Top performances, based on focused training and recovery from injury? I’m not buying that. – By Dr Ross Tucker
The intersex-athlete issue is one of the most controversial in sport, and South African Caster Semenya, who finished with a bronze in the 1500m at the World Athletic Championships Monday night, has been at the forefront of it since she won the women’s 800 metres at the 2009 World Championships. The bungling of her case – first by Athletics South Africa, and then the IAAF – exposed us to the idea that a person can be genetically male or female, but for reasons that usually relate to how the body produces and uses hormones, they develop as the opposite sex.
The problem for sport is that this person may be ‘partly androgenised’ – androgenisation being the biological term for ‘made male’. That’s what testosterone gives to boys at puberty: deepening of the voice, hair growth, a different shape of the skeleton, increased muscle mass and reduced body-fat percentage.
Some of those are irrelevant, for sport; but low body-fat percentage and increased muscle mass and strength are a big deal for an athlete, and that’s why the issue is controversial.
Testosterone gives men huge performance advantages, which is why the sexes are separated for fairness at Olympic events.
For decades, authorities have grappled with whether these women – who live in society as female, so that is their gender – should compete in women’s sport.
That all came to a head in 2015, when an Indian intersex sprinter, Dutee Chand, went to the Court of Arbitration for Sport (CAS) to have them overturn the IAAF policy that (at that time) required her to take medication to lower her testosterone levels to compete.
The Upper Limit
After the Semenya debacle in 2009, the IAAF had come up with a new policy that would not expose women to the kind of invasive testing Semenya underwent. Instead of doing ‘gender verification’ testing, the IAAF had set an upper limit for testosterone, since this was the root cause of the perceived advantage.
Based on some testing of female athletes, and data from men and women, they decided on an upper limit of 10nmol/L – any female who had a T level above 10 would have to take medication to lower it. For reference, 99% of elite female athletes have a T level below 3.1nmol/L, so the upper limit was three times higher than 99% of women’s testosterone.
That was the so-called ‘hyperandrogenism’ policy that Chand challenged at CAS. She won. CAS ruled that, at the time, there was insufficient evidence to defend what was a discriminatory rule (because it applied to women only, and European law came into it). CAS gave the IAAF two years to look for better evidence, and a more sound argument, and that two-year period has now expired.
The IAAF published their evidence earlier this year in a scientific journal. They showed that women with higher levels of T (but still normal) had a performance advantage of 2% to 5% in some, but not all events.
Previous IAAF evidence on this had also showed that nine of the women participating in the 2011 and 2013 World Championships were intersex, which is a considerably higher proportion than you’d find in the non-athletic world, further suggesting a benefit.
Will That Be Enough?
Will that convince CAS that the policy is needed? I doubt it. CAS made clear in their previous decision that they were looking for a ‘large’ advantage, comparable to what men enjoy over women in sport. That’s around 10% to 12%, so I think the IAAF evidence falls short of that.
But who knows? I thought CAS were wrong the first time round, and it wouldn’t surprise me if they changed their ruling now – for shaky reasons, given the legal process last time. If they did, and those women with high T have to go back onto medication, then I’ve no doubt they’ll all slow
The controversy, on the other hand, is unlikely to slow down.
RW Scientific Editor Dr Ross Tucker has a BSc (Med) (Hons) Exercise Science Degree and PhD from the Sports Science Institute. Visit him at www.sportsscientists.com.