Intended for healthcare professionals


Sex, health, and athletes

BMJ 2014; 348 doi: (Published 28 April 2014) Cite this as: BMJ 2014;348:g2926
  1. Rebecca M Jordan-Young, associate professor1,
  2. Peter H Sönksen, emeritus professor of endocrinology23,
  3. Katrina Karkazis, senior research scholar4
  1. 1Barnard College, Columbia University, New York, USA
  2. 2St Thomas’ Hospital and King’s College, London
  3. 3Southampton University, Southampton, UK
  4. 4Stanford University, 1215 Welch Road, Stanford, CA 93405, USA
  1. Correspondence to: K Karkazis karkazis{at}

Recent policy introduced by the International Olympic Committee to regulate hyperandrogenism in female athletes could lead to unnecessary treatment and may be unethical, argue Rebecca Jordan-Young, Peter Sönksen, and Katrina Karkazis

The International Olympic Committee (IOC) and international sports federations have recently introduced policies requiring medical investigation of women athletes known or suspected to have hyperandrogenism. Women who are found to have naturally high testosterone levels and tissue sensitivity are banned from competition unless they have surgical or pharmaceutical interventions to lower their testosterone levels.1 2

Sports authorities have argued that women with naturally high testosterone have an unfair advantage over women with lower levels, and thus the primary aim of the policies is to address this perceived advantage. However, sports bodies have also claimed that the investigations are for the medical benefit of athletes with hyperandrogenism.3 4 5 We consider this claim in the light of a new study of four young athletes (aged 18-21) from developing countries who had gonadectomy and “partial clitoridectomy” after being identified as hyperandrogenic under these policies.6 The report notes that these procedures were not required for health reasons. These interventions are invasive and irreversible, and given the potential number of female athletes affected the report prompts an important question: do the new policies undermine ethical care?

Why were policies on hyperandrogenism introduced?

The new rules were made in response to international outrage over the investigation of Caster Semenya, a South African middle distance runner, after fellow athletes questioned her sex at the 2009 Berlin world championships. After undergoing intensive medical and psychological examinations, Semenya said, “I have been subjected to unwarranted and invasive scrutiny of the most intimate and private details of my being.”7

Intended to improve the handling of such cases, these policies have nevertheless generated controversy.3 8 9 10 Most …

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