For years, female athletes have struggled to be treated equally to male athletes. Gender equality for female athletes in sports is still far away. I believe you as female athletes deserve the same medical and sport science support as male athletes. I also believe you deserve the same publicity and adoration as male athletes, and ultimately, the same financial benefits. However, in the pursuit of gender equality, we should be careful not to fall into the obvious trap of suggesting that this implies gender similarity.

Men and women are not the same. Besides the obvious characteristics most of us appreciate, recent biological research has confirmed that men and women are genetically very different. In fact, when looking at the genetic differences between the sexes, some world experts have suggested that human men and women are about as different as human males and chimpanzee males. Just think about that!


Chromosomes carry our genes, which contain our DNA material. Men and women have the same number of chromosomes (46 that come in 23 pairs), but men have an X and a Y pair, and women have a two X pair. The total number of genes in a human being is about 20 000. However, the X chromosomes carry more than 1 000 genes, whilst Y chromosomes carry less than 50 genes. This means men and women possess a very different number of genes. Not only that: There are 163 genes that occur either only in men or occur in men and women in different amounts. Additionally, there are another 800 genes that are affected by sex hormones so that their expression is different between men and women.

The most interesting fact in this revelation is that these differences are not limited to sexual organs, as we used to believe. Every cell in your body has a sex because every cell in your body carries your sex chromosomes, as well all those genes that are different between men and women.

We have already started seeing the consequences of these differences in other areas of medicine. For example, we now know that women who smoke suffer lung cancer at a younger age than men. They have higher levels of the enzyme which causes lung cancer in smokers. On the other hand, men more often suffer from Parkinsonism, a disease of the nervous system affecting movement).


Similarly, the livers of men and women contain different amounts of a certain enzyme (cytochrome CYP3A). This enzyme is responsible for how our body metabolizes almost 50% of all the medications we know today. This means that men and women metabolise these medications differently. Therefore, the dosages for certain medications should be different for men and women. Indeed, in 2013, the FDA finally recommended a lower dose of a sleeping tablet (Zolpidem) for women. It had been shown that they suffered more severe side effects from it. For some, this had very serious consequences: women were more often involved in car crashes—because they felt so drowsy the morning after taking it. And yet, apart from Zolpidem, when was the last time you read different dosage instructions for men and women on a box of pills?

Why is this important? We know that their different genetic setup causes women to respond differently to illnesses and medications than men. Hence, women may also be different from men in how we experience sports illnesses and injuries. The immediate next question is: Do we need to treat these illnesses and injuries differently in female athletes?

Essentially, we cannot just take research that has been done in male athletes and apply it to female athletes.  Just like we would not try to apply research done in chimpanzee males to human males! We need to first check if the results are valid for female athletes.


Research that has been done in many of the large sporting competitions in the world (such as the FIFA World Cup, the Olympic Games, and the IAAF World Championships) seems to support this. Whilst the frequency of injuries is more or less the same in male and female athletes, the types of injuries are very different. We know, for example, that female footballers are more than twice as likely as male footballers to have an anterior cruciate ligament rupture. We also know that female athletes are more likely to suffer from a concussion. In fact, when they do have a concussion, it tends to be more severe than in male athletes. On the other hand, male athletes are more likely to have groin, hamstring, and ankle injuries than female athletes.

And here is the main problem: At this point, we cannot answer the question of whether male and female athletes with the same injury should be treated differently. We simply do not know. We also do not know if the current proven injury prevention programs should be the same for both sexes. The main reason for this lack of knowledge is a huge research gap between male and female athletes. If we want to achieve gender equality for female athletes in sports, we need to overcome this gap.


For example, less than 20% of all the original football research articles in three of the world’s best sports medicine journals include women in their research and look at the differences between male and female athletes in their projects. What does this mean? Many doctors use the knowledge presented in these journals and apply it to female football players. They do so in the best faith. Yet, in 80% of cases, this is about as scientific as consulting the American Journal of Primatology to treat a human male athlete. Sounds ridiculous? If you think about this objectively and from a genetic perspective, it becomes obvious.

Female athletes deserve better than this. It is time to address this glaring gap in sports medicine research.

The first step in the process is to raise awareness of the research gap—among sports medicine practitioners, researchers, scientific journal editors, and, above all, female athletes.

As female athletes, you have the strongest voice to demand change. However, you also have a big responsibility. Research in female athletes can only happen if you are willing to participate. Indeed, DEMAND to participate, in every potential research project that comes your way. Researchers often claim that it is difficult to enrol women in studies. Others are concerned that women’s hormonal status might affect the outcomes. This is a very poor excuse since differing hormonal status is a fact of life for female athletes – which will not suddenly change when they get sick or injured.


Therefore, research has to include women at various stages of their hormonal cycle, since this mimics real life. Participation in research requires you to commit time and energy. But we cannot expect researchers to get excited about female athletes if female athletes are not willing to contribute themselves. So, this is a call to action for those of you who believe you deserve better care.

It is time to acknowledge that gender equality is not gender similarity. You, your teammates, your competitors, and all female athletes worldwide should LEAD the movement to tackle the gender gap in sports medicine research. It is an essential step towards gender equality for female athletes in sports.


  • Dr. Celeste Geertsema is a sports physician who qualified in New Zealand and currently works at Aspetar in Doha, Qatar. She has significant experience working with elite athletes, having been the team physician for the New Zealand national football team for seven years, and team physician for New Zealand at the Commonwealth Games and the Winter Olympics. She has worked with FIFA at several World Cups and was the first-ever female team physician at the FIFA World Cup (in South Africa 2010) and the first-ever female FIFA Venue Medical Officer (VMO) at a World Cup (in Russia 2018). She has also worked with the IOC at the Winter Olympics, and with several other sports, including handball, tennis, and swimming at large international events. She is passionate about equal opportunities, without discrimination based on sex, gender, race or cultural background.