The debate raging about testosterone tests in track and field will come to an ugly climax in Rio, and reasonable people on both sides agree it is unfair that the ugliness has landed squarely on the shoulders of women like South African middle-distance runner Caster Semenya.
Semenya, who first came to international attention after she won gold in the 800m at the 2009 World Championships, has become the face of a debate about who gets to compete as a woman in the Olympics. At the time, suspicions were raised about Semenya due to her “masculine” appearance and athletic dominance. As a result, she was subjected to gender verification tests and examinations. News of those tests was leaked to the press, followed by speculation from both athletes and officials. Pierre Weiss, general secretary of the IAAF, track and field’s governing body, publicly stated at the time “She is a woman, but maybe not 100 percent.”
Intersex advocates have been outraged by this kind of treatment. “It’s a case of faux-science being used to further discrimination,” said Hida Viloria, a UC Berkeley alum, intersex writer, and chairperson of the Organisation Intersex International (OII) in an interview with California. And in the lead-up to Rio, Stanford bioethicist Katrina Karkazis wrote, “They deserve our admiration and respect. Not only for their courage, but also for their exceptional athletic talent. Instead, this dehumanizing speculation, commentary, and depiction is intensifying.”
Semenya meanwhile, continues to dominate, winning her last 800m race before the Olympics in a world-leading time of 1:55.33. On Aug. 20, she is expected to win gold in Rio, and many think she will break a 33-year-old world record in the process. She may also dominate in the 400m, and if she beats American favorite Allyson Felix there, it is unlikely U.S. fans will take the loss well.
Advocates for testosterone limits on female runners point to her dominance as further proof that Semenya, who has never publicly confirmed her presumed intersex status, has an unfair advantage over other women. In online forums, more hateful critics grudgingly refer to her as “he” or even “it.”
Semenya is, in all likelihood, an intersex woman. Intersex is a general term used to refer to a wide range of conditions including hormonal variations, like higher levels of testosterone or a dormant Y chromosome, or physical variations, like abnormal genitals. Semenya likely never heard the term intersex before being tested in 2009.
“Many people who are intersex don’t even know they are, much less use the term to i.d. themselves,” said Viloria. At a 2010 International Olympic Committee (IOC) meeting on the topic, Viloria lobbied for Semenya’s right to compete without altering her body and petitioned the IOC not to refer to intersex athletes, or athletes with hyperandrogenism, as “people with sex disorders.”
Hyperandrogenism was the official term track’s governing body, IAAF, adopted to characterize Semenya. It means she has a higher level of testosterone than the normal woman. The IAAF also came up with a new policy in 2011 to apply to athletes like her: women whose testosterone levels are higher than 10 nanomoles/liter would have to bring those levels under the upper limit to be allowed to compete as women. This could be accomplished via shots or, in at least a handful of known cases, surgery. The general normal female range, on average, is about 1 to 3.3 nanomoles/liter, though the extent of normal variation is a topic of debate.
Last year, however, the Court of Arbitration for Sport overturned this rule, eliminating the upper testosterone limit for women. Semenya is no longer required to take shots to decrease her body’s natural testosterone production. Since that decision, she has been running faster than ever.
Semenya is not the only known athlete with hyperandrogenism competing in Rio. Indian sprinter Dutee Chand, who will run in the 100m later this month, is another. Chand was unaware that she had high levels of testosterone until she was called in to Delhi for testing in 2014.
As with Semenya, publicity surrounding her case was poorly handled. She, too, was subjected to tests to measure her genitalia, breast size, and pubic hair in order to determine the effect of her high levels of testosterone. Her name was leaked to the media and false inferences were made about her gender. She was told she’d have to take shots to lower her testosterone levels but decided instead to fight the rule.
“I want to remain who I am and compete again. I have lived my life as a girl,” Chand said in the Indian Express when the case went to the court.
James Bunting, a Canadian lawyer who took up Chand’s case, said that because of ongoing appeals neither he nor Chand could speak about the case but recommended that California talk to Bruce Kidd, a professor of kinesiology at the University of Toronto and a member of the Commonwealth Advisory Board on Sport. For Kidd, who worked with the Indian federation to put Chand in touch with Bunting and with advocates like Karkazis and Viloria, the issue is a matter of human rights. It simply wasn’t fair, he said, to require athletes to alter their natural bodies in order to compete.
“The ideal of sport is that it pits people against themselves,” said Kidd. “She was not doping. They’re not the hormonal Olympics; they’re the Olympics.”
“Who is it fair for? And who does it harm?” asked Karkazis of the rule.
Karkazis and Viloria both became involved with Chand’s legal case, which came down to the question of whether or not higher levels of testosterone convey an unfair advantage in female athletic competition. The court decided it did not.
The decision read: “While the evidence indicates that higher naturally occurring levels of testosterone may increase athletic performance, the panel is not satisfied that the degree of that advantage is more significant than the advantage derived from numerous other variables which also affect female athletic performance.”
The IAAF and the World Anti-Doping Agency’s own study, which measured androgen levels, came to a similar conclusion: “The lack of definitive research linking female hyperandrogenism and sporting performance is problematic…there is no clear scientific evidence proving that a high level of T[estosterone] is a significant determinant of performance in female sports.”
But the issue is by no means cut and dried. The range of normal testosterone levels overlap for women and men—different studies of those ranges in elite athletes have found different results. One study found that 13.7% of female elite runners fell above the standard female testosterone range. Another found that just 1.5% did. The difference was in methodology and, importantly, in who was included in the pool of normal woman. It is true that men have a competitive advantage, in general, of about 10-12 percent over women, according to multiple studies and testimony during the case, and higher levels of testosterone are an important factor in that advantage. (Interestingly, that 10-12 percent different is also true for post-surgery transgender athletes.) It is also true that doping with testosterone correlates to a performance advantage.
What has not been proven, however, is that naturally occurring high levels of testosterone automatically confer an unfair advantage to some women, greater than say the genetic benefits of being taller or having a greater ability to process oxygen, something Karkazis seizes on. After all, she points out, “We don’t say you can’t compete because your VO2 max is amazing.”
Not everyone thinks that’s an accurate comparison. Ross Tucker, a well-respected South African sports scientist, recently penned a long blog post on the topic in which he argued that “we have a separate category for women because without it, no women would even make the Olympic Games.” Unlike, say, short people, “women are a protected class in order to preserve their ability to compete on a level playing field.”
“The presence of the Y-chromosome is the single greatest genetic advantage a person can have,” Tucker continued. “That doesn’t mean that all men outperform all women, but it means that for elite sport discussion, that Y-chromosome, and specifically the SRY gene on it, which directs the formation of testes and the production of testosterone, is a key criteria on which to separate people into categories.”
The testosterone limit was an imperfect rule, Tucker concedes, but one necessary to preserve women’s sports.
And the rule may not be gone for good. The court essentially left the door open for the IAAF to come back with better proof of its position and it is expected that the governing body will try to appeal by the mid-2017 deadline. For now, neither the International Olympic Committee or the IAAF are speaking publicly on the topic.
A number of female athletes have voiced their own concerns, however.
“It challenges and threatens the integrity of women’s sports to have intersex athletes competing against genetic women,” said Bay Area Olympian Shannon Rowbury at the U.S. Track and Field Olympic Trials in July. “I think Caster is a wonderful person, I have nothing against her, but I think we already have an established precedent of men’s sports and women’s sports. Women have fought far too long to be able to even have the right to compete, and now it’s being challenged by intersex and trans athletes, and I don’t think that’s right.”
For Karkazis and Viloria, though, it’s hard to ignore the fact that women from “the Global South” are more often subject to speculation about their intersex status. (Many women in developing countries reach adulthood without the types of medical interventions or surgeries that are fairly common in more affluent Western countries.) They also find it problematic that women who appear less feminine are most frequently the target of suspicions—and, in turn, the target of testing.
“It’s mainly masculine-looking women who are being discriminated against,” said Viloria.
The issue is not new. The Olympics have a long history of requiring women to prove they’re women. This used to be done through the 1960s via what are now referred to as “naked parades.” That was replaced in late-1960s by a chromosome test. But the chromosome test was abandoned after Spanish hurdler Maria José Martínez-Patiño, who “failed” a gender test administered at the 1985 World University Games, fought it and won.
Martínez-Patiño was born with X and Y chromosomes, and tests later showed she had internal testes, but because of genetic variations her body was not able to process the testosterone they produced. The leaked test, however, caused her to lose her university scholarship, her medal, and her boyfriend. Though the chromosome test was officially done away with by the late-1990s, an Indian athlete, Santhi Soundarajan, was also found to have an unknown Y chromosome in 2005. She too displayed no male characteristics, and attempted suicide after the finding was leaked to the press.
“The IOC has always had problematic policies towards women,” said Viloria. “This is almost the current-day version of that.” Historically, she said, these kinds of discriminatory attitudes used to be wielded against lesbians, with assumptions being made about performance advantages they must have.
In the age of Caitlyn Jenner, of course, many old attitudes regarding gender and athletics are falling by the wayside. The IOC adopted for the first time this Olympics a policy allowing transgender athletes to compete without having to first undergo surgery.
While trans and intersex are two different things, in both cases certain fears arise, not unlike those that crop up around transgender bathroom rights; namely, that men masquerading as women will sneak into female competitions.
But advocates like Karkazis and Viloria dismiss such fears as misplaced. “It’s a solution in search of a problem,” said Karkazis. After all, just as your documentation proves your age, name, and nationality, it also lists your country-accepted gender, she said. To pretend to be a woman, when you’re really a man, would take years of preemptory lying.
“I just think that scenario’s never going to happen,” said Viloria.
In the long-term, said Viloria, this is part of a larger battle for intersex people to get more recognition and understanding about who they really are. Yes, that might mean having to ask ourselves tough questions about how we’ve defined societal gender categories. As long as there are only male and female categories, forcing people into one slot or another will continue to be problematic. At the same time, creating a separate category for intersex athletes is a bit unrealistic, since they account for less than 2 percent of the population.
Viloria hopes that as society becomes more educated on the issue, the IAAF and IOC will simply leave intersex athletes alone. “This is just what these people are born like, and these are women and you’re just going to have to deal.”