Hunter et al. 2023, Biological basis of sex differences in athletic performance: ACSM consensus statement

This ten-author American College of Sports Medicine consensus statement synthesises the biological and physiological mechanisms behind the 10–30% sex performance gap across athletic events, attributing it primarily to testosterone-driven differences in haemoglobin concentration, cardiac size, body fat and VO₂max. The document addresses haematological advantages, substrate utilisation differences and fatigue resistance, and notes that the gap emerges at puberty when testosterone rises 30-fold in males. Evidence: strong.