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 Semenya, 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 Semenya, 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.  But I think that genetic variations which allow for production of endogenous testosterone are a part of that athlete’s makeup; the situation  is ultimately no different than the issue of the athlete’s  hair color.  Yes, that genetic endowment creating higher levels of T is an athletic blessing in a way that red hair, say, is not.  In 2014 we have the ability with our testing to distinguish exogenously administered from endogenously produced T.  If  the T is part of that woman’s genetic make up, I think the current medical and surgical attempts to supposedly redress the situation are an ethical mess.

I think it is particularly insidious that such rules are being applied solely to female athletes.  Having women medically treat themselves to lower their T is akin to handicapping a horse in a race.   If a man has supranormal levels of endogenously produced T, might not some consideration be made for putting him on Lupron?  Let us even the field, men and women alike!

I certainly hope while the governing bodies are working through these issues (and there are plenty more wrinkles to come, with ‘genetic’ doping on the horizon) that they are consulting medial ethicists, and that there are plenty of women at the highest levels of the committees making the ultimate decisions on how to test and intervene.  How often do we see over the millenia groups of men dictating to women what must be done to and about their bodies.

If you’re looking for more on this subject, Jessie Ellison in the Daily Beast gives a very thorough overview of the new IOC policies. If you’re looking to know more about the evidentiary basis behind gender differences in athletes, CJSM publishes frequently on the issue. And please, take the poll or draft a comment below to let us know what you think about this issue.