Women with hyperandrogenism may face ban from competitive sports

Issue: June 2011

If a female athlete has androgen levels in the male range, she may be ineligible to compete as a woman, according to new rules and regulations adopted by the International Association of Athletics Federations.

The International Association of Athletics Federations (IAAF) is the first group to approve the new policy governing the eligibility of women with hyperandrogenism in competitive sports. The rules were recommended by the International Olympic Commission and then accepted by the IAAF on April 12. The regulations are the culmination of an 18-month review by a working group that studied issues related to the participation of female athletes with hyperandrogenism in athletics, according to the IAAF.

The androgen cut-off levels are not yet specified. However, the normal total testosterone range for an adult woman is typically defined as 15 ng/dL to 70 ng/dL. For men, the range is typically 260 ng/dL to 1,000 ng/dL.

As stated by the IAAF, the new rules and regulations will be published and implemented for all International Competitions on May 1, 2011. Key principles include:

A woman with hyperandrogenism who is recognized as a female by law shall be eligible to compete in women’s competition in athletics provided that she has androgen levels below the male range (as measured by reference to testosterone levels in serum); or, if she has androgen levels within the male range she also has an androgen resistance, which means that she derives no competitive advantage from such levels.
Competition in athletics will continue to be divided into men’s and women’s competition, recognizing that there is a difference in sporting performance between elite men and women that is predominantly due to higher levels of androgenic hormones in men.
A pool of international medical experts has been appointed by the IAAF to review cases referred to it under the regulations as an independent expert medical panel and to make recommendations to the IAAF in such cases to decide on the eligibility of female athletes with hyperandrogenism.
A three-level medical process under the regulations shall ensure that all potentially relevant data are made available to the expert medical panel for the purposes of evaluating an athlete’s eligibility. This medical process may include, where necessary, the expert medical panel referring an athlete with potential hyperandrogenism for full examination and diagnosis in accordance with best medical practice at one of the six IAAF-approved specialist reference centers around the world.
The medical process under the regulations shall be conducted in strict confidentiality and all cases shall be referred to the expert medical panel on an anonymous basis.
A female athlete who declines, fails or refuses to comply with the eligibility determination process under the regulations shall not be eligible to compete in women’s competition.

The IAAF Council further modified its existing regulations concerning the participation in women’s competition of athletes who have undergone male to female sex reassignment. These regulations will also be published on May 1, 2011.

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