Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study
Abstract
Objective: To investigate the effects of a moderate increase in serum testosterone on physical performance in young, physically active, healthy women. Methods: A double blind, randomised, placebo controlled trial was conducted between May 2017 and June 2018 (ClinicalTrials.gov ID: NCT03210558). 48 healthy, physically active women aged 18–35 years were randomised to 10 weeks of treatment with 10 mg of testosterone cream daily or placebo (1:1). All participants completed the study. The primary outcome measure was aerobic performance measured by running time to exhaustion (TTE). Secondary outcomes were anaerobic performance (Wingate test) and muscle strength (squat jump (SJ), counter movement jump (CMJ) and knee extension peak torque). Hormone levels were analysed and body composition assessed by dual energy X-ray absorptiometry. Results: Serum levels of testosterone increased from 0.9 (0.4) nmol/L to 4.3 (2.8) nmol/L in the testosterone supplemented group. TTE increased significantly by 21.17 s (8.5%) in the testosterone group compared with the placebo group (mean difference 15.5 s; P=0.045). Wingate average power, which increased by 15.2 W in the testosterone group compared with 3.2 W in the placebo group, was not significantly different between the groups (P=0.084). There were no significant changes in CMJ, SJ and knee extension. Mean change from baseline in total lean mass was 923 g for the testosterone group and 135 g for the placebo group (P=0.040). Mean change in lean mass in the lower limbs was 398 g and 91 g, respectively (P=0.041). Conclusion: The study supports a causal effect of testosterone in the increase in aerobic running time as well as lean mass in young, physically active women.
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Hyperandrogenic 46,XY DSD female athletes in the 2011 IAAF World Championships were 140 times more prevalent (0.7% of athletes had testosterone concentrations >15.6 nmol/L) compared to 0.005% reported in the general population.
“Hyperandrogenic 46, XY DSD female athletes in the 2011 IAAF World Championships were 140 times more prevalent (0.7% of athletes had testosterone concentrations of > 15.6 nmol/L [20]) compared to 0.005% [20, 21] reported in the general population [22, 23]”
From Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement (2021) · cites this paper as [22]
The study of 24 healthy physically active women reported improved running time to exhaustion during an incremental maximal test on a treadmill by 21.17 s (8.5%) and an increase in lean body mass.
“This study reported improved running time to exhaustion during an incremental maximal test on a treadmill by 21.17 s (8.5%) and an increase in lean body mass.”
From Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement (2021) · cites this paper as [22]
Support for the <5 nmol/L limit for transwomen athletes emerges from a study where 24 healthy, physically active women aged 18-35 years underwent 10 weeks of testosterone treatment.
“The support for the < 5 nmol/L limit (Table 1) for transwomen athletes emerges from a study where 24 healthy, physically active women aged 18–35 years underwent 10 weeks of testosterone treatment [22].”
From Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement (2021) · cites this paper as [22]
The average testosterone concentrations of participants in the 10-week testosterone treatment study did not exceed 5 nmol/L (from 0.9 ± 0.4 to 4.3 ± 2.8 nmol/L), considerably below the 10 nmol/L threshold used by the IOC.
“the average testosterone concentrations of these participants did not exceed 5 nmol/L (from 0.9 ± 0.4 to 4.3 ± 2.8 nmol/L) [22], which is considerably below the 10 nmol/L threshold used by the IOC [54].”
From Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement (2021) · cites this paper as [22]
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- Authors
- Hirschberg, A. L., Elings Knutsson, J., Helge, T., Godhe, M., Ekblom, M., Bermon, S., & Ekblom, B.
- Affiliations
- Karolinska University Hospital (SE)
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Swedish School of Sport and Health Sciences (SE)
- Monaco Institute of Sports Medicine, Monaco
- Astrand Laboratory of Work Physiology, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Corresponding author
- Hirschberg, Angelica Lindén
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2019-10-15
- Volume
- 54
- Issue
- 10
- Pages
- 599-604
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2981269334
- Cited by
- 106
- References
- 31
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 12 · 2023: 24 · 2022: 12 · 2021: 15 · 2020: 13 · 2019: 1
- FWCI
- 8.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Karolinska Institutet
- Swedish Military Forceś Research Authorities (#AF9220914)
- International Athletics Foundation
- Swedish Research Council for Sport Science
- Swedish Research Council (2017-02051)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- testosterone supplementation, serum testosterone, physical performance, young women, aerobic performance, time to exhaustion, anaerobic performance, muscle strength, lean body mass, body composition, physically active women
- MeSH terms
- Adolescent, Adult, Body Composition, Double-Blind Method, Exercise Test, Female, Humans, Running, Sex Characteristics, Testosterone, Body Mass Index, Muscle Strength, Athletic Performance, Young Adult, Performance-Enhancing Substances
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