Hyperandrogenism Regulations have been criticised on the ground that they are a form of sex testing, though just a little more discreet than their predecessor policies. The regulations seem indirectly to suggest that a hyperandrogenic woman is not woman enough for the purpose of athletic competition.
Madeleine Pape, a former Olympian, who competed alongside Caster Semenya at the World Athletics Championships in Berlin in 2009, said (at the Court for Arbitration of Sport) that “the act of drawing a line between the endogenous testosterone levels of male and female athletes, in combination with scrutinising other bodily and behavioural characteristics of women, is unmistakably an attempt to define those who are not women for the purposes of athletic completion, even if they are not explicitly defined as men”. She added that “the use of the term ‘masculine’ in place of ‘male’ is a semantic strategy that in no way absolves the Regulations of their sex test function”.
The International Olympic Committee inadvertently recognised the regulations as a sex-testing tool during its Consensus Meeting on Sex Reassignment and Hyperandrogenism in November 2015. It recommended: “To avoid discrimination, if not eligible for female competition the athlete should be eligible to compete in male competition”.
According to William C. Rhoden’s book Forty Million Dollar Slaves: The Rise, Fall, and Redemption of the Black Athlete, an Olympic official Norman Cox had suggested in the early 20th century: “The international Olympic committee should create a special category of competition for them—the unfairly advantaged ‘hermaphrodites’, who regularly defeated ‘normal women’, those less skilled ‘child-bearing’ types with ‘largish breasts, wide hips (and) knocked knees.’”
Such a characterisation of strong female athletes as “looking like men” has often been used to diminish their performance. Serena and Venus have been called Williams Brothers. It was Caster Semenya’s appearance that brought her powerful performance under scrutiny. This seemed true in Dutee Chand’s case too, as the Athletics Federation of India admitted that they asked her to undergo medical examinations after the Asian Athletics Association raised doubts about her “appearance” and “gender issue” during the Asian Junior Athletics Championship in Taipei in May 2014.
Former Olympian and Professor, Faculty of Kinesiology and Physical Education, University of Toronto Scarborough, Bruce Kidd calls it “biological racism” against strong women. “(t)he regulations constituted a form of ‘gender policing’ because they had a chilling effect, encouraging women to conform to an expected look of ‘femininity’ or else trigger a test,” Kidd wrote in an email.
He argues that going by the IOC consensus statement of November 2015, which recommends allowing hyperandrogenic women to compete in the male category, gender-verification has been the intention (behind Regulations) all along—this is mentioned later in the fallout of the CAS ruling.
Going by known cases, hyperandrogenism regulations also seem to be discriminatory against women from developing countries and low income societies.
Dr Stephane Bermon, IAAF’s “go-to person for all matters relating to the Hyperandrogenism Regulations” has said (at the CAS) that “undeveloped countries tended to have more elite athletes with certain DSDs than developed countries”. The reason, he suggested, was that DSD conditions were less likely to be diagnosed at an early stage in undeveloped countries. Bermon, president of the International Society of Exercise and Immunology, joined in 2009 the IAAF working group responsible for reviewing IAAF policies in light of the problems highlighted by the case of Caster Semenya. He participated in the development of Hyperandrogenism Regulations.
Dutee wondered why “experts” failed to see her simple logic, when she told me: “Usain Bolt has very long legs. They say that is why he can run so fast. But it is something that he was born with. Why can’t I run the way I was born?” With her simple logic, she may have nailed the issue. There are no rules that disqualify or ban an athlete from competing based on a physical characteristic, other than the testosterone level.
Usain Bolt is 6’5” and capable of longer than usual strides with his extraordinarily long legs. Swimming legend Michael Phelps is believed to benefit from a number of genetic advantages including his greater than-usual lung capacity, hand size, shoe size and wingspan. Basketball has seen exceptionally tall men be greatly successful.
“Elite athletes are, by definition, outliers,” Richard Holt, Professor of Diabetes and Endocrinology at the University of Southampton, who has advised a number of anti-doping agencies including WADA, said in his expert testimony at CAS.
Dr Katrina Karkazis, senior research scholar at Center for Biomedical Ethics at Stanford University, who has written about the treatment of hyperandrogenic female athletes, told the CAS panel: “Elite athletes never begin on a fair playing field, since if they were not exceptional in one way or another, they would never have made it to a prestigious international athletic arena… Athletic excellence is the product of a complex entanglement of biological factors and material resources.”
Height, vision, aerobic capacity, endurance and muscle growth are just a few of the biological traits that could give athletic advantage, so why single out testosterone even if it gives an advantage, critics of the Hyperandrogenism Regulations have argued.
“(B)y focusing on a single biological trait, the Hyperandrogenism Regulations exhibit a profound failure to appreciate the many different ways in which the sport of track and field is inherently un-level,” Madeleine Pape argued at CAS.
Some scientists claim there are genetic markers that contribute to athletic ability. For instance, the ACTN3 gene is believed to be the “speed gene”. While genetic advantage could be an issue of debate the advantage of nutritious food and health supplements, state-of-the-art training facilities and methods, superior coaching and access to sports psychology and sports-science services on athletic performance cannot be denied.
What caused outrage was the IAAF requirement for hyperandrogenic female athletes to undergo medical intervention to suppress their testosterone levels to compete again. It often requires surgery. A paper co-authored by Dr Stephane Bermon in The Journal of Clinical Endocrinology and Metabolism (2012), describes such a procedure on “four elite young female athletes”.
The women, who were found hyperandrogenic during tests for London 2012, were between 18 and 21 years and from “rural or mountainous regions of developing countries”.
The “tall, slim, and muscular young women but with a complete lack of breast development” were put through extensive medical examination including clinical inspection of genitalia, chromosomal analysis, MRI, magnetic resonance imaging and x-rays in Nice and Montpellier University Hospitals in France, which collaborate as reference centres for DSD in elite athletes on behalf of sports governing bodies (IAAF and IOC).
Their internal male gonads were removed, clitorises partially removed, vaginas were “feminised” with plastic surgery, and they were then put on estrogen replacement therapy—all in order to reduce their testosterone levels to below IAAF’s specified 10nmol/L.
The paper said the women had “slight degree of genital malformation” and “leaving male gonads in them carried no health risk” but they submitted to the procedure because doctors said they could compete after the procedure. The four were allowed to compete in the female category one year after the surgeries.
These young women weren’t the only ones. According to Bermon’s statement at CAS, “All the female athletes found to be hyperandrogenic since 2012, underwent treatment to reduce testosterone levels to less than 10 nmol/L.”
Following treatment, all athletes experience a decrease in athletic performance. The extent of the decrease varied among individuals. Of the athletes who received treatment, approximately half returned to a high level of international competition, while the others did not repeat their initial level of performance and retired. All of the remaining cases are ongoing. Some athletes experienced minor side effects following surgical treatment; however these were successfully treated by the use of oral contraceptives”.
Kidd said, “Thirty athletes were tested in the first three years.”