{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:31:31Z","timestamp":1785767491781,"version":"3.56.0"},"reference-count":48,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,27]],"date-time":"2018-09-27T00:00:00Z","timestamp":1538006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Clarus Therapeutics"},{"name":"TesoRx"},{"DOI":"10.13039\/100014928","name":"Antares","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014928","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>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 (<jats:styled-content style=\"fixed-case\">DSD<\/jats:styled-content>), and to determine the separation or overlap of testosterone levels between normal and affected males and females.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A literature review was conducted for published papers, from peer reviewed journals, reporting testosterone levels in healthy males and females, males with 46<jats:styled-content style=\"fixed-case\">XY DSD<\/jats:styled-content>, and females with hyperandrogenism due to polycystic ovary syndrome (<jats:styled-content style=\"fixed-case\">PCOS<\/jats:styled-content>). Papers were selected that had adequate characterization of participants, and description of the methodology for measurement of serum testosterone and reporting of results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010 to fivefold higher than the upper end of the female range(males 8.8\u201030.9\u00a0nmol\/L, females 0.4\u20102.0\u00a0nmol\/L). Individuals with 46<jats:styled-content style=\"fixed-case\">XY DSD<\/jats:styled-content>, specifically those with 5\u2010alpha reductase deficiency, type 2 and androgen insensitivity syndrome testosterone levels that were within normal male range. Females with <jats:styled-content style=\"fixed-case\">PCOS<\/jats:styled-content> or congenital adrenal hyperplasia were above the normal female range but still below the normal male range.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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 <jats:styled-content style=\"fixed-case\">DSD<\/jats:styled-content> or hyperandrogenism.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13840","type":"journal-article","created":{"date-parts":[[2018,8,23]],"date-time":"2018-08-23T07:13:36Z","timestamp":1535008416000},"page":"15-22","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":76,"title":["Large divergence in testosterone concentrations between men and women: Frame of reference for elite athletes in sex\u2010specific competition in sports, a narrative review"],"prefix":"10.1111","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0546-515X","authenticated-orcid":false,"given":"Richard V.","family":"Clark","sequence":"first","affiliation":[{"name":"United States Anti\u2010Doping Agency  Colorado Springs Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Wald","sequence":"additional","affiliation":[{"name":"qPharmetra  North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald S.","family":"Swerdloff","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Department of Medicine LA Biomedical Research Institute Harbor\u2010Univ of Calif\u2010LA Medical Center  Torrance California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Wang","sequence":"additional","affiliation":[{"name":"Clinical and Translational Science Institute LA Biomedical Research Institute Division of Endocrinology Department of Medicine Harbor\u2010Univ of Calif\u2010LA Medical Center  Torrance California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick C. 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