Are High Endogenous Testosterone Levels Performance-Enhancing in Women?

Posted by The Evidence Blog on May 14, 2014

The use of performance-enhancing drugs among professional athletes is not new, and its toll on professional sports continues to grow. When we hear the term “performance-enhancing drug,” we usually think of drugs such as anabolic steroids that are taken by athletes to improve their performance. There is abundant evidence that supports current regulations regarding the use of performance-enhancement drugs in competitive sports. But what about athletes who have higher-than-normal levels of certain naturally occurring hormones? Should these athletes be singled out and banned from competition, too?

The New York Times recently posted an op-ed piece that called attention to revised eligibility rules for participation in women’s sporting events issued by the International Association for Athletics Federation (IAAF) and the International Olympics Commission (IOC) that do just that. Both the IAAF and IOC regulations target women with levels of androgenic hormones such as testosterone that are above the lower limit of normal for men, a condition called hyperandrogenism. We won’t go into details about the regulations here. You can read them yourself here.

The bottom line is if a female athlete’s natural testosterone levels are considered too high, she is expected to undergo treatment—surgery or medication—to reduce testosterone to levels considered to be within the normal range for women before she can participate in women’s sports. The rationale for these eligibility criteria is the presumption that in women, high levels of naturally occurring androgenic hormones have performance-enhancing effects. Thus, the assumption is that women with hyperandrogenism will be stronger, more powerful, and faster than female athletes who have lower testosterone levels, giving them an unfair advantage in competition.

As you can imagine, the regulations have met with criticism, and several experts have questioned the fundamental logic for applying such a standard. (We’ve linked to 3 sources at the end of this post.) The primary concern is that there is no definitive evidence linking higher testosterone levels with improved athletic performance.

The issue of how to balance a desire to ensure fairness in sports with respect and awareness of the physical diversity of the human body will continue to be a matter of much debate. Ideally, we would like to see evidence guide the governing bodies so that the regulations reflect true science rather than assumptions.

For additional information on this subject:

  • Xavier NA, McGill JB. Hyperandrogenism and intersex controversies in women’s olympics. J Clin Endocrinol Metab. 2012;97(11):3902-3907. Available at:
  • Sánchez FJ, Martínez-Patiño MJ, Vilain E. The new policy on hyperandrogenism in elite female athletes is not about “sex testing.” J Sex Res. 2013;50(2):112-115. Available at:
  • Karkazis K, Jordan-Young R, Davis G, Camporesi S. Out of bounds? A critique of the new policies on hyperandrogenism in elite female athletes [correction appears in Am J Bioeth. 2012;12(10):56]. Am J Bioeth. 2012;12(7):3-16. Available at:

Topics: Hayes Blog

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