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Hyperandrogenism controversy in elite women’s sport: an examination and critique of recent evidence
  1. Peter H Sőnksen1,2,
  2. L Dawn Bavington3,
  3. Tan Boehning1,
  4. David Cowan4,
  5. Nishan Guha5,
  6. Richard Holt1,
  7. Katrina Karkazis6,
  8. Malcolm Andrew Ferguson-Smith7,
  9. Jovan Mircetic8,
  10. Dankmar Bőhning9
  1. 1 Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
  2. 2 Department of Endocrinology, St Thomas’ Hospital and King’s College, London, UK
  3. 3 School of Physical Education, University of Otago, Dunedin, New Zealand
  4. 4 Department of Pharmacy and Forensic Science, Drug Control Centre, King’s College London, London, UK
  5. 5 Clinical Biochemistry, Oxford University Hospitals NHS Trust, Oxford, UK
  6. 6 Center for Biomedical Ethics, Stanford University, Stanford, California, USA
  7. 7 Veterinary Medicine, University of Cambridge, Cambridge, UK
  8. 8 Medical Faculty Carl Gustav Carus, Technical University, Dresden, Saxony, Germany
  9. 9 Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
  1. Correspondence to Professor Peter H Sőnksen, East Wing Preshaw House, Preshaw, Southampton, Southampton SO32 1HP, UK; PHSonksen{at}aol.com

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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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