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The limitations of a cross-sectional study design
In July 2017, the International Association of Athletics Federations (IAAF) was expected to return to the Court of Arbitration for Sport (CAS) with evidence to justify reinstatement of their controversial hyperandrogenism rule. CAS has granted IAAF a 2-month extension for their response, which was due by the end of September. CAS suspended the IAAF Hyperandrogenism Regulations1 2 years earlier following the successful appeal by the Indian runner Dutee Chand.2 IAAF advisors have published two recent articles in this journal3 4 to support their claims that women with high endogenous testosterone levels have such a significant performance advantage over women with lower levels that it is necessary to exclude them from competing in the female category.
Both papers have examined the relationship between blood testosterone concentration and athletic performance using a cross-sectional design. While such studies can show the presence of association, they do not prove causality and no mention is made of the possible importance of associated androgen insensitivity, while in some there may be a contribution from …
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