The Hormone Games

Note: In July 2015, the LA Times asked me to write a commentary on the Court of Arbitration for Sport’s ruling in the case of Dutee Chand. I wrote a piece looking at the ruling, but the editor wanted a somewhat different piece, so what was ultimately published was pretty different from what I originally penned. Since this issue has come up again, I’m posted the original version here.

The just-released, 161-page report issued by the international Court of Arbitration for Sport on the role of testosterone in women’s sport reads like a science-soaked, live-free-or-die drama. Call it The Hormone Games.

In it, Indian sprinter Dutee Chand tells of being born and raised a girl in a village now perhaps unsure of its feelings for its track star, thanks to sporting authorities treating her as if she may not really be female. Chand came before the court specifically to challenge the claim by the International Association of Athletics Federation (IAAF) that, because her body makes “too much” testosterone, she must submit to medical interventions to lower it before she is allowed to continue competing as a woman.

Although people call testosterone a “male hormone,” in fact all women and men make it naturally. Some women are born with body types that push their naturally-occurring testosterone level higher than most women’s. Various genetic conditions—called “intersex” or “differences of sex development”—can cause this.

Both sides in Chand’s case agree on this basic biology. Argument centers on whether having higher levels of naturally-produced testosterone matters enough that some women should be stopped from playing as women.

In a chilling bit in the report, Chand’s own national sporting authority, the Athletics Federation of India, admits it pursued “gender verification test” for Chand “so as to avoid any embarrassment to India in the International arena at a later stage.” For her part, Chand pleads with the court to understand how much her life depends on its decision: “She described how a young female friend had been forced to leave her village after people refused to accept her as a girl because of her physical appearance. . . . She fears that if she loses her appeal, she will have to leave her village.”

Chand’s fears are not unfounded. While the IAAF and the International Olympic Committee (IOC) insist their policy is not a “gender test,” women athletes who have been subjected to this kind of scrutiny have historically experienced significant social backlash and psychological harm. Whatever the IAAF and IOC thinks they’re up to, the court of public opinion takes these rulings as determinations of an athlete’s true sex and gender.

One of the former athletes testifying to the court, Maria José Martínez-Patiño, spoke to the harm that accrued to her when in 1986 sports authorities dismissed her from the Spanish Olympic hurdling team because they discovered she had been born with a Y chromosome and testes. Another similarly-judged woman athlete is known to have attempted suicide.

In the Chand case, both sides agree that if a woman’s body doesn’t respond normally to testosterone, then even if she makes a male-typical amount, she should be allowed to play as a woman. Such is the case for Martínez-Patiño, now a professor at a Spanish university. She was born with the genetic condition complete androgen-insensitivity syndrome (AIS), which means that although she was born with a Y chromosome and testes making normal levels of testosterone, her cells don’t respond to it. Presumably this means she gets no athletic advantage from testosterone. (Because their bodies are testosterone-insensitive, girls with AIS develop so typically female, it is common for them not to be diagnosed until after puberty.)

But the IAAF says that women athletes like Chand, with “male levels” of testosterone and apparently normal sensitivity to testosterone, should not be allowed to play as women unless they submit to pharmacological or surgical interventions that will lower their testosterone levels. Chand and her defenders disagree, saying hers is a natural advantage, akin to any other natural advantage, like those that give some athletes greater height, bigger hands, or better oxygen-processing capability.

One of the weirdest moments in the report comes when Martínez-Patiño defends the IAAF’s regulations. Why is this weird? Remember, her own cells lack the ability to respond to testosterone, yet she managed to win a medal. So how can she argue testosterone is so incredibly important when she, a woman who gets no kick from testosterone, became a top athlete?

The IAAF claimed to the court that “hyperandrogen” (high testosterone) conditions show up at a rate of only 1 in 20,000 women in the general population but at a rate of 142 in 20,000 elite women athletes. This, they insisted, proves how much of an advantage these hormones give you.

But the court was unpersuaded by the IAAF’s data, reading back to the IAAF team their own published work showing no clear causal link between testosterone levels and winning. According to the court, the science shows only a relatively small advantage gained from increased levels of testosterone.

A female, decided the court, is she who is legally recognized as a female. Given that Chand has always been a girl/woman, why shouldn’t she be allowed to use her inborn natural advantage, just as men who naturally have unusually high levels of testosterone are allowed to use theirs?

Concluded the court, ““A rule that prevents some women from competing at all as a result of the natural and unmodified state of their body is antithetical to the fundamental principle of Olympism that ‘Every individual must have the possibility of practicing sport, without discrimination of any kind’.”

All settled?

No. In the strangest plot twist, the Court then rules not that the IAAF’s regulation for “hyperandrogenism in women athletes” is fundamentally unfair—that testosterone-effect levels are the wrong way to divide women and men. Instead, it concludes that the IAAF has just failed, so far, to scientifically prove that testosterone matters enough to use that to divide women and men. For now, Chand can play, but that could change if the IAAF finds more evidence that testosterone matters.

Says the court, “the Panel is not satisfied that the degree of that advantage is more significant than the advantage derived from the numerous other variables which the parties acknowledge also affect female athletic performance: for example, nutrition, access to specialist training facilities and coaching, and other genetic and biological variations. Further evidence,” it says, is required to support the IAAF’s rule.

So while the court acknowledges that Chand and women like her are women, while it acknowledges that testosterone is as much a woman’s hormone as a man’s, while it acknowledges Chand’s testosterone level represents an inborn genetic advantage—far more “natural” than the significant social advantages accrued to athletes from wealthier nations—it still concludes that the IAAF might someday convince them testosterone should function as the thing that divides women’s sport from men’s!

Illogical, if you ask me. The IAAF and IOC did just that—asked me—a couple of years ago, and I told them the same then. As an historian, I believe we will look back on this regulation, and now this ruling, as being just as illogical and unfair as what happened when Martínez-Patiño was banned for her Y chromosome.

If the IAAF, IOC, and the Court really believe what they’re saying—that this isn’t supposed to be a “gender verification test” or “sex testing”—then they’re eventually going to have to conclude that what makes you a woman is just being in the world as a woman. All the rest will have to be understood as allowable variation, or you really are deciding who counts as a woman on the playing field.

Only if and when we go back to how women’s sport began—as a simple socially-based division—will the hormone games finally end.