Academic journal article Law and Contemporary Problems

Endocrinology and Women's Sports: The Diagnosis Matters

Academic journal article Law and Contemporary Problems

Endocrinology and Women's Sports: The Diagnosis Matters

Article excerpt


The participation of women in sports, and in particular elite sports, is a relatively recent phenomenon starting at the turn of the twentieth century. Shortly after the establishment of women's competitions in the Olympic Games, a few participants who were later found to be biologically male competed in these events. (1) These instances led to efforts to police the entry criteria to the women's events, but sport authorities soon recognized that a single dichotomous criterion for defining a "female" athlete was difficult to identify.

In parallel with the rise of women's sports, doping with performance-enhancing substances, particularly androgens, began to plague elite sports starting in the (1950)s. In an effort to preserve the safety and fairness of sport, extensive programs for anti-doping and testing have become a fixture of professional and now also recreational competitions.

The East Germans quickly recognized that androgen doping was particularly effective in women, in whom androgen action could be raised from the low female status to higher male realms and beyond. (2) Today, every elite athlete is subjected to rigorous testing for doping using sophisticated mass spectrometry systems that can cost roughly $1,000,000 with certified authentic standards and vigorous chain-of-custody documentation--testing far more technologically advanced than most non-athletes will ever receive in their medical care.

Using these three points of reference as a framework, this Article will logically approach a discussion of sex in sport from the endocrinologist's perspective. Part II will explain critical differences between male and female biology. Part III clarifies confusion resulting from the sex versus gender distinction. Part IV concludes that sex, and testosterone in particular, is fundamental to the discrepancies in athletic performance between men and women. Part V proposes solutions to defining the women's category for the purposes of competitive sport.



A. Human Androgen Biology

1. Sexual Differentiation

Early studies, like Alfred Jost's pioneering work in rabbits, sought to define the mechanisms of external genitalia formation, (3) but subsequent studies illuminated the totality of androgen biology. Jost demonstrated that a secretion from the testis was carried through the circulation as an endocrine hormone to cause fusion of the labia and formation of the penis. Jost reproduced this action with exogenous testosterone (T), confirming that T was the major circulating hormone required to cause male sexual differentiation of the external genitals. (4) What Jost did not know is that an enzyme in the prostate and genital skin, 5[alpha]-reductase type 2 (5R2), was required to metabolize T to dihydrotestosterone (DHT), and it was D HT that elicited this action to form the prostate, scrotum, and penis. (5) Jean Wilson, Jim Griffin, Mike McPhaul, David Russell, and Stefan Andersson in Dallas then went on to define the genetics and molecular biology of 5R2 and the androgen receptor (AR, also known as NR3C4), the latter of which mediates most if not all actions of T, DHT, and synthetic androgens. With colleagues from around the world, they identified genetically male patients with mutations in either the SRD5A2 gene encoding 5[alpha]-reductase type 26 or the AR gene, (7) and these seminal studies form the basis of our knowledge about androgen biology.

2. Disorders of Androgen Biology: Androgen Insensitivity and 5R2 Deficiency

AIS and 5R2 deficiency (5R2D) afford very different phenotypes:

AIS patients appear phenotypically female at birth and feminize during puberty. (8) They develop breasts but lack facial and body hair and--critical for our discussion--do not develop male-pattern upper-body muscular development during puberty despite a rise of circulating T that reaches the normal male range. …

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