Gender Issues in Sport

April 15, 2014 by 2 Comments

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.

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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.   Read more of this post

Filed under CJSM Polls, Doping in Sport, Elite sport, Ethics and probity in SEM, Female Athletes, Women in Sport Tagged with

Female Athlete Triad: The 2014 Consensus Statement

March 12, 2014 by

Did you know that the most recent issue of CJSM contains the recent, important consensus statement on Female Athlete Triad (F.A.T.):  2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad?

Did you also know that we are always keen on having guest bloggers on this site?  Our guest blog post guidelines will help you get some idea of what we are looking for.  I am especially keen to see readers of CJSM studies write critical appraisals of commentary on those journal offerings; but we will also consider potential posts that look at anything new and exciting in the world of sport and exercise medicine (evidence-based preferred).

stacy fischer

Dr. Fischer: when not caring for patients
or researching Female Athlete Triad.
Eating up the roads in Vail pass.

This month, figuring you all might grow weary of my writing ‘voice,’ I sought out a colleague of mine with experience in the area of F.A.T. to write a post about the consensus statement.  Dr. Anastasia Fischer is a pediatric sports medicine specialist at Nationwide Children’s Hospital, and is leading that group’s investigations of F.A.T. in adolescent and younger female athletes.  In the brief amount of time she has between seeing patients, doing academic medicine, taking care of three children, and biking, she sat down to share some of her thoughts below.

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So what’s so cool about the new 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad (link to article)?  EVERYTHING.  Seriously, everything.  For any professional who takes care of female athletes, this is a must read and will become part of your reference library.  This new consensus statement offers several features – first, it gives a comprehensive overview of the Triad, encompassing where the science started and how it evolved, where it is, and where research is needed or headed.  It gives a comprehensive review of treatment strategies that have been proposed or studied and evaluates their efficacy for athletes, in a straightforward, bulleted manner that has never before been published.  Finally, the icing on the cake is an evidence-based risk stratification point system that takes into account the magnitude of risk to assist the physician in decision-making regarding sport participation, clearance and return to play.  Truly, this document can be used as a guide to managing the female athlete from youth to maturity, across any spectrum of athletic performance, and give physicians a framework for screening and managing athletes across their careers.  It can help providers (physicians, athletic trainers, dieticians, etc.) optimize the performance and ultimately, the health and wellbeing of their athletes for years to come.

A few standout points of the statement: Read more of this post

Filed under Female Athletes, General Interest

The Sports Gene: How Olympians are made (or born)

February 5, 2014 by 1 Comment

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Erika Coimbra,
Brazilian Summer Olympian,
and one of the subjects of
“The Sports Gene”

The venues at Sochi are still, it seems, a work in progress.  Nevertheless, before the week’s end, we will (should?) see the Winter Olympic games start up.  Soon, we’ll get to watch some of the finest athletes in the world compete at their sport.

There has been a lot of talk about the on-going construction at the most expensive games in Olympic history, as well as the issue of gay rights and cultural sensibilities in Russia;  and there have been worries about the potential for terrorism.  But soon, when the competitions begin, I hope the focus will justifiably be on the athletes on the snow and ice.

Or in Tweet speak: #LetGamesBegin

I’ve not been consciously preparing for this elite sporting event, but rather coincidentally recently picked up a book that highlights elite athletes and has received a great deal of positive ‘buzz’:  The Sports Gene, by David Epstein.

You likely have heard of the book.  It has been receiving excellent reviews and is generating a lot of chatter in print, visual and social media.  On Monday, for instance, The Guardian hosted a live chat online with the author.  Subtitled, “Inside the Science of Extraordinary Athletic Performance,” the book delves into one of the ‘ultimate’ questions in sport:  nature or nurture, which is more important?  And, specifically, which is more important in the realm of elite sport?

Like many ‘ultimate’ questions, the real answer is not a clean, binary one.  That said, I walk away from reading this book thinking the bulk of the evidence is in favor of nature:  genetic endowments favor the production of elite athletes. Read more of this post

Filed under Elite sport, Female Athletes, General Interest, Women in Sport Tagged with , ,

World Cup time in Germany for the International Women’s Football Teams

June 26, 2011 by

It’s an exciting time in Germany right now as the Women’s Football World Cup kicked off today with the hosts off to a winning start against Canada, and with France beating Nigeria.

Since 1991, the tournament has been held every 4 years, this being only the second time that the tournament has been staged in Europe since it was last hosted by Sweden in 1995. Germany will be looking to win the Cup for the third time running, and as hosts are the current favourites and the team to beat according to most commentators. There are 16 teams competing for the title, with the final taking place on the 17th of July in Frankfurt.

Having had the privilege of working with the England Women’s under 23’s team for a few years prior to taking on my current role with Leyton Orient FC, I am taking a particular interest in the England Women’s team and hoping that they will go at least one step further than the quarter final stages which is the furthest they have gone so far in the tournament last time out in China in 2007 and in Sweden in 1995. Another fan is my 12-year old niece Anna, who plays for a local team in Sheffield. They had a great season and managed to win their local Cup tournament this year making this uncle particularly proud!

I have nothing but the greatest of respect for top-level Women Footballers who are incredibly dedicated athletes, often competing in a world far removed from that of their male International counterparts and receiving only a fraction of the financial rewards of the men. They commonly work in other occupations or are to be found studying for qualifications in their spare time, all the while pursuing their careers as top-level International athletes. Their level of dedication and training matches that of the men for the most part, and I have found them an absolute pleasure to work with and have been humbled by their dedication to their Sport.

I had the pleasure of watching the England Women’s measured performance during their 2-1 win against the USA earlier this year in preparation for their World Cup bid. The game was held at our very own Brisbane Road stadium, my team Leyton Orient’s home ground, and I had the fortune to sit back, relax, and watch the game as crowd doctor on that occasion. England got off to a great start with 2 early goals and managed to keep in front until the end, despite a goal from the visitors and a USA-dominated second half.

Women’s Football is not without its particular problems when it comes to injuries, with most of us being aware of a well-documented significantly increased risk of ACL injuries in women when compared to their male counterparts. Hartmut and colleagues’s 1 year prospective study of the Women’s Bundesliga published last year in CJSM followed up 254 players from all 12 Women’s Premier League teams in Germany and reported an injury rate of 3.3 per 1000 hours (games 18.5 per 1000 hours ; practice 1.4 per 1000 hours). Most of these (31%) were ankle injuries, with 22.1% knee, 12.9% thigh, and 7.1% head injuries, with a seasonal peak towards the start of the season and with injury rates doubling in the last half an hour of play. The authors noted that most of the severe injuries were non-contact injuries, and speculated that these may well be prevented by ‘certain coordinative training methods’ (Hartmut G et al, 2010). 

This FIFA health and fitness guide for players and coaches, written by Katharina Grimm and Donald Kirkendall and based on original articles published as a supplement on Women’s Football in the British Journal of Sports Medicine in 2007  ,explains some injury prevention strategies for women footballers, and includes the ‘PEP’ programme (Prevent injury and Enhance Performance) with specific exercises focussed on the prevention of the more common injuries including ACL injuries, ankle and head injuries. It also provides additional useful information about nutrition, bone health and some more general topics in a format friendly to coaches and players. Well worth a read.

(picture by WOGERCAN10)

Filed under Female Athletes, General Interest, Patient Education Tagged with

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