When it comes to regulations for women with naturally high testosterone levels, people can talk about “unfair advantage” all they want, but by the experts' own admission, “there is no clear scientific evidence proving that a high level of T is a significant determinant of performance in female sport.” But if the policies aren’t about that, then why do they exist, and why are so many people so confused?
Everyone knows that synthetic testosterone, a.k.a. steroids, give athletes an unfair advantage — which is why people assume naturally high testosterone levels do too — but according to the world’s leading experts, natural testosterone acts very differently in the human body than steroids. As stated by one of the authors of the paper cited above, Dr. Martin Ritzen, who was interviewed with me on Al Jazeera last week, “If you add a little bit of testosterone to the high male levels it doesn’t make much of a difference, but it does make a difference if you treat with very high levels of testosterone, and that’s why this is called doping and is forbidden in sport.” So according to the experts, “very high levels of testosterone” are called doping (which refers to steroids), and doping is forbidden because that is what has been proven to make a difference.
I stated on the show that if women are subjected to these policies, men should be too, prompting the host to ask Ritzen why men are exempt. He responded, “Because there’s no scientific proof that higher testosterone levels in men will increase their physical performance.” So there you have it: There’s no proof that high levels of natural testosterone give men or women a competitive advantage, so men are not tested for this (makes sense), but women are (huh?).
Once you realize these regulations are unfair because (a) only women are subjected to them and (b) not all women are tested, just those who “fall under suspicion,” on a case-by-case basis (sounds like a witch hunt to me), it becomes obvious that the only real reason they exist is because some people think women with intersex traits are not really women and should thus be banned from competition. Unless they change their bodies in ways that consist of “surgical procedures that have little to do with improving a woman’s health. Surgery to alter sexual organs may harm sexual function," according to the British Medical Journal. "And hormone-suppressive drugs have risky side effects with potentially lifelong health risks.”
Stanford bioethicist Dr. Katrina Karkazis pointed out in the same interview that the International Association of Athletics Federations and International Olympic Committee “have been adamant that this isn’t sex testing, and yet when you listen very carefully to the conversation there have been notions about what divides males from females, men impersonating women, and these women not being women.” Indeed, Ritzen’s opening remark was, “The fact that sport is divided into male and female categories is the real background problem here.”
The perception that intersex people are not exactly male or female exists for good reason: We’re not. People born with sex traits that are not typical for males or females — currently known as “intersex” — were formerly known as hermaphrodites. (However, the greater community prefers “intersex” because we don’t actually have both sets of genitals or sex organs, like certain animal species, but typically fall more on one side or the other, physically speaking.)
To many it follows that if someone’s not a “regular woman,” but an intersex woman or hermaphrodite, they shouldn’t be allowed to compete against women. Some have even suggested we should have our own separate category, but our numbers are low, and few people become elite athletes to begin with, so there wouldn’t be much actual competition. As one of my intersex friends joked, “I’d compete then, because I’d be sure of bringing home at least a bronze!” And while that might be funny to people who aren’t elite athletes, I doubt it is to those who’ve spent their whole lives training to compete against more than just a handful of folks.
Also, even though some think intersex women are so different that they should be segregated, athletic performance demonstrates that the differences we’re born with don’t amount to what many people assume is some sort of advantage. For example, Indian runner Dutee Chand, the latest victim of these regulations, ranks 225th among women in the world in her best event, and has an overall women’s ranking of only 2136. Even Caster Semenya, who brought this issue to public attention when she blew her competitors in the 800-meter race out of the water during the 2009 World Championships, didn’t break the women’s world record for that event — 1:53.28 compared to her time of 1:55.45 — or come anywhere near the male record of 1:40.91. She just looked like she was in another league because all her competitors happened to perform nowhere near the top female speed that day.
Simply put, having intersex traits doesn’t imbue women with the athletic capabilities of men or even of a separate category of humans that performs somewhere between males and females. (Note: These athletes haven’t called themselves “intersex women” as far as I’ve seen, or I would respect their identity by referring to them as such.) This, in addition to the lack of scientific evidence to back these regulations up, reveal there’s no valid reason for them to exist.
Which brings me back to the central question: What’s really behind these rules? Perhaps looking at others who’ve been picked on might give us an idea. I’m talking about men who have also had their gender called into question.
During the 2010 Winter Olympics, commentator Claude Mailhot of the French-language RDS network posed whether gay figure skater Johnny Weir lost points "due to his costume and his body language."
Alain Goldberg responded by saying Weir’s femininity may reflect poorly on other male figure skaters. “They’ll think all the boys who skate will end up like him. It sets a bad example.” Goldberg was also quoted as saying, “We should make him [Weir] pass a gender test at this point,” and Mailhot then joked that Weir should compete in the women’s competition.
Apparently anyone whose appearance and gender expression is not considered normative is vulnerable to attack in the traditionally homophobic, gender-variant phobic arena of sports. However, LGBT people are legally protected from discrimination in many parts of the world, including Canada. Thus, after local LGBT associations and others came to his defense (I submitted a letter via my organization OII-USA), he was issued an apology rather than subjected to testing.
Sporting officials are aware of anti-discrimination statutes, and thus keep insisting that, “oh yes, these athletes are women” — in order to not discriminate against their legal gender as women — while still adding that they’re not “female enough” to compete as women, which still discriminates against their gender expression. However, as I’ll discuss shortly, sporting authorities have discriminated against intersex women, unchecked, for decades because we’re not specifically protected by antidiscrimination legislation (except in Australia).
However, even if you can legally get away with it, discrimination is still wrong according to the Olympics’ own charter, which states, “Every individual must have the possibility of practicing sport, without discrimination of any kind … ” Hmmm. Are we not individuals? Let me check again. Yes, I’m human.
There’s also, “Any form of discrimination with regards to a country … gender or otherwise is incompatible with belonging to the Olympic Movement.” Seems like everyone who’s complained about or regulated against intersex women should leave elite sports then, because whether you define these athletes as “female,” “women,” “intersex women,” or even just “intersex,” it’s obviously their gender that’s being discriminated against.
However, many still get caught up in the “but they’re intersex, not female, so it makes sense to not allow them to compete as women” argument. What they don’t realize is that some intersex women have been allowed to compete, as is, since 2000. I’m talking about women with CAIS, who have XY (typically male) chromosomes, and testes rather than ovaries, but no functional testosterone. This makes them appear uber-female: perfect skin, no body hair, typically female genitalia, curvy hips and breasts, small, skinny bones … so it wouldn’t make sense to assign and raise them male.
Still, during the era of mandatory gender verification testing (1968-1999), which used chromosome swab tests, dozens of CAIS women’s lives were ruined with the declaration that they were “really men.” There were reports of suicides. Former sprinter Dr. Maria Patino of Spain, who was banned in 1986, said, "I lost friends, my fiancé, hope and energy.” Patino fought the regulations and won, by arguing that with no functional testosterone, women with CAIS had a competitive disadvantage.
Interestingly, as we discussed at the IOC’s 2010 meeting of experts that I participated in (obviously I objected to the regulations, and I wasn’t alone, but we didn’t have the majority voice), the fact that you find more CAIS women in elite competition than in the regular female population is further evidence that testosterone doesn’t give women a competitive advantage. Also, the decision to let CAIS women compete, as is, wasn’t just about testosterone: the fact that they look feminine by mainstream standards was a significant factor. The reasoning goes, “I mean look at them, how can we not let them compete as women?”
Right now, and since the dawn of time, people born with testes and XY chromosomes have been living as women since birth, demonstrating that biological sex is less important in classifying sex than someone’s perceived gender. You can have testes and compete as a woman because you’re perceived to be female. Or you can be able to have a baby but not be allowed to compete as a woman if you’re found to have high testosterone levels, because that’s perceived to be overly masculine for females.
Once you examine these facts, you see that this issue is not really about “biological sex” but about perceptions of gender. The only way to avoid the complications stemming from this would be to eliminate these categories altogether. Which is why some have suggested that if sporting bodies are going to dishonor intersex women’s status as women, under the theory that testosterone is the determining factor for separating athletes, then they should create categories based on that instead, and test everyone’s T levels. The IOC and IAAF don’t seem interested in this approach, though. Although it would be fair and not invalidate people’s gender, it would entail creating a whole new system, which is complicated and costly.
So policymakers keep looking for ways to justify their current policies, in part because so many female athletes have complained about competing against women with intersex traits. You hear things like “We need protection from men competing as women” (that's a direct quote, but I won’t embarrass by naming the person who said it). I never used to think of women athletes as damsels in distress, but that’s the card many have been playing to disqualify women like Dutee Chand (who, with a ranking of 2136, is obviously such a threat!).
I haven’t been a top athlete since I was MVP of my eighth-grade basketball team, but back in those days this type of behavior was called poor sportsmanship.
As Dr. Payoshni Mitra, who is advising Dutee on behalf of Sports Authority of India, pointed out on Al Jazeera, if people are truly concerned about fairness than factors such as the greater access that first world athletes have to training resources should be taken into account. Meanwhile, I’m thrilled to see intelligent thinkers noticing what’s at work. People like bioethicists Arthur Caplan and Lee Igel of New York University’s Sports & Society Program, who stated in Forbes, “The IAAF policy not only confuses doping with biological luck, disregards medical science, and asks women to undergo medical intervention that does nothing for their overall health, but it also shames women who are born with intersex traits.”
However, as more people get savvy, policymakers are switching to the "they’re abnormal and thus need medical attention" angle. For example, Dr. Ritzen described us in opposition to “normal, healthy women” twice, even calling us “individuals that have these inborn errors.” Excuse me? I pointed out that I take offense at having my natural physical variation (which, incidentally, I love) described as an “inborn error” and that these women are actually very “healthy” — after all, they're elite athletes.
While it’s upsetting to be portrayed as inferior in order to justify discrimination, I’ve certainly seen it before, and it demonstrates how strong prejudice against intersex people is.
What actually infuriates me, though, is that intersex women of color from Third World nations, who escaped harmful medical practices as infants because they’re not readily available there, are still being hurt if they’re “found out” as adults. Their healthy bodies and/or the successful lives and careers they’ve built for themselves are being ripped away because of some people’s irrational fear of their difference. And medical authorities are saying they’re disproportionately targeted for testing because they weren’t “corrected” as kids, the way intersex people are in First World nations — as if that’s the “civilized” thing to do.
When you take this cultural climate into consideration, it makes those who are speaking out in our support as pioneering as the folks who spoke out against slavery when it was still fashionable for people to brag about how many they owned. Just like the early abolitionists, our allies are currently few in number, and their efforts are not hugely supported. I can imagine it’s going to be pretty awesome for them to look back though and see that they were on the right side of history.
If you want to be too, please support the Let Dutee Run campaign by signing the petition created by Payoshni Mitra, Katrina Karkazis, and Bruce Kidd. Dutee is fighting the ruling against her, and international support will help.
HIDA VILORIA is chairperson of OII, the Organization Intersex International, and director of its American affiliate, OII-USA. She educates about intersex as a writer, television and radio guest (BBC, Huffpost Live, Al Jazeera, 20/20, Oprah), lecturer, and consultant, and recently became the first openly intersex person to speak at the United Nations, along with Jason Collins and Martina Navratilova, at the event Sport Comes Out Against Homophobia. Follow her on Twitter @hidaviloria.