Sex, health, and athletes

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?