Intended for healthcare professionals


Sex, gender, and sports

BMJ 2019; 364 doi: (Published 20 March 2019) Cite this as: BMJ 2019;364:l1120
  1. Cara Tannenbaum, professor of medicine and pharmacy12,
  2. Sheree Bekker, prize research fellow3
  1. 1Université de Montreal, Montreal, Canada
  2. 2Institute of Gender and Health, Canadian Institutes of Health Research
  3. 3Department for Health, University of Bath, Bath, UK
  4. Correspondence to: C Tannenbaum

New regulations challenge the evidence based, benevolent ethos that underlies medical practice

In 2018, the International Association of Athletics Federations (IAAF) introduced new eligibility regulations for female athletes with differences of sex development, including those with congenital adrenal hyperplasia, androgen insensitivity syndrome, and 5α-reductase deficiency (box 1).1 The regulations are based on the contention that women with high levels of endogenous testosterone and androgen sensitivity have a performance advantage over their peers. Athletics South Africa and Mokgadi Caster Semenya, the South African runner who won Olympic gold medals in 2012 and 2016, are contesting the legality of the new regulations.

Box 1

IAAF eligibility regulations for female athletes with differences of sex development1

  • The regulations apply to athletes in events from 400 m to 1 mile, including 400 m, hurdles races, 800 m, 1500 m, 1 mile races, and combined events over the same distances

  • Any athlete who has a difference of sexual development, defined by a circulating testosterone concentration ≥5 nmol/L, and who is androgen sensitive must meet the following criteria to be eligible to compete in restricted events in an international competition or to set a world record in a competition that is not international:

  • She must be recognised in law as either female or intersex (or equivalent)

  • She must reduce her blood testosterone concentration to below 5 nmol/L for a continuous period of at least six months (for example, by using hormonal contraceptives)

  • Thereafter she must maintain her …

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