Abstract
Essential hyperandrogenism seems to be overrepresented in female elite athletes. This
applies to mild forms such as polycystic ovary syndrome, as well as rare differences/disorders
of sex development (DSD). The reason is likely a selection bias since there is increasing
evidence that androgens are beneficial for athletic performance by potent anabolic
effects on muscle mass and bone mass, and stimulation of erythropoiesis. XY DSD may
cause a greatly increased production of testosterone in the male range, that is, 10
to 20 times higher than the normal female range. The established regulations concerning
the eligibility of female athletes with severe hyperandrogenism to compete in the
female classification remain controversial. The most common cause of menstrual disorders
in female athletes, however, is probably an acquired functional hypothalamic disturbance
due to energy deficiency in relation to energy expenditure, which could lead to low
bone mineral density and increased risk of injury. This condition is particularly
common in endurance and esthetic sports, where a lean body composition is considered
an advantage for physical performance. It is important to carefully evaluate endocrine
disturbances and menstrual disorders in athletes since the management should be specific
according to the underlying cause.
Keywords
differences of sex development - female athlete triad - functional hypothalamic amenorrhea
- hyperandrogenism - polycystic ovary syndrome
