Too fast to be female? Unravelling the controversy over androgens in female elite athletes

Told through the example of South African middle-distance runner Caster Semenya, this discussion starter examines the controversial area of gender in sport from a scientific viewpoint. Women have been segregated from men in most sporting disciplines for as long as they have been permitted to compete, but seated in a society only just beginning to delineate the concepts of sex and gender identity, consensus needs to be reached on how or if we should categorise elite athletes, whilst upholding the integrity and fairness of competitive sport. The parameters used to sort athletes into today’s binary gender categories have recently come under scrutiny in the cases of athletes with Differences of Sex Development (DSD). Semenya has elevated serum testosterone and her eligibility to continue competing and winning with females has now been brought into contention by the IAAF resulting in a legal battle. However, the scientific evidence on which the IAAF ruling is based is far from robust. Athletics, a sport tainted by a history of doping with anabolic steroids, is fighting to maintain values of fairness by aiming to govern the levels endogenous steroids permitted in competition. Semenya’s is a pertinent example of a wider issue which is of interest from a scientific, ethical, political, legal and social standpoint because of the complexity of hormone systems and the fact that circulating levels of hormone do not necessarily equate with actions of those hormones. With confusing mainstream media coverage lacking consensus, the scientific community deserve clarity on the issue to allow us to engage in meaningful discussion and contribute to the debate

The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip

Aims: Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods: We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results: The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion: The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH. Cite this article: Bone Jt Open 2023;4(8):635–642