From policy to practice: A South African clinical toolkit for SRY gene screening in sport.

The recent implementation of SRY (sex-determining region Y) gene screening by international sporting federations has introduced new clinical responsibilities for practitioners involved in athlete care. Recent policy developments, including updated guidance from the International Olympic Committee, further signal the expanding role of genetic screening in elite sport. While federation-level policies exist, there is limited clinician-focused guidance on how to operationalise screening, manage results, and ethically support athletes, particularly in low- and middle-income settings. This paper presents a practical toolkit and a step-by-step clinical pathway to support clinicians involved in SRY gene screening. Informed by clinical implementation and refined through multidisciplinary peer feedback, the proposed framework emphasises role clarity, informed consent, confidentiality, appropriate referral, and athlete-centred communication. It is intended as a clinical support tool rather than a formal guideline, consensus statement, or legal interpretation. By translating policy into a structured clinical process, the framework supports consistent, ethical, and contextually relevant practice.