How is the Topic of Intersex Athletes in Elite Sports Positioned in Academic Literature Between January 2000 and July 2022? A Systematic Review

Jensen, Marisa; Schorer, Jörg; Faber, Irene R.

doi:10.1186/s40798-022-00520-0

Sports Medicine - Open

Table 1 Characteristics of studies included in the systematic review in chronological order (publication year)

From: How is the Topic of Intersex Athletes in Elite Sports Positioned in Academic Literature Between January 2000 and July 2022? A Systematic Review

Author	Year	Country	Perspective/solution	Theme	Statement
Elsas et al. [44]	2000	USA	Perspective	Sex verification	Sex verification is ethically indefensible
Elsas et al. [44]	2000	USA	Solution	Information and knowledge	Educate about sex diversity
Dickinson et al. [45]	2002	USA	Perspective	Sex verification	Sex verification is ethically indefensible
			Perspective	Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	Sex verification	Abolish sex verification
Wackwitz [46]	2003	USA	Perspective	The sex construct	Sex is not binary
Wackwitz [46]	2003	USA	Perspective	Sex verification	Sex verification is ethically indefensible
Carlson [47]	2005	USA	Perspective	The sex construct	Sex is not binary
				Sex verification	Sex verification is ethically indefensible
				Information and knowledge	High androgen levels do not always provide an athletic advantage
Reeser [48]	2005	USA	Perspective	Sex verification	Sex verification is ethically indefensible
Reeser [48]	2005	USA	Perspective	Information and knowledge	High androgen levels do not always provide an athletic advantage
Ritchie et al. [6]	2008	GB	Perspective	Sex verification	Sex verification is ethically indefensible
Ritchie et al. [6]	2008	GB	Perspective	Information and knowledge	High androgen levels do not always provide an athletic advantage
Amy-Chinn [32]	2010	GB	Perspective	The sex construct	Sex is not binary
Amy-Chinn [32]	2010	GB	Perspective	Information and knowledge	High androgen levels do not always provide an athletic advantage
Camporesi and Maugeri [49]	2010	IT	Perspective	The sex construct	Sex is not binary
				Fair play and intersex athletes	Excluding intersex athletes from elite sporting competition is unfair
				Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	Fair play and intersex athletes	Do not use a third category to separate sporting competition
			Solution	Information and knowledge	Include other specialists to find a solution
Dreger [50]	2010	USA	Perspective	The sex construct	Sex is not binary
			Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Fair play and intersex athletes	Use self-identification as a criterion to separate sporting competition
Hercher [51]	2010	USA	Perspective	Sex verification	Gender cannot be identified through simple test
				Sex verification	The athlete’s privacy must be ensured
				Fair play and intersex athletes	High androgen levels are one of many athletic advantages
				Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	The sex construct	Do not abolish sex segregation in sporting competition
			Solution	Fair play and intersex athletes	Intersex athletes should limit androgens to compete in the female category
Merck [52]	2010	GB	Perspective	Sex verification	The athlete’s privacy must be ensured
			Perspective	Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	The sex construct	Abolish sex segregation in sporting competition
Nerva [53]	2010	GB	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Saleem [54]	2010	USA	Perspective	Sex verification	Sex verification is ethically indefensible
			Perspective	Sex verification	The athlete’s privacy must be ensured
			Solution	Sex verification	Abolish sex verification
Tucker and Collins [55]	2010	ZA	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Wonkam et al. [56]	2010	ZA	Perspective	Sex verification	Sex verification can cause great harm
				Sex verification	The athlete’s privacy must be ensured
				Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	Sex verification	Set a clear policy on sex verification
			Solution	Information and knowledge	Include other specialists to find a solution
Vannini and Fornssler [57]	2011	CA	Perspective	The sex construct	Sex is not binary
Foddy and Savulescu [58]	2011	GB	Perspective	The sex construct	Sex is not binary
				The sex construct	Sex segregation in sporting competition is unjust
				Fair play and intersex athletes	Excluding intersex athletes from elite sporting competition is unfair
			Solution	The sex construct	Abolish sex segregation in sporting competition
			Solution	Fair play and intersex athletes	Intersex athletes should limit androgens to compete in female’s category
Wiesemann [59]	2011	DE	Perspective	Sex verification	Sex verification is ethically indefensible
				Sex verification	Sex verification can cause great harm
				Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	Sex verification	Abolish sex verification
Schultz [60]	2011	USA	Perspective	Fair play and intersex athletes	High androgen levels are one of many athletic advantages
			Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Information and knowledge	Include other specialists to find a solution
Adair [28]	2011	USA	Perspective	Sex verification	Sex verification is ethically indefensible
					Sex verification supports stereotypes
					The athlete’s privacy must be ensured
				Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	The sex construct	Abolish sex segregation in sporting competition
				Sex verification	Set a clear policy on sex verification
				Information and knowledge	Include other specialists to find a solution
Ballantyne et al. [61]	2011	NL	Perspective	Sex verification	The athlete’s privacy must be ensured
			Perspective	Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	Fair play and intersex athletes	Intersex athletes should limit androgens to compete in the female category
			Solution	Information and knowledge	Include other specialists to find a solution
Pierson [62]	2011	USA	Perspective	Sex verification	Privacy is a sacrifice when competing in elite sports
Glazer [23]	2012	USA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
				Fair play and intersex athletes	High androgen levels are one of many athletic advantages
				Information and knowledge	Information on intersex variations/androgens is lacking
Vilain and Sánchez [63]	2012	USA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
				Information and knowledge	Information on intersex variations/androgens is lacking
				Information and knowledge	High androgen levels do not always provide an athletic advantage
			Solution	Fair play and intersex athletes	Set new criteria to separate sporting competition
Viloria and Martinez-Patino [64]	2012	USA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
			Perspective	Information and knowledge	Information on the treatment set by IOC/World Athletics in 2011 is lacking
			Solution	Fair play and intersex athletes	Abolish the 2011 regulations on hyperandrogenism
Wahlert and Fiester [65]	2012	USA	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Wiederkehr [66]	2012	DE	Perspective	The sex construct	Sex is not binary
Wiederkehr [66]	2012	DE	Solution	Fair play and intersex athletes	Do not use a third category to separate sporting competition
Cooky and Dworkin [67]	2013	USA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
			Perspective	The sex construct	Sex is not binary
			Solution	Fair play and intersex athletes	Set new criteria to separate sporting competition
				Fair play and intersex athletes	Treat all advantages in sporting competition equally
				Sex verification	Abolish sex verification
Sánchez et al. [68]	2013	USA	Perspective	Fair play and intersex athletes	High androgen levels are one of many athletic advantages
Sánchez et al. [68]	2013	USA	Solution	Fair play and intersex athletes	Do not use a third category to separate sporting competition
Gandert et al. [69]	2013	USA	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Dabholkar [70]	2013	IN	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
Dabholkar [70]	2013	IN	Solution	Fair play and intersex athletes	Abolish the 2011 regulations on hyperandrogenism
Ferguson-Smith and Bavington [71]	2014	GB	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
				Information and knowledge	Information on intersex variations/androgens is lacking
					Information on the treatment set by IOC/World Athletics in 2011 is lacking
					High androgen levels do not always provide an athletic advantage
			Solution	Fair play and intersex athletes	Abolish the 2011 regulations on hyperandrogenism
Teetzel [72]	2014	CA	Perspective	Sex verification	The athlete’s privacy must be ensured
			Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
			Solution	Fair play and intersex athletes	Set new criteria to separate sporting competition
			Solution	Fair play and intersex athletes	Include women in the debate
Zehnder [26]	2014	CH	Perspective	The sex construct	Sex is not binary
			Solution	The sex construct	Abolish sex segregation in sporting competition
				Fair play and intersex athletes	Do not use a third category to separate sporting competition
				Fair play and intersex athletes	Set new criteria to separate sporting competition
Henne [73]	2014	CA	Perspective	The sex construct	Sex is not binary
				Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
				Fair play and intersex athletes	High androgen levels are one of many athletic advantages
Jakubowska [74]	2014	PL	Perspective	The sex construct	Sex is not binary
Jakubowska [74]	2014	PL	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
Pieper [75]	2014	USA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
Blithe and Hanchey [76]	2015	USA	Perspective	The sex construct	Sex is not binary
Blithe and Hanchey [76]	2015	USA	Perspective	Sex verification	Sex verification is ethically inconsistent
Sonksen et al. [77]	2015	GB	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
Sonksen et al. [77]	2015	GB	Solution	Fair play and intersex athletes	Abolish the 2011 regulations on hyperandrogenism
Buzuvis [78]	2016	GB	Perspective	The sex construct	Sex is not binary
				Fair play and intersex athletes	Diversity is what makes sports interesting
				Fair play and intersex athletes	High androgen levels are one of many athletic advantages
			Solution	Fair play and intersex athletes	Use self-identification as a criterion to separate sporting competition
Gleaves and Lehrbach [79]	2016	USA	Perspective	Fair play and intersex athletes	Excluding intersex athletes from elite sporting competition is unfair
Gleaves and Lehrbach [79]	2016	USA	Solution	The sex construct	Abolish sex segregation in sporting competition
Müller [80]	2016	DE	Perspective	The sex construct	Sex is not binary
Newbould [5]	2016	GB	Perspective	The sex construct	Sex is not binary
			Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
			Solution	Fair play and intersex athletes	Do not use testosterone as a criterion to separate sporting competition
			Solution	Fair play and intersex athletes	Do not use biological parameters as criteria for separating sporting competition
Pitsiladis et al. [81]	2016	GB	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Lovett [82]	2016	USA	Solution	Information and knowledge	Include other specialists to find a solution
Auchus [25]	2017	USA	Perspective	Sex verification	The athlete’s privacy must be ensured
			Perspective	Information and knowledge	High androgen levels provide an athletic advantage
			Solution	Fair play and intersex athletes	Intersex athletes should limit androgens to compete in female’s category
			Solution	Fair play and intersex athletes	Do not use self-identification as a criterion to separate sporting competition
Pielke [83]	2017	USA	Perspective	The sex construct	Sex is not binary
			Perspective	Fair play and intersex athletes	High androgen levels are one of many athletic advantages
			Solution	Fair play and intersex athletes	Do not use self-identification as a criterion to separate sporting competition
Katz and Luckinbill [84]	2017	USA	Solution	Fair play and intersex athletes	Use self-identification as a criterion to separate sporting competition
Ingthorsson [85]	2017	SE	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
					Diversity is what makes sports interesting
					High androgen levels are one of many athletic advantages
				Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Fair play and intersex athletes	Do not use a third category to separate sporting competition
Davis and Preves [86]	2017	USA	Perspective	The sex construct	Sex is not binary
Ljungqvist [87]	2018	SE	Perspective	Fair play and intersex athletes	A new rule for intersex athletes in elite sports is necessary
Karkazis and Jordan-Young [7]	2018	USA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
Fields [88]	2018	USA	Perspective	Sex verification	The athlete’s privacy must be ensured
			Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Sex verification	Set a clear policy on sex verification
Linghede [89]	2018	SE	Perspective	The sex construct	Sex is not binary
Virgilii [90]	2018	IT	Solution	Fair play and intersex athletes	Use categories based on weight and height to separate sporting competition
Harper et al. [4]	2018	CH	Perspective	The sex construct	Binary categories for elite sporting competition are appropriate
			Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Fair play and intersex athletes	Use an athletic gender
			Solution	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are currently the best method
Jakob [91]	2018	DE	Perspective	The sex construct	Binary categories for elite sporting competition are appropriate
			Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Fair play and intersex athletes	Do not use a third category to separate sporting competition
			Solution	Fair play and intersex athletes	Do not use testosterone as a criterion to separate sporting competition
Karkazis and Carpenter [92]	2018	USA	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Karkazis and Carpenter [92]	2018	USA	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Harper et al. [93]	2018	GB	Perspective	The sex construct	Sex is not binary
				The sex construct	Binary categories for elite sporting competition are appropriate
				Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Fair play and intersex athletes	Use an athletic gender
Vilain and Martinez-Patiño [94]	2019	USA	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Vilain and Martinez-Patiño [94]	2019	USA	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Mahomed and Dhai [95]	2019	ZA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
					The World Athletics’ 2018 Eligibility Rules are ethically debatable
					Excluding intersex athletes from elite sporting competition is unfair
					High androgen levels are one of many athletic advantages
Posbergh [96]	2019	USA	Perspective	The sex construct	Sex is not binary
Posbergh [96]	2019	USA	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Wells [97]	2019	USA	Perspective	Fair play and intersex athletes	The regulations on hyperandrogenism from 2011 are ethically debatable
			Perspective	Fair play and intersex athletes	A new rule for intersex athletes in elite sports is necessary
			Solution	Fair play and intersex athletes	Abolish the 2011 regulations on hyperandrogenism
			Solution	Fair play and intersex athletes	Use self-identification as a criterion to separate sporting competition
Carpenter [98]	2020	AU	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Holzer [99]	2020	CH	Perspective	The Sex Construct	Sex is not binary
Martínková [100]	2020	CZ	Solution	Fair play and intersex athletes	Set new criteria to separate sporting competition
Martínková [100]	2020	CZ	Solution	Fair play and intersex athletes	Use a third category to separate sporting competition
Pereira-García et al. [101]	2020	ES	Perspective	Fair play and intersex athletes	High androgen levels are one of many advantages
Schneider [102]	2020	GB	Solution	Fair play and intersex athletes	Include women in the debate
Kavoura and Kokkonen [103]	2020	FI	Solution	Fair play and intersex athletes	Set new criteria to separate sporting competition
Kavoura and Kokkonen [103]	2020	FI	Solution	Information and knowledge	Educate about sex diversity
Hirschberg et al. [104]	2020	SE	Perspective	Information and knowledge	High androgen levels provide an athletic advantage
Astobiza [105]	2020	ES	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Astobiza [105]	2020	ES	Perspective	Fair play and intersex athletes	High androgen levels are one of many athletic advantages
Brömdal [106]	2020	AU	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Loland [107]	2020	NO	Perspective	The Sex Construct	Sex is not binary
			Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
			Solution	Fair play and intersex athletes	Set new criteria to separate sporting competition
			Solution	Fair play and intersex athletes	Use categories based on weight and height to separate sporting competition
Gollnast et al. [108]	2021	DE	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Hamilton et al. [109]	2021	GB	Perspective	Information and knowledge	High androgen levels provide an athletic advantage
			Solution	The sex construct	Do not abolish sex segregation in sporting competition
				Fair play and intersex athletes	Intersex athletes should limit androgens to compete in the female category
				Fair play and intersex athletes	Do not use self-identification as a criterion to separate sporting competition
Krane and Waldron [110]	2021	USA	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Winkler and Gilleri [111]	2021	FR	Perspective	Fair play and intersex athletes	High androgen levels are one of many athletic advantages
				Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
				Information and knowledge	Information on intersex variations/androgens is lacking
			Solution	Information and knowledge	Include other specialists to find a solution
Schultz [112]	2021	USA	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Mohapatra [113]	2021	IN	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Hamilton et al. [114]	2021	GB	Perspective	Information and knowledge	Information on intersex variations/androgens is lacking
Hamilton et al. [114]	2021	GB	Solution	Fair play and intersex athletes	Do not use a third category to separate sporting competition
Camporesi and Hämäläinen [115]	2021	GB	Perspective	Fair play and intersex athletes	High androgen levels are one of many athletic advantages
Moyer [116]	2021	USA	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Richter-Unruh [117]	2021	DE	Perspective	Information and knowledge	High androgen levels provide an athletic advantage
				Information and knowledge	Information on intersex variations/androgens is lacking
				Fair play and intersex athletes	High androgen levels are one of many athletic advantages
			Solution	Fair play and intersex athletes	The decision on a participation permission should be conducted for each case individually
Vann [118]	2022	USA	Perspective	Fair play and intersex athletes	A new rule for intersex athletes in elite sports is necessary
				Fair play and intersex athletes	High androgen levels are one of many athletic advantages
				Information and knowledge	High androgen levels provide an athletic advantage
Shinohara [119]	2022	CH	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Chanda and Saha [120]	2022	IN	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
Krane et al. [121]	2022	USA	Perspective	Fair play and intersex athletes	The World Athletics’ 2018 Eligibility Rules are ethically debatable
				Fair play and intersex athletes	High androgen levels are one of many athletic advantages
				Information and knowledge	Information on intersex variations/androgens is lacking
				Sex verification	Sex verification can cause great harm

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