Elite sports these days operate on a strict male/female binary. Intersex athletes face structural disadvantages under the current system as they are sometimes required to undergo hormone suppression or surgery to compete in their category, disqualified from competition altogether, or compete under regulations that do not reflect their physiology. Advocates, sports scientists, and policymakers are currently debating different reform strategies, like (i) replacing sex categories entirely with biometric performance tiers based on testosterone, muscle mass or bone density, (ii) creating a dedicated intersex category alongside existing male and female categories, or (iii) allowing intersex athletes to self-determine which category they compete in without eligibility conditions.