D8 N THE NEW YORK TIMES, MONDAY, JUNE 18, 2012

O L Y M P I C S2 0 1 2

The International Olympic Committee is soon expected to announce new policies on the eligibility of women with hyperandrogenism, which involves an excessive production of androgens.Guidelines have been drafted that will be applied at the Summer Olympics in London and serve as recommendations for international federations to follow. The guidelines were approved bythe I.O.C.’s executive board and now must be validated by the group’s juridical commission. Three experts in intersex issues were invited to share their thoughts on sex testing for athletes.

GENDER GAMES

By REBECCA JORDAN-YOUNG and KATRINA KARKAZIS

The International Olympic Commit-tee’s new policy governing sex verifica-tion is expected to ban women with nat-urally high testosterone levels, a condi-tion known as hyperandrogenism, fromwomen’s competitions, claiming theyhave an unfair advantage. I.O.C. officialsportray this as a reasonable compro-mise in a difficult situation, arguing thatthe rules may be imperfect, but thatsports are rule-based — and that therules should be clear.

We agree that sports need clear rules,but we also believe that the rules shouldbe fair and as rational as possible. Thenew policy, if it is based on testosteronelevels, is neither.

So what is a better solution? First, at the very least, female athletes

should be allowed to compete through-out any investigation. Suspending themfrom competition once questions areraised violates their confidentiality andimposes sanctions before relevant infor-mation has been gathered.

Second, when it comes to sex, sportsauthorities should acknowledge thatwhile science can offer evidence, it can-not dictate what evidence we shoulduse. Scientifically, there is no clear orobjective way to draw a bright linebetween male and female.

Testosterone is one of themost slippery markers thatsports authorities have comeup with yet. Yes, average testos-terone levels are markedly differ-ent for men and women. But levelsvary widely depending on time ofday, time of life, social status and— crucially — one’s history ofathletic training. Moreover,cellular responses range sowidely that testosteronelevel alone is meaningless.

Testosterone is not the mas-ter molecule of athleticism. Oneglaring clue is that women whosetissues do not respond to testosteroneat all are actually overrepresentedamong elite athletes.

As counterintuitive as it might seem,there is no evidence that successful ath-letes have higher testosterone levelsthan less successful ones.

Yes, doping with testosterone willmost likely improve your performanceby increasing muscle size, strength andendurance. But you cannot predict howwell athletes will do in a competition byknowing their relative testosterone lev-els. There is just too much variation inhow bodies make and respond to testos-terone — and testosterone is but one ele-ment of an athlete’s physiology.

Third, if we want a clear answer towho is eligible for women’s competi-tions, it is time to stop pawning this fun-damentally social question off onto sci-entists.

Bruce Kidd, a former Olympian who isa professor of kinesiology and physicaleducation at the University of Toronto,favors prioritizing athletes’ rights tobodily integrity, privacy and self-identifi-cation, and promoting broad inclusive-ness. “If the proclaimed human right ofself-expression is to mean anything,surely it should protect the right toname one’s own gender,” he says.

We agree. At present, though, becausemost nations do not offer their citizensthe right of self-defining gender, the bestbet might be to let all legally recognizedwomen compete. Period.

Fourth, any policies must be devel-oped through a transparent process withbroad input. A major problem with theI.O.C.’s effort to create a new policy is itsopaqueness. Which types of expertiseand evidence were drawn on? What is-sues were considered?

Finally, the I.O.C. and other sportsgoverning bodies should denounce gen-der bashing among athletes, coaches,the news media and fans. Policing wom-en’s testosterone would exacerbate oneof the ugliest tendencies in women’ssports today: the name-calling and theinsinuations that an athlete is “too mas-culine,” or worse, that she is a man. (Do-minika Cibulkova of Slovakia recentlysaid that she lost at the French Open be-cause her opponent “played like a man.”Such comments do not do female ath-letes any favors.)

Sex testing of female athletes will al-ways be discriminatory. Under the newpolicy, men will most likely continue toenjoy freedom from scrutiny, eventhough they, too, have greatly varyingtestosterone levels, along with othervariations in natural attributes that af-fect athletic performance.

Sex tests are based on the notion thatfair competition requires “protecting”female athletes. Protection has been thecloak that covers all manner of sex dis-crimination, and it is seldom, if ever, thebest way to advance equality.

What are these tests protecting wom-en from? Men infiltrating women’s com-petitions? A century of monitoring com-petitions for sex fraud says no. Will su-perwomen crowd out other athletes? Noagain. Women who have been ensnaredby sex-testing dragnets have often beenimpressive, but not out of line with otherelite female athletes.

What about letting go of the idea thatthe ultimate goal of a fair policy is to pro-tect the “purity” of women’s competi-tions? If the goal is instead to group ath-

letes so that everyone has achance to play, to excel and— yes — to win, then sex-segregated competition isjust one of many possible op-tions, and in many cases itmight not be the best one.

Rigidly protecting theprinciple of sex segregationsometimes undermines fe-male athletes, as with the re-cent rule that women’s mara-thon records cannot be set inraces that include men; the

rule could have eliminated Paula Rad-cliffe’s best time, in 2003, which beat therecord by three minutes.

Sex segregation may obscure othergender inequities in sports. Men, for ex-ample, have 40 more events in the Olym-pics and have longer distances and dura-tions — with no clear rationale.

Sex segregation is probably a goodidea in some sports, at some levels andat some moments. But it is time to refo-cus policy discussions at every level sothat sex segregation is one means toachieve fairness, not the ultimate goal.Ensuring gender equity through accessto opportunity is just as important.

Unlike in doping cases, women withhyperandrogenism have not cheated.There is no reason to disqualify womenwhose bodies produce any of the com-plex ingredients that add up to athleti-cism, be they superb vision, big lungs,flexibility, long legs or testosterone.

The obsessive focus on sex has doneenough harm. María José Martínez-Pati-ño, whose hurdling career was derailedby sex testing, said a new policy basedon testosterone levels would further the“decades-long persecution of women insports.” As she told us, “It’s enough.”

You Say You’re a Woman?That Should Be Enough

ILLUSTRATION BY SAM MANCHESTER/THE NEW YORK TIMES

Rebecca Jordan-Young is an associateprofessor of women’s, gender and sexu-ality studies at Barnard College, Colum-bia University, and the author of “BrainStorm: The Flaws in the Science of SexDifferences.”Katrina Karkazis is a senior researchscholar at the Center for Biomedical Eth-ics at Stanford University and the authorof “Fixing Sex: Intersex, Medical Au-thority, and Lived Experience.”

By ERIC VILAIN

Is LeBron James too tall and too fastto play basketball?

In times of extreme political correct-ness infiltrating almost every societaltopic, sport stands out as an oddity. Itcaptures the passion of billions of peo-ple around the world, yet it is gro-tesquely unequal. There are no remedi-al programs for ungifted athletes.

Yet when it comes to women insports, everyone frets about equality.

This was particularly true in the out-rage over the case of Caster Semenya,the South African athlete who won the800 meters at the world championshipsin Berlin in 2009 and was accused ofholding an unfair advantage becauseshe was thought to compete unjustly ina women’s event. When men are moretalented than others, it is an expressionof the beauty of sports. But when wom-en outcompete others, suspicions abouteligibility and arguments for a levelplaying field often arise.

Sports officials are faced with an im-possible quandary: a socially imposedsex division in sports (allowing half ofthe world’s population to have a chanceat winning) with no clear objective wayto draw a line between male and female.

So what should be done?There are what could be called the so-

cial solutions, not involving biology.A simple possibility would be not to

segregate the sexes in sports. But fe-male athletes would lose most, if not all,elite competitions. For all the brouhahaaround Semenya’s eligibility as a fe-male athlete and perceived advantage,one should remember that her time inthe 800 meters at the world champion-ships — 1 minute 55.45 seconds — wouldnot have even qualified for the men’s fi-nal, in which the worst time was 1:47.80.

Another radical solution would sim-ply be to accept the declared sex of eachathlete. No other questions asked. Notest. But in times of instant fame andwealth in sports, such an honor systemseems unrealistic. It would allow formen to compete as women, unchal-lenged.

Another way would be to separateathletes by legal sex. Instead of tryingto give a messy biological answer (withso many different biological parametersdetermining sex) to sports, why not justlook at the sex written on the athlete’sgovernment-issued identification?There is some attractiveness to that so-lution, as it would often correspond withwhether the athletes were raised asboys or girls, which might be a fair wayto go. Athletes raised as girls competeas girls. This would create barriers for

transsexual athletes in many countriesnot open to such legal changes andthere would be a risk of forceful ma-nipulation of the legal sex in nondemo-cratic states.

Historically, one-size-fits-all biologi-cal tests have attempted to define sex,with one biological parameter for sys-tematic “gender verification” of ath-letes, from counting the number of Xchromosomes to detecting SRY, a Ychromosome gene. All were fraughtwith the misconception that a single setof sex chromosomes or a single genesystematically leads to one gender.

In the midst of all these extreme op-tions, there could be pragmatic, sport-centric answers. Let’s forget for a while

about gender identity politics: eligibilityof women in sports has long beenframed as a gender issue. It should notbe. Let’s focus strictly on athletic per-formance and do a thought experiment.

What if there was one parameter thatclearly provided an advantage in sports,with levels that did not overlap betweenmen and women and could entirely ex-plain why men did better than women inelite sports? Would this substance meetenough criteria to be a valid way of sep-arating men and women on the field,and only on the field? And what shouldbe the threshold for the level of this sub-stance above which female athleteswould have all the physical advantagesof men and therefore would unfairlycompete with other women?

The reality is that there is a prettygood candidate for such a substance:testosterone. We know that exogenoustestosterone enhances performanceand is therefore considered a dopingsubstance, forbidden in all Olympicsports. We also know that there is prac-tically no overlap between normal maleand female ranges of endogenous tes-tosterone levels.

Would levels of testosterone abovethe typical female range provide an ath-letic advantage in women? Probably.Would that be unfair? No more thanother genetic traits that confer advan-tages to elite female athletes (height,number of red blood cells, etc.). Should

there be a threshold above which ath-letes would not be eligible to competewith other women? If testosterone isthe main explanation for sex differencesin sports, the logical answer should be:yes, if the level reaches the male range.

Such a threshold would be extraordi-narily difficult to reach for women, andmost female athletes with testosteronelevels higher than normal (whether theywere born with a disorder of sex devel-opment, or have developed hyperandro-genic conditions) would be eligible,therefore recognizing and including thewide variations of what could influenceabilities within one sex category.

Is it a perfect parameter? Of coursenot. There are problems with it. The

main one is that the levels of testoster-one are relevant to sports performanceonly if the body (and the muscles in par-ticular) is fully responsive to it. A smallnumber of individuals have some de-gree of resistance to it, and what reallymatters is not just the raw level of tes-tosterone but a combination of itsamount and a measure of its functionali-ty, which is not always easy to test for.

Another issue is that, unlike in ourthought experiment, testosterone is notthe unique explanation for sex differ-ences in athletic performance. Otherscould be direct, sex-specific, genetic ef-fects on motivation to win, aggressive-ness or shape of the bones and joints.These are more complex to reliablymeasure than testosterone, and it is stillunclear what relative proportion of sexdifferences these other factors will in-fluence. But sports authorities shouldpursue a more complex algorithm of pa-rameters.

From a pragmatic standpoint, the In-ternational Olympic Committee’s newguidelines, which will identify function-al testosterone as a key element for eli-gibility in women’s competition, are astep in the right direction. It is certainlyimperfect, but it allows women to com-pete with a shot at winning and it allowssuch a wide range of genetic and hor-monal differences within the women’sgroup that we are in for the excitingtreat of watching women compete pas-sionately with all their unjust, innate,athletic abilities that make sports so ex-hilarating.

Let the (genetically unfair) Gamesbegin.

No Clear Option for Testing;Testosterone Level Is a Start

RAINER JENSEN/EUROPEAN PRESSPHOTO AGENCY

Dr. Eric Vilain is a medical geneticistand the director of the Institute of Soci-ety and Genetics at U.C.L.A. He wasamong the medical experts who advisedthe International Olympic Committee onits new policies regarding gender testingfor elite athletes.

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