The International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) adopted testosterone level criteria for eligibility (i.e. 10 nmol/l or 290 ng/dl in blood for IAAF, levels ‘within the male range' for IOC) to compete in the ‘includes females' category. The policies address the assertion that women with very high endogenous testosterone (unless they are androgen-resistant) have an unfair advantage over women with lower natural levels. Recently, the Court of Arbitration for Sport suspended the ‘hyperandrogenism regulation' by the IAAF, but added: ‘since there are separate categories of male and female competition, it is necessary for the IAAF to formulate a basis for the division of athletes into male and female categories for the benefit of the broad class of female athletes. The basis chosen should be necessary, reasonable and proportionate to the legitimate objective being pursued' [Branch J: Dutee Chand, Female Sprinter with High Testosterone Level, Wins Right to Compete. The New York Times, July 27, 2015]. An analysis of available evidence below - scientific as well as experiential - suggests that androgen-based criteria can, in fact, be rationally defended as the best currently available and practical approach to determine eligibility for competition in the ‘includes females' category. However, to justify such policies, the IOC and IAAF must also show them to be not only rational, but also fair, necessary, and consistent with the treatment of athletes with other endogenous non-physiologic advantages.

Karkazis K, Jordan-Young R: Science and society. Debating a testosterone ‘sex gap'. Science 2015;348:858-860.
Braunstein GD, Reitz RE, Buch A, Schnell D, Caulfield MP: Testosterone reference ranges in normally cycling healthy premenopausal women. J Sex Med 2011;8:2924-2934.
Bermon S, Garnier PY, Hirschberg AL, Robinson N, Giraud S, Nicoli R, Baume N, Saugy M, Fenichel P, Bruce SJ, et al: Serum androgen levels in elite female athletes. J Clin Endocrinol Metabol 2014;99:4328-4335.
Healy ML, Gibney J, Pentecost C, Wheeler MJ, Sonksen PH: Endocrine profiles in 693 elite athletes in the postcompetition setting. Clin Endocrinol 2014;81:294-305.
Ritzen M, Ljungqvist A, Budgett R, Garnier PY, Bermon S, Linden-Hirschberg A, Vilain E, Martinez-Patino MJ: The regulations about eligibility for women with hyperandrogenism to compete in women's category are well founded. A rebuttal to the conclusions by Healy et al. Clin Endocrinol 2015;82:307-308.
Sonksen P, Ferguson-Smith MA, Bavington LD, Holt RI, Cowan DA, Catlin DH, Kidd B, Davis G, Davis P, Edwards L, et al: Medical and ethical concerns regarding women with hyperandrogenism and elite sport. J Clin Endocrinol Metabol 2015;100:825-827.
Franke WW, Berendonk B: Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government. Clin Chem 1997;43:1262-1279.
Rickenlund A, Carlstrom K, Ekblom B, Brismar TB, von Schoultz B, Hirschberg AL: Hyperandrogenicity is an alternative mechanism underlying oligomenorrhea or amenorrhea in female athletes and may improve physical performance. Fertil Steril 2003;79:947-955.
Van Caenegem E, Wierckx K, Taes Y, Dedecker D, Van de Peer F, Toye K, Kaufman JM, T'Sjoen G: Bone mass, bone geometry, and body composition in female-to-male transsexual persons after long-term cross-sex hormonal therapy. J Clin Endocrinol Metabol 2012;97:2503-2511.
Karkazis K, Jordan-Young R, Davis G, Camporesi S: Out of bounds? A critique of the new policies on hyperandrogenism in elite female athletes. Am J Bioeth 2012;12:3-16.
Bermon S, Ritzen M, Hirschberg AL, Murray TH: Are the new policies on hyperandrogenism in elite female athletes really out of bounds? Response to ‘out of bounds? A critique of the new policies on hyperandrogenism in elite female athletes'. Am J Bioeth 2013;13:63-65.
Hutchinson A: An Imperfect Dividing Line. The New Yorker, March 2015.
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