Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement

Blair Hamilton, Giscard Lima, James Barrett, Leighton Seal, Alexander Kolliari-Turner, Guan Wang, Antonia Karanikolou, Xavier Bigard, Herbert Löllgen, Petra Zupet, Anca Ionescu, Andre Debruyne, Nigel Jones, Karin Vonbank, Federica Fagnani, Chiara Fossati, Maurizio Casasco, Demitri Constantinou, Bernd Wolfarth, David NiederseerAndrew Bosch, Borja Muniz-Pardos, José Antonio Casajus, Christian Schneider, Sigmund Loland, Michele Verroken, Pedro Manonelles Marqueta, Francisco Arroyo, André Pedrinelli, Konstantinos Natsis , Evert Verhagen, William O Roberts, José Kawazoe Lazzoli, Rogerio Friedman, Ali Erdogan , Ana V Cintron, Shu-Hang Patrick Yung, Dina Christina Janse Van Rensburg, Dimakatso A Ramagole, Sandra Rozenstoka, Felix Drummond, Theodora Papadopoulou, Paulette Y O Kumi, Richard Twycross-Lewis, Joanna Harper, Vasileios Skiadas , Jonathan Shurlock, Kumpei Tanisawa, Jane Seto, Kathryn N. North, Siddhartha S Angadi, María-José Martínez Patiño, Mats Börjesson, L. Di Luigi, Michiko Dohi, Jeroen Swart, James Lee John Bilzon, Victoriya Badtieva, Irina Zelenkova, Juergen M. Steinacker, Norbert Bachl, Fabio Pigozzi, Michael Geistlinger, Dimitrios G Goulis, Fergus Guppy, Nick Webborn, Bulent O Yildiz, Mike Miller, Patrick Singleton, Yannis Pitsiladis

Research output: Contribution to journalArticlepeer-review


Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport’s governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete’s unique makeup.

Original languageEnglish
Pages (from-to)1401-1415
Number of pages15
JournalSports Medicine
Issue number7
Publication statusPublished - 24 Mar 2021

Bibliographical note

This is a post-peer-review, pre-copyedit version of an article published in Sports Medicine. The final authenticated version is available online at:


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