidence: 99%

Impossible “Choices”: The Inherent Harms of Regulating Women’s Testosterone in Sport

Karkazis

Carpenter

2018

Bioethical Inquiry

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In April 2018, the International Association of Athletics Federations (IAAF) released new regulations placing a ceiling on women athletes' natural testosterone levels to "ensure fair and meaningful competition." The regulations revise previous ones with the same intent. They require women with higher natural levels of testosterone and androgen sensitivity who compete in a set of "restricted" events to lower their testosterone levels to below a designated threshold. If they do not lower their testosterone, women may compete in the male category, in an intersex category, at the national level, or in unrestricted events. Women may also challenge the regulation, whether or not they have lowered their testosterone, or quit sport. Irrespective of IAAF's stated aims, the options forced by the new regulations are impossible choices. They violate dignity, threaten privacy, and mete out both suspicion and judgement on the sex and gender identity of the athletes regulated.

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Medical and Ethical Concerns Regarding Women With Hyperandrogenism and Elite Sport

Cited by 28 publications

References 9 publications

Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex‐specific competition in sports, a narrative review

Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex‐specific competition in sports, a narrative review

Female hyperandrogenism and elite sport

Impossible “Choices”: The Inherent Harms of Regulating Women’s Testosterone in Sport

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