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Physiological Basis of Sex Differences in Human Performance and Exercise-Associated Pathology
David A Holdsworth1,2, Thomas J O'Leary3,4, Craig L Doig5
1Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre of Defence Medicine, Birmingham, UK.
Clinical Endocrinology
|April 30, 2026
Summary
Biological sex significantly impacts human physical performance due to hormonal and physiological differences. Men
Area of Science:
- Exercise Physiology
- Sports Science
- Endocrinology
Background:
- Sex differences in human physical performance are well-established.
- Understanding the biological drivers of these differences is crucial for sports medicine and clinical endocrinology.
Purpose of the Study:
- To review hormonal and physiological determinants of sex differences in exercise performance.
- To examine how these differences affect athletic capabilities and exercise-related pathologies.
Main Methods:
- Review of human trials focusing on hormonal and physiological factors.
- Analysis of data on exercise capacity, performance gaps, and pathology risks.
Main Results:
- Higher testosterone in men contributes to greater muscle mass and cardiac output, widening the performance gap.
- Female physiology offers advantages in prolonged submaximal exercise, improving fatigue resistance and fat oxidation.
- Performance gaps persist across sports, varying with event duration, strength, and power demands.
Conclusions:
- Sex is a fundamental biological variable in exercise physiology and sports performance.
- Recognizing sex-based differences is vital for tailored training, clinical management, and understanding exercise-related pathologies.
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