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Peter Sonksen, Malcolm A. Ferguson-Smith, L. Dawn Bavington, Richard I. G. Holt, David A. Cowan, Don H. Catlin, Bruce Kidd, Georgiann Davis, Paul Davis, Lisa Edwards, Anne Tamar-Mattis, Medical and Ethical Concerns Regarding Women With Hyperandrogenism and Elite Sport, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 3, 1 March 2015, Pages 825–827, https://doi.org/10.1210/jc.2014-3206
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In May 2011 and June 2012, respectively, the International Association of Athletics Federations (IAAF) (1) and the International Olympic Committee (IOC) (2) implemented new regulations governing the eligibility of female athletes with hyperandrogenism to compete in elite sport. The IAAF policy stipulates that a female athlete is eligible to compete in the women's category only if she has blood T levels below 10 nmol/L, the lower limit for men. Athletes found to have T levels above this lower limit, without an associated androgen insensitivity, are required to undergo medical intervention or risk being excluded from women's events. The move by the IAAF and IOC to use serum T as the sole biological variable to regulate eligibility in women's events has been met with controversy (3). Critics argue that this decision relies on the false assumption that T levels in blood determine athletic performance, which is not supported scientifically (4–7).
The IOC/IAAF policy is motivated by a misguided sense of “fairness.” The policymakers seem to believe that some natural qualities in women (like endogenous T) are so significantly associated with outstanding athletic performance that, unlike other naturally occurring variations that may affect performance, they must be diagnosed by testing and reduced or eliminated by medical intervention to create fairness in athletic competition. Even if it can be shown that high levels of natural T predictably determine better athletic performance (which the research to date does not support), we do not accept that it would necessarily violate the ideals of sport. We must point out that for many years now, natural advantage among male athletes has not been policed and reduced in sports, but on the contrary has been admired and celebrated. These are important arguments; however, our primary concern here is with the medical and ethical issues these policies raise regarding the governance of elite sport.
