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Clin Endocrinol (Oxf). 2019 Jan;90(1):15-22. doi: 10.1111/cen.13840. Epub 2018 Sep 27.

Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex-specific competition in sports, a narrative review.

Author information

United States Anti-Doping Agency, Colorado Springs, Colorado.
qPharmetra, North Carolina.
Division of Endocrinology, Department of Medicine, LA Biomedical Research Institute, Harbor-Univ of Calif-LA Medical Center, Torrance, California.
Clinical and Translational Science Institute, LA Biomedical Research Institute, Division of Endocrinology, Department of Medicine, Harbor-Univ of Calif-LA Medical Center, Torrance, California.
Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
LD Bowers LLC, Southern Pines, North Carolina.
Geriatric Research, Education and Clinical Center, V.A. Puget Sound Health Care System, and Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington.

Erratum in



The purpose of this narrative review was to summarize available data on testosterone levels in normal, healthy adult males and females, to provide a physiologic reference framework to evaluate testosterone levels reported in males and females with conditions that elevate androgens, such as disorders of sex development (DSD), and to determine the separation or overlap of testosterone levels between normal and affected males and females.


A literature review was conducted for published papers, from peer reviewed journals, reporting testosterone levels in healthy males and females, males with 46XY DSD, and females with hyperandrogenism due to polycystic ovary syndrome (PCOS). Papers were selected that had adequate characterization of participants, and description of the methodology for measurement of serum testosterone and reporting of results.


In the healthy, normal males and females, there was a clear bimodal distribution of testosterone levels, with the lower end of the male range being four- to fivefold higher than the upper end of the female range(males 8.8-30.9 nmol/L, females 0.4-2.0 nmol/L). Individuals with 46XY DSD, specifically those with 5-alpha reductase deficiency, type 2 and androgen insensitivity syndrome testosterone levels that were within normal male range. Females with PCOS or congenital adrenal hyperplasia were above the normal female range but still below the normal male range.


Existing studies strongly support a bimodal distribution of serum testosterone levels in females compared to males. These data should be considered in the discussion of female competition eligibility in individuals with possible DSD or hyperandrogenism.


ambiguous genitalia; androgen insensitivity; disorders of sexual development; hyperandrogenism; polycystic ovary syndrome; testosterone


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