Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing physiological mechanisms without systematic review methodology.
PubMed 30010735 · doi:10.1210/er.2018-00020
What was done
This narrative review synthesized physiological and endocrine evidence regarding sex differences in athletic performance, focusing on circulating testosterone, muscle mass, strength, and hemoglobin levels across life stages to evaluate biological criteria for female sports eligibility.
What was found
Post-pubertal male testes produce 30 times more testosterone than before puberty, causing circulating testosterone to exceed female levels by more than 15-fold. This divergence exhibits a dose-response relationship with muscle mass, strength, and hemoglobin, resulting in an estimated 8% to 12% ergogenic advantage in men. Suppressing elevated testosterone in hyperandrogenic athletes reduces performance, an effect reversed upon stopping suppression. Based on liquid chromatography-mass spectrometry measurements showing a bimodal distribution, the authors recommend a serum testosterone cutoff of <5.0 nmol/L for female athletic eligibility to accommodate athletes with mild hyperandrogenism such as polycystic ovary syndrome.
Why it matters
It establishes a quantitative, endocrine-based rationale for setting specific serum testosterone thresholds to regulate entry criteria in sex-segregated elite sports.
Limits
The abstract describes a narrative review rather than a systematic review or empirical trial, omitting formal study selection criteria and aggregated sample sizes. Applying a single physiological cutoff across diverse sports assumes androgen sensitivity and performance advantages scale uniformly across all athletic disciplines.
Cited by
- supports Men have approximately 10 to 20 times more testosterone than women.