What makes and athlete exceptional? The exceptional case of testosterone?

By Silvia Camporesi @silviacamporesi

The winter Olympic Games in Pyeongchang are just around the corner. As usual with the Olympics, they will surprise us with exceptional performances of athletes, and lead those of us who watch from the sidelines to wonder: What makes an Olympic athlete who s/he is? Many would agree that the answer is a combination of genetic predisposition and extreme work ethic. Thanks to advances in the study of the genetic basis of sports performance,[1,2] we are now able to determine many genetic variants that are present in elite athletes, spanning from variations in oxygen carrying capacity of red blood cells, to enzymes involved in the conversion of angiotensin (ACE) which is associated with increased endurance performance in athletic cohorts, to allelic variations in the alfa-actinin gene which plays a role in the fibre type distribution in muscles.

Court of Arbitration of Sport in Lausanne, December 2017. Photo courtesy of Dr Letizia Zannoni

Some of these variations lie at the border between the physiological and the pathological, depending on the context: while they can be advantageous on the field of play, they can be disadvantageous in other aspects of life. Take the case of Finnish skier Eero Mäntyranta,[3] who rose to athletic fame in cross-country skiing during the ‘60s. Mäntyranta’s training was no doubt aided by a condition known as familial primary polycythemia, which leads to an increased production of red blood cells. This in turn led to an increase of his oxygen carrying capacity and understandably conferred an advantage in long-distance competitions such as cross-country skiing. It likely played a role in his claiming multiple gold medals at the Innsbruck winter Olympics in 1964. To note, Mäntyranta’s natural advantage in competition was not considered unfair; on the contrary, it was considered part of the natural endowment that made him an exceptional athlete. Not all biological variations, however, are viewed in as favourable a light by sports regulatory bodies. High levels of testosterone, for example, are not considered a fair and natural endowment for an athlete. The issue of correlation between higher levels of endogenous testosterone and performance advantages is of current significance with the debate surrounding the reinstatement of the IAAF (International Association of Athletics Federations) Hyperandrogenism Regulations front and centre.

The Hyperandrogenism Regulations, some readers may recall, were enacted in 2011 after South African Caster Semenya’s case (Caster Semenya’s gold medal was revoked hours after her victory at the Berlin track championship in 2009, and a gender investigation was initiated. For a recap see [4]). They were later suspended for two years in 2015 by a landmark Interim Decision of the Court for Arbitration of Sport (CAS) in the case of another athlete who was targeted by the regulations in 2014 and who later appealed, Indian sprinter Dutee Chand vs. AFI (Athletics Federation of India) & IAAF.[5] IAAF filed material on 29 September 2017 to CAS that includes draft revised regulations [not available in the public domain] that would apply only to female track events over distances of between 400 metres and one mile. The CAS Panel has made no ruling as of today about the sufficiency of the evidence put forward by IAAF. As of a press release dated January 19, 2018, the regulations remain suspended for an additional six months in which the IAAF is to advise the CAS on how it intends to implement the regulations moving forward. [6]

However, as I argued soon after the Regulations were suspended in 2015,[7] even if the IAAF were to put forward clear evidence that an athlete’s own levels of testosterone had a positive correlation with athletic performance, that would not constitute sufficient evidence for a reinstatement of the Regulations. The answer to the question of whether women with hyperandrogenism should be allowed to compete in the female category is not to be found in statistical correlations only, but in a discussion of what it means for competition to be fair. In other words, the question posed by the CAS panel should not be: will more research prove the correlation between increased testosterone levels and athletic performance? Instead, as the CAS Panel ponders the sufficiency of the evidence put forward by IAAF over the next six months, they should address the following question: what constitutes fairness in competition? Thus, there is no solid ground on which reinstatement of the regulations can be justified through evidence alone of an advantage in competition due to endogenous testosterone. Singling out levels of testosterone from other biological and genetic variations that make an athlete exceptional would be an exceptional and unwarranted move. The question of what counts as fairness in competition is an ethical question, and the CAS panel should recognise the role of ethics (and philosophy) in creating categories in sport, not solely of medical or scientific evidence.

Dr Silvia Camporesi (@silviacamporesi) is a lecturer in Bioethics & Society at King’s College London, where she directs the MSc in Bioethics & Society. Her latest book, “Bioethics Genetics and Sport”, co-authored with Mike McNamee, is forthcoming for Routledge in March 2018.

Court of Arbitration of Sport in Lausanne, December 2017. Photo courtesy of Dr Letizia Zannoni



  1. Ostrander, E. A., Huson, H. J., & Ostrander, G. K. (2009). Genetics of athletic performance. Annual review of genomics and human genetics10, 407-429.
  2. Pitsiladis, Y., Wang, G., Wolfarth, B., Scott, R., Fuku, N., Mikami, E., … & Lucia, A. (2013). Genomics of elite sporting performance: what little we know and necessary advances. Br J Sports Med, bjsports-2013.
  3. Eero Mantyranta Olympic Card https://www.olympic.org/eero-mantyranta (Accessed January 23, 2018)
  4. Camporesi, S (2017, February 28) Who is a sportswoman? Elite female athletes are subjected to invasive gender tests, and hormone treatments if they fail. This is deeply unfair. https://aeon.co/essays/sports-culture-binds-us-to-gender-binaries-this-is-unfair (Accessed January 23, 2018)
  5. Court of Arbitration for Sport. Interim Arbitral award: CAS2014/A/3759 Dutee Chand v. Athletics Federation of India (AFI) & The International Association of Athletics Federations. 2015 July 24. Available from: http://www.tas-cas.org/fileadmin/user_upload/award_internet.pdf (Accessed January 23, 2018)
  6. Court of Arbitration for Sport media release January 19, 2018: http://www.tas-cas.org/fileadmin/user_upload/Media_Release_3759_Jan_2018.pdf (Accessed January 23, 2018)
  7. Camporesi, S. (2016, July 29). Clear Skies Overhead for Dutee Chand, But Clouds Loom on the Horizon. https://www.huffingtonpost.com/entry/clear-skies-overhead-for-_b_7896924.html (Accessed January 23, 2018)




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