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      Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance

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          Abstract

          Elite athletic competitions have separate male and female events due to men’s physical advantages in strength, speed, and endurance so that a protected female category with objective entry criteria is required. Prior to puberty, there is no sex difference in circulating testosterone concentrations or athletic performance, but from puberty onward a clear sex difference in athletic performance emerges as circulating testosterone concentrations rise in men because testes produce 30 times more testosterone than before puberty with circulating testosterone exceeding 15-fold that of women at any age. There is a wide sex difference in circulating testosterone concentrations and a reproducible dose-response relationship between circulating testosterone and muscle mass and strength as well as circulating hemoglobin in both men and women. These dichotomies largely account for the sex differences in muscle mass and strength and circulating hemoglobin levels that result in at least an 8% to 12% ergogenic advantage in men. Suppression of elevated circulating testosterone of hyperandrogenic athletes results in negative effects on performance, which are reversed when suppression ceases. Based on the nonoverlapping, bimodal distribution of circulating testosterone concentration (measured by liquid chromatography–mass spectrometry)—and making an allowance for women with mild hyperandrogenism, notably women with polycystic ovary syndrome (who are overrepresented in elite athletics)—the appropriate eligibility criterion for female athletic events should be a circulating testosterone of <5.0 nmol/L. This would include all women other than those with untreated hyperandrogenic disorders of sexual development and noncompliant male-to-female transgender as well as testosterone-treated female-to-male transgender or androgen dopers.

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          The biology of infertility: research advances and clinical challenges.

          Reproduction is required for the survival of all mammalian species, and thousands of essential 'sex' genes are conserved through evolution. Basic research helps to define these genes and the mechanisms responsible for the development, function and regulation of the male and female reproductive systems. However, many infertile couples continue to be labeled with the diagnosis of idiopathic infertility or given descriptive diagnoses that do not provide a cause for their defect. For other individuals with a known etiology, effective cures are lacking, although their infertility is often bypassed with assisted reproductive technologies (ART), some accompanied by safety or ethical concerns. Certainly, progress in the field of reproduction has been realized in the twenty-first century with advances in the understanding of the regulation of fertility, with the production of over 400 mutant mouse models with a reproductive phenotype and with the promise of regenerative gonadal stem cells. Indeed, the past six years have witnessed a virtual explosion in the identification of gene mutations or polymorphisms that cause or are linked to human infertility. Translation of these findings to the clinic remains slow, however, as do new methods to diagnose and treat infertile couples. Additionally, new approaches to contraception remain elusive. Nevertheless, the basic and clinical advances in the understanding of the molecular controls of reproduction are impressive and will ultimately improve patient care.
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            Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement.

            The objective of the study was to evaluate the current state of clinical assays for total and free testosterone. The five participants were appointed by the Council of The Endocrine Society and charged with attaining the objective using published data and expert opinion. Data were gleaned from published sources via online databases (principally PubMed, Ovid MEDLINE, Google Scholar), the College of American Pathologists, and the clinical and laboratory experiences of the participants. The statement was an effort of the committee and was reviewed in detail by each member. The Council of The Endocrine Society reviewed a late draft and made specific recommendations. Laboratory proficiency testing should be based on the ability to measure accurately and precisely samples containing known concentrations of testosterone, not only on agreement with others using the same method. When such standardization is in place, normative values for total and free testosterone should be established for both genders and children, taking into account the many variables that influence serum testosterone concentration.
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              Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care

              The goal of this update regarding the diagnosis and care of persons with disorders of sex development (DSDs) is to address changes in the clinical approach since the 2005 Consensus Conference, since knowledge and viewpoints change. An effort was made to include representatives from a broad perspective including support and advocacy groups. The goal of patient care is focused upon the best possible quality of life (QoL). The field of DSD is continuously developing. An update on the clinical evaluation of infants and older individuals with ambiguous genitalia including perceptions regarding male or female assignment is discussed. Topics include biochemical and genetic assessment, the risk of germ cell tumor development, approaches to psychosocial and psychosexual well-being and an update on support groups. Open and on-going communication with patients and parents must involve full disclosure, with the recognition that, while DSD conditions are life-long, enhancement of the best possible outcome improves QoL. The evolution of diagnosis and care continues, while it is still impossible to predict gender development in an individual case with certainty. Such decisions and decisions regarding surgery during infancy that alters external genital anatomy or removes germ cells continue to carry risk.
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                Author and article information

                Journal
                Endocr Rev
                Endocr. Rev
                edrv
                Endocrine Reviews
                Endocrine Society (Washington, DC )
                0163-769X
                1945-7189
                October 2018
                13 July 2018
                13 July 2018
                : 39
                : 5
                : 803-829
                Affiliations
                [1 ]ANZAC Research Institute, University of Sydney, Concord, New South Wales, Australia
                [2 ]Department of Andrology, Concord Hospital, Sydney, New South Wales, Australia
                [3 ]Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
                [4 ]Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
                [5 ]Laboratoire Motricité Humaine, Education, Sport, Santé, Université Côte d’Azur, Nice, France
                [6 ]Health and Science Department, International Association of Athletics Federations, Monaco
                Author notes
                Correspondence and Reprint Requests:  David J. Handelsman, PhD, ANZAC Research Institute, University of Sydney, Hospital Road, Concord Hospital, Sydney, New South Wales 2139, Australia. E-mail: djh@ 123456anzac.edu.au .
                Article
                edrv_201800020
                10.1210/er.2018-00020
                6391653
                30010735
                555596dc-9715-47aa-a049-e48167e6d4bf
                Copyright © 2018 Endocrine Society

                This article has been published under the terms of the Creative Commons Attribution License (CC BY; https://creativecommons.org/licenses/by/4.0/).

                History
                : 28 January 2018
                : 18 June 2018
                Page count
                Pages: 27
                Categories
                Reviews
                Reproductive Biology and Sex-Based Medicine

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