Explained: What is Hyperandrogenism, and why is it a key issue in sports?

Hyperandrogenism is a medical condition where a woman produces an increased amount of male sex harmone (Testesterone). This condition can be caused due to various factors including polycystic ovary syndrome (PCOS), obesity, etc. It can also be present from birth.

In hyperandrogenism, testosterone levels are 3x times higher than in an average woman. Generally, increased testosterone levels result in extra speed, strength, and power. Hence, when it comes to sports, there is a huge debate on hyperandrogenism in athletics.

How is hyperandrogenism a key issue in sports?

12 flex ✔️ pic.twitter.com/O7sVN2BKSH

— Caster Semenya (@caster800m) June 7, 2021

The debate on hyperandrogenism caught the public eye when sprinter Caster Semenya was asked to undergo sex tests to investigate her recent improvements.

It was discovered that Semenya had hyperandrogenism. Therefore the IAAF (now World Athletics) raised questions about the South African's participation in the female category. They felt that it would be unfair for other competing athletes.

The following is a statement released by IOC ahaead of London Olympics 2012:

"Nothing in these Regulations is intended to make any determination of sex. Instead, these Regulations are designed to identify circumstances in which a particular athlete will not be eligible (by reason of hormonal characteristics) to participate in 2012 Olympic Games (OG) Competitions in the female category. In the event that the athlete has been declared ineligible to compete in the female category, the athlete may be eligible to compete as a male athlete, if the athlete qualifies for the male event of the sport. "

As per the regulations, hyperandrogen athletes must participate among males.

Testestrones level chart

Now, if the average testosterone level of women is 1.8nmol, then an average athlete with hyperandrogen would have a range of around 6.4-7nmol. The level is still 1nmol less than the minimum testosterone levels of a man.

Who is at a disadvantage?

Intersex females who participate among males or those playing in the females category are considered to be at a disadvantage. There is no evidence of hyperandrogen affecting the result of a game or a race.

The regulations were placed in the intersex category and the decision faced a major backlash from activists and law individuals. The opposing groups stated that the tests are a breach of privacy and also there is no medical evidence to the fact that higher level of testosterone gives an unfair advantage to the athlete.

The regulations were a sham as they regulated an athlete's participation due to a natural process of the body.

Asian Games - Dutee Chand

In 2014, a similar incident took place with Indian sprinter Dutee Chand. She was dropped from participating in the Commonwealth Games in 2014 as the federations stated that hyperandrogenism made her ineligible to play as female. However, upon filing a case against AFI and AAIF, the ruling was announced in her favor.

The court stated that since there is no proper evidence on increased advantage, the federations must remove their regulations on hyperandrogenism or submit proper evidence.

New sex criteria for athletes with hyperandrogenism

Following the verdict of Dutee Chand's case, the IOC on November 1, 2018 adopted new criteria regarding "Differences of Sexual Development" .

The IOC released a statement on the adoption

"For female athletes competing in the following races: 400 m, 800 m, 1 mile, hurdles, and events that include a combination of these distances. Athletes with testosterone levels equalling or exceeding 5 nmol/L and wanting to participate in the above-mentioned events at the global level must legally be female or intersex, must get their testosterone levels below 5nmol/L for six consecutive months and must ensure their levels stay below this level."

To sum up, an intersex or female with increased testosterone must reduce it to the average levels found in females. However, the new criteria is still unfair as there is no concrete evidence that hyperandrogenism affects the results of a game.