Serum Androgen Levels in Elite Female Athletes
Abstract
Objective: Prior to the implementation of the blood steroidal module of the Athlete Biological Passport, we measured the serum androgen levels among a large population of high-level female athletes as well as the prevalence of biochemical hyperandrogenism and some disorders of sex development (DSD). Methods and Results: In 849 elite female athletes, serum T, dehydroepiandrosterone sulphate, androstenedione, SHBG, and gonadotrophins were measured by liquid chromatography-mass spectrometry high resolution or immunoassay. Free T was calculated. The sampling hour, age, and type of athletic event only had a small influence on T concentration, whereas ethnicity had not. Among the 85.5% that did not use oral contraceptives, 168 of 717 athletes were oligo- or amenorrhoic. The oral contraceptive users showed the lowest serum androgen and gonadotrophin and the highest SHBG concentrations. After having removed five doped athletes and five DSD women from our population, median T and free T values were close to those reported in sedentary young women. The 99th percentile for T concentration was calculated at 3.08 nmol/L, which is below the 10 nmol/L threshold used for competition eligibility of hyperandrogenic women with normal androgen sensitivity. Prevalence of hyperandrogenic 46 XY DSD in our athletic population is approximately 7 per 1000, which is 140 times higher than expected in the general population. Conclusion: This is the first study to establish normative serum androgens values in elite female athletes, while taking into account the possible influence of menstrual status, oral contraceptive use, type of athletic event, and ethnicity. These findings should help to develop the blood steroidal module of the Athlete Biological Passport and to refine more evidence-based fair policies and recommendations concerning hyperandrogenism in female athletes.
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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 [20]
The high prevalence of hyperandrogenic 46,XY DSD female athletes in the 2011 IAAF World Championships could be an indicator of performance advantage.
“which could be an indicator of performance advantage [20].”
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 [20]
The first three conditions, components of 46,XY DSDs, are 140-fold more prevalent among elite female athletes than expected in the general population.
“There is evidence that the first three conditions, components of 46,XY DSDs, are 140-fold more prevalent among elite female athletes than expected in the general population (80).”
From Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance (2018) · cites this paper as [80]
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Collomp, K., Buisson, C., Gravisse, N., Belgherbi, S., Labsy, Z., Do, M., Gagey, O., Dufaÿ, S., Vibarel-Rebot, N., & Audran, M. (2018) · Endocrine · doi:10.1007/s12020-017-1514-z · Cited by 18 · see citing works
“, steroid screening) [45, 46], to be followed by a second confirmatory analysis using mass spectrometry (MS) techniques [47], which take more time.”
BackgroundOberlin, D. J. (2023) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2023.1224476 · Cited by 21 · see citing works
Barsky, S. T., & Monks, D. A. (2025) · Biology of Sex Differences · doi:10.1186/s13293-025-00707-6 · Cited by 19 · see citing works
“There seems to be greater prevalence of androgen dysregulation in elite-level female athletes via polycystic ovarian syndrome (PCOS) [273–276], and in experimental settings, women show responsiveness to androgen supplementation in an age-and dose-dependent manner [277–280], supporting the…”
Women With Hyperandrogenism in Elite Sports: Scientific and Ethical Rationales for Regulating
Bermon, S., Vilain, E. J. N., Fénichel, P., & Ritzen, M. E. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3603 · Cited by 17 · see citing works
Self-citationAllen, D. B. (2016) · Hormone Research in Paediatrics · doi:10.1159/000444054 · Cited by 17 · see citing works
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“FAI measurement helps determine whether a cycle is ovulatory or not, as it is elevated in anovulatory cycles [16,18].”
BackgroundIs testosterone responsible for athletic success in female athletes?
Ahmetov, I. I., Stepanova, A. A., Маулетовна, Б. Э., Semenova, E. A., Сергеевна, Щ. И., Bets, L. V., Andryushchenko, L. B., Borisov, O., Andryushchenko, O. N., Generozov, E. V., et al. (2020) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.20.10171-3 · Cited by 17 · see citing works
Kidd, B. (2017) · Sport in Society · doi:10.1080/17430437.2018.1401357 · Cited by 15 · see citing works
“(Bermon et al. 2014) ‘My mind’s made up–don’t confuse me with the facts’ has been a long-standing pattern of the medical commissions.”
BackgroundGenes, Gender, Hormones, and Doping in Sport: A Convoluted Tale
Rogol, A. D., & Pieper, L. P. (2017) · Frontiers in Endocrinology · doi:10.3389/fendo.2017.00251 · Cited by 17 · see citing works
“Why the controversy? Should the levels of testosterone (alone) be the arbiter, irrespective of other naturally occurring variations? There are two large sets of data from elite athletes (23, 24).”
BackgroundThe Fairest of Them All: Gender-Determining Institutions and the Science of Sex Testing
Pape, M. (2017) · Emerald Group Publishing Limited eBooks · doi:10.1108/s1529-212620170000024011 · Cited by 15 · see citing works
Allyship in Elite Women’s Sport
Teetzel, S. (2020) · Sport Ethics and Philosophy · doi:10.1080/17511321.2020.1775691 · Cited by 15 · see citing works
Bushell, A., & Crespi, B. J. (2024) · Frontiers in Reproductive Health · doi:10.3389/frph.2024.1475132 · Cited by 14 · see citing works
Crewther, B. T., Hamilton, D., Kilduff, L. P., Drawer, S., & Cook, C. J. (2017) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2017.09.017 · Cited by 14 · see citing works
Sport intensif et troubles du cycle chez la jeune femme : retentissement sur la masse osseus
Maïmoun, L., Paris, F., Coste, O., & Sultan, C. (2016) · Gynécologie Obstétrique & Fertilité · doi:10.1016/j.gyobfe.2016.09.001 · Cited by 7 · see citing works
Androgenic steroid excess in women
Karila, D., Kerlan, V., & Christin‐Maître, S. (2023) · Annales d Endocrinologie · doi:10.1016/j.ando.2023.11.001 · Cited by 11 · see citing works
Lafitte, A., Dupuit, M., Chassard, T., Barlier, K., Badier, N., Duclos, M., Toussaint, J., & Antero, J. (2024) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2024-002078 · Cited by 10 · see citing works
“14 15 Such studies, however, involved a single cycle, and questions also remained related to the precise phases when measurements were taken, as well as whether the salivary test would capture such differences.”
The Interconnected Histories of Endocrinology and Eligibility in Women’s Sport
Rogol, A. D., & Pieper, L. P. (2018) · Hormone Research in Paediatrics · doi:10.1159/000493646 · Cited by 11 · see citing works
The unfinished race: 30 years of gender verification in sport
Martínez‐Patiño, M. J., Vilain, E. J. N., & Guerra, N. B. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30963-1 · Cited by 9 · see citing works
Schultz, J. (2024) · Oxford University Press eBooks · doi:10.1093/oso/9780197616499.001.0001 · Cited by 8 · see citing works
Eklund, E., Diamandis, E. P., Muytjens, C. M. J., Wheeler, S., Mathew, A., Stengelin, M. K., Glezer, E. N., Nikolenko, G. N., Brown, M. D., Zheng, Y., et al. (2017) · F1000Research · doi:10.12688/f1000research.11821.1 · Cited by 7 · see citing works
Self-citationHormones, Stress and Financial Decision Making
Herbert, J. (2020) · Springer eBooks · doi:10.1007/978-3-030-45500-2_3 · Cited by 6 · see citing works
Clinical Concerns on Sex Steroids Variability in Cisgender and Transgender Women Athletes
Luigi, L. D., Greco, E. A., FOSSATI, C., Aversa, A., Sgrò, P., & Antinozzi, C. (2022) · International Journal of Sports Medicine · doi:10.1055/a-1909-1196 · Cited by 7 · see citing works
The future of sex in elite sport
Photopoulos, J. (2021) · Nature · doi:10.1038/d41586-021-00819-0 · Cited by 6 · see citing works
Csöndör, É., Karvaly, G., Ligetvári, R., Kovács, K., Komka, Z., Móra, Á., Stromajer-Rácz, T., Olah, A., Tóth, M., & Ács, P. (2022) · Metabolites · doi:10.3390/metabo12020091 · Cited by 6 · see citing works
“High androgen concentrations may be associated with hyperandrogenic syndromes [19].”
BackgroundCardiorespiratory Fitness in Young Adult Women With a History of Premature Adrenarche
Tennilä, J., Jääskeläinen, J., Utriainen, P., Voutilainen, R., Laitinen, T. P., & Liimatta, J. (2023) · Journal of the Endocrine Society · doi:10.1210/jendso/bvad041 · Cited by 5 · see citing works
“Elite athletes benefit from exogenous [ 27] and endogenous androgen excess [6, 7].”
Female Hyperandrogenism in Elite Sports and the Athletic Triad
Hirschberg, A. L. (2021) · Seminars in Reproductive Medicine · doi:10.1055/s-0041-1736337 · Cited by 7 · see citing works
Self-citationBiology and Management of Male‐Bodied Athletes in Elite Female Sports
Handelsman, D. J., & Bermon, S. (2025) · Drug Testing and Analysis · doi:10.1002/dta.3876 · Cited by 4 · see citing works
“These physical advantages of the unrecognized male puberty explain the 140–200-fold increase in prevalence of XY DSD in elite female Olympic sports, compared with the general community [14,28].”
Self-citationDefining sex in the sporting world
Handelsman, D. J., & Bermon, S. (2025) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2025.102005 · Cited by 5 · see citing works
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“In addition, the prevalence of people with disorders of sexual development (DSD) is much higher in elite female athlete populations [17].”
Zúñiga-Vergara, P., & Mauricio Castro, S. (2022) · Archivos de la Sociedad Chilena de Medicina del Deporte · doi:10.59856/rev.sochmedep.vol67-n1.23 · Cited by 3 · see citing works
“Las comparaciones con datos publicados establecen que los jugadores de R7 de nivel internacional poseen valores de aceleración similares con los Backs del RU profesionales (30).”
BackgroundThe Role of Androgens for Body Composition and Physical Performance in Women
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“…application of the present findings is for the non-invasive screening of young women seeking entry to elite female athletic events for XY DSD as there is a 140-200-fold increase in the prevalence of XY DSDs in female Olympic athletic events [31,32] compared with the general female population [33].”
Brodsky, J. L., & Genel, M. (2016) · Hormone Research in Paediatrics · doi:10.1159/000444170 · Cited by 2 · see citing works
Hirschberg, A. (2019) · Encyclopedia of Endocrine Diseases · doi:10.1016/b978-0-12-801238-3.64954-1 · Cited by 2 · see citing works
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Physiological and perceptual responses to training and competition in elite female netball players
Birdsey, L. P. (2021) · doi:10.23889/suthesis.58707 · Cited by 2 · see citing works
Bermon, S., Coleman, D. L., & Handelsman, D. J. (2026) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-110997 · Cited by 2 · see citing works
Self-citationSerum androgen profile of elite athletes
Handelsman, D. J., & Bermon, S. (2026) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgag196 · Cited by 1 · see citing works
Self-citationIntersex: Intersectionality, Epistemic and Structural Violence
Carpenter, M. (2015) · Cited by 1 · see citing works
Not Born of Woman: Gendered Robots
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Les Jeux olympiques, la lutte contre le dopage et le maintien de l’équité
Bigard, A. X. (2019) · Bulletin de l Académie Nationale de Médecine · doi:10.1016/j.banm.2019.03.019 · Cited by 1 · see citing works
Sex Hormone Disturbances in Athletes: Implications for Voice
Hamdan, A., Sataloff, R. T., & Hawkshaw, M. J. (2021) · Springer eBooks · doi:10.1007/978-3-030-69831-7_10 · Cited by 1 · see citing works
Harmful anachronism: World Athletics reinstates gene testing to participate in women’s competitions
Camporesi, S., Heffernan, S. M., Borry, P., Brehaut, J., Cable, N. T., Cooper, J., Cox, L. T. J., Duval, A., Fife, N. T., Gollish, S., et al. (2026) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-110787 · Cited by 1 · see citing works
The Future of Performance Enhancement in Sport
Hackney, A. C. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-813442-9.00011-0
Administering drugs to an individual in a non-pathological situation: The Caster Semenya case
Jagadeesh, N. (2020) · Indian Journal of Medical Ethics · doi:10.20529/ijme.2020.030
The influence of sports policies on the right to fair competition for women
Hissa, M. R. N., & Hissa, M. N. (2021) · International Journal of Human Rights in Healthcare · doi:10.1108/ijhrh-04-2021-0084
(2018) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-78743-753-120181009
CENÁRIO ESPORTIVO: EXISTE ESPAÇO PARA AS PESSOAS INTERSEXO?
Chaves, B. S., Freitas, D. D. C. A., Silva, A. F. D. L. E., & Mourão, L. N. (2022) · Instituto Scientia eBooks · doi:10.55232/1082022.33
Intersex: bodies exclued in sport
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- Authors
- Bermon, S., Garnier, P. Y., Hirschberg, A. L., Robinson, N., Giraud, S., Nicoli, R., Baume, N., Saugy, M., Fénichel, P., Bruce, S. J., Henry, H., Dollé, G., & Ritzen, M.
- Affiliations
- Laboratoire Motricité Humaine Éducation Sport Santé (FR)
- International Association of Athletics Federations Medical and Anti-Doping Department and Commission (S.B., P.Y.G., M.S., G.D.), 98000 Monaco
- Centre Hospitalier Universitaire Vaudois (CH)
- Inserm (FR)
- Karolinska University Hospital (SE)
- Corresponding author
- Bermon, Stéphane
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-11-01
- Volume
- 99
- Issue
- 11
- Pages
- 4328-4335
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2113140165
- Cited by
- 125
- References
- 32
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 21 · 2023: 14 · 2022: 7 · 2021: 11 · 2020: 6 · 2019: 8 · 2018: 17 · 2017: 12 · 2016: 9 · 2015: 8 · 2014: 1
- FWCI
- 32.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- World Anti-Doping Agency
- Korea Institute of Science and Technology
- Topics
- Social Sciences › Sociology and Political Science › Doping in Sports
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- serum androgens, female athletes, hyperandrogenism, 46,XX disorders of sex development, testosterone, dehydroepiandrosterone sulfate, androstenedione, sex hormone-binding globulin, gonadotropins, oral contraceptives, amenorrhea, oligomenorrhea, Athlete Biological Passport, doping detection, reference values
- MeSH terms
- Adolescent, Adult, Androstenedione, Female, Humans, Menstrual Cycle, Middle Aged, Sex Hormone-Binding Globulin, Testosterone, Prevalence, Hyperandrogenism, Dehydroepiandrosterone Sulfate, Young Adult, Athletes
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