Sports-governing authorities currently acknowledge that not all disorders of sexual development (DSDs), now often referred to as differences in sexual development, offer a competitive advantage to the affected female athlete. The advantages appear to be related to the degree of functional androgen levels in these athletes. In this way, testosterone levels have been used as a determinant of ineligibility for certain competitions and implemented as a metric to disqualify female athletes in women’s sports. Conversely, testosterone levels have not been used as a qualifier for participation in male competitions. These parameters have been directly included in policies by different sporting bodies. For example, in 2018, the International Association for Athletics Federation (IAAF), which governs track and field competitions, issued regulations banning female athletes with testosterone levels above a certain threshold from participating in the 400-, 800-, and 1500-meter races. This decision was based on the assumption that higher testosterone levels may offer an unfair advantage to these athletes. This decision is clearly biased against individuals with disorders of androgen insensitivity, since their testosterone levels would be significantly elevated but nonfunctional.
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