Gender Issues in Sport

I was taken by an editorial that I read in the New York Times this weekend:  The Trouble With Too Much T.  If you didn’t have the chance to see it yourself already, by all means click on the link and read this piece.


Caster Semanya, South African Olympian

The authors, Katrina Karkazis and Rebecca Jordan-Young, give a broad overview of how current sports governing bodies determine if an athlete is ‘really’ female.  Of note, Karkazis and Jordan-Young are also the principal authors of  The American Journal of Bioethics critique of the current gender-testing policies of the IOC, IAAF and other governing  bodies.

They lead with the well-known story of Caster Semanya, the South African woman who, in 2009, was barred from international competition and was compelled to undergo testing after the Berlin World Championships (she has subsequently been reinstated, and in the 2012 London Olympics was the flag-bearer for the S. African team and earned a silver medal in the 800m).  After the uproar that ensued over the Semanya case, the previously mentioned sports governing bodies instituted new gender-testing policies and interventions to redress the ‘problem.’

The new policies, as described in the editorial, are arguably no improvement and, it seems, a step in the wrong direction.

In the editorial, the authors tell the story of four female athletes with endogenously high levels of testosterone (‘T’) who all went through a battery of tests: physical examination (including genital inspections), blood tests, MRI, and psychosexual histories.  They then underwent surgery:  gonadectomy and (inexplicably) clitoral surgery.  They were required to do this to lower their levels of T, and they all subsequently were allowed to return to competition.

The essence of the current gender policies is 1) an identification of abnormally high levels of endogenous T; 2) a ‘therapeutic proposal’ which would be offered to athletes who test ‘too high’ and which include medications and/or surgery; 3) a disqualification from elite sport for women who elect not to have their T altered with said ‘therapeutic proposal.’

We’ve discussed some aspects of this issue in a previous blog post, our review of David Epstein’s sublime book ‘The Sports Gene.’ Epstein devotes an entire chapter (‘Why Men Have Nipples’) to female athleticism, and the powerful role that testosterone can often play in elite performance.  After reading this editorial, I thought it was time to write another post and poll the readership about aspects of this issue.

I can sympathize with the need to screen for use of exogenous testosterone, the systemic abuse of which led to most of the superior performances produced by East German athletes in the 1970′s.   Read more of this post

NOT Sports Medicine


The 2014 Boston Marathon will be run in a little more than a week (Monday April 21). We look back on the events of last year while we look forward to a safe running in 2014. Good luck to all the clinicians and staff who will be taking care of a record number of runners!


Boston Strong!

Originally posted on Clinical Journal of Sport Medicine Blog:

I don’t think any of us in sports medicine got into the field expecting to be involved in an event like that which transpired in Boston yesterday .

Map of Boston Bombings

Like many people around the world, I became riveted to TV, internet newsfeeds, and Social Media yesterday as I tried to make sense of what was occurring in Boston:  at 2:50 p.m., a little over four hours after the start of the Boston Marathon, two bombs exploded near the finish line, creating a chaotic scene resulting at this moment in three deaths and over 100 casualties.  A scene of sporting joy and celebration had been turned into mayhem.

In the days ahead and as the investigation into this event unfolds, we will likely learn ‘who’ was behind this and for what supposed purpose.   It is my hope that ‘they’ become a footnote in history, and that instead…

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#AMSSM14 is the tag to follow on Twitter the next few days if you want to stay on top of what is topical in the world of sports medicine.  The American Medical Society for Sports Medicine (AMSSM) is having its 2014 annual meeting in New Orleans these next several days.  #AMSSM14 began Friday and is continuing through Wednesday.  It’s already been a rich experience, one we’ve been looking forward to for a while.


Happy conference attendees, Drs. Jane Sando and Natalie Stork.

Among the speakers who have already graced the podium:  David Epstein, a journalist and author of The Sports Gene, gave a great keynote speech Sunday on some of the factors that go into the ‘making’ of an elite athlete.  He presented a compelling argument for avoiding early sport specialization, allowing the youth athlete to sample and perhaps find the sport that ‘fits’ his or her unique physical attributes.  The talk was the perfect prelude to the afternoon’s sessions, ‘From Best Practices to Burnout,’ a series of lectures on how sports medicine clinicians might best guide youth athletes and families as they work their way through the North American sport system.

Dr. John DiFiori, the outgoing AMSSM president and lead author on the statement on youth sport specialization and burnout we published in January, spoke at length about the findings of that systematic review.  In case you missed the lecture and/or are elsewhere than New Orleans this weekend, take a look at our ’5 Questions with CJSM’ interview with Dr. DiFiori.  Dr. Tracy Ray discussed ‘Patient Centered Care’ of the collegiate athlete that I particularly enjoyed.   The focus was the InterAssociation Consensus Statement on Best Practices for Sports Medicine Management for Secondary Schools and Colleges.

I already have my eye on a series of ‘point/counterpoint’ discussions tomorrow morning:  contact sport: should it be embraced or avoided? Spondylolysis:  to brace or not to brace? And vitamin D:  to screen and treat or not?  I’ll be there and I’ll be sure to be tweeting the high points of those sessions.

I think it’s a testament to the quality of the sessions that I am sitting in a large auditorium at 5 pm on a weekend day here in New Orleans…..and it’s nearly full!  Great to see folks want to hear about positive and negative likelihood ratios rather than enjoying the temptations of Bourbon street…..well, at least for an hour more perhaps!

Follow us on @cjsmonline, follow the AMSSM on @TheAMSSM, and follow the hashtag #AMSSM14 for all the info coming hot off the press from this conference!!

There Be Monsters

“In like a lion, out like a lamb,” that’s what they say about March.

To the extent that expression applies to the weather this month and to this blog, I think 2014 may be the exception that proves the rule!  We may be going out like a lion in both areas.

The east coast of North America is ready for spring, but this month that opened up with winter is ending the same way.  If there was an outdoor lacrosse game in Buffalo, New York this weekend, the players were dealing with snow!


More like a lion than a lamb: an NHL body check.

As for this blog, we opened the month with a post that had both sound and teeth, like the proverbial carnivore itself:  our first podcast was a discussion with Drs. Neil Craton and Oliver Leslie, the authors of the March 2014 CJSM lead editorial, Time to Re-Think the Zurich Guidelines: a Critique on the Consensus Statement on Concussion in Sport.  I continue to hear about this editorial, on social media, on the American Medical Society for Sports Medicine email ListServ, and most recently at a symposium on concussions held at Ohio State University (OSU).  It has stirred a tremendous amount of interest.  And so I thought it would be fitting to end the month where we started, with the subject of concussion in sport.

The featured speaker of the OSU symposium was Kevin Guskiewicz, who spoke about “Sports concussions: paranoia or legitimate concern?”  Both he and Dr. Jim Borchers, the Ohio State Team Physician, mentioned the editorial critique in their respective talks.

If you follow the literature on sport-related concussions, you most certainly will come across Dr. Guskiewicz’s name.  He has contributed mightily to the research on several dimensions of this injury.  And so it was a pleasure to hear him speak for an hour on the subject.

As the title of his talk would indicate, Dr. Guskiewicz took as his theme the fear surrounding sport-related concussion.  Dr. Guskiewicz did an admirable job underscoring the importance of both the injury (concussion) and the need to avoid throwing out the baby with the bathwater:  eliminating collision sports such as American football out of possibly misplaced concern over short- and long-term deleterious effects on the brain.  The high points of his talk focused on the various aspects of sport amenable to change which can minimize injury risk and maximize participation.

I especially enjoyed his approach because, in many respects, it is the work that he and a few others have done (amplified by the media) that has helped unleash the beast of “concussion fear.” Read more of this post

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