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Sports policies that exclude women with high testosterone must end, experts say

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Women who have always competed as women should be allowed to continue

MANJUNATH KIRAN / Stringer

Last summer, Indian sprinter Dutee Chand was barred from competing against other women because of a testosterone policy. Track’s governing body, the International Association of Athletics Federations (IAAF), told her that she could only return to the sport after she lowered her natural testosterone levels to ones that were beneath the IAAF’s guidelines. To do that, she would have to have to undergo surgery, or take hormone-suppressing drugs. She refused and is now fighting the decision.

"You have women with naturally high testosterone who all of a sudden find themselves unable to compete in the category they have always competed in," says Katrina Karkazis, a bioethicist at Stanford University. "They were born as girls, raised as girls, they identify as women, and their legal documents identify them as women — and all of a sudden they must undergo medical interventions that are not for their health, but simply to lower their testosterone."

"medical interventions that are not for their health."

Karkazis is one of two experts who published a report yesterday in Science calling for an end to sports policies that ban women from sports because their bodies produce naturally high levels of testosterone — levels that exceed 10 nanomoles per liter in their blood. These bans are designed to prevent women with high testosterone from competing in sports against other women because they have an "unfair advantage."

"Androgenic hormones have performance-enhancing effects, particularly on strength, power and speed, which may provide a competitive advantage in sports," the IOC wrote in 2013. But the authors of the Science report argue that the rationale behind the ban is faulty, and that women who were raised as women and who have competed as women their whole lives should be allowed to continue. In short, they’re arguing that their biology shouldn’t be policed.

"The IAAF wants to say [that if they have high testosterone], well that means they don’t really count as female," says Alice Dreger, a bioethicist at Northwestern University who didn’t participate in the Science report. "That’s true if you define female-ness according to testosterone levels. It doesn’t define women as we define them, which is your social role."

"It doesn’t define women as we define them, which is your social role."

Thus, if sporting officials want to base their categories on testosterone, then they should do away with categories like "men" and "women" altogether, and they should call them hormone classes, Dreger says. "Let’s not call them gender, and have a [low testosterone] class and a [high testosterone] class — and confuse the crap out of everybody else in the world about what you’re talking about."

The IOC and the IAAF no longer perform "sex tests" on its athletes; the IOC dropped chromosomal testing as a requirement in 1999. But they do have testosterone tests which act as a proxy for determining who should be allowed to compete in men’s or women’s sports, in addition to being used to scope out athletes who use testosterone as a performance-enhancing drug. Women who are intersex — people born with a mix of sex characteristics, some traditionally considered male and some considered female, in the same body — sometimes display high levels of testosterone, and these policies disproportionately target them.

The IAAF asked Caster Semenya, a South African runner, to undergo a gender test in 2009. (Credit: Erik van Leeuwen/ Wikimedia commons)

The idea behind the regulation is that testosterone conveys an athletic advantage and that testosterone levels in men and women don’t overlap. But two studies, both released last year, present somewhat contradictory findings with regards to the presence of a testosterone "sex gap."

The first, funded by the IOC, looked at 234 female athletes and found that 13.7 percent of women had high testosterone levels. That same study also found that 16.5 percent of elite male athletes had testosterones levels that fell below the "typical" range for men. Taken together, these numbers provide evidence for a "complete overlap between the sexes," the authors write. But the second study — a study of 849 elite women athletes funded by the IAAF — found that only 1.5 percent of women had unusually high testosterone.

"Complete overlap between the sexes."

The reason for this difference is that the IAAF-funded study pre-emptively excluded women who are intersex from its analysis, the Science report concludes. This is a move that Karkazis says essentially defeats the purpose of figuring out what consists a "normal range" for testosterone in all women. "It’s circular," she says. The IAAF-funded study was conducted using the same policy it’s now being used to support.

The Verge contacted the IAAF and the IOC by email. The IOC responded to our request for comment by stating that "the IOC has always taken great care that such sensitive issues are dealt with by broad consensus using the latest scientific knowledge and research in that area." The IAAF has yet to respond to our inquiry.

Testosterone is one of the drugs that athletes rely on when they dope. There is definitely some kind of link between testosterone and athletic performance, Karkazis says, but when it comes to naturally produced testosterone, things aren’t clear cut. After all, the IOC-funded study shows that men with low testosterone are able to compete at elite levels. "You can’t rank athletes by testosterone level and assume that people with lower levels won’t do well," Karkazis says.

"Female athletes have the right to some semblance of a level playing field."

Of course, there is an alternative view. Joanna Harper, a medical physicist at the Providence Portland Medical Center and transgender athlete who has written about her experiences competing against other women while taking hormone therapy says that testosterone is the best method we have for distinguishing women’s and men’s sports. "The IAAF and IOC have struggled for decades over what they should do with intersex women in sport, and scientists affiliated with both agencies would acknowledge that their current policies are not perfect," she says. (Athletes shouldn’t be named publicly, and they should not be made to feel that they need to have surgery to compete, Harper says.)  But in the end, "I think that billions of potential female athletes have the right to some semblance of a level playing field."

Still, the results from the men’s side of the testosterone spectrum make it hard not to ask why the hormone has become this all-encompassing marker for the type of human that gets to compete in women’s sports. People who are banned from competing are usually punished because they’re cheating or doping. In this particular situation, however, women who are intersex may benefit from a natural biological process. This is just how their bodies work, which means that the IAAF and the IOC are punishing women for not suffering from what would amount to unnaturally low levels of testosterone for them.

And what’s worse, the solution that many propose is to alter a healthy person’s natural biology in order to let her compete in a sport that she has worked tirelessly to excel at. (In the case of the IOC, women with high testosterone are allowed to compete with men if they qualify for an event. But again, men with low testosterone aren’t being forced to compete against women.)

"We don't ban athletes from competition because they're an inch taller."

"We don't ban athletes from competition because they're an inch taller or have more fast-shortening muscle fibers than their competitors — we don't say that it's ‘unfair’ that these athletes have these natural traits," says Claudia Astorino, an intersex activist. "Instead of barring these athletes from competing, the IAAF, the IOC, and other games commissions could simply allow anyone with natural testosterone levels to compete."

Despite these arguments, the IOC and the IAAF have singled out testosterone. "People who say, ‘this is nothing; we don’t need this rule,’ don’t know sports or are at some distance from sport," Arne Ljungqvist, the former chair of the IOC Medical Commission, told The New York Times last fall. But the logic doesn’t appear to come full circle. "There’s no other realm of sport where we say a natural advantage disqualifies you," Dregger says. "This is literally the only place."

Dutee Chand filed an appeal with the Court of Arbitration for Sport in Switzerland in September. "I feel that it’s wrong to have to change your body for sport participation," she told The New York Times, in Hindi. "I’m not changing for anyone." An arbitration panel met to discuss the appeal in March; they will make their decision known soon.