Challenging the principle of “No presumption of advantage” with a focus on testosterone and gender eligibility in sports

The IOC's principle of "No Presumption of Performance Advantage" contradicts a substantial body of scientific evidence. While inclusion and fairness are important goals, the framework's rejection of testosterone as a key determinant of athletic performance risks undermining competitive fairness and athlete safety in sex-segregated sports, particularly where strength and power are critical. Acknowledging testosterone as a key determinant of performance, our study proposes a novel multi-layered evaluation framework that integrates real-time sensor data with omics analyses. This innovative approach supports the development of adaptive, context-specific, and ethically grounded policies that promote fair, inclusive, and safe competition while offering a forward-looking roadmap for future policy and research.