Br J Sports Med 46:614-617 doi:10.1136/bjsm.2010.082552
  • Original articles

Sex and gender issues in competitive sports: investigation of a historical case leads to a new viewpoint

Open Access
  1. J Anton Grootegoed2
  1. 1Department of Forensic Molecular Biology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Reproduction and Development, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to J Anton Grootegoed, Department of Reproduction and Development, Erasmus MC – University Medical Center Rotterdam, Room Ee 09-71, PO Box 2040, 3000 CA Rotterdam, The Netherlands; j.a.grootegoed{at}
  1. Contributors KNB and MK designed the experiments, KNB carried out the experiments, MK provided lab equipment and test materials, all authors contributed to the data interpretation, the writing of this manuscript was led by JAG, and all authors approved the final manuscript.

  • Accepted 28 March 2011
  • Published Online First 3 May 2011


Based on DNA analysis of a historical case, the authors describe how a female athlete can be unknowingly confronted with the consequences of a disorder of sex development resulting in hyperandrogenism emerging early in her sports career. In such a situation, it is harmful and confusing to question sex and gender. Exposure to either a low or high level of endogenous testosterone from puberty is a decisive factor with respect to sexual dimorphism of physical performance. Yet, measurement of testosterone is not the means by which questions of an athlete's eligibility to compete with either women or men are resolved. The authors discuss that it might be justifiable to use the circulating testosterone level as an endocrinological parameter, to try to arrive at an objective criterion in evaluating what separates women and men in sports competitions, which could prevent the initiation of complicated, lengthy and damaging sex and gender verification procedures.


  • Note On 12 April 2011, the International Association of Athletics Federations (IAAF) announced the adoption of new rules and regulations governing the eligibility of females with hyperandrogenism to participate in women's competition, which will come into force from 1 May 2011 (

    It appears that these new IAAF rules, as announced, are in full agreement with the viewpoint expressed in our article, which at the time of the IAAF announcement was already in press with the British Journal of Sports Medicine. We would like to emphasise that our viewpoint was composed independently from IAAF, and that none of the authors has been in contact with the respective IAAF expert working group.

  • Funding KNB and MK were supported by the Netherlands Forensic Institute (NFI), and the Netherlands Genomics Initiative (NGI)/Netherlands Organization for Scientific Research (NWO) within the framework of the Forensic Genomics Consortium Netherlands (FGCN).

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This paper is freely available online under the BMJ Journals unlocked scheme, see