International sports governing bodies such as the International Association for Athletics Federation and the International Olympic Committee have recently revised their policies for inclusion of athletes competing in women's international sports competitions. Previously, the focus was on verification of gender or femininity. The mishandling of Caster Semanya's case brought the complex issues of fairness with regard to athletes with disorders of sexual development or hyperandrogenism into both public and private debates. The new International Association for Athletics Federation and International Olympic Committee policies for inclusion in women's sporting events rest largely on the serum testosterone level, mandating that it be less than the lower limit of normal for men as the defining criteria. This report provides an overview of past problems and an update of the newly adopted policies for eligibility for competition in women's events. Endocrinologists will play a key role in the evaluation and treatment of women athletes who have elevated androgen levels, regardless of the underlying cause.