The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine

Abstract

Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%–30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, but remains low in females. The primary goal of this consensus statement is to provide the latest scientific knowledge and mechanisms for the sex differences in athletic performance. This review highlights the differences in anatomy and physiology between males and females that are primary determinants of the sex differences in athletic performance and in response to exercise training, and the role of sex steroid hormones (particularly testosterone and estradiol). We also identify historical and nonphysiological factors that influence the sex differences in performance. Finally, we identify gaps in the knowledge of sex differences in athletic performance and the underlying mechanisms, providing substantial opportunities for high-impact studies. A major step toward closing the knowledge gap is to include more and equitable numbers of women to that of men in mechanistic studies that determine any of the sex differences in response to an acute bout of exercise, exercise training, and athletic performance.

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“…Individuals whose gender identity corresponds with their biological sex (or the sex designated at birth) (16).…”

“…A multidimensional construct that encompasses gender identity and expression, as well as social and cultural expectations about status, characteristics, and behavior as they are associated with certain sex traits (16).…”

“…Refers to peptide and steroid sex hormones secreted by the pituitary and the gonads (16). Many other organs, such as the liver, brain, adipose, adrenals, and the placenta, also can make de novo steroid sex hormones from cholesterol (17); however, after puberty (and until menopause in women), gonads are the major site for synthesis and secretion of sex steroid hormones.…”

“…Recognizing the need to share the latest scientific knowledge and subject matter expertise, the American College of Sports Medicine has published an expert consensus, "The Biological Basis of Sex Differences in Athletic Performance" (16), with the hopes "to contribute to the public dialogue by providing the latest scientific knowledge and subject matter expertise on the sex differences in athletic performance, while assisting with evidence-based solutions and ensure an equitable and fair solution for all" (24).…”

“…Research on biological sex-based performance is mixed. Men typically outperform women because of fundamental sex differences dictated by their sex chromosomes and sex hormones at puberty in sports rely on endurance, muscle strength, speed, and power (16).…”