The abuse of testosterone by professional athletes has long been a focus of anti-doping legislation in sports. We know that a sportsperson who takes synthetic testosterone will be able to build muscle mass faster than without it, and this effect is more prominent in women. But what if a woman is naturally producing testosterone at a rate deemed higher than normal? Should she be treated as the she has the same unfair advantage as an athlete who was taking enhancing drugs?
This question was asked this year after Indian track star, Dutee Chand, had her sporting career threatened when hormone testing revealed elevated testosterone levels. Despite physically and emotionally identifying as a women, her condition (hyperandrogenism, meaning excessive levels of androgens in the body) put her in the male range in the eyes of her sport's governing body.
Dutee's story raised an ongoing debate over the physical and psychological perceptions of gender in sport. It also asked a difficult and modern question: where should lines be drawn in order to balance inclusivity and competition fairness in a less binary world?
Nowhere else is the divide between male and female so clearly defined than in professional sport. Here our understanding of gender is at its simplest. While many argue it is culture, not nature, that places people into assigned genders, sport is completely built on a dimorphic understanding of sex.
For some background, intersex variations affect men and women, but it's primarily an issue in sports when female athletes are concerned. There are two Differences of Sexual Development (DSDs) that can carry an impact. First is androgen insensitivity syndrome (AIS). People born with this usually appear traditionally female, but carry a mutation that prevents testosterone from being absorbed by the body. Because of this, any athletic advantage they might have is very small.
The second is Five Alpha Reductase Deficiency (5-ARD), these individuals have a mutation which prevents the creation of dihydrotestosterone—a hormone that triggers the formation of male genitalia. Because of this, children are often assigned female gender. But unlike individuals with AIS, they are affected by the testosterone in their system and as a result become more masculine during puberty. Because of this change in muscle mass and development, they arguably can have an athletic advantage.
In the history of professional sport, hormone testing has been brought in and abolished several times over. Presently the International Association of Athletics Federation and the International Olympic Committee measure functional testosterone to decide if an athlete is able to compete as a female.
If a woman's testosterone levels are too high, she has the option to lower it with surgery or drugs in order to continue competing. However, medical intervention is hugely controversial in the intersex community. Many argue that not only is the perceived testosterone advantage unproven, but the process of lowering the hormone (surgically or medically) would unfairly impact an athlete's ability to train and compete.
Intersex activist and president of Organisation Intersex International Australia, Morgan Carpenter, is quick to dismiss the perceived advantage of women with intersex variations. "Show us the women that are winning in a dramatic way," he told VICE. "You look at [controversial South African Olympian] Caster Semenya and a number of other athletes in recent years, and we can't say they have an unfair advantage. I mean, do they win all the time? Do they win by that much?"
Morgan instead feels the system of removing women from competition based on their testosterone levels is a product of fear and a lack of understanding. "We can't see that intersex athletes have a clear and visible advantage over other women athletes," he said. "That data is not there."
But the fear, while irrational, is understandable. As mentioned, testosterone has been used by athletes across genders as a doping agent. However, there is a breakdown between the effects of artificial versus natural testosterone. The consumption of artificial testosterone by a female athlete without intersex diversions would result in her being able to build muscle mass more quickly than usual. But when the growth hormone occurs naturally the body of a woman with intersex diversions, she cannot make use of the testosterone in the same way.
Endocrinologist Dr Sonia Davison explained to VICE that the role of hormones in the body is murky and hard to make a definitive statement about. But she points out that in situations where women have higher testosterone levels due to polycystic ovary syndrome, it's far from being a competitive advantage.
"They tend to struggle with weight excess and will be unlikely to perform better in physical pursuits," she said. In fact, as Dr Davison puts it, the more prevalent physical effects are an "increased risk of developing metabolic disorders including type two diabetes, and we also think cardiovascular disease". None of which would impact athletic performance in any positive way.
In Australia, some steps have been taken to manage the inclusion of intersex athletes. The 2013 Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act stated that sports exemptions will not be applied as a blanket rule, but include case by case assessment. Although Organisation Intersex Internationale argued the anti-discrimination legislation didn't go far enough, and called for all sports exemptions that may eliminate intersex athletes from competition to be removed.
In her paper "In the Halfway House of Ill Repute: Gender Verification under a Different Name, Still No Contribution to Fair Play," Linköping University's Maren Behrensen backs this reasoning and takes it one step further. She suggests athletes with intersex variations should be at "liberty to exploit their congenital traits". At first this seems defiantly at odds with the nature of fair competition, but she compared a hormonal advantage such as increased testosterone to the physical advantage of being born tall or broad shouldered.
It's an opinion reflected by Dr Davison who stated that any real advantage between performance is related to "physique, muscle mass, natural ability, training and experience."
This thinking begs the larger question: is gender any form of gender segregation in sports fair? Maren suggests another answer could be to commit to a classification system that "tracks genetic predisposition rather than gender."
Sadly, many athletes have been excluded and removed from competition before turning pro. In Australia, although some members of the intersex community work within sport and participate on a school level, Morgan told VICE "none of them have sought to compete professionally".
He notes issues for intersex athletes in sport begin before they get near the need for genetic testing—and the first issue is basic inclusivity. The process of non-voluntary hormonal and physical intervention on intersex children has left many adults physically scarred and weary of participating in any activity when their body is on display and open to scrutiny.
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