Eligibility of Athletes With a Difference in Sex Development in Elite Sport: Opinions of National, Elite and World Class Athletes.

There have been limited studies allowing key stakeholders the opportunity to voice their opinions on DSD athlete participation in elite sport. The purpose of this study was to survey athletes eligible to compete in the female category regarding DSD athletes' inclusion. This study surveyed national, elite and world class athletes (n = 147) competing in the female category regarding their opinions on the eligibility of DSD athletes in elite sport. The study compared current and retired Olympic sport athletes, elite versus world class athletes and current Olympic sport versus current Olympic-recognised sport athletes. Most athletes believed that it was an unethical requirement to medicate in order to comply with eligibility regulations (67.2%). Overall, athletes did not support a separate category for DSD athletes, an opinion most strongly held for precision sports (69.5%) and a majority believed their participation in the female category was fair (54.4%, precision sports). This opinion was more commonly held by Olympic-recognised sport than current Olympic sport athletes, particularly for sports heavily reliant on physical capacity (61.1% vs. 20%). More current Olympic sport athletes believed that the eligibility of DSD athletes for the female category was unfair, compared to Olympic-recognised sport athletes. Athletes agreed that sports federations could be doing more to make sport more inclusive for DSD athletes (82.2%), with only 8.2% believing such athletes were treated fairly. After reviewing these novel results, the athletes' voice (in combination with scientific evidence) should be utilised to create appropriate policies that align with the collective values of athletes.