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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 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]
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“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]
In the citing paper
“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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“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
“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
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
“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
Self-citationBascharon, R. A., Sethi, N. K., Estevez, R., Gordon, M., Guevara, C., Twohey, E. E., & deWeber, K. (2023) · The Physician and Sportsmedicine · doi:10.1080/00913847.2023.2286943 · Cited by 5
“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
“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
Hirschberg, A. L. (2019) · ISGE series · doi:10.1007/978-3-030-14358-9_4 · Cited by 3
Self-citationWang, Y., Davis, S. R., Gialouris, J. V., Desai, R., & Handelsman, D. J. (2025) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2025.106796 · Cited by 2
“…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
Hirschberg, A. (2019) · Encyclopedia of Endocrine Diseases · doi:10.1016/b978-0-12-801238-3.64954-1 · Cited by 2
Self-citationMullen, J. (2018) · Figshare · Cited by 2
Physiological and perceptual responses to training and competition in elite female netball players
Birdsey, L. P. (2021) · Cronfa (Swansea University) · doi:10.23889/suthesis.58707 · Cited by 2
Bermon, S., Coleman, D. L., & Handelsman, D. J. (2026) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-110997 · Cited by 3
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
Self-citationIntersex: Intersectionality, Epistemic and Structural Violence
Carpenter, M. (2015) · Cited by 1
Not Born of Woman: Gendered Robots
Shah, H., & Roberts, F. (2023) · Intelligent systems reference library · doi:10.1007/978-3-031-21606-0_7 · Cited by 1
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
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
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
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
Chaves, B. S., & Mourão, L. N. (2023) · Concilium · doi:10.53660/clm-1067-23c73
Alvares, L. A. M. (2022) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.5.2022.tde-18042023-163159
Metadata
- 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
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › 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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