Hormonal Eligibility Criteria for 'Includes Females' Competition: A Practical but Problematic Solution.

The International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) adopted testosterone level criteria for eligibility (i.e. 10 nmol/l or 290 ng/dl in blood for IAAF, levels 'within the male range' for IOC) to compete in the 'includes females' category. The policies address the assertion that women with very high endogenous testosterone (unless they are androgen-resistant) have an unfair advantage over women with lower natural levels. Recently, the Court of Arbitration for Sport suspended the 'hyperandrogenism regulation' by the IAAF, but added: 'since there are separate categories of male and female competition, it is necessary for the IAAF to formulate a basis for the division of athletes into male and female categories for the benefit of the broad class of female athletes. The basis chosen should be necessary, reasonable and proportionate to the legitimate objective being pursued' [Branch J: Dutee Chand, Female Sprinter with High Testosterone Level, Wins Right to Compete. The New York Times, July 27, 2015]. An analysis of available evidence below - scientific as well as experiential - suggests that androgen-based criteria can, in fact, be rationally defended as the best currently available and practical approach to determine eligibility for competition in the 'includes females' category. However, to justify such policies, the IOC and IAAF must also show them to be not only rational, but also fair, necessary, and consistent with the treatment of athletes with other endogenous non-physiologic advantages.