1
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Jennings K, Braun E. Beyond Suppressing Testosterone: A Categorical System to Achieve a "Level Playing Field" in Sport. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:4-17. [PMID: 37436362 DOI: 10.1080/15265161.2023.2232750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
Regulations implemented by World Athletics (WA) require female athletes with differences of sexual development to suppress their blood testosterone levels in order to participate in certain women's sporting competitions. These regulations have been justified by reference to fairness. In this paper, we reconstruct WA's understanding of fairness, which requires a "level playing field" where no athlete should have a significant performance advantage based on factors other than talent, dedication, and hard work over an average athlete in their category. We demonstrate that by placing regulations only on testosterone levels, while ignoring physical as well as socioeconomic advantages, WA consistently fails to meet its own definition of fairness. We then discuss several ways in which this definition could be met. Our analysis shows that a categorical system, in which athletes are divided into categories based on properties leading to significant performance advantages, is best suited for meeting WA's definition of fairness.
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2
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Handelsman DJ. Toward a Robust Definition of Sport Sex. Endocr Rev 2024; 45:709-736. [PMID: 38578952 DOI: 10.1210/endrev/bnae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/17/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
Elite individual sports in which success depends on power, speed, or endurance are conventionally divided into male and female events using traditional binary definitions of sex. Male puberty creates durable physical advantages due to the 20- to 30-fold increase in circulating testosterone producing a sustained uplift in men's muscle, bone, hemoglobin, and cardiorespiratory function resulting from male puberty and sustained during men's lives. These male physical advantages provide strong justification for a separate protected category of female events allowing women to achieve the fame and fortune from success they would be denied if competing against men. Recent wider social acceptance of transgender individuals, together with the less recognized involvement of intersex individuals, challenge and threaten to defeat the sex classifications for elite individual female events. This can create unfair advantages if seeking inclusion into elite female events of unmodified male-bodied athletes with female gender identity who have gained the physical advantages of male puberty. Based on reproductive physiology, this paper proposes a working definition of sport sex based primarily on an individual's experience of male puberty and can be applied to transgender and various XY intersex conditions. Consistent with the multidimensionality of biological sex (chromosomal, genetic, hormonal, anatomical sex), this definition may be viewed as a multistrand cable whose overall strength survives when any single strand weakens or fails, rather than as a unidimensional chain whose strength is only as good as its weakest link.
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Affiliation(s)
- David J Handelsman
- Andrology Department, ANZAC Research Institute, University of Sydney, Concord Hospital, Syndey, NSW 2139, Australia
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3
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Hunter SK, Senefeld JW. Sex differences in human performance. J Physiol 2024; 602:4129-4156. [PMID: 39106346 DOI: 10.1113/jp284198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/08/2024] [Indexed: 08/09/2024] Open
Abstract
Sex as a biological variable is an underappreciated aspect of biomedical research, with its importance emerging in more recent years. This review assesses the current understanding of sex differences in human physical performance. Males outperform females in many physical capacities because they are faster, stronger and more powerful, particularly after male puberty. This review highlights key sex differences in physiological and anatomical systems (generally conferred via sex steroids and puberty) that contribute to these sex differences in human physical performance. Specifically, we address the effects of the primary sex steroids that affect human physical development, discuss insight gained from an observational study of 'real-world data' and elite athletes, and highlight the key physiological mechanisms that contribute to sex differences in several aspects of physical performance. Physiological mechanisms discussed include those for the varying magnitude of the sex differences in performance involving: (1) absolute muscular strength and power; (2) fatigability of limb muscles as a measure of relative performance; and (3) maximal aerobic power and endurance. The profound sex-based differences in human performance involving strength, power, speed and endurance, and that are largely attributable to the direct and indirect effects of sex-steroid hormones, sex chromosomes and epigenetics, provide a scientific rationale and framework for policy decisions on sex-based categories in sports during puberty and adulthood. Finally, we highlight the sex bias and problem in human performance research of insufficient studies and information on females across many areas of biology and physiology, creating knowledge gaps and opportunities for high-impact studies.
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Affiliation(s)
- Sandra K Hunter
- Movement Science Program, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathon W Senefeld
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
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4
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Cheung AS, Zwickl S, Miller K, Nolan BJ, Wong AFQ, Jones P, Eynon N. The Impact of Gender-Affirming Hormone Therapy on Physical Performance. J Clin Endocrinol Metab 2024; 109:e455-e465. [PMID: 37437247 PMCID: PMC10795902 DOI: 10.1210/clinem/dgad414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
CONTEXT The inclusion of transgender people in elite sport has been a topic of debate. This narrative review examines the impact of gender-affirming hormone therapy (GAHT) on physical performance, muscle strength, and markers of endurance. EVIDENCE ACQUISITION MEDLINE and Embase were searched using terms to define the population (transgender), intervention (GAHT), and physical performance outcomes. EVIDENCE SYNTHESIS Existing literature comprises cross-sectional or small uncontrolled longitudinal studies of short duration. In nonathletic trans men starting testosterone therapy, within 1 year, muscle mass and strength increased and, by 3 years, physical performance (push-ups, sit-ups, run time) improved to the level of cisgender men. In nonathletic trans women, feminizing hormone therapy increased fat mass by approximately 30% and decreased muscle mass by approximately 5% after 12 months, and steadily declined beyond 3 years. While absolute lean mass remains higher in trans women, relative percentage lean mass and fat mass (and muscle strength corrected for lean mass), hemoglobin, and VO2 peak corrected for weight was no different to cisgender women. After 2 years of GAHT, no advantage was observed for physical performance measured by running time or in trans women. By 4 years, there was no advantage in sit-ups. While push-up performance declined in trans women, a statistical advantage remained relative to cisgender women. CONCLUSION Limited evidence suggests that physical performance of nonathletic trans people who have undergone GAHT for at least 2 years approaches that of cisgender controls. Further controlled longitudinal research is needed in trans athletes and nonathletes.
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Affiliation(s)
- Ada S Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
| | | | - Brendan J Nolan
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
| | - Alex Fang Qi Wong
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
| | - Patrice Jones
- Institute for Health and Sport (IHeS), Victoria University, Footscray 3011, Australia
| | - Nir Eynon
- Institute for Health and Sport (IHeS), Victoria University, Footscray 3011, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton 3800, Australia
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5
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Hunter SK, S Angadi S, Bhargava A, Harper J, Hirschberg AL, D Levine B, L Moreau K, J Nokoff N, Stachenfeld NS, Bermon S. The Biological Basis of Sex Differences in Athletic Performance: Consensus Statement for the American College of Sports Medicine. Med Sci Sports Exerc 2023; 55:2328-2360. [PMID: 37772882 DOI: 10.1249/mss.0000000000003300] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
ABSTRACT Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%-30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, but remains low in females. The primary goal of this consensus statement is to provide the latest scientific knowledge and mechanisms for the sex differences in athletic performance. This review highlights the differences in anatomy and physiology between males and females that are primary determinants of the sex differences in athletic performance and in response to exercise training, and the role of sex steroid hormones (particularly testosterone and estradiol). We also identify historical and nonphysiological factors that influence the sex differences in performance. Finally, we identify gaps in the knowledge of sex differences in athletic performance and the underlying mechanisms, providing substantial opportunities for high-impact studies. A major step toward closing the knowledge gap is to include more and equitable numbers of women to that of men in mechanistic studies that determine any of the sex differences in response to an acute bout of exercise, exercise training, and athletic performance.
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Affiliation(s)
- Sandra K Hunter
- Exercise Science Program, Department of Physical Therapy, and Athletic and Human Performance Center, Marquette University, Milwaukee, WI
| | | | - Aditi Bhargava
- Department of Obstetrics and Gynecology, Center for Reproductive Sciences, University of California, San Francisco, CA
| | - Joanna Harper
- Loughborough University, Loughborough, UNITED KINGDOM
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, SWEDEN
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kerrie L Moreau
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, and Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, CO
| | - Natalie J Nokoff
- Department of Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Nina S Stachenfeld
- The John B. Pierce Laboratory and Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Stéphane Bermon
- Health and Science Department, World Athletics, Monaco and the LAMHESS, University Côte d'Azur, Nice, FRANCE
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6
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Di Luigi L, Greco EA, Fossati C, Aversa A, Sgrò P, Antinozzi C. Clinical Concerns on Sex Steroids Variability in Cisgender and Transgender Women Athletes. Int J Sports Med 2023; 44:81-94. [PMID: 36174581 DOI: 10.1055/a-1909-1196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In the female athletic community, there are several endogenous and exogenous variables that influence the status of the hypothalamus-pituitary-ovarian axis and serum sex steroid hormones concentrations (e. g., 17β-estradiol, progesterone, androgens) and their effects. Moreover, female athletes with different sex chromosome abnormalities exist (e. g., 46XX, 46XY, and mosaicism). Due to the high variability of sex steroid hormones serum concentrations and responsiveness, female athletes may have different intra- and inter-individual biological and functional characteristics, health conditions, and sports-related health risks that can influence sports performance and eligibility. Consequently, biological, functional, and/or sex steroid differences may exist in the same and in between 46XX female athletes (e. g., ovarian rhythms, treated or untreated hypogonadism and hyperandrogenism), between 46XX and 46XY female athletes (e. g., treated or untreated hyperandrogenism/disorders of sexual differentiation), and between transgender women and eugonadal cisgender athletes. From a healthcare perspective, dedicated physicians need awareness, knowledge, and an understanding of sex steroid hormones' variability and related health concerns in female athletes to support physiologically healthy, safe, fair, and inclusive sports participation. In this narrative overview, we focus on the main clinical relationships between hypothalamus-pituitary-ovarian axis function, endogenous sex steroids and health status, health risks, and sports performance in the heterogeneous female athletic community.
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Affiliation(s)
- Luigi Di Luigi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
| | - Emanuela A Greco
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy.,Department of Science of Movement, Università degli Studi Niccolò Cusano, Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Paolo Sgrò
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
| | - Cristina Antinozzi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
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7
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Jensen M, Schorer J, Faber IR. How is the Topic of Intersex Athletes in Elite Sports Positioned in Academic Literature Between January 2000 and July 2022? A Systematic Review. SPORTS MEDICINE - OPEN 2022; 8:130. [PMID: 36264373 PMCID: PMC9584019 DOI: 10.1186/s40798-022-00520-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Within the topic of intersex athletes in elite sports, science has become a decisive factor in decision- and policy-making. However, in the academic literature approaches to this topic vary. An overview of these approaches is proposed to provide better insight into relevant aspects and underlying values and may serve as a starting point on the path toward a solid solution of the question of categorization of intersex athletes in elite sporting competition. OBJECTIVE This systematic review aims to discover how the topic of intersex elite athletes is positioned in the academic literature from January 2000 to July 2022 from a neutral perspective. METHODS A comprehensive search in eleven databases using the search terms [intersex* and sport*] yielded 87 articles. A qualitative content analysis was conducted to find all authors' statements including perspectives on intersex athletes and proposals for solutions. Underlying values were extracted and connected to each other during axial coding. RESULTS The results provide an overview of the sometimes-contradictory perspectives toward intersex elite athletes and proposals for solutions. Three core values were distilled: social justice for intersex elite athletes, competition fairness, and evidence-based practice. The authors' statements disclose an interaction/conflict between social justice and competition fairness. CONCLUSIONS The results raise an important discussion on the role of science within the topic of intersex elite athletes. A multidisciplinary approach including scientists and other experts is suggested to find an appropriate solution. Additionally, more awareness on intersex variations is needed for a better overall understanding and to ensure a respectful approach for everyone involved.
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Affiliation(s)
- Marisa Jensen
- grid.5560.60000 0001 1009 3608Institute of Sport Science, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Jörg Schorer
- grid.5560.60000 0001 1009 3608Institute of Sport Science, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Irene R. Faber
- grid.5560.60000 0001 1009 3608Institute of Sport Science, Carl Von Ossietzky University, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany ,grid.449957.20000 0004 0487 360XResearch Centre Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, The Netherlands
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8
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Loland S. Caster Semenya, athlete classification, and fair equality of opportunity in sport. JOURNAL OF MEDICAL ETHICS 2020; 46:584-590. [PMID: 32690761 DOI: 10.1136/medethics-2019-105937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 06/11/2023]
Abstract
According to the Differences of Sex Development (DSD) Regulations of the International Association of Athletics Federations (IAAF), Caster Semenya and other athletes with heightened testosterone levels are considered non-eligible for middle distance running races in the women's class. Based on an analysis of fair equality of opportunity in sport, I take a critical look at the Semenya case and at IAAF's DSD Regulations. I distinguish between what I call stable and dynamic inequalities between athletes. Stable inequalities are those that athletes cannot impact or control in any significant way such as inequalities in biological sex, body size and chronological age. Dynamic inequalities, such as inequalities in strength, speed and endurance, or in technical and tactical skills, can be impacted and to a certain extent controlled by athletes. If stable inequalities exert significant and systematic impact on performance, they provide a rationale for classification. If high testosterone level is an inborn, strong and systemic driver of performance development, inequalities in such levels can provide a rationale for classification. As is emphasised by the Court of Arbitration for Sport (CAS), this leads to a dilemma of rights: the right of Semenya to compete in sport according to her legal sex and gender identity, and the right of other athletes within the average female testosterone range to compete under fair conditions. I conclude with providing conditional support of the CAS decision in the Semenya case and of IAAF's DSD Regulations.
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Affiliation(s)
- Sigmund Loland
- Department of Sport and Social Sciences, The Norwegian School of Sport Sciences, Oslo, Norway
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9
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Khattab A, Marshall I, Radovick S. Controversies surrounding female athletes with differences in sexual development. J Clin Invest 2020; 130:2738-2740. [DOI: 10.1172/jci138479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Handelsman DJ, Hirschberg AL, Bermon S. Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance. Endocr Rev 2018; 39:803-829. [PMID: 30010735 PMCID: PMC6391653 DOI: 10.1210/er.2018-00020] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022]
Abstract
Elite athletic competitions have separate male and female events due to men's physical advantages in strength, speed, and endurance so that a protected female category with objective entry criteria is required. Prior to puberty, there is no sex difference in circulating testosterone concentrations or athletic performance, but from puberty onward a clear sex difference in athletic performance emerges as circulating testosterone concentrations rise in men because testes produce 30 times more testosterone than before puberty with circulating testosterone exceeding 15-fold that of women at any age. There is a wide sex difference in circulating testosterone concentrations and a reproducible dose-response relationship between circulating testosterone and muscle mass and strength as well as circulating hemoglobin in both men and women. These dichotomies largely account for the sex differences in muscle mass and strength and circulating hemoglobin levels that result in at least an 8% to 12% ergogenic advantage in men. Suppression of elevated circulating testosterone of hyperandrogenic athletes results in negative effects on performance, which are reversed when suppression ceases. Based on the nonoverlapping, bimodal distribution of circulating testosterone concentration (measured by liquid chromatography-mass spectrometry)-and making an allowance for women with mild hyperandrogenism, notably women with polycystic ovary syndrome (who are overrepresented in elite athletics)-the appropriate eligibility criterion for female athletic events should be a circulating testosterone of <5.0 nmol/L. This would include all women other than those with untreated hyperandrogenic disorders of sexual development and noncompliant male-to-female transgender as well as testosterone-treated female-to-male transgender or androgen dopers.
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Affiliation(s)
- David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord, New South Wales, Australia.,Department of Andrology, Concord Hospital, Sydney, New South Wales, Australia
| | - Angelica L Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stephane Bermon
- Laboratoire Motricité Humaine, Education, Sport, Santé, Université Côte d'Azur, Nice, France.,Health and Science Department, International Association of Athletics Federations, Monaco
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11
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Ospina Betancurt J, Zakynthinaki MS, Martinez-Patiño MJ, Cordente Martinez C. Hyperandrogenic athletes: performance differences in elite-standard 200m and 800m finals. J Sports Sci 2018; 36:2464-2471. [PMID: 29659337 DOI: 10.1080/02640414.2018.1464620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The purpose of this study was to examine whether the difference in elite-standard track and field performance between women athletes with and without hyperandrogenism reaches the 10-12% difference in performance between men and women, using only results from elite-standard track and field final competitions. Officially available data from two hyperandrogenic women (Caster Semenya and Dutee Chand) were compared with the characteristic performance of 200m and 800m elite-standard finals. The finishing times of Caster Semenya, before her ineligibility to compete in 2009 and after the suspension of the 2011 IAAF Hyperandrogenism Regulations were found to be respectively 1.24% and 1.49% faster than the predicted performance in 800m finals. When compared with the result of the second classified, the difference was respectively 0.65% and 2.08%. The analysis of the finishing times of Dutee Chand did not lead to any conclusions due to the lack of available data. The present study indicates that the percentage difference in performance between women with and women without hyperandrogenism does not reach the 3% difference requested by the Court of Arbitration for Sport for the reinstatement of the Hyperandrogenism Regulations, neither does it reach the 10% accepted range of difference in performance between men and women.
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Affiliation(s)
- Jonathan Ospina Betancurt
- a Faculty of Health Sciences, Physical Activity and Sports Sciences , Isabel I University , Burgos , Spain
| | - Maria S Zakynthinaki
- b Department of Electronics , University of Applied Sciences of Crete (TEI) , Chania , Greece.,c Applied Mathematics and Computers Laboratory , Technical University of Crete , Chania , Greece
| | - Maria Jose Martinez-Patiño
- d Department of Special Didactics, Faculty of Education Sciences , University of Vigo , Pontevedra , Spain
| | - Carlos Cordente Martinez
- e Faculty of Sciences for Physical Activity and Sport (INEF) , Technical University of Madrid , Madrid , Spain
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12
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Sönksen PH, Holt RIG, Böhning W, Guha N, Cowan DA, Bartlett C, Böhning D. Why do endocrine profiles in elite athletes differ between sports? Clin Diabetes Endocrinol 2018; 4:3. [PMID: 29445518 PMCID: PMC5804043 DOI: 10.1186/s40842-017-0050-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endocrine profiles have been measured on blood samples obtained immediately post-competition from 693 elite athletes from 15 Olympic Sports competing at National or International level; four were subsequently excluded leaving 689 for the current analysis. METHODS Body composition was measured by bioimpedance in a sub-set of 234 (146 men and 88 women) and from these data a regression model was constructed that enabled 'estimated' lean body mass and fat mass to be calculated on all athletes. One way ANOVA was used to assess the differences in body composition and endocrine profiles between the sports and binary logistical regression to ascertain the characteristic of a given sport compared to the others. RESULTS The results confirmed many suppositions such as basketball players being tall, weightlifters short and cross-country skiers light. The hormone profiles were more surprising with remarkably low testosterone and free T3 (tri-iodothyronine) in male powerlifters and high oestradiol, SHBG (sex hormone binding globulin) and prolactin in male track and field athletes. Low testosterone concentrations were seen 25.4% of male elite competitors in 12 of the 15 sports and high testosterone concentrations in 4.8% of female elite athletes in 3 of the 8 sports tested. Interpretation of the results is more difficult; some of the differences between sports are at least partially due to differences in age of the athletes but the apparent differences between sports remain significant after adjusting for age. The prevalence of 'hyperandrogenism' (as defined by the IAAF (International Association of Athletics Federations) and IOC (International Olympic Committee)) amongst this cohort of 231 elite female athletes was the highest so far recorded and the very high prevalence of 'hypoandrogenism' in elite male athletes a new finding. CONCLUSIONS It is unclear whether the differences in hormone profiles between sports is a reason why they become elite athletes in that sport or is a consequence of the arduous processes involved. For components of body composition we know that most have a major genetic component and this may well be true for endocrine profiles.
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Affiliation(s)
- Peter H. Sönksen
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Richard I. G. Holt
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Walailuck Böhning
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Nishan Guha
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
- Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - David A. Cowan
- Department of Pharmacy and Forensic Science, Drug Control Centre, King’s College London, London, UK
| | - Christiaan Bartlett
- Department of Pharmacy and Forensic Science, Drug Control Centre, King’s College London, London, UK
| | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
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13
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Sőnksen PH, Bavington LD, Boehning T, Cowan D, Guha N, Holt R, Karkazis K, Ferguson-Smith MA, Mircetic J, Bőhning D. Hyperandrogenism controversy in elite women's sport: an examination and critique of recent evidence. Br J Sports Med 2018; 52:1481-1482. [PMID: 29351951 DOI: 10.1136/bjsports-2017-098446] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Peter H Sőnksen
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Endocrinology, St Thomas' Hospital and King's College, London, UK
| | - L Dawn Bavington
- School of Physical Education, University of Otago, Dunedin, New Zealand
| | - Tan Boehning
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Cowan
- Department of Pharmacy and Forensic Science, Drug Control Centre, King's College London, London, UK
| | - Nishan Guha
- Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Richard Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Katrina Karkazis
- Center for Biomedical Ethics, Stanford University, Stanford, California, USA
| | | | - Jovan Mircetic
- Medical Faculty Carl Gustav Carus, Technical University, Dresden, Saxony, Germany
| | - Dankmar Bőhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
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14
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Kasai F, Ferguson-Smith MA. A collection of XY female cell lines. Hum Cell 2018; 31:175-178. [PMID: 29330774 DOI: 10.1007/s13577-017-0195-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
Discordance between sexual phenotype and the 46,XY sex chromosome complement may be found in certain disorders of sexual development (DSD). Many of these DSD patients with female external genitalia and secondary sex characteristics have undescended testes and male internal genitalia. Causative mutations involving genes of the sex determining pathway, including the androgen receptor, SRY and the 5-alpha-reductase genes, are well-known, but the origin of other cases remain unresolved. In this report, we introduce our collection of lymphoblastoid lines derived from female patients with a 46,XY karyotype. These cell lines have been deposited and registered with the JCRB Cell Bank. They are available for comparison with other DSD cases and for further characterization of genetic loci involved in the mammalian sex determining pathway.
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Affiliation(s)
- Fumio Kasai
- Japanese Collection of Research Bioresources (JCRB) Cell Bank, Laboratory of Cell Cultures, National Institutes of Biomedical Innovation, Health and Nutrition, Saito-Asagi, Ibaraki, Osaka, 567-0085, Japan. .,Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK.
| | - Malcolm A Ferguson-Smith
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK.
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15
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Brodsky JL, Genel M. The 2015 Pediatric Endocrine Society Ethics Symposium: Controversies Regarding 'Gender Verification' of Elite Female Athletes - Sex Testing to Hyperandrogenism. Horm Res Paediatr 2017; 85:273-7. [PMID: 26918844 DOI: 10.1159/000444170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/20/2016] [Indexed: 11/19/2022] Open
Abstract
An overview of the Pediatric Endocrine Society's Ethics Symposium held in April 2015 at the annual meeting of the Pediatric Academic Societies is provided by the panel moderators with a summary of efforts by international athletic governing bodies over several decades to 'verify' the eligibility of athletes to compete in female only events, culminating in the hyperandrogenism policies that were the focus of the panel debate. This history was extensively reviewed in the symposium's opening presentation by Alan Rogol, in collaboration with Lindsay Pieper. Two sharply divergent views were then conveyed. David Allen's, in support, is provided in his article which follows. The opposing case, provided by Katrina Karkazis, is extensively summarized herein and reflected in her Science essay with Rebecca Jordan-Young which appeared shortly after the meeting. The subsequent ruling by the international Court of Arbitration for Sport to suspend the hyperandrogenism rule is noted with some speculation regarding the implications if it is upheld.
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16
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Rogol AD, Pieper LP. Genes, Gender, Hormones, and Doping in Sport: A Convoluted Tale. Front Endocrinol (Lausanne) 2017; 8:251. [PMID: 29075233 PMCID: PMC5643412 DOI: 10.3389/fendo.2017.00251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/13/2017] [Indexed: 11/14/2022] Open
Abstract
We are writing this piece in the aftermath of the 2016 Olympic Games in Rio de Janeiro, Brazil. Each of the words in the title plays a role(s) in deciding who may compete, especially who may compete as a woman. We shall be careful to disentangle the issues of genes and gender from hormonal levels of the potent androgen testosterone, and very clearly demarcate these natural occurrences from those of doping, for which the World Anti-Doping Agency has established strict guidelines. These elements became conflated in the aftermath of the Court of Arbitration of Sport's decision, now more than 2 years ago, concerning the teenage Indian sprinter, Dutee Chand. Although many people associate hyperandrogenism with doping and gender determination, each is different and has a distinct function.
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Affiliation(s)
- Alan D. Rogol
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
- *Correspondence: Alan D. Rogol,
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17
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Sonksen P. Determination and regulation of body composition in elite athletes. Br J Sports Med 2016; 52:219-229. [DOI: 10.1136/bjsports-2016-096742] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/04/2016] [Accepted: 10/23/2016] [Indexed: 11/04/2022]
Abstract
In 2011, the International Association of Athletics Federations (IAAF) and IOC introduced a ‘hyperandrogenism’ rule that excluded women with a serum testosterone >10 nmol/L from participating in elite sport. This rule was based on the false premise that the greater lean body mass in men was a consequence of their higher serum testosterone. This rule did not have scientific backing and the Court of Arbitration for Sport subsequently rescinded the rule following an appeal from an Indian athlete barred from the Commonwealth Games. This review covers the scientific knowledge about the development and regulation of body composition in humans but also considers the lessons learnt from evolution and breeding in animals. The importance of heredity has been documented in family and twin studies. The roles of growth hormone and sex steroids are reviewed. The Androgen Insensitivity Syndrome (AIS) is considered as a model of the role of testosterone in development of body composition and also as evidence of the importance of other factors carried on the Y-chromosome that are of prime importance but have been systematically ignored. Finally the key factors determining body composition are considered and placed in a suggested order of importance.
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18
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Prokop JW, Deschepper CF. Chromosome Y genetic variants: impact in animal models and on human disease. Physiol Genomics 2015; 47:525-37. [PMID: 26286457 DOI: 10.1152/physiolgenomics.00074.2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Chromosome Y (chrY) variation has been associated with many complex diseases ranging from cancer to cardiovascular disorders. Functional roles of chrY genes outside of testes are suggested by the fact that they are broadly expressed in many other tissues and correspond to regulators of basic cellular functions (such as transcription, translation, and protein stability). However, the unique genetic properties of chrY (including the lack of meiotic crossover and the presence of numerous highly repetitive sequences) have made the identification of causal variants very difficult. Despite the prior lack of reliable sequences and/or data on genetic polymorphisms, earlier studies with animal chrY consomic strains have made it possible to narrow down the phenotypic contributions of chrY. Some of the evidence so far indicates that chrY gene variants associate with regulatory changes in the expression of other autosomal genes, in part via epigenetic effects. In humans, a limited number of studies have shown associations between chrY haplotypes and disease traits. However, recent sequencing efforts have made it possible to greatly increase the identification of genetic variants on chrY, which promises that future association of chrY with disease traits will be further refined. Continuing studies (both in humans and in animal models) will be critical to help explain the many sex-biased disease states in human that are contributed to not only by the classical sex steroid hormones, but also by chrY genetics.
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Affiliation(s)
- J W Prokop
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama; and
| | - C F Deschepper
- Institut de recherches cliniques de Montréal (IRCM) and Université de Montréal, Montreal, Quebec, Canada
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19
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Bermon S, Vilain E, Fénichel P, Ritzén M. Women with hyperandrogenism in elite sports: scientific and ethical rationales for regulating. J Clin Endocrinol Metab 2015; 100:828-30. [PMID: 25587809 DOI: 10.1210/jc.2014-3603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The recent implementation by some major sports-governing bodies of policies governing eligibility of females with hyperandrogenism to compete in women's sports has raised a lot of attention and is still a controversial issue. This short article addresses two main subjects of controversy: the existing scientific basis supporting performance enhancing of high blood T levels in elite female athletes, and the ethical rationale and considerations about these policies. Given the recently published data about both innate and acquired hyperandrogenic conditions and their prevalence in elite female sports, we claim that the high level of androgens are per se performance enhancing. Regulating women with clinical and biological hyperandrogenism is an invitation to criticism because biological parameters of sex are not neatly divided into only two categories in the real world. It is, however, the responsibility of the sports-governing bodies to do their best to guarantee a level playing field to all athletes. In order not cloud the discussions about the policies on hyperandrogenism in sports, issues of sports eligibility and therapeutic options should always be considered and explained separately, even if they may overlap. Finally, some proposals for refining the existing policies are made in the present article.
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Affiliation(s)
- Stéphane Bermon
- Laboratoire Motricité Humaine, Education, Sport, Santé (S.B.), Nice Sophia Antipolis University, 06107 Nice, France; Monaco Institute of Sports Medicine and Surgery (S.B.), 98000 Monaco; Department of Human Genetics and Unité Centre National de la Recherche Scientifique Unité Mixte Internationale 3663 "Epigenetics, Data, Politics" (E.V.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-7088; Department of Reproductive Endocrinology (P.F.), and INSERM Unité 1065, Hôpital l'Archet, University Hospital of Nice, 06200 Nice, France; and Department of Women's and Children's Health (M.R.), Karolinska Institutet and University Hospital, SE-141 86 Stockholm, Sweden
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