Absurd New Rules for Intersex Athletes

Caster Semenya, in green, competing in the women’s 800-meter final at the Commonwealth Games in Australia this month.CreditMark Schiefelbein/Associated Press
Caster Semenya, in green, competing in the women’s 800-meter final at the Commonwealth Games in Australia this month.CreditMark Schiefelbein/Associated Press

Caster Semenya, the South African middle-distance runner, is the world champion in the women’s 800 meters. But because of new regulations unveiled on Thursday by the International Association of Athletics Federations, she’ll never be able to win that race on the global stage again as a woman — unless she submits to medical procedures to alter her body.

The regulations, which are to take effect in November, mandate that women athletes with naturally elevated testosterone levels, like Semenya, cannot compete in any races between 400 meters and a mile unless they undergo endocrine treatments or surgery to bring those levels down into what is judged to be the “acceptable” range for females.

Back in the day, dividing sports by gender was easy. People who had been raised as girls competed as women. Those raised as boys competed as men. But the more science we obtained, and the more competitive (and lucrative) sports became, the more officials started insisting we had to be careful not to let athletes who were “really” males compete with “real” females.

The International Olympic Committee and the I.A.A.F., the two groups that govern international track and field competition, have tried, over the years, various ways to be “fair”: making women athletes show their genitals to screeners; testing women athletes to see if they have a Y chromosome; and, more recently, checking their hormone levels to see if they make “too much” testosterone.

In 2012, in response to questions raised about Semenya, the I.O.C. and I.A.A.F. issued new rules saying that women found to have hyperandrogenism — androgen levels, including testosterone, closer to or in what is considered the male-typical range — would have to subject themselves to hormone-squashing medical interventions or not play as women.

Caught in this web, the Indian sprinter Dutee Chand challenged the rules in 2014. In response, the international Court of Arbitration for Sport required the I.O.C. and I.A.A.F. in 2015 to come up with better evidence that their rules made sense. The I.O.C. did more research and decided that it can now at least prove that high levels of androgens in women matter to track performance in races of 400 meters to one mile. Hence this week’s new rule.

To their credit, the I.O.C. and I.A.A.F. haven’t just sought better science. They have also tried to make life less miserable for athletes who might be ruled ineligible to play as women. They have tried to make testing more equitable and confidential and to ensure informed consent before athletes submit to hormone-altering interventions.

They’ve also tried hard to tell everybody they’re not really judging anyone’s sex or gender when they test hormone levels. The I.A.A.F. says the new regulations are “in no way intended as any kind of judgment on, or questioning of, the sex or the gender identity of any athlete.”

But come on. How does telling a woman she can’t play as a woman, but “assuring” her that she might be able to qualify to run in the men’s race, not judging her gender identity or sex?

There’s no question that some athletes raised as girls and playing as women do not have female-typical bodies. Some were born with differences of sex development (intersex conditions) that mean their bodies have a blend of male-typical and female-typical traits.

A 2014 study by I.A.A.F.-affiliated scientists estimates that 7 in 1,000 elite women athletes have a Y chromosome with hyperandrogenism, a rate “140 times higher than expected in the general population.” And that 7 in 1,000 figure would be even higher if it counted all the differences of sex development that can cause hyperandrogenism.

But the truth is that no elite athlete’s body can be called fully “typical” in a statistical sense, and every other type of inborn advantage is allowed in sports. You can be born with natural advantages in terms of muscle development, oxygen processing, vision — all of those are allowed, without question. We’d never entertain the idea that Michael Phelps should be barred from swimming competitions because his extraordinary “wingspan” gives him an advantage.

As Chand put it in her court testimony: “I am unable to understand why I am asked to fix my body in a certain way simply for participation as a woman. I was born a woman, reared up as a woman, I identify as a woman and I believe I should be allowed to compete with other women, many of whom are either taller than me or come from more privileged backgrounds, things that most certainly give them an edge over me.”

It’s worth noting that men who naturally make extraordinarily high levels of testosterone are allowed to play without question. Additionally, the World Anti-Doping Agency, which regulates doping in sports, allows men who can prove they have naturally low levels of testosterone to take testosterone supplementation without considering it doping. So how is this just about natural hormone levels and fairness — and not actually about cultural norms of sex and gender?

Elite sports agencies also allow non-intersex women to manipulate their hormones, through birth control pills, to ensure that they are at the most advantageous part of the menstrual cycle when they compete. That’s considered fair. In fact, I learned about this from a world-class marathoner who admitted, at an I.O.C. meeting in 2013 where she and I were consulting on sex-testing, that she does this herself.

But women born with differences of sex development are subject to a whole different set of principles. For them, natural advantage is considered unfair, and unlimited testosterone is understood to be something men get to enjoy, even though all women also make it naturally.

As it turns out, Chand runs distances (100 and 200 meters) for which the I.O.C. and I.A.A.F. can’t prove that hormone levels matter. But for runners like Semenya who compete in those rarefied 400-meter-to-one-mile spans where a hormone level may temporarily turn you from a woman athlete to maybe a man, life will remain risky.

Chand told the court just how dangerous it is to have your sex questioned internationally. It can mean losing everything you have worked for: your career, your income and your identity as a woman worthy of admiration.

In the 1980s, the Spanish hurdler Maria José Martínez-Patiño had her life turned upside down when she was discovered to have a Y chromosome. She lost her athletic scholarship. She lost her fiancé. And she faced humiliation on the international stage, as did Semenya. The Indian sprinter Santhi Soundarajan attempted suicide after having her sex brought into question in 2006.

The data may be convincing when it comes to the question of what testosterone, on average, can do for particular athletes in particular sports. But the new policy around this hormone is absurd and cruel. As the lives of Semenya, Chand, Martínez-Patiño and Soundarajan show, this is not just a game.

Alice Dreger is a historian of science and medicine and the author of Galileo’s Middle Finger: Heretics, Activists, and One Scholar’s Search for Justice. She was recently awarded the Courage Award by Heterodox Academy.

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