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J Clin Endocrinol Metab. 2014 Nov;99(11):4328-35. doi: 10.1210/jc.2014-1391. Epub 2014 Aug 19.

Serum androgen levels in elite female athletes.

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International Association of Athletics Federations Medical and Anti-Doping Department and Commission (S.B., P.Y.G., M.S., G.D.), 98000 Monaco; Laboratoire Motricité Humaine Education Sport Santé (S.B.), Nice Sophia Antipolis University, 06107 Nice, France; and Monaco Institute of Sports Medicine and Surgery (S.B.), 98000 Monaco; Department of Women's and Children's Health (A.L.H., M.R.), Karolinska Institutet and University Hospital, SE-141 86 Stockholm, Sweden; Swiss Laboratory for Doping Analyses (N.R., S.G., R.N., N.B., M.S.), University Center of Legal Medicine, Geneva and Lausanne, and Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1005 Lausanne, Switzerland; Department of Reproductive Endocrinology, and INSERM Unité 1065 (P.F.), Hôpital l'Archet, University Hospital of Nice, 06-003 Nice, France; Department of Clinical Chemistry (S.J.B., H.H.), Centre Hospitalier Universitaire, University Hospital of Lausanne, Vaudois, 1011 Lausanne, Switzerland.



Prior to the implementation of the blood steroidal module of the Athlete Biological Passport, we measured the serum androgen levels among a large population of high-level female athletes as well as the prevalence of biochemical hyperandrogenism and some disorders of sex development (DSD).


In 849 elite female athletes, serum T, dehydroepiandrosterone sulphate, androstenedione, SHBG, and gonadotrophins were measured by liquid chromatography-mass spectrometry high resolution or immunoassay. Free T was calculated. The sampling hour, age, and type of athletic event only had a small influence on T concentration, whereas ethnicity had not. Among the 85.5% that did not use oral contraceptives, 168 of 717 athletes were oligo- or amenorrhoic. The oral contraceptive users showed the lowest serum androgen and gonadotrophin and the highest SHBG concentrations. After having removed five doped athletes and five DSD women from our population, median T and free T values were close to those reported in sedentary young women. The 99th percentile for T concentration was calculated at 3.08 nmol/L, which is below the 10 nmol/L threshold used for competition eligibility of hyperandrogenic women with normal androgen sensitivity. Prevalence of hyperandrogenic 46 XY DSD in our athletic population is approximately 7 per 1000, which is 140 times higher than expected in the general population.


This is the first study to establish normative serum androgens values in elite female athletes, while taking into account the possible influence of menstrual status, oral contraceptive use, type of athletic event, and ethnicity. These findings should help to develop the blood steroidal module of the Athlete Biological Passport and to refine more evidence-based fair policies and recommendations concerning hyperandrogenism in female athletes.

[Indexed for MEDLINE]

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