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Saturday, September 12, 2009

Semenya's performance advantage: An irrelevant question?

Caster Semenya's potential performance advantage may be a non-factor as medical consideration takes over

As mentioned in my tennis post below, I had a quick thought to share on Caster Semenya and the discussion around whether she has a performance advantage and should be allowed to run, assuming the reports of internal testes are correct.

A lot of the discussion revolves around whether Semenya will be banned. Politicians and officials have threatened World War III if this happens, and vowed that Semenya will continue to run regardless of her condition. Her supporters are saying that she should be allowed to run no matter what, while others are saying she should not run if she a enjoys a performance advantage as a result of the condition.

The reality is that there may never even need to be a decision, and any controversy around the issue may well be dealt with as a result of medical concerns taking precedence over performance concerns.

Having initially written this post on Saturday 12 Sep, I've learned a bit more, courtesy colleagues in pathology and from your comments, and so I've edited this post to improve its accuracy. Thanks as always for your time and comments!

The IAAF Decision: Performance advantage vs Semenya's decision: Medical

The issue of what the IAAF should do regarding Semenya's participation in sport may very well be completely irrelevant. That's because, if the reports are true, and she has internal testes, then SHE would almost certainly have to seek medical treatment.

In cases like this, three options options often exist

  1. Surgical removal of the testes, which is likely the recommended option. According to Alice Dreger, an expert on intersex conditions, "Women with testes are at risk of testicular cancer. So doctors typically recommend having them taken out and having women take hormone replacement therapy (to retain bone health)". Thanks to Amby for that comment, as well.
  2. Hormonal treatment and gender re-assignment. However, according to Dr Pete, a commenter in the post, this is very unlikely in the current scenario. It would require the correct internal anatomy and according to experts I've spoken to, is quite unlikely. Also, the testes would need to be removed anyway.
  3. Do nothing. It is still possible Semenya chooses to do nothing (against medical advice). This is risky, because the danger of malignancy and cancer is substantially higher. Also, it's more difficult to detect with internal testes, and so she'd need careful monitoring. Once again, from Alice Dreger: "But one option is leaving them in and using watchful waiting so far as cancer risk is concerned, and more and more women with AIS feel that is a reasonable option"
Of the three, I'd say 1 and 3 remain on the table.

So why might this make the argument over performance advantages and the IAAF irrelevant? Because this situation has by now become a HEALTH issue first, and a performance one second. If Semenya has surgery, then the source of the potential advantage - the testes and the testosterone - will no longer be present and she can compete without any question (obviously, provided the issue is cleared up, as for the IAAF policy on sex reassignment). The necessary medical intervention may eliminate any debate over whether she has complete Androgen Insensitivity Syndrome or a partial AIS, and how much the testosterone might be helping her.

So rather than ask what the IAAF will do about her performance advantage, one should perhaps be asking whether the medical treatment SHE seeks is going to affect performance, and whether that medical treatment might negate the responsibility of the IAAF to make a decision at all.

Of course, it's possible that she chooses to do nothing, and then the ball is in the IAAF court once again, and they'd have to look at performance advantage. I'll look at that in the future, for sure.

But here are the two scenarios:

She goes for surgery, has the testes removed. 2010 will bring one of two results:
  1. She runs just as fast as in 2009, but should then not be questioned, since the "advantage" is no longer present.
  2. She slows down, but should still not be doubted. Either way, there is no issue of a 'ban' because of a performance advantage.
In this case, the Minister of Sport, ASA and everyone else 'threatening' the IAAF don't ever have to carry out their threats. In fact, the only way they would be able to stand their ground and occupy their current position is if they refuse to allow her to seek medical advice for a potentially life-threatening condition.

Meanwhile, those saying she should not run because of an advantage need not worry about the advantage. The medical concerns may well negate all the controversy.

Ross

109 Comments:

Anonymous said...

Why does she need medical treatment? I've seen other references to her "condition" being "threatening," but I've seen no explanation of what hazard her being intersex actually causes. Would she seek treatment simply to comply with the rules governing sport? You would help a lot of confused individuals by posting something to help us understand a little better.

Anonymous said...

Nevermind! I just read a previous posting that provides more information, although it declares that the testes might become malignant without providing any epidemiological or statistical information to back up the assertion. Still, that really did help me. Thanks!

Ross Tucker and Jonathan Dugas said...

Hi Anonymous

Glad you found it - I guess I should always post all the detail. Because this is maybe the 4th or 5th post in the last 3 days, I tend to default into assuming people have read all the posts, which is a mistake.

I'll actually go back and add that in.

To respond to your second post, difficult to give you any statistical information on this, because there is not any that I know of. The problem is that intersex conditions causing internal testes are so rare, and so often untreated, that identifying that they become cancerous is difficult. So this statement is based on my work and consultation with oncologists, chemical pathologists and doctors, and the fact that the standard medical practice is the removal of the internal testes.

It's never guaranteed that they become cancerous, but the risk is very high. It is thought to be related to the higher temperature internally.

I'll see if I can find some stats and I can assure you, I'll post much more on this whole issue and the health risks in due course - this is all part of one big picture.

Thanks!
Ross

Anonymous said...

I note the use of the pronoun, "she", in the blogpost. Question for Dr. Ross: Do you say that Caster Semenya is female because he/she has been normed as one? Why cannot it be said validly that he is male, but the victim of genetic/biochemical/social error?

I am sad for Caster. He should be helped, and should have been helped years ago. If he is fortunate, he can get out of the public view and have some peace. He should not be scorned or derided, especially by his Berlin competitors, provided no fraud was involved.

Frans Rutten said...

For example, let's say she goes for surgery, has the testes removed. 2010 will bring one of two results:

1.She runs just as fast as in 2009, but should then not be questioned, since the "advantage" is no longer present.
2.She slows down, but should still not be doubted. Either way, there is no issue of a 'ban' because of a performance advantage.

Interesting new angle, Ross, which brings me again to Pamela Jelimo.

What did exactly cause the extreme dramatic decline of Jelimo's performance level in 2009?

Right from the start of the season, although at first hidden, because she did alternative distances and didn't directly face some international competition.

At first it was attributed to change of environmental issues (like getting married, overnight becoming rich), lack of training due to surgery in Spring. But 2 or 3 months later still nothing really did change. No apparant injury, no hidden virus disease. Performing clean now after being continually doped?? Giving the enormous differences hardly likely.

The most dramatic thing of all was the overall picture of seeing Jelimo competing as if she still was the magician, but becoming a magician finding out during the act that the magic spell was gone. The most compelling thing of all is that comparing Semenya between Bydgoszcz and Berlin just shows the opposite picture.

If she slows considerably down, quite like Jelimo, the case is of cause solved.

The scaring part though is that no one knows where her absolute TOP is. In Bydgoszcz you could clearly see, that she was quite a novice in 800m running. In Berlin she was more experienced, but her last quarter finish (1:54 pace) was 1 to 1,5s FASTER than practically all of Jelimo famous winning streak 800m races. More than 2 full seconds faster than Jelimo in the Beijing race won by her in 1:54,87.

And above all that on an age, where most trainers even wouldn't allow eagerly such girls to compete in fierceful international competition.

I already posed the intriguing question: What did such a young girl of a rural village (no offense) do far from home in an international competition (2008)? Normally it would be a very peculiar question to ask, of cause, but I wonder if it's in this case.

To make a long story short. What if she's in 2009 still performing at an extreme good level and being still capable of rapid improvements?

How much work load can she have had in hardly one year, in which she even had a 3 months vacation. She might be practising longer than that year of cause, but on such a low level, that you can hardly consider that as top level work load.

Her performance level would still be linked though to her condition.

I stated from the beginning that there is no way out, regardless of innocence of intent of who ever is involved in this case.

The cases Jelimo and Semenya are IMO intertwined. This kind of duplicating of events in my view cannot be attributed to chance.

Time will tell if I'am right.

Zoe Brain said...

The figures I was given were a 1 in 500 chance of testicular cancer under normal circumstances, and 1 in 50 when the testes were internal.

Moreover, the diagnosis of testicular cancer is usually by palpation, after other symptoms have been noted because the testes are externally visible.

6-monthly checks via ultrasound would reduce the risks caused by internal testes consoderably. It may be useful to have them remain, as they provide both estrogen and testosterone in amounts the adrenals may not be able to. Such hormones are prophylactic for a number of long-term conditions, notably osteopyrosis.

I'm intersexed - (one of the rare conditions, not plain common old AIS) and had my glands removed when a pre-cancerous lesion was found via ultrasound. I had the rest of the genital area reconstructed to resemble normality at the same time.

If Ms Semlaya has high-degree AIS, as seems likely from these reports, she probably won't have that problem, external genitalia will be normally female.

I wonder who's supposed to pay for these surgeries, by the way? My own cost about $15,000 US, and as it required going overseas to a specialist, this was all out-of-pocket, covered neither by insurance nor medicare.

I'm Steve said...

I claim complete ignorance on this issue (and all the potential benefits of her condition and increased testosterone production), but I wonder if she has the surgery and looses the potential source of increased testosterone, does that mean she immediately gets slower and enjoys no advantage? I have two questions along that regard:

1)I assume that as soon as the testes would be removed, there would be an immediate decrease in testosterone production. But would that decrease have an effect on things like muscle mass (and whatever other benefits heightened testosterone gives) immediately? Would it be a sudden drop off, and she'd lose muscle mass and potentially start changing skeletal structure immediately? Or would it be a gradual process that would take years? What is the recovery time from this type of surgery? I guess to boil my questions down to one simple question would be this: Would she actually lose her performance advantage faster than she could recover from the surgery and return to racing form?

(and if not, it unleashes potential future complications...i.e. federations identifying these athletes early and purposely training them with masculine abilities before removing the testes and allowing them to compete as women for a short time. If we can hypothesize about Nike raising superior 'blade runners' from birth, this concept doesn't seem any more nefarious. Wow, when I imagined that situation, an athlete potentially trained unknown for years as a man, and then racing for a short, dominant time before losing her advantage, two words immediately popped into my head: Pamela Jelimo)

2)Even if she loses things such as muscle mass and reparation immediately, I imagine there are permanent differences, especially in terms of skeletal shape. Will she still have the narrow hips and broad, powerful shoulders? Is this in itself an advantage? Even if she loses some power, would she enjoy a more efficient form and resistance to injury because of her past condition?

Maybe foolish questions, I don't know, but I have to wonder. If she has the surgery and still returns to form as an internationally competitive middle distance runner, people are always going to wonder, and people will ask the same questions I ask now. Moreover, if she manages to break the 800 WR, rightly or not, people will always view that with a big * in their minds, just like the Chinese women, because of the questions I ask.

As much as I hate to say it for her sake, I sincerely hope that she's not still internationally competitive after this potential surgery, for the sake of our sport, which is already filled with too many *s and question marks.

To quote Spock: "the good of the many outweighs the good of the few, or the one."

Sorry for my disjointed ramblings, but can we say with certainty, that, assuming her condition is as reported, she would still enjoy no advantage post-surgery?

Ross Tucker and Jonathan Dugas said...

Hi all

Thanks for the comments:

To Anonymous at 12.33am:

Fair points, though I have to disagree with some of them. Firstly, I think it's assuming a lot to say that the testes would have been assigned gender at birth - I gather you're not from SA, but Semenya was born in a very remote Limpopo province, and I can assure you from personal experience that the medical "stringency" at many of these hospitals would not necessarily even pick this up. That's because these areas are understaffed and under-equipped, and often just get by. So the assumption that this was picked up then is not necessarily true, so I believe it remains an option.

I disagree on point 2 - the risk of testicular cancer is 10 times higher with ONE internal testis, and so for both, it is much, much higher, and so to compare it to removal of breasts is not entirely valid. I guess it's the same as saying that all cars should be banned because there's a risk of death while driving. But you'd think twice about driving in the dark with your eyes closed and speeding, when the risk is much higher. Without doubt, the medically prudent option will be to opt for treatment of some sort, not to leave them.

And finally, I don't think you can make a definitive statement like your point 3. What you can say is that YOU don't have a performance advantage, but given the range of these conditions, and the spectrum at which they occur, to say there is any guarantee is massively over-simplifying this.

Ross

Ross Tucker and Jonathan Dugas said...

Hi Anonymous at 12.37

I think the pronoun "she" is appropriate, until told otherwise. Semenya has lived as a girl, her gender is female, and even the presence of the internal testes does not change that. Unless one were to define "male" as someone who has testes, and that isn't true. So classification of gender is done on three levels - chromosomal, gonadal and gender, and Semenya's gender, for now, dictates that I think one should say she.

If she opts for reassignment, then it becomes he. Biologically, I guess you're right though according to two of the criteria of classification, but Semenya still has a choice to make and 18 years of her life so far make me feel it's reasonable to go with "she" until we know for sure it's "he".

I must point out, for example, that people with AIS CAN compete as females - it's happened many times in the past. So these are XY females - genetically male, produce testes, but develop as females. So does that mean that "men" have run against women before?

It highlights how complex it is, so rather than introduce that, I think it best to go with "she".

Ross

Ross Tucker and Jonathan Dugas said...

Hi Frans

As a sceptic of most things, I applaud your view! However, I'm not sure I'd go so far as to say it's likely, not just yet! It's certainly possible, though as one poster has said, Jelimo may yet be back in 2010, running as fast as before, and then we'll have some confirmation that it was her situation that changed to slow her down.

I guess time will tell that.

On Semenya, I really do agree that her rapid improvement, the level she has reached, the way that she has run, and the potential for improvement are all very telling factors. What about late onset of adolescence causing a testosterone induced spike in performance? And what is the limit to performance?

I just think that with the right conditions and race, Semenya could run 1:52, and that's at 19 years. It seems unreasonable, though of course nothing is impossible.

The point about this debate is that performance analysis is a flag, but not proof of anything, because there's always an equally provable/unprovable argument on the other side.

So time may yet tell, if Semenya opts for the removal of testes (assuming she has them) and slows down, and if Jelimo can improve to her previous levels in the future, then one would have to revisit this again.

It's probably not fair on Jelimo to say she's definitely the same as Semenya, though I can see the reason one might - it's just that there are a few other factors that could very reasonably explain it as well!

Ross

Ross Tucker and Jonathan Dugas said...

Hi Zoe

thanks for that information - I'd found the same stats, by the way, though my figure was for one undescended testis. I wonder if the risk rises by another factor of 10 if both are undescended? I couldn't find this out.

In any event, interesting information you provide - so it's the risk of developing cancer as well as the risk of not being able to detect it early that makes it risky. So certainly, it would seem the prudent response would be some kind of medical treatment, at the very least monitoring. I've not spoken to any doctors who would NOT recommend removal (six out of six so far).

If she chose to do nothing, the IAAF would have to make a decision, I guess. I wonder if on health grounds, they might enforce that she either have treatment or not compete? It's been done before - hematocrit above 50% is deemed dangerous and riders forced to sit out until the level returns. It's subtly different, but that's another interesting angle to this issue.

Ross

Ross Tucker and Jonathan Dugas said...

Hi I'm Steve

Not foolish questions at all - they're very good, in fact.

To respond, the muscle advantage (and a few other physiological one - testosterone also exerts effects on the cardiovascular system, for example) would diminish relatively quickly. Just as it comes relatively quickly - just think of doping for an illustration of this.

The east Germans has worked out that one season of doping could improve performance by 5% to 10%. Within months. But equally, when doping stops, performance reverses at about the same rate. So to answer, I think that yes, the muscle strength advantage would disappear quickly, to the best of my knowledge (of course,given that this hasn't exactly happened before, we don't KNOW this for sure)

That doesn't account for skeletal structure, which is also different. Here, the changes won't be quick, and may not happen at all. But I'm not convinced this is a major success factor - small part, sure, but I think the main benefit would have been on muscle function and cardiovascular function. Ability to tolerate training, to recover from hard efforts would be reduced, and that means slower times as well.

So on the whole, I think performance would decline pretty quickly, certainly by the time the season rolls around next year, I'd expect very little advantage, with the exception of skeletal structure.

Time will tell, perhaps. I guess there is a third option that she does nothing, and then of course, the ball is back in the IAAF's court, asking them to make some decision.

But if she has removal, I think she'd slow down. If she doesn't, then I guess we debate whether the long term effects are responsible or if she's just that good. I hear your concerns on that one!

Ross

Frans Rutten said...

Although I made remarks before not specific based on athletics, I sticked primarily to those.
Female athletes do mature at an earlier stage than male athletes, but World Class 800m Performances of female youth athletes are still rare for the obvious reason.

With regard to that for me the biggest question still is, what did Caster Semenya actually train (work load) in her up to now short but steep career?

The All-Time World Top-10 (11 athletes in all) is very conclusive in many ways.
Range: 1:57.18 to 2:01.29.

3 out of 11 athletes apparently ended their career in the year after running their PB’s, since no future marks were listed.

7 out of 11 athletes didn’t progress at all after setting their PB’s.

3 out of 4 from those who did, came out of the former GDR, one of them being Christine Wachtel, who progressed 5,84s. Total progression of the 3 others was a mere 3,43s.

Only 1 out of 11 athletes did reach absolute world level in women’s 800m, being of cause Christine Wachtel.

Her progression:
1982 (17-05) 2:01,16
1983 none
1984 (19-05) 1:58,24
1985 none
1986 none
1987 (22-08) 1:55.32 World Champion Roma

The situation with the male youth is somehow different.

First of all completely dominated by African runners and more contemporary based. About half didn’t progress or stepped up to other events.

The most prominent figure of cause being Wilson Kipketer starting with 1:47.0 (A) at age 15-07 but didn’t progress sub 1:45.0 until 1994 (age 21-08). He set his WR in 1997 (age 24-09).

About what is the limit of performance?
Man vs. Machine or Organism versus Configuration.

An aeroplane designed to fly maximally 1000km/h, will never “learn” to fly 1200km/h, and will soon after it’s been tried disintegrate. A human organism has his own boundaries, but until then there’s a long and winding road and a lot of options, all depending how well the organism is handled.

But as soon as other factors are brought into the equation of maximizing performance, you (can) wind up with unforeseen progression. I don’t need to go in details. But in such conditions, which IMO includes the case of Caster Semenya, there’s no longer talk of pure human organism performance. And of cause there’s still the hardly understood phenomenon of the so-called autonomic physiological human capacity, if that’s the right phrase, which can only temporarily be unravelled in absolute extraordinary stressful situations. Most enlightning of cause being the (possible) lifting performance of a mother seeing her child overridden by a car.

And the most amazing experience of seeing Semenya run must have had Elena Mirela Lavric (ROU), the girl that ultimatily won the World 2008 Youth title (2:00.06) in Bydgoszcz, where Semenya first emerged at the world scene. She didn’t progress this year (2:01.52), but finished 6th in a heat in 2:04.49, yes, in BERLIN.

LL said...

If the early reports were true (they were right about everything else), and Dr. Ekkart Arbeit, one the DDR’s chief chemists and athletics trainers who now works in South Africa, found a way to temporarily surpress Semenya’s testosterone levels, does that mean that her testosterone levels might be even higher than those 3 times the normal limit we are hearing about now?

If she was given something to mask testosterone levels, how can they be sure those drugs are not still in affect and giving her a lower testosterone level on tests (as intended by Dr. Arbeit) and she in fact has more normal male levels? I'm not sure if the new allegations from Australia mentions how high the testosterone levels were exactly (from the IAAF tests in Berlin), they just mention there were high levels. The tests done in Pretoria before Berlin were the ones that mentions 3 times higher levels than average for females. But I wonder if Ekkart didnt give her something on a regular basis to pass doping tests at that point.

I cant fathom how Caster can be insensitive to male hormones, even if just partially, and manage to look just as muscular and built as her male 800m stable mate Mbulaeni Mulaudzi, who also won gold in the 800m race in Berlin. It has been bugging me a bit, it does not add up..but if the reports about Ekkart finding a way to "mask" her testosterone levels to "only" 3 times the average (which SA claims is still within the accepted range allowed for female athletes) it would make more sense to me.

Here is a photo of Mbulaeni Mulaudzi :
http://www.southafrica.info/cm_pics/news/696-7399-0-0_1761152.jpg

And a quote from another article about Ekkart coaching Semenya:

"But the South African team member told The Daily Telegraph via email that Arbeit was indeed fully in control of Semenya's training preparation. "Caster trained with Ekkart while she was at the training camp in Germany,'' the South African source explained.

"It was very strange; Caster's coach was the only personal coach of possible medallists who was not present at the training camps in Germany or at the actual world championships.

"ASA covered the costs of all the other relevant personal coaches of Khotso (long jump medallist Godfrey Mokoena), (men's 800m winner Mbulaeni) Mulaudzi, and (hurdler) LJ van Zyl even had the costs of his own physiotherapist paid for by ASA.

"Ekkart and team management knew there would be trouble about Semenya and numerous times our coaches and officials were told not to discuss anything about Caster with anyone.''

The whole article:
http://www.dailytelegraph.com.au/sport/more-sports/doping-expert-coached-semenya/story-e6frey6i-1225768489059

Could it be that Semenyas testosterone levels is higher in the tests taken in Berlin (where Ekkart got cold feet), than those taken in Pretoria where Ekkart would have been present to mask the problem before the tests?
I'm speculating wildly here, but at this point I believe ASA is capable of being that cynical, KNOWING good and well Caster is not completely female, just trying to get her hormone levels "invisible" on tests.

If they are capable of duping her into taking a gender test, telling her it's just a doping test, what other things have been going on behind her back, how long have they known and tried to hide it?

Ross Tucker and Jonathan Dugas said...

Hi LL

All good points. I don't know about those suppressed testosterone levels. As you say at the end, it would not surprise if it were true. There is also the matter of variability in testosterone levels anyway, they can vary widely, so it might be as simple as the fact that they were measured at a time when they were lower. Of course, it could work both ways. Perhaps the proper testing has more detailed results, who knows.

Regarding AIS, I agree, she's not completely insensitive. Therefore, there is some kind of performance advantage, of that I have little doubt. Quite how to manage this, I don't know, I must confess.

Time will tell, both that, plus the management issue from ASA, and whether we're looking at the most corrupt attempt at cover up in sport for many years...

Ross

Amby Burfoot said...

Hi Ross, Jonathan: Thanks for your great coverage of this important issue. Here's what intersex expert Alice Dreger emailed me today about the testicular cancer risk. She has seemed to me a reasonable voice in the ongoing debate:

"Women with testes are at risk of testicular cancer. So doctors typically recommend having them taken out and having women take hormone replacement therapy (to retain bone health). But one option is leaving them in and using watchful waiting so far as cancer risk is concerned, and more and more women with AIS feel that is a reasonable option."

Of course, if Semenya followed this path, she could continue competing (if not IAAF banned) until her docs advised her to pursue serious medical-health procedures.

Best, Amby

DrPete said...

Hi Ross

Just a few points re your article:

1. Men with a history of undescended testis have an increased incidence of developing testicular germ cell cancers of 1 in 1000 to 1 in 2500, versus 1 in 100,000 in the general population. The risk of developing testicular cancer is affected by the location of the undescended testicle. Compared to intraabdominal testes, inguinal testes are four times less likely to become cancerous

Th risk of cancer in DSD depends on the diagnosis, (but is 6% in a broad series; http://tinyurl.com/o656mo):

As an example, patients with mixed and XY gonadal dysgenesis have an increased risk of gonadal malignancy (>30 percent in some series). Gonadectomy should ideally be performed within the first decade of life in these children. In contrast to the dysgenetic gonads seen in most other patients with disorders of sexual development, the risk of gonadal malignancy in patients with androgen insensitivity is minimal until late puberty. Delaying gonadectomy until after puberty may permit a relatively "natural" female puberty and greater bone density.

(See http://tinyurl.com/mqrr3e)


2. In the unlikley case that Caster wants gender reasignment, the testes would still need to be removed (or watched very closely with scans and tumour markers as mentioned by others - not adviseable after puberty), there is no effective medical treatment to 'bring them down' nor does it reduce cancer risk. Surgery is possible at a very young age in some situations but not really an option here.

3. Gonadectomy will undoubtedly lead to rapid muscle loss and, combined with appropriate hormone replacemnt (oestrogen) a substantial alteration in body habitus.

thomas said...

Assuming Semenya has enjoyed an advantage from extra testosterone, does this advantage totally cease if testes are removed? That is, muscle has developed as a result off additional testosterone. Does that muscle atrohpy or disappear if the testosterone supply is reduced?

Rob

Anonymous said...

Hi Ross, does the benefit derived from additional testosterone diminish once testosterone levels reduce. That is, does the additional muscle grown that has occured due to the extra testosterone in Semenya's body, atrophy or disappear once testosterone supply is reduced?
Rob

Ross Tucker and Jonathan Dugas said...

Hi all

Amby:

Thanks for that info - I had actually spoken to a few people since doing this post and discovered that third option, so I should revise the post, I guess. But yes, she has that option with ongoing observation. If that is the option she follows, then of course the ball is back in the IAAF's court, and one wonders how they'll handle it.

THanks for the info though, I'm going to use it for sure!

To Dr Pete:

Same to you, thanks a lot! That is very useful information, a lot of which is new to me, so I really appreciate it!

And finally, to Thomas and Rob:

Yes, the muscle loss will be rapid, as you've seen from Dr Pete above.

Thanks all!

Ross

Zoe Brain said...

From a fellow researcher in the area - though I'm more a dilletante, a collator and organiser of multidisciplinary strands of knowledge than an expert.

Hi Zoe, After reading the Daily Telegraph of London, I read some of the 299 comments and per usual everybody has an opinion about something they know nothing about. All speculative! As a Urologist, who lectures on this very subject to medical doctors, let me tell you what I think I know from reading the AP from Pretoria, SA. Caster Semenya has a probable genetic Disorder of Sexual Development known as Partial Androgen Insensitivity Syndrome, probably Grade 5 or 6, where the external genitalia are female-like and the internal genitalia are vestigial testes, which produce Testosterone and Estrogen. I say probable because we cannot know if she has any ovarian tissue mixed with the testis tissue until these vestigial organs are examined under the microscope by a pathologist. This will probably never happen, unless it is presented to her as a condition for receiving female hormones. At this moment everyone is assuming she is an XY woman. Now somebody said she had three times the normal female Testosterone level, which according to this one lab gives her less than their normal male values. Now every lab has its own normal values and we have not seen any numbers. So here are the values from just one lab, not her testing lab.
http://www.bloodindex.org/normal_laboratory_values.php
Determination Normal Reference Value
Testosterone: Conventional units SI units
Female 6–86 ng/dl 0.21–3 nmol/L
Male 270–1070 ng/dl 9.3–37 nmol/L
But it doesn't matter what her serum Total or Free Testosterone is because the definition of PAIS implies that the cells which receive T cannot utilize it because their Androgen Receptors will not bind the T effectively. That's why she has female external genitalia at birth. Interestingly the research in this area is so complete that the Chromosomal mutation on the Androgen Receptor can be identified. Usually these women and I say women, because that is how they have been raised and gender identify as female, are diagnosed in their teens because they cannot menstruate or conceive. Now in truth I know no more about her physical condition than what I read in the newspapers. Is the London Daily Telegraph a tabloid or the cousin to the New York Daily News? Poor Girl !!!!


Pretty much what I'd figured, though we also can't rule out 5alpha-reductase-2 deficiency (5alpha-RD-2) and 17beta-hydroxysteroid dehydrogenase-3 deficiency (17beta-HSD-3), or something exotic.

I'm not real thrilled about the "DSD" terminology - it was a concensus reached without sufficient consultation with the Intersex community, but never mind. Certainly if it interferes with fertility (as most IS conditions do), or involves distress caused by cross-gendered neuroanatomy compared to the rest of the body, it's a disorder. But many such conditions are asymptomatic or nearly so. Is Albinism a disorder? I think so. Left handedness? More a natural variation. Colour blindedness? Somewhere in between. But I digress.

Ross Tucker and Jonathan Dugas said...

Hi Zoe

Thanks so much for that, it's great!

What I'm most interested in is that your researcher colleague is his referral to Grade 5 or 6.

What does that mean exactly? The reason I ask is because we've already pretty much written about AIS and the mechanism, and somewhere in amongst my posts, I've looked at testosterone levels and explained how having high levels does not mean an advantage, just as this expert writes.

But what I haven't been able to find is the spectrum over which AIS occurs. I know it's either complete or partial AIS, and that partial happens in varying degrees, and this mention of Grade 5 or 6 is the first I've seen.

The reason I ask is because this would have implications for understanding how they'd judge the performance advantage. What does Grade 5 mean? What is the highest - is 10 complete? Is 1 very partial?

Is there any way of finding this out, and how do they make the diagnosis? I cannot find this information, but I'd love to so that I can start to think about how the IAAF would decide about performance advantages?

Thanks again for the time posting and reading!
Ross

DrPete said...

For further info:

There is a very wide spectrum of clinical presentation in AIS, from women with unambiguous external genitalia (but no hair), female body habitus and normal breat development (as in complete AIS) to the infertile male syndrome or even the undervirilised, fertile male (in partial forms).

There is some genotype-phenotype correlations: major deletions or premature termination codons in the AR gene have been found only in patients with complete androgen insensitivity. Amino acid-substitutions (a single changed amino acid in the gene sequence is all that's required) can cause the entire spectrum of phenotypes from infertile men to complete androgen insensitivity, and there are 100's of different mutations known, and many unknown.

Drs. Charmian Quigley and Frank French (The Laboratories for Reproductive Biology, The University of North Carolina ) proposed a grading system for the phenotypic features (external appearance) in AIS, modelled on the Prader classification for Congenital Adrenal Hyperplasia (CAH). The scale runs from AIS Grade 1 to Grade 7 with increasing severity of androgen resistance - and hence decreasing masculinization with increasing feminization.

At the CAIS end of the spectrum the outward appearance is completely female (AIS Grades 6/7) and the sex of rearing is invariably female. In PAIS the outward genital appearance can lie anywhere from being almost completely female (Grade 5), through mixed male/female, to completely male (Grade 1). Some babies with PAIS may be raised as males but many are re-assigned as female.

Peter.Raubenheimer at uct dot ac dotza

Zoe Brain said...

A good guide is at the AIS Support Group.

Basically:

Grade 1 Male genitals, infertility

Grade 2 Male genitals but mildly 'under-masculinized', isolated hypospadias

Grade 3 Predominantly male genitals but more severely 'under-masculinized' (perineal hypospadias, small penis, cryptorchidism i.e. undescended testes, and/or bifid scrotum)

Grade 4 Ambiguous genitals, severely 'under-masculinized' (phallic structure that is indeterminate between a penis and a clitoris)

Grade 5 Essentially female genitals (including separate urethral and vaginal orifices, mild clitoromegaly i.e. enlarged clitoris)

Grade 6 Female genitals with pubic/underarm hair

Grade 7 or CAIS Female genitals with little or no pubic/underam hair

Diagnostic differentiation, again from the AIS Support Group:
In AIS Grades 5 and 4, the clitoris is enlarged. In Grade 5, there may be partial fusion of the labia majora (outer vaginal lips), in which the posterior (back) portion of the labia form a web of tissue across the back part of the vaginal outlet. In Grade 4, this fusion extends further forward, covering both the vaginal opening and the true urethral opening. The cavity formed by the fused labia, through which urine exits, is called a urogenital sinus.

The labial fusion can be surgically divided, making the vaginal opening accessible for pressure dilation (a non-surgical way of lengthening the vagina). This division is a relatively minor operation, and is unlikely to adversely affect erotic sensitivity, but it should be performed by a physician familiar with this type of surgery. Vaginal dilation can be successful in Grade 4 AIS, and should always be attempted before surgical vaginoplasty is planned.

In Grade 3 and the more masculinized form of Grade 4, the labia are completely fused, so that the urethral opening is at the base of the clitoris/penis. The fused labia may have a rugose, or wrinkled appearance and form a bifid, or double, scrotum. The fusion is then more properly called 'labio-scrotal fusion'. The phallus has the appearance of a large clitoris, or a small, bent, penis, bound down in structures called chordee. The chordee is formed from the same tissues that form the labia minora in the female and the frenulum of the penis and the tissues surrounding the urethra (corpus spongiosum) on the underside of the penis in the male. It is not true that the presence of chordee makes erections painful.

In Grade 2, the genital appearance is that of a male with hypospadias, that is, with a urethral opening located somewhere on the underside of the penis. There may be an open gutter running from the urethral opening to the glans of the penis.


Sometimes PAIS-1 is split into MAIS - Mild AIS - and PAIS-1, "undervirilised fertile male syndrome", which can involve a micropenis but only infertile rather than sterile gonads.

The Grading, while useful, is still rather arbitrary, and individual cases may have some characteristics of one grade, and others of another.

As far as I'm aware, diagnosis of PAIS is solely on the basis of physical examination and an androgen study. While there are reliable tests for CAIS, and it appears a chromosome analysis is definitive, PAIS of the lower grades is only responsive to cellular testing less than 50% of the time.

Basically, if there is incomplete masculinisation in the presence of a male-normal androgen series, it is deduced that some degree of AIS must be present, barring other diagnoses.

Zoe Brain said...

The AISS definition of "complete or nearly complete" AIS would seem to correspond to grades 7 and 6 respectively. Grade 5 would be a "line ball decision", with an associated male-normal rather than high-female level of testosterone possibly causing disqualification. I fear that the decision may be more due to politics and appearances than biology though.

My own personal opinion is that if the AIS is severe enough to cause genital ambiguity, then it would take a high male level of Testosterone to cause an advantage. This is not unlikely, as the feedback mechanisms may cause excess hormone production in an effort to compensate for a perceived lack.

If the genitalia is not just ambiguous, but actually feminised, the degree of AIS is so high that no amount of testosterone could realistically be advantageous, not even a high male level.

In this case, 1/3 of the normal male level combined with at least somewhat feminised genitalia would be a very strong indication of no significant advantage. I think they may have to look at skeletal and other factors as well, and pretend that there's some correlation with testosterone-induced muscle mass. It's plausible, likely even, but still guesswork.

The hope is that the degree of somatic masculinisation in other areas will give us a guideline as to how likely the testosterone levels are to be unacceptable in terms of building muscle mass.

As I'm intersexed myself, I can't pretend to objectivity though.

Anonymous said...

As I understand it IAAF rules stipulate that she will not be automatically eligible to compete after surgery, and definitely not as soon as 2010. See
http://www.iaaf.org/mm/Document/imported/36983.pdf

"Reconstructive surgery and sex reassignment
[...]
- if the sex change and hormone therapy is done after puberty then the
athlete has to wait two years after gonadectomy before a physical and
endocrinological evaluation is conducted"

Anonymous said...

Your comments and pronouncements on this whole issue have been callous, uncaring and total without sympathy for the feelings of the athlete involved and her family.

The women is a human being and not a lab rat, please try and show some sensitivity and tact in your discussion of this whole issue.

Declan.

DrPete said...

Sorry, should acknowledge source of my last post on the 'Quigley grade' as http://tinyurl.com/2cxr3x. Excellent general info site.

Penny said...

I'm glad you are focusing on it being a health issue right now rather than a performance issue. Yes, IF she has internal testes perhaps she performed at a higher level than she would have otherwise. However, the focus should be on getting her health in order then, and only then, will we know about how she may perform in the future. Does a medal really matter if she also develops cancer if (again if the reports are true) she does not get the testes removed? In my book, the answer is "NO!"

Thanks for your thoughtful review and insight on this topic.

Ross Tucker and Jonathan Dugas said...

Hi Declan

I'm not sure which comments specifically. i appreciate the sentiment, but I'd like to know how else to address it? I gather you'd like everyone to leave it alone?

I don't think that is an option here - there is too much interest and one might argue that this perverse and wrong, but it is now at the point where people will discuss it.

What I have tried to do is to explain the facts (eg. she is not a hermaphrodite, she will not necessarily be banned), because the reports that are going to come out are misrepresenting those facts.

I guess one could say we should just stop, but I don't find this satisfactory - this site was set up to try to provide objective perspectives on complex issues, and this is one such issue.

It's peculiar that some have written in saying that the posts here are very supportive of Semenya, because they try to get to the truth behind the stories, while others feel we are being callous.

So I'm sorry you feel that way - I disagree, I think we're doing the whole story a positive service by trying to stick to fact.

But please, let me know how to show more sensitivity around the issue, and still cover facts, and I will try. My intention is not to offend or be callous, but if you think I am, say how, and I'll try harder to avoid a mistake. But providing facts so that people know, rather than speculate wildly is not a mistake, in my opinion.

Ross

Ross Tucker and Jonathan Dugas said...

Hi Zoe

Huge thank you for the informative posts, that really is great, and I'll definitely make use of it, if it is AIS. Until I know that, I probably won't post in too much detail, because I don't want to speculate and give such detail only to discover later that it's something else altogether! And I have to constantly remind myself that all of this is based on an as yet unconfirmed report from the Australian paper - it may be completely misplaced speculation!

So there are a number of possibilities, but this info on AIS has taught me a lot, and I may well use in the future so thank you so much!

Also, to Penny, thank you for the kind words. Let's see how this unfolds, and let us hope that the officials and politicians who have already decided that Semenya is a female will allow her to reach whatever conclusion she wants to by herself.

Ross

maaahty said...

Due to some life-threatening medical maladies I have incurred since my 20s (I am now in my 30s), I suffer from hypogonadism, or the inability to produce NORMAL amounts of testosterone for a man. I cannot even produce trace amounts or the amount that a woman produces despite the fact I was perfectly healthy in that respect through about my mid 20s when I had a blunt trauma to my pituitary. It is embarrassing to admit this, but the reason I bring it up is because it is very relevant to this Semenya controversy.

Going from normal amounts for a male to producing zero (not even what a women who produces lower than normal amounts for a female produces) HAS ZAPPED ME OF ANY AND ALL ENERGY so much so that I went from being athletic and active to - despite the fact I get Testosterone Replacement therapy (and thus would never be able to participate in the Olympics, but I was never in danger there anyhow, but I am a sports journalist and a fiction writer)- being so empty in testosterone that I literally am almost completely homebound and it takes days of recovery for me to recoup after running a simple errand like going to the local food market.

THE REASON I POINT THIS OUT IS THAT IF A PERSON ALLEGES TO BE A FEMALE but HAS THREE TIMES THE AMOUNT OF TESTOSTERONE she is either doping - which would be illegal - or has a serious medical condition that would require immediate treatment and running in IAAF races would be at the bottom of her urgency issues that need addressing. She probably was not nor has ever been a female. She was born, which is a lot more prevalent than people realize, with ambiguous genitalia, and until the last half-decade or so the protocol for such was to surgically open a canal for urine and NOT EVEN BOTHER to do any genetic testing to see whether or not this person is a male or female, which regardless of how they present can be determined with genetic testing AT BIRTH.

If she (he) does indeed believe that she is a woman, I repeat that running fast times is the least of her worries as she has medical issues that need to be addressed immediately. If, more likely, she is indeed a man then she has either a) perpetuated a HUGE fraud on IAAF and should be punished harshly with a lifetime ban, or b) been living a lie unwittingly and unknowingly, and she will need medical as well as psychological intervention to make sure that a healthy person emerges when the scandal comes to an end. Regardless, her medical records should never have been breached and for that you have reporters and their sources WHO PLACE THE RIGHT TO KNOW above all else to blame (it is not like national security was at risk ... And to those in the medical and journalistic professions who are involved in the leak, I think the medical side should lose their licenses with LIFETIME bans and the employers of those who first reported the leak about Semenya should be fined, the reporter fired, and both employer and employee should be ostracized from the Track and Field Community with no ban being long enough, whether Semenya is a woman, a man, or (LEAST LIKELY) honestly an anomaly as their really is no such thing as - despite the perversions of those with some strange fetishes - a MEDICAL HEMAPHRODITE.

I hope if Semenya is innocent in all of this, while I find it unlikely, that if she is not complicit she should sue the leakers and the original purveyors of her confidential medical records and maybe even the governing bodies if the leaks occurred with a wink and a nod from the IAAF as Semenya's life will forever be synonymous with scandal.

-Scott M

Tina said...

Scott M said-

IF A PERSON ALLEGES TO BE A FEMALE but HAS THREE TIMES THE AMOUNT OF TESTOSTERONE she is either doping - which would be illegal - or has a serious medical condition that would require immediate treatment and running in IAAF races would be at the bottom of her urgency issues that need addressing.

This is nothing but pure speculation and hyperbole presented as fact- there is nothing in any pertinent medical literature to suggest that a female simply having elevated T levels is a "serious medical condition" that requires "immediate treatment"...

he also states-

"She was born, which is a lot more prevalent than people realize, with ambiguous genitalia..."

this is another claim that is utterly and completely unsubstantiated neither by known test results or medical records, nor by any legitimate scientific literature- having internal testes is NOT always accompanied by ambiguous or otherwise non-standard genitalia.

Both claims are at this point nothing but pure speculation and rumormongering, and only serve to cast aspersions on someone who certainly never chose to be intersexed, and were they to be guilty of doping would have been exposed long ago.

Zoe Brain said...

Ross and Jonathan:

Thanks for the appreciation of the help. I try to educate as best I can.

Part of that's out of self-interest. The more that's known - especially by the medical profession, but not just them - about Intersex conditions, the fewer problems we'll face.

Some of the problems are, well, they're problems. At times they can be pretty dire. Such everyday matters like obtaining a passport, or getting married, can present extreme difficulties. Sometimes they can be impossible. Sometimes just filling in a form can lead to charges of fraud, and being confined in an inappropriate remand center before trial - with the predictably fatal results.

As for Romantic relationships... don't ask. Getting involved with the wrong person can also be fatal. Disclose early to someone on the first date, and you have a distinct chance of ending up in the ER. Let the relationship grow without disclosure, and if you misjudge your potential partner, you can end up in the morgue.

Even being in a minor car accident can be life-threatening. Primum non nocere when the ER personnel are confronted with anatomy outside their experience can lead them to denying all treatment, and the patient exsanguinating from a perfectly survivable trauma, nothing to do with the anomalies.

The violation of Ms Semlaya - and that is what it is, bluntly - is unfortunately not an isolated incident. Santhi Soundarajan had even worse treatment in 2006. Sarah Gronert got off comparatively lightly - but still after treatment that would be considered beyond the pale if she wasn't Intersexed.

Ross Tucker and Jonathan Dugas said...

Hi Tina, and Scott

Scott, thank you for your insights.

To Tina, I actually agree with Scott's first assessment regarding the testosterone. If a female presents with values above about 3nmol/L, they would be considered, medically, to have some kind of pathology and would be investigated further. That's because most often, this high value would indicate a testosterone-producing tumor, which certainly is pathology.

Based on your comments, that terminology is obviously unfavourable, so maybe one should say that a level of testosterone above about 3nmol/l is indicative of further investigation. Then, because it's sport, doping is an option. And most athletes do dope without being caught, so there's no certainty about being exposed. So Scott is actually correct on that one.

Regarding the ambiguous genitalia, that's certainly a possibility here. Given the media reports, it seems likely, though Tina, you're right that it is an assumption based on rumor, and one does need to be careful.

However, in athletics, when an athlete gives a doping sample, they are often seen by an official, which means that Semenya does have female or apparently female genitalia. If the reports are true that she has internal testes, then I think it's fair to classify them as ambiguous, because they don't match the chromosomal or gonadal sex.

Where you are correct is that there will be ranges of these physiological changes, and so it might be that she doesn't. However, my reading of Scott's post is his opinion, based on what has been stated. Certainly not an accusation.

Thanks both for the posts

Ross

Tina said...

Hi Ross-

I have to respectfully disagree on a couple of points...

If in fact Semenya's heightened testosterone levels are congenital and her (so far undisputed) history of having masculine looks and physique for her entire life is true, then one has to consider that she has had this condition for her entire life and not only was not in the throes of any acute medical emergency for 18 years, but by all accounts was happy and functional and was obviously healthy enough to not only survive, but to become a world class athlete who regularly places extraordinary demands on a body with a supposedly "serious medical condition that would require immediate treatment".

This just doesn't make any logical sense, nor does the idea that her undiagnosed and untreated condition suddenly became one in need of "immediate treatment" just because she was made aware of it.

Semenya's life long visible physical androgyny, which is being treated as beyond dispute when used to support the idea that she and those around her had to know that she was not entirely female, and especially the reported internal testes that are similarly being treated as proof of her not being entirely a woman, would also nullify any claim that her condition was the result of doping.

As for a female with this kind of heightened T level being "considered, medically, to have some kind of pathology", one must consider that simply calling something "a pathology" does not automatically make it so, even when someone with "M.D." after their name does it.

In Semenya's case, there is nothing in any reports I have seen to indicate that her condition has in any way impaired her normal functioning (she may very well be infertile, but this is hardly something that requires immediate treatment)...quite the contrary- it is presented as giving her an "unfair advantage".

No, it is only being called a pathology because that allows it to be treated as something negative and abnormal that should be dealt with severely.

This treatment of intersex conditions as being dire medical emergencies in many cases has no real basis in fact or science, but is the result of societal demands that all people fit neatly into one of two boxes with all non-conforming individuals labeled as sick and in need of fixing.

Alice Dreger's statement that "Women with testes are at risk of testicular cancer" is tantamount to saying that "women with feet are at risk for ingrown toenails"...men with testes are also at risk for testicular cancer too, but we don't suggest preemptively removing them on that basis in every case.

More often than not, when an intersexed women with testes, or a clitoris deemed "too large", or "excessive" body/facial hair has any of those removed or otherwise altered, it is because of social strictures that say women aren't "supposed" to have any of those things, rather than any immediate medical necessity.

(contd)

Tina said...

As for the claim that "most often, this high (testosterone) value would indicate a testosterone-producing tumor..."

could you please cite a source?

My understanding of various conditions that involve heightened T levels in females is that congenital adrenal hyperplasia is a more likely cause, and that most of the tumors you reference that would cause this type of secretion are associated with the ovaries- which we are told Semenya doesn't have.

Finally, when you say-

"most athletes do dope without being caught"

- I think you mean most athletes *who dope* do so without being caught...but even then, how can this claim be made logically?

If "most" athletes who dope are not caught, how can any accurate determination of relative percentages even be made...?

Regardless, as I pointed out earlier one cannot logically use Semenya's (alleged) internal testes as de facto evidence of her having a natural advantage because she's supposedly partly male, and then turn around and accuse her of doping because she's a woman with "too much" testosterone...

I suppose in some Bizzaro world someone intent on doping for unfair advantage might choose an intersexed person as their platform, but come on- if some coach or country didn't care about the rules and were intent on winning via subterfuge and remaining undetected, does anyone truly believe that they would pick a woman so visibly androgynous and *then* give her still more juice, when any subsequent tests had a better than average chance of turning up an IS condition that could call the win into question?

Of course not, they would find someone who they knew could pass all genetic and other gender tests, and then dope her...it might cause noticeable virilization over time, but at least her genetic makeup would not be in dispute were suspicions raised.

If, as her detractors claim, Semenya has an "unfair advantage" because she is intersexed then there would be no sensible reason for further doping...her value would be in not *needing* to be doped for unfair advantage.

Sorry, but if the purported medical evidence surrounding her is to be believed, the mere suggestion that Semenya is also on the juice and deliberately cheating is so far fetched that it immediately comes under suspicion as nothing but a gratuitous allegation designed to smear her.

Tina said...

Ross- Sorry to be so long winded, but I wanted to make one more point-

you said-

"However, in athletics, when an athlete gives a doping sample, they are often seen by an official, which means that Semenya does have female or apparently female genitalia. If the reports are true that she has internal testes, then I think it's fair to classify them as ambiguous, because they don't match the chromosomal or gonadal sex."

Just to be clear, in common usage "genitalia" refers to external sex organs, and not internal plumbing...and especially in the context of intersex, "ambiguous genitalia" refers to visible external structures traditionally used to determine sex, not internal reproductive organs...so at best, referring to internal testes as "ambiguous genitalia" is confusing and not in keeping with standard usage.

Ross Tucker and Jonathan Dugas said...

hi Tina

Thanks for the reply.

A couple of points. First, there's no guarantee that she has had high testosterone levels her whole life. in fact, pre-puberty, there is very little different between boys and girls, so that theory is already incorrect. Second, the medically harmful aspect of the condition certainly exists, and could well be present for a number of years. Remember, we're talking about the risk of developing cancer, which could happen any time. In fact, it tends to happen a little later in life, in the 20s, but medically, you would not wait before it was potentially too late, knowing that risk exists and in treatable. Discovery later does not mean action later. It's the same as if you had very high cholesterol levels - you have a risk of a stroke. Do you ignore it, because it's been that way for 10 years? Because it doesn't affect your normal routine or daily life? Of course not. You change diet, look at meds, because it's risky otherwise. So that is why doctors recommend surgery - not to discriminate, but to potentially save a life.

I agree on the use of the term "pathology", and I certainly acknowledge your concerns, particularly in the previous post, but you're effectively slating the medical field on an issue of semantics. And they're controversial semantics, I agree, but the issue is still serious. And all I am doing is telling you how this issue would be treated medically (aside form all the PC-requirements).

The fact of the matter is that a testosterone level of 3 or higher is a flag that something may be wrong. This does not mean doctors set their sights to condemn the person, it means they look at it as a value that warrants further investigation, because it might be a tumor (or CAH, as you point out - again, you're attacking semantics. Remember, I'm trying to answer your email in the middle of a work day - so i'm discussing something with you, rather than presenting the whole argument, top to bottom, so go easy on a missing word!), it might be something else. Regardless, it needs to be looked at, whether it's a tumor or CAH. And I think that is what Scott is saying. The source to cite? Every chemical pathologist and specialist who has seen these values, endocrinologists (at least 3 colleagues of mine, who work in that field). High levels of testosterone are treated very seriously, because it might save lives. Pretty much everyone.

That's what is done medically.

Then I do feel you're reacting very badly to the issue of doping. First of all, people who follow the sport of athletics know that doping is prevalent. Therefore, I stand by what I said "most athletes do dope without being caught". What sport has shown in the last decade is that the ability to catch dopers is limited. Fewer than 50% of dopers are caught. in the 1990s, in cycling, about 5% of dopers were ever caught. We know this because samples are retrospectively evaluated and analysed, and then the true picture emerges years after the fact. Also, a number of people admit to doping without being caught, so they are counted among those who evaded detection. It's not difficult to evaluate that. Therefore my statement is accurate.

Second, the fact that Semenya might have been doping (and Scott was not accusing her, he was simply pointing out a possibility, and he is right. That's not the same as accusation, it's part of the discussion, which I think is quite good) has little to do with being intersex. It seems you've somehow connected these two and created a conspiracy theory to deliberatel dope an intersex person. That is not at all how I read Scott's post. All he is saying, and I agree, is that massively raised testosterone levels are indicative of one of two things:
1. Doping. or 2. condition requiring further investigation.

Ross Tucker and Jonathan Dugas said...

So the doping issue is one that is always present, not meant as an accusation, in my mind, but an observation.

I will say this: if questions were not raised about her sex, there would be questions about doping, because the performance improvement, the history of the event, and the manner of her racing cause people in the sport of athletics to sit up and take notice.

I'm not advocating that people are guilty by performance, because that would be unfair. What I am saying though is that there is an area of exercise science that looks at performance as a flag, and this would be one such case - it's been used very effectively in cycling, incidentally. We did a couple of posts on this recently, at the beginning of August, if you're interested.

But thanks for the discussion, I think it's been really great. There are semantic issues, I agree, and there is an implied opinion in many of the terms used. As I said, I'll try harder to use words that are not so "loaded". But also, just bear in mind that people are expressing opinions, not necessarily accusing (I refer to Scott) and they often do so from a distance. Doesn't make them malicious, just decontextualized!

Thanks for the time to post!

Ross

CataCristão said...

Dear Ross Tucker
I am a Portuguese Journalist from Diário de Notícias (ww.dn.pt) and I would like to make you some questions about this subject (Semenya's performance). Can you connect me by my email address, please? catarinacristao@hotmail.com. It’s urgent. Thank you.

Anonymous said...

Look at how big/muscular Semeneya is in this video. It might be the angle, but she looks even more muscular than she did during the Berlin championships, I cant see any diffrence between her and other male 800m runners her height. I doubt she will be allowed to run with woman unless she agrees to remove the internal testes and goes through extensive hormone treatments. On the other hand, looking at her in that video, makes me think she could easaly run with the fellas one day instead.. The men she runs with at Tuks (she trains with the guys instead of the girls) admit they can't keep up with her on the shorter distances!

http://www.canada.com/news/videos/index.html#Y0Byh9FmobNj_8mIYNVbLPSU43EeWbc3

Tina said...

Ross-

I do appreciate your responses and the conversation.

As for what Scott may or may not have meant, obviously you and I can interpret that until the cows come home without ever really knowing...if you detect any frustration on my end, it is in part because in discussing this matter here and elsewhere online there is a tendency for comments like Scott's that could be *interpreted* as erroneous and needlessly judgmental to be made, and for that poster to then simply disappear as if their pronouncements are all that needs to be said and no further discussion or clarification is necessary...it is aggravating and IMO condescending and paternalistic.

as for this-

"there's no guarantee that she has had high testosterone levels her whole life. in fact, pre-puberty, there is very little different between boys and girls, so that theory is already incorrect."

In the case of CAH, it is by definition a congenital condition, which of course means "existing at or dating from birth"...girls with CAH do not present with "normal" sex hormone levels until puberty at all, and symptoms include things like a deep voice, virilized musculature and sometimes genitalia that presents at birth as partially to completely virilized.

So while it is true that there is very little different between **non-intersexed** pre-pubertal boys and girls, that is not what we are talking about here.

In Semenya's case, all reports agree that she has shown marked virilization since early childhood, has been called "a boy" by friends, family and casual observers for most of her life and as I have repeatedly pointed out this is taken at face value when it is being used to make a case that she and/or her handlers "should have known" that she had some variation from the norm...

but now you contend that "pre-puberty, there is very little different between boys and girls, so that theory (of her elevated androgenic hormone levels being congenital) is already incorrect..."

Sorry, you simply cannot have it both ways.

Pointing out that a testosterone secreting tumor that may or may not be congenital, and CAH- which by definition *is* congenital- are two very different things is not "attacking semantics" or being "PC".

BTW, the citation I asked for was specifically re: the claim (i'm paraphrasing) that a tumor was the most likely cause for elevated T levels in women...my asking was not intended to discredit you through some "Gotcha!" moment, but because my reading on the subject tells me something different- but I fully admit that I may be mistaken and that evidence to the fact may exist.

Regardless, I have never advocated that elevated T levels in a female don't "need to be looked at", what I have been saying is that it is a sweeping generalization to act as if this situation is always a medical emergency requiring immediate surgical intervention, it simply isn't...

(contd)

Tina said...

Again, if you detect irritation on my part, consider that much of the reason that there is so little research and documentation on non- "normalized" IS adults with non-standard physiologies is because so few of them exist because those non-standard physiologies have been surgically eliminated.

it is easy to claim that patients who do not receive the surgery will experience dire consequences when nearly all cases that might disprove that theory have been surgically done away with- it's like arguing that circumcised males don't experience a significant loss of sensation- how can anyone know if they have no other point of reference?


This is a direct result of an attitude that treats doctors and their opinions about medical intervention in IS cases as unerring and beyond question, that acts as if medical authorities are never motivated by anything but the right reasons, and would never perform surgery based on anything but absolute medical necessity.

History shows that this is a naive attitude, especially when discussing IS conditions and their treatment- as a group, doctors and researchers who specialize in IS conditions and gender issues have more than the average share of dubious theories, failed experiments and ruined lives to show for their efforts, and in some cases a mind-boggling level of arrogance and outright disdain for honest patient feedback that doesn't support their theories and decisions...

some of these doctors and their abhorrent treatment of IS and gender variant people and utter contempt for scientific procedure are downright legendary-

http://en.wikipedia.org/wiki/John_Money#David_Reimer

http://en.wikipedia.org/wiki/Kenneth_Zucker#Criticism_of_work

http://en.wikipedia.org/wiki/The_Man_Who_Would_Be_Queen#Allegations_against_Bailey

http://en.wikipedia.org/wiki/Blanchard,_Bailey,_and_Lawrence_theory#Questionable_scientific_use_of_terminology

The days of simply accepting something regarding IS as gospel because 'doctors say so' are over- more than perhaps any other facet of medicine, these people and their theories need to be questioned and held to the strictest scientific standards...the history of IS/gender treatment shows that they often won't do it themselves, as all legitimate scientists must.

As has been pointed out, their theories and decisions not only affect the physical health and day to day life of IS people, they often create practically insurmountable negative implications that affect their core identities, social standing and ultimately mental health.

This is not "semantics", it is real people's lives- David Reimer is dead by suicide, Santhi Soundarajan attempted it after being publicly humiliated based on her IS condition, and it is now reported that Caster Semenya is on suicide watch...once more, do you see a pattern here?

one more thing...you say-

"I'm not advocating that people are guilty by performance, because that would be unfair"

-problem is that this is exactly what is happening...there have been other cases where women have "failed" a gender test based on an XY genotype, and have still been allowed to compete based on the IAAF rules that explicitly allow them to compete as women.

Yet despite this supposed standard being in place, Santhi Soundarajan was stripped of a silver medal based on being XY, and now Caster Semenya is being labeled by many as a cheater even though it is likely that she is not in violation of any rules...why the shifting and arbitrary interpretation and application of the rules?

Obviously it is for no other reason than because of performance- nobody is testing the woman who came in last, no matter how masculine she looks...

the message is clear- intersexed women are allowed to compete as women, just not win.

Ross Tucker and Jonathan Dugas said...

Hi Tina

Thanks for the follow up.

I have to say I think you're being a little unfair, quick on the trigger. Especially in your final concluding statement.

I must just emphasize that I think you're forming your position based on this post - I may be wrong. But if you go back to the start of August, you'll get an idea of the context of where many of my replies are coming from. I can't sit at work and compose long, complete responses to comments so I kind of rely on the fact that much of what has been posted before deals with some of the issues.

So to address your latest one:

First, you say "you cannot have it both ways", based on my contention that she pre-puberty there is little difference. You're putting words in my mouth - I don't know what Caster Semenya looked like at 12 years old, I must confess that I haven't seen pictures or even reports. I know that throughout high school, from say 14, she was boyish, so perhaps that was the first sign. Perhaps earlier. But you're criticizing me for an argument made by others, which is unfair.

It's clear that you have a great issue with the way that medicine has approached IS conditions. And that's fine. I've really gone out of my way to accommodate that, even to say that I'll try harder to avoid what is actually the scientific name for the cause of intersex. I agree on most of the points before.

But really, I think you're being unfair to be so critical and to pull apart so many statements. I also think that there is an athletics context that you may be missing here - particular with reference to the doping issue, and performance analysis.

It seems as though you were always going to conclude that the problem is that we don't want intersex people to run fast. And I'll be honest, it comes across that you are going to view everyone as discriminating, regardless of what they say. So people are on thin ice all the time.

So again, I do think you're being a little unfair, on Scott, my replies, and maybe the issue in general. And I'd encourage you to read all the posts, dating all the way back to August, to get the context, and you may see that I'm trying very hard to explain ALL the options, not to condemn people with a condition/disorder/variant to a lifetime of medical persecution!

So just to finish off with your final statement, nobody is discriminating or 'hunting' Semenya because she's fast. But you need to be more tolerant of other people's views to - the athletics community is rightly suspicious. Doesn't mean she's judged on that basis, but their natural response is suspicion. That's normal, and I agree, knowing the history of the event, the physiology that it takes, and the rate of improvement that athletes can achieve at this level. it's suspicious. That's a fact, not an opinion. If she was banned on this basis, then your last statement is valid. As it is, I don't believe it is.

All I'm saying is that I feel you're being too quick to find discrimination when people are in fact asking questions and wanting to debate, and it leads to a thin-ice sensation. I find it counter-productive to progressive discussion.

Thanks!
Ross

Anonymous said...

Ross,

I think you should stop any further discussion with Tina because it would be pointless. She behaves like what we call a "Wing-Nut" here in the U.S.

Zoe Brain said...

Ross - please pardon us - and by that I mean me anyway - if we sometimes see things that are not there.

I've disagreed with you on a few relatively trivial issues, and you do evidence some degree of "cis-privilege" that sometimes grates. But.... you try to work against that. You try to be fair and objective.

I try to do the same, and no doubt fail at least as often, and possibly more. I think between the two of us we will get a better result than either alone.

There has been a history of medical arrogance towards IS people. I'd even say it's the norm. Not Universal, but not far off.

Consider the issue of Ms Semanya's internal testes. Yes, there is a large cancer risk, 1 in 50 as far as we can see. There's not too much actual evidence in an AIS context.

But prophylactic mastectomy in the case of familial history of breast cancer is not considered a medical emergency, is it? Even though the risk is much, much higher than 1 in 50?

An endocrinologist would be able to tell you the benefits of having some natural, pituitary-regulated hormone-secreting glands - even if somewhat dysfunctional - as opposed to having to rely on external supplements. I know from personal experience. I'm keeping my funny-looking enlarged adrenals too, barring some neoplasm being detected. I have enough problems with the testicular, ovo-testicular, and ovarian tissue having been removed. But I digress.

The thing is, we are often told by well-meaning but hopelessly incompetent medics what we are, and what we should do. The state of knowledge of most run-of-the-mill physicians is one step removed from leechcraft and letting out malignant humours.

As for the researchers, some of the experimentation had been Mengelesque. Conjectures get published, accepted as hypotheses in the absence of any evidence, and ten years later are accepted wisdom, regardless of contradictory evidence.

As for arrogance - consider this story. The evidence indicates there's a 1 in 3 chance the child is a boy. But better to risk that than have someone whose anatomy upsets others.

The thing is... these surgeons are no doubt proud of what they've done. Such surgery is technically challenging and quite risky at that age.

Now look at this story about what happens one time in three.

You can see why we sometimes are unreasonably over-sensitive.

Please consider this as part of an apology for being so. It's not that you did anything wrong, it's just that we've been victimised by your profession before, and still are being. I'd go as far as to say that in an international context, it's even the default.

Anonymous said...

To Tina

I agree with Ross - you are obviously very passionate and committed to the cause of IS individuals, and it's great that you are. But you are too quick to shout discrimination and it is destructive to reasoned debate.

I'm a lawyer, and I recall from my studies, we had a lot of people who were "rebels with a cause" and after a while it becomes tiresome, it's a case of "here we go again" and they can't see reasoned perspectives from the OTHER side's point of view, because everything is about the "cause".

Not that I'm disagreeing with you - I've read a site called A.E Brain (http://aebrain.blogspot.com/), it's magnificent. Someone who is defending IS as well. But in a reasoned stance.

So keep up the passion, but try to be a bit more reasoned. No one enjoys skating on thin ice all the time.

Byron

Robbie Fields said...

A.E Brain (http://aebrain.blogspot.com/)

is our very own Zoe's blog!

I am long overdue for stating that I also gained so much from reading Zoe's blog and using it as a jumping off point for learning more about IS.

Thank you, Zoe!

Zoe Brain said...

*Blush*

Thanks.

A good discussion on the subject of biological advantage is at Sophia's blog - she's from OII International.

And a good discussion about the human side is from Gina of OII Australia.

I think it would be useful if the IAAA, the IOC, and local bodies would communicate with various Intersex support groups. We know a lot about the science - we have to for our own health - and we tend not to let things like religious belief, politics, or the far more important "Ick! A Freak!" factor get in the way.

Right now, we have the Asian Olympic Committee banning anyone with 46,xy chromosomes as "not being female" - even if they've given birth.

But we also have the IAAA giving carte blanche to 46,xx men with CAH to race in female games, despite some obvious and permanent advantages that are equal to many other men.

Given the tradition of pretending that there's a "bright line" between male and female, we can perhaps give some advice into formulating a set of rules that doesn't deny reality too badly. And that doesn't unfairly penalise anyone too much.

Ideally, such an endocrine-based system could be expanded to include other conditions such as acromegaly and other syndromes causing naturally high "banned performance-enhancing substance" levels.

Here's an interesting tidbit from history. After the success of a number of Black women in athletics events in 1948, according to “Coming on strong: gender and sexuality in twentieth-century women’s sport”
By Susan K. Cahn p 111

…Olympic governing bodies of the 1950s once again considered eliminating several women’s track-and-field events because the competitors were “not truly feminine”.
In the discussions that followed, Olympic Official Norman Cox sarcastically proposed that rather than ban women’s events, the IOC should create a special category for the unfairly-advantaged “hermaphrodites”, who regularly defeated “normal” women, those less-skilled “child-bearing” types with “largish breasts, wide hips [and] knocked-knees.”


This wasn't based on chromosomes, or hormone levels. It was based on them not appearing feminine enough by the standards of the time. Few female athletes, Black or White, would pass that test by the standards of the 1950's.

Anonymous said...

Earlier someone posted that they thought that the remarks on this issue are “callous, uncaring and totally without sympathy for the feelings of the athlete involved and her family”
I have to say that out of all sources of information on this issue that I have come across so far, this website has been the most neutral in terms of opinion (I’m referring to the content posted by Ross, not necessarily the comments by outsiders).

What this website has done, and is doing, is far from damaging to Semenya. If anything the content of this website is indirectly beneficial to her (and her feelings) in that reading the content available will dispel sensationalist rumors, which are what is ‘damaging’ her, and replace these instead with an intelligent scientific knowledge around the issue.

So thank you to Ross and all (well, most) commenter’s. You have provided an invaluable source of information and one I hope more people can have the privilege of reading.

Joanne said...

from an OII perspective, we wonder why there are no suggestions that Michael Phelps should be surgically modified as he clearly has some genetic advantages over his competitors.

http://www.psychologytoday.com/blog/the-playing-field/200808/did-michael-phelps-cheat

We think this entire maelstrom is generated by this athlete's possible intersexuality. Any advantages she might get on the track are quickly negated elsewhere, in other aspects of her life.

Zoe Brain said...

Joanne - you bring up an excellent point. If someone has a congenital - not necessarily genetic - somatic advantage, due to an anomalous body, they get feted for their success.

Unless... they're Intersexed. For us, the rules are different.

I think we are justified in asking why. I think we deserve a good, logical answer. A Justification that is self-evidently fair, and consistent with the way other, equally anomalous people with indubitable rather than dubious advantages are treated.

I'm not holding my breath though, and neither are you.

Ross Tucker and Jonathan Dugas said...

Hi all

I just have to comment on the issue of performance advantage.

Joanne, point taken. The reality is that when we watch sport, we are watching, to some extent, the outcome of a genetic lottery, and some people are destined to outperform others. No amount of training, for example, will put me within 20m of Usain Bolt in a 100m race!

Same for Phelps - long arms, double jointed, and so on. I will say this - that article is actually very poor. If you think Phelps swims faster because he's tall and has doubled jointed advantages, then it's missing a big part of the picture. So I don't put much stock in that argument to begin with. For one thing, if those were 'success factors', there'd be far more tall, double-jointed swimmers, and there aren't. It's something that comes up often when looking at sports - let's "simplify" and say that this athlete is a champion because of X. It's untrue.

So I don't buy the examples. I don't know what makes Bolt super fast. It can't be his height, otherwise history would have produced dozens of tall sprinters. So it's something else.

But allow me to play devil's advocate here. This is not necessarily my opinion on intersex participation, just a thought, and I'll probably post on it in the future.

Let's say you have an athlete who has testes - gonadally, they're male. Genetically, they're male. Because because of AIS, they develop as female and their gender is female.

We're saying that they should be allowed to compete as females, even if there is a chance that their physiology provides a large advantage over females.

So, first point:
1) We don't compete in categories of arm length or double-jointedness or height, but we DO compete in categories of MALE and FEMALE, so it's not quite as simple as saying "people have advantages, get over it"

2) Why should this person be allowed to compete as a female because of AIS, when one could take the opposite point of view, and say that they are simply "unlucky", in the same way I'm unlucky that I'm not as fast as Usain Bolt if I compete against men?

3) What is the physiological difference between this person and a male (gender, gonadally, genetically) who wishes to compete as a female because he or she lacks the same levels of testosterone as other males? Can he drop down and race women?

I think one needs to be careful making the argument that people should compete because they have an advantage - it's not far off to say that we should just get rid of the gender categories, and let everyone run together. Because as long as we have male and female races, there needs to be some distinction, and it doesn't work to simply say "let her run, she's just lucky to be faster". Because her advantage (if it exists, I'm assuming this) is one that blurs this distinction.

I guess what I'm saying is that comparing this to Phelps is a flawed argument. If we competed in height, arm length or joint categories, fine. Or, the corollary is that we should do away with gender categories and then it's also fine.

Obviously, I'm playing the extreme view here, and I don't necessarily believe everything I've asked above. But it is the other side, which I think people must acknowledge.


Ross

Joanne said...

And in part I take that point, Ross. But I also have to put it that human life is a genetic lottery. Some come off with a better genetic or endocrinal ticket than others

http://intersex-nz.blogspot.com/2009/09/ms-semenya-i-never-knew-you-from-gina.html

The point is made in the above article, and it does not need making again here.

What makes Lance Armstrong special?
or Tiger Woods? or Serena Williams? Genes? Determination? Dedication and practice?

Answer: all the above - plus whatever X factors are at play.

But the rub here is nobody is suggesting they should be handicapped out of their games.

That is being suggested for Ms Semenya: not because she willfully cheated, but because she allegedly doesn't meet requirements she never invented, for being female.

My challenge to you is that you articulate those requirements without ending up in the same morass you'd end up were you to try and define the requirements for belonging to any given race.

Sigh - as Zoe will agree, its the lawyer coming out in me. :-)

Ross Tucker and Jonathan Dugas said...

Hi Joanne

Thanks for the comeback! Like you say, it is a challenge. And as I said above, not one I can see an immediate answer to.

To answer that last point though, we don't compete in categories of race though, so it's again a case where the creation of categories causes the problem, because fitting people in those categories is what causes the problem!

So the more and more I think about it, the more I am starting to think that the only solution is to do away with the gender categories completely...

Or is it? Can I ask you, as a lawyer, how you would represent someone ON THE OTHER SIDE of the debate? In other words, let's say Semenya and any other intersex individual is allowed to compete. What would your legal advice be to the competitors?

I find this area fascinating, because as you rightly point out, the problem is the categorization of people. Luckily, we don't categorize according to race. We do categorize according to age, but this is simple, you just stand on a scale at a weigh-in, for boxing, wrestling, taekwondo etc.)

We do categorize according to age, which is not that simple, but generally seems to work. And we do categorize according to gender. So how do you, as a lawyer, represent the OTHER side, if you had to?

Seems to me we need to get rid of this artificial line and let everyone compete in one race...?

Or not. Surely there is an issue of unfair competition that way?

Ross

Anonymous said...

English is not my first language, so please forgive the bad grammar.

I don't agree with the comparison too the size of Phelps feet, or Shaquille O'neils height. It would have been a mire valid argument had basketball leagues been divided according to the hight of the players, or swimmers by the size of their feet or flexibility of their joints. There are many things that has come together to make a good athlete, it's nit a single factor that determined wether you'll succeed or not. However there are HUGE differences between the athletic gifts that male hormones and females hormones gives. That's why there is a 10second gap between the best female 800m runners, and the best males on the same distance. If Semenya continues to wreck her personal best, which she likely will, she will improve on her current time by 4 seconds, comterably beating a record that no female runner has been able to beat in over 20 years, from an era of super dopers...things that make you go hmmm... I don't think it would be surprising if the IAAF tests reveals she has a huge advantage that "normal" woman without those testosterone levels can never ever hold a candle too. Some "normal" females may even give up on even trying that feat, what damage that would do too womans track and field! There's no point in even dreaming of it anymore unless your born with testes that can give you a huge boost a normal female heathy body could never give. In these sports with, where margins of a few nano seconds, those extra male hormones do come in handy, there is no point in arguing over it.
The atheltics body will have to choose between to evils. Take away the gender divider in sports, and see most females not even qualify for the first round heats of sports that require explosive stenght and super endurance, or continue as before and risk not having a place for intersexed individuals that are too "male" (unless they comply with hormone treatments) compared to general female population at large, but still not "male" (hormonally) enough to ever make an impact as a male athlete. Either way, someone would be left out, wether it be a small group of intersexed athletes, or a large group of female athletes.

Joanne said...

Hi Ross :-)

Firstly, as to sex and race. I've never looked, but I'd wager you could find countless attempts to define by race in US state, and federal law.

What about who gets to be a native American Indian for the purposes of benefiting from a tribal trust, for example?

You may argue these have nothing to do with sport. However they are precisely the kind of precedent case law that would be used in any attempt to try and define 'Male' and/or 'Female' in any context including sport.

The debate is fascinating. You ask:

Or is it? Can I ask you, as a lawyer, how you would represent someone ON THE OTHER SIDE of the debate? In other words, let's say Semenya and any other intersex individual is allowed to compete. What would your legal advice be to the competitors?

My response is: it isn't them I need to advise. It's the sport's Governing Body. My knee-jerk answer is to look toward other sports.

Would boxing be a fair example - or weightlifting? They have categories according to weight and size. Maybe its time to stop denying that there are categories of sexual embodiment?

Just a few other thoughts ...

The Adam and Eve model is bad biology, Ross. That's why it has to be policed and enforced.

Note: I'm not talking "gender" here. I'm operating the sex-gender distinction and talking biological sex, not gender role expression and behavior.

Ross Tucker and Jonathan Dugas said...

Hi Joanne

Interesting. I'm not 100% sure I follow your conclusion though. When you say "Maybe its time to stop denying that there are categories of sexual embodiment?", is that saying that the gender classification doesn't work and we should in fact let everyone compete in one race?

And I still don't know the any governing body can adopt that. So while I appreciate you're taking the position that you'd advise the governing body, surely there is a problem doing that. I really want to know what legal "defence" the other female athletes have. Let's say your name is Jenny Meadows, you're ranked 6th in the world, you came 3rd in Berlin. Do you have a case? Semenya seems to have one. What is the counter-argument?

Then I must confess I don't know what you mean by "The Adam and Eve model is bad biology, Ross. That's why it has to be policed and enforced".

When you say it has to be policed and enforced, is that saying there SHOULD be categories, or not? Forgive me if I'm missing the obvious.

It just seems to me that your position of allowing people to run because they have this advantage opens up a Pandora's box with huge consequences, and I really want to know what the counter-point is, legally. Because I'll tell you what I'd do - if I was a female athlete running against Semenya, I'd refuse to run, and get everyone else to agree. I don't think it would be difficult, putting the IAAF in an impossible situation. Doesn't matter if the performance advantage is non-existent, I'd refuse on the grounds of "inequality of gender" (forgive my term).

I just want to know what the repurcussions are, because I'm looking at this from the sport's point of view, and I see massive implications, as the anonymous poster has suggested above. I agree with him, I think.

But I'd love to know the legal position, but not argued from the point of passion, but from the other side...

Ross

Joanne said...

Kiaora from New Zealand Ross.

Forgive me if I my last response was not clear.

You wrote:
Then I must confess I don't know what you mean by "The Adam and Eve model is bad biology, Ross. That's why it has to be policed and enforced".

When you say it has to be policed and enforced, is that saying there SHOULD be categories, or not? Forgive me if I'm missing the obvious.


No I was alluding to a more holistic set of behaviors and practices that reject and deny biological diversity in sex development per se.

That rejection and denial starts at birth with the so-called paedatric 'gender' assignments and continue pretty much thereafter to the grave.

My basic contention is that the "is he or isn't she' furor surrounding this athlete, at this time, is nothing more than another aspect of that policing and enforcement process.

Now: I asked you if you could could offer a definition of female that didn't lead to the same morass as an attempt to define race would lead to.

In riposte you invited me to construct a case for 'female' athletes, against the participation of females with Caster Semenya's advantages.

But I'm legally trained. I'm not a biologist. I need some expert opinion that enables me to define 'female'.

I did try to offer up one 'out of the box' solution. I invited you to consider the way some sports had classes of competition based on weight and size: bantamweight, heavyweight, etc.

Is it possible to recognize biological diversity in SEX development, the same as we recognize biological diversity in every other dimension of human existence?

I need you - the biological scientists - to tell me - the legally trained none scientist.

Because the best answer I can offer up to the individuals who you would advise not to compete, is to do the opposite.

After all Ross, if we were discussing a motor cycle race, then a 500cc bike coming 4th, behind three 1000cc bikes would equal first in the 500cc category - wouldn't it?

Zoe Brain said...

"Same for Phelps - long arms, double jointed, and so on. I will say this - that article is actually very poor. If you think Phelps swims faster because he's tall and has doubled jointed advantages, then it's missing a big part of the picture. So I don't put much stock in that argument to begin with. For one thing, if those were 'success factors', there'd be far more tall, double-jointed swimmers, and there aren't."

I'd bet long odds that there are more than female swimmers with AIS.

The last reliable figures we had were that 8 women with AIS or similar conditions were in the 1996 Olympics. Out of how many competing? 10,318 I believe. I don't have the breakdowns, but 4000 female competitors is a plausible number.

Now compare how many female competitors were tall compared to the average. The rate of double-jointedness I'll conservatively assume is no higher than for the general population, as I lack the figures.

Zoe Brain said...

Because I'll tell you what I'd do - if I was a female athlete running against Semenya, I'd refuse to run, and get everyone else to agree. I don't think it would be difficult, putting the IAAF in an impossible situation. Doesn't matter if the performance advantage is non-existent, I'd refuse on the grounds of "inequality of gender" (forgive my term).

The same policy was tried in the 1930's, to disqualify Black athletes on the basis of inequality of race. Regardless of lack of advantage.

Didn't South Africa also have racially divided sports teams at one time?

The "Doesn't matter if the performance advantage is non-existent" bit is, to put it undiplomatically, and all other things being equal, prejudice.

I think two requirements are needed when it comes to fitting a messy reality into a neat Male/Female divide. In order to "police the Adam and Eve model", the strict binary, because reality won't cooperate with fantasy without being coerced.

The first is that the competitor must have a "gender identity" not contrary to the gender they're a candidate competitor for. This means a life history of being recognised as that gender, or a specific set of rules for transitioning having been adhered to.

Amongst other things, this would preclude transitioned trans men from entering women's events. it would not preclude them entering men's events.

The next is a general rule, applicable even in open events.

The second is that the competitor must not have a biological advantage from whatever cause greater than a level deemed acceptable compared to peers.

Defining that though is tricky. Very tricky.

As regards legality - Oi Ve, what a schlemozzle. To give you a taste of it, just the merest hint with no International law complications....

A lawyer for the transgendered plaintiff in the Littleton case noted the absurdity of the country’s gender laws as they pertain to marriage: “Taking this situation to its logical conclusion, Mrs. Littleton, while in San Antonio, Tex., is a male and has a void marriage; as she travels to Houston, Tex., and enters federal property, she is female and a widow; upon traveling to Kentucky she is female and a widow; but, upon entering Ohio, she is once again male and prohibited from marriage; entering Connecticut, she is again female and may marry; if her travel takes her north to Vermont, she is male and may marry a female; if instead she travels south to New Jersey, she may marry a male.”

It's exactly as bad, and for the same reason, as when the laws against miscegenation were in effect in the US. Someone's race could change as soon as they crossed a state line, and a legal marriage become illegal, or vice-versa.

In Australia, where I live, I'm legally female for all purposes.
In the UK, where I was born, I'm legally male for some purposes (eg marriage), female for others (eg passport).

Joanne said...

Gender Identity. There you go with the ideology again Zoe!

I guess that sooner or later somebody was going going to introduce identity politics into the discussion.

It's just a diversion. It still doesn't help us define male or female. The only thing that argument does successfully is convert the issue from a biological sex based issue, into a social and cultural performance based issue.

For somebody who claims to be a scientist, you aught be ashamed of yourself for making it!

Alessandra said...

Joanne wrote:
"But the rub here is nobody is suggesting they should be handicapped out of their games.

That is being suggested for Ms Semenya: not because she willfully cheated, but because she allegedly doesn't meet requirements she never invented, for being female"

But apparently Ms/Mr Semenya did cheat.

If what is being reported in various papers is true, SA officials knew the rules of the competition and Semenya did as well. They all knew about her intersex condition before Berlin (whatever it is), and they cheated by enrolling her/him in a category Semenya doesn't belong to. Whether they agree or not with the reasoning behind the two-sex sport division is irrelevant to their dishonest behavior.

Furthermore, they lied when they said they had no information about Ms/Mr Semenya's biological make-up before Berlin.

We may never find out if Semenya also cheated by taking "medications" which alter his/her hormone levels, as previously alleged in the Swiss paper, but that is also a possibility.

In the media this week:

Name of the LAB DOCTOR, name of the LAB, and NAME OF PSYCHOLOGIST WHO COUNSELED SEMENYA that s/he is intersex, ALL BEFORE BERLIN.

If the info below is correct, one more layer of SA's fraudulent endeavor exposed.

(http://www.dispatch.co.za/article.aspx?id=346287 for full article)

The M&G reported that Semenya had been tested at the Medforum Medi-Clinic in Pretoria early last month and that she had received counselling from ASA board member and psychologist Laraine Lane before hand.

The tests were conducted by Oscar Shimange, a medical doctor specialising in obstetrics and gynaecology.

The M&G said Chuene had also denied Adams was the official doctor of team SA. Adams was, in fact, commissioned by the International Association of Athletics Federations (IAAF) to oversee Semenya’s gender tests in SA, and was listed in an ASA press release for the championships as a “team doctor”.
The M&G quoted a senior official close to ASA saying that when Team SA was in Neubrandenburg, Adams received a call from Medforum Medi-Clinic informing him of Semenya’s gender test results, which were “not good”.

The official said Adams then convened a meeting with Chuene and ASA vice-president Kakata Maponyane, among other ASA officials.

Adams advised them to withdraw Semenya from the competition, but they refused, said the M&G.

Meanwhile, the National Assembly’s sport committee yesterday postponed its meeting with ASA, which was scheduled for Tuesday.

This was because of the change in the parliamentary programme next week.
The meeting will be rescheduled in the next parliamentary term, starting on October 6 . — SDR, additional reporting by Sapa

Alessandra said...

Or, in simple but very smart English, as a commenter on another blog put it:

Appropriately named ASAs look like they are in trouble !

Alessandra said...

Athletics South Africa (ASA) president Leonard Chuene admitted on Saturday that he refused to accept advice from ASA team doctor Harold Adams to withdraw Caster Semenya from the world athletics championships in Berlin last month.

CHUENE ALSO ADMITTED THAT HE HAD LIED to the South African public about not having any knowledge of gender tests conducted on Semenya in Pretoria last month.

He added that ASA's deception on the matter was intended to protect Semenya's confidentiality.

"We fully agree that we could have handled this matter differently but something like this has never happened in this country before and we at ASA believe we acted in the best interests of the athlete," he said.

But while Chuene was advised by Adams to withdraw Semenya, he said he refused to do so without any concrete evidence. He said that Adams' verbal recommendation was not sufficient for him to make a decision on such a sensitive matter.

The IAAF is still awaiting the results of gender tests conducted in Berlin but Chuene said he would not accept those results because the world governing body did not follow the correct protocol.
========

This from the guy who said that the suggestion to test Caster was all a matter of ignorant racism...

Zoe Brain said...

Joanne - our problem isn't so much a scientific one as a social and cultural one.

The belief that there's some rational, reasonable and scientific way of sorting out male from female easily in every single case just isn't true.

Even Ross - whose works and thinking I admire, was honest enough to say that if he was an intrasexed competitor against an intersexed one, he'd agitate to have her disqualified on the grounds of "gender inequality". Whatever that means.

If such reasonable, rational, and compassionate people as Ross can feel like that, then we have to work within the context of their superstitions.

Scientifically, it's bunkum. And yes, as a scientist, I am ashamed that I do it. I just see no alternative, barring the generational changes required to educate people out of the "XX=F,XY=M, nothing else exists" meme.

In order to gain acceptance, and avoid a boycott, we have to not just *be* female enough, but *appear to be* female enough.

If Ms Semenya's birth certificate had said "boy" (as mine still does by the way... it will require a change in UK law, even though all my other documentation in two countries has been corrected), had she been raised as a boy, recognised by her family as a boy, been recognised by society as a boy, thought of herself as a boy... biologically, she'd still be female in terms of sporting abilities. Probably have some better ballistics aptitude in javelin-throwing etc, as that part of the brain is sexually dimorphic, and a masculine gender identity means that is probably affected too - but otherwise the same situation as now. Except that in that case, I'd find it hard to argue against her disqualification from a female competition on the grounds of being male, even if mostly female-bodied.

I'd feel the same for a man who'd been "injured in the stones" when young, whose body had no advantage over that of a woman. On the grounds that despite that, he's male.

Not that that makes any scientific or biological sense, but it makes a great deal of social sense.

Ross Tucker and Jonathan Dugas said...

Hi Joanne, Zoe

In a bit of a rush, but I had to quickly respond to this one:

Zoe wrote: "Even Ross - whose works and thinking I admire, was honest enough to say that if he was an intrasexed competitor against an intersexed one, he'd agitate to have her disqualified on the grounds of "gender inequality". Whatever that means."

Please, that's not what I said. Reread the context of my post. I am arguing from the counter-position. I am trying to adopt the opposing view in the interests of stimulating debate. I very specifically said in my post that I did NOT know where I stood, but that I was playing devil's advocate on the matter, and trying to draw out what the approach would be from the other side.

So the reference to other athletes refusing to run, Joanne, and this reference, Zoe, are not my "superstitions" - I'm just trying to put out both sides of the argument, since I think that is needed here. Otherwise it becomes a debate where only one side is expressing an opinion. I really want to get to the bottom of the issue, and specifically, how the other side would feel.

My prediction, which I think you may have taken as my position, is that there will be a big fall-out among rivals and women's athletes if no action is taken. Call it pragmatic, call it cynical, that's what will happen. I'm just expressing the possibility, not my opinion. I've yet to formulate that.

Gotta run!

Ross

Anonymous said...

If I had dedicated my life, time and money to train to be a top athlete and this was basically my livelihood, I would definitely think that it is unfair for someone who could have an unfair advantage over me to compete against me. If they have a fair or legal advantage then thats fine, good for them for coming out better than me in the "genetic lottery". If I knew that I was going to have to compete against people who I would have no chance of beating because of their unfair advantages, I wonder if I would bother to compete at all? Because at the end of the day, athletes who are competing at the top level are doing so to win.

(Forgive me if this is a stupid question)
What about dividing into male,female and intersex devisions? Would that be possible? I suppose there are too few to compete and also that human rights would have to come into play in term of confidentiality of personal issues.
Its just that in talking about just amalgamating males and females into one group would never work because the males would always win and females would probably stop competing at all.

Then another question (and I'm sure I'll be shot down for this one!) Are there enough intersexed individuals in sport that we need to accommodate for them? Should we not just say sorry you need to find a new vocation? This just sounds so discriminatory I'm embarrassed to ask! I have heard this opinion expressed many times though so this is why I ask.

Thank you for your time and I mean no offense to anyone by asking these questions.

Alessandra said...

Regarding sports categories, I know extremely talented volleyball players who aren’t tall enough to play in the top-level teams because nature made them 15 or 20 cm too short. I have always thought that we should have different divisions in pro sports based on height for certain sports. There are some shorter volleyball players who are just as fantastic as the taller ones. Why can’t they play in the best teams and earn money like the taller ones? Because nature made them shorter. Is this fair? Does anyone care? No. Apparently, there was a nature mishap regarding the definition of sex in Semenya. Is it fair? No. Why is it any different than being born too short for so many other sports?

Another example, it would be much fairer if we computed the world high jump record based on bar height compared to body height. A 1.60m-tall woman and a 2.0m-tall woman who both clear a bar at a 2.0m height have not achieved the same feat at all. In fact, the astounding feat, in this fictional example, is really accomplished by the shorter athlete. But in real life, a woman who is 1.60m tall would never be allowed to compete in the high jump. Is this fair? And the muscle differences between white and black people, is this fair in racing? No, but it’s the way it is.

And as I have written before, because of so many intersecting reasons, we should allow all kinds of doping in sports as long as athletes informed exactly what cocktails they had taken. At least we could have more fairness with the ones who aren't doping.

We don't have these mysterious sex test results yet, but it just smells like Semenya has a significant advantage. Why would the ASA counsel for her not to go to Berlin otherwise? It also makes me think that had her body fully developed into either a normal female or male individual, she wouldn't have been a champ in either category.

Alessandra said...

mistake - I wrote quickly, maybe other readers are not familiar with the details. It should have been:

Why would the ASA doctor counsel Chuene for her not to go to Berlin otherwise?

Anonymous said...

Even if she has the internal testes removed, her skeletal system is already that of a man. The angles of her hips and knees alone will give her advantage over other women for the rest of her life. Her pelvic shape is male. Testosterone has permanent lasting effects if it's present during development.

Zoe Brain said...

Ross - sorry for misinterpreting you.

Anonymous - re skeleton - what little evidence we have is that when it comes to running, a denser, more robust skeleton is an actual disadvantage.

It's offset by the greater muscle mass that's usually associated with it.

In other athletic events, such as weightlifting, a robust skeleton on its own appears to be advantageous.

Tina said...

alessandra-

regarding your contention Semenya "did cheat" because she and her trainers/handlers were allegedly aware of her IS condition, internal testes, etc., this is the crux of the issue- if rules are rules, then what are the applicable rules?

from the IAAF's own website-

6. Conditions that should be allowed:

(a) Those conditions that accord no advantage over other females:

- Androgen insensitivity syndrome (Complete or almost complete -
previously called testicular feminization);

- Gonadal dysgenesis (gonads should be removed surgically to avoid
malignancy);

- Turner’s syndrome.

(b) Those conditions that may accord some advantages but nevertheless
acceptable:

- Congenital adrenal hyperplasia;
- Androgen producing tumors;
- Anovulatory androgen excess (polycystic ovary syndrome).

http://www.iaaf.org/mm/Document/imported/36983.pdf.

As I read the above, the *only* bit of wiggle room that might make the cheating accusation stick in Semenya's case is the part about "Complete or almost complete" AIS...it would all fall to the question of whether or not her AIS is complete enough...and the rules don't define that.

besides that, there's this-

B.Current IAAF Policy
In 1992,the Medical Committee recommended and the Council adopted the
current policy on gender verification,which states:

1.The general “health check ” is strongly recommended,but no longer
required.
2.Visual examination of the genitalia during the delivery of a urine
specimen in the women ’s doping control station is a sufficient method
of determining whether the athlete is male or female.The risk of a male
being discovered during the doping control procedure is sufficient
deterrent to prevent males from attempting to compete as females
.

http://www.iaaf.org/mm/Document/imported/42028.pdf

Seems to me that she did everything according to IAAF rules, so I fail to understand why she is being demonized rather than those who wrote those rules...?

Zoe Brain said...

Tina - excellent comment, I wish I'd made it myself.

Ross Tucker and Jonathan Dugas said...

Hi all

Thanks for the discussion, very interesting.

I recall reading a book, very good, about Steve Jobs, and the process by which he and his team made decisions. They would discuss a matter, and identify who occupied which position - who was for and who was against.

Then, they would deliberately try to adopt the counter-position, so that they could attempt to understand the position from the other person's point of view. So if Steve wanted to launch the iPhone, but Paul wanted to delay the launch and work on iTunes, they'd force each to actually defend the other side's position.

I've always tried to do that, I find it helps a lot when it comes to this kind of debate.

Yet I still don't see it being done here. Alessandra has made a really good counter-point, I think, in pointing out the examples where athletes are 'excluded' on the basis of what they are born with (a lack of height, too heavy, too slow).

Is that different from being born intersex? I guess in a way, yes, because the one is a disadvantage, the contention here is that being intersex is an advantage. But still, I think it's a good principle.

And I've tried to find out how the "defendants" (apologies for the word) would consider the matter from the other side, but still nothing.

Instead, words like "demonized" pervade the discussion, which I don't think helps, I must be honest.

Let me speak from an athletics point of view - the sport would be undermined in a 19-year old athlete breaks a 27 year old record, which was set in the peak of the doping era, and which has survived 27 years of women doping (with testosterone, I must add), until she comes along. Not to shade it, but to break it, potentially by 2 seconds. Yes, this hasn't happened, but I'm again just trying to point out why people are adopting the position they are.

Followers of athletics know Jarmila Kratochvilova, they know the 1980s, they know what women did then, and they know that 16 of the top 20 times in history have been set by dopers. So an 18 year old girl running as fast? That's going to cause suspicion, and I think it is helpful to at least understand that. It's not judgment based on performance (though for some it might be), it's just a key piece of the puzzle.

Because those who are advocating that she didn't break the rules are effectively saying that it would be OK for the record to be smashed by a huge margin. And maybe it is, I don't know. As an athletics follower, I'd lose interest in the event if it was being won by 50m every time. It would be a farce.

And for all the other women, and I have to come back to this, because not one person has yet addressed this side of the debate (except Alessandra), what do they do?

I think it's quite clear Semenya has an advantage, by the way, and I say that as an athletics follower, coach, sports scientist. Is that advantage sufficient to exclude her from competition? That, I don't know, but I think people who sees this advantage are coming into this debate from that perspective, not necessarily seeing the intersex-point of view, whereas those seeing the intersex point of view are not seeing the performance advantage, and implications for everyone else in the sport.

I still think a page from Steve Jobs would help here...

Ross

Alessandra said...

My contention is based on analyzing several behaviors of those involved in this debacle. This, in addition to the allegations in various papers.

(One intriguing thing concerning allegations that came out this week and that goes counter to what the papers are saying is: "Kessler says various "leaked reports" about Semenya aren't true. " But this from the lawyer that is now on the case.
http://amlawdaily.typepad.com/amlawdaily/2009/09/the-gender-confusion-chronicles-a-fastpaced-look-at-sports-and-the-law.html)

Back to my contention. Let us suppose, for the sake of argument, that Semenya's biology does not offer her a significant advantage over other women (first scenario).

1)
Why would Chuene lie about sex tests in the first place? If Semenya's biology belongs to the female category and offers her no advantage, the tests are certainly proof of this. The ASA would have said a long time ago: we did the tests, we have the proof, we sent our proof to the IAAF, and there is nothing to be questioned here. Yet they did exactly the opposite: Chuene did everything he could to discredit even the *idea* of testing ("we will not let any testing define our little "girl," only her mother and father know what she really is," etc etc).
Second, Chuene lied on every single occasion about such tests in SA. He did all he could to hide the existence of the tests, not only from the public (which can certainly be argued on the privacy issue), but from every other single authority. However, by a series of media leaks, he has been forced to admit his lying. This week:

The Ministry of Sport and Recreation SA has noted with shock, Athletics South Africa's (ASA) President, Mr Leonard Chuene's admission to lying about his knowledge of the testing of Ms Mokgadi Semenya, prior to her departure for Berlin.

"We have on two occasions requested a report from Mr Chuene, on what happened prior, during and after Berlin, and we still have not received it. After observing his acknowledgement, we are not surprised by his lack of response to our request. Mr Chuene has not only lied to us as the Ministry, but to the whole country, and this is not acceptable. "
=====
Mr Chuene's latest claims is that he did all this lying to protect Semenya. I contend he is/was lying to protect himself. Why didn't he furnish a report to the Ministry if he is so right on all accounts? All he needed to do to "protect Semenya's privacy" is to label the report confidential and furnish it. He is stonewalling.

Third, having now been forced to admit he was lying, Chuene is saying that although the tests were carried out, he was not informed of them.

What in the world is in these tests?!!

Second scenario: the tests showed Semenya does not fall into the female category, but the ASA has a problem with the category definition. So, instead of respecting the rules and questioning the IAAF rules publicly, they enroll her anyways. That is cheating.

Nevertheless, again, if they were so sure that Semenya should run with women, their argument to the media once all the accusatory leaks had been made, would have been: we have done the tests, we think Semenya should run with the women because we believe the rules and definitions for female athletes are wrong or unclear. However, that's not what they did at all. There is no reason to lie and stonewall completely about these tests unless the tests prove them wrong.

Although I'm no expert about the IAAF and their rules and rulings, from what I have understood, the texts you quoted do not encompass all the different possibilities for biological make-ups that differ from what is normal. It is for this reason that the IAAF's current policy is to examine the cases that are not clearly addressed by the list of rules you copied in your email on a case-by-case basis. The IAAF has analyzed 8 cases in recent years and has asked 4 of these athletes to end their careers. I haven't seen any more details of their analyses in the media, only the stated fact that this is how the IAAF proceeded recently.

Alessandra said...

2)
According to the allegations in the papers this week, based on leaked emails, and, so far, no one, not even Chuene, has said these are forged emails, so, *at present*, there is no dispute on the authenticity of these emails:

In an email sent to IAAF general secretary Pierre Weiss, ASA manager Molatelo Malehopo said the ASA had been inundated with media inquiries alleging that Davies had made a statement that Caster’s results were out and that the local association was impeding the IAAF’s efforts to contact the athlete.

“Mr Chuene will be embarrassed when the results are released and this will leave him with no option but to resign. We need the clarity urgently on these utterances so that we can respond appropriately to the media,” Malehopo’s email read.
====
Why would ASA's manager write this to the IAAF general secretary, if Chuene's claims are correct? Why would he have to resign, if this is only enforced in the case of serious mismanagement or wrongdoing?

3)
"South African papers have reported that when Semenya was in Berlin, the Pretoria clinic called the ASA team doctor, Harold Adams, and said the test results were "not good". Dr Adams than reportedly called a meeting with fellow ASA officials and advised her withdrawal, but was overruled."

Why would the Pretoria clinic say the results are "not good?" Why would Dr Adams counsel the ASA to withdraw Semenya, if, as you say, there are no issues with her biology and the IAAF's rules?

Chuene is alleging that Dr Adams is not the ASA doctor, but that shouldn't be difficult to ascertain. Why was there this lack of agreement on the withdrawal of Semenya? Does the answer to this question have anything to do with the points 4,5,6 below?

One issue is if Semenya has a natural competitive advantage compared to other women which then can be categorized as "unfair." The other issue is if she (and her handlers) are involved in additional drug cheating to enhance this natural advantage.

4)
This article, which came out "ages" ago (Aug 24), when there was basically no other information on concealed actions regarding Semenya, is being slowly proved correct so far :

http://www.bild.de/BILD/news/bild-english/sport-news/more-sport/2009/08/21/caster-semenya-sex-test/ex-coach-says-world-800m-champion-is-a-hermaphrodite.html

"Caster Semenya’s ex-coach has claimed the sex test controversy athlete is actually a hermaphrodite. The unnamed coach told Swiss tabloid 'Blick' that tests to determine her gender had already been taken. South Africa carried them out in March. The result is clear. Semenya should not have been allowed to start with the women at the World Championships in Berlin.

The unnamed source also claimed that South Africas head coach Ekkart Arbeit, who used to hold the same position with East Germany, knew exactly what had to be done to get Semenya past authorities in previous competitions.

Her testosterone level can be altered using medication so that she was not found out in previous doping tests."

OK, so the article says March, and maybe it was March and August, or just August. If the ASA lied about tests in August, they could have lied about them in March as well.

Can the IAAF and other authorities properly test for such hormone manipulations? I don't know. But the question is also: are they currently testing for such cheating in an effective way? Could such an intersex athlete get away with this at the moment if they attempted it, because there are no present effective tests for this kind of cheating?

5)
This is the contextual background of Ekkart Arbeit:

http://www.clinchem.org/cgi/content/full/43/7/1262

Hormonal doping and androgenization of athletes: a secret program of the German Democratic Republic government
Werner

6)
Reported in the media:

“A guttural laugh from Semenya came at a question about whether she had received hormone injections from Ekkart Arbeit, head coach of the South African team.”

What’s so funny, I wonder?

Alessandra said...

7)
In the beginning of September, Semenya's coach, Wilfred Daniels resigned, ashamed of the role he had played related to these concealed sex tests.

"The Star, a Johannesburg daily, quoted Daniels on Monday as saying tests were done in South Africa in July, before Semenya won the 800-meter race at the world championships in Germany last month. Daniels told The Star Semenya believed she was undergoing a doping test.

The South African officials have said tests were done only abroad, not in South Africa. Athletics South Africa President Leonard Chuene told The Associated Press that Daniels' statements were "wild allegations," and that he did not consider Daniels to be Semenya's coach."

This last week, Chuene has been proved to be lying concerning his declarations above. On the other hand, Daniels' account has also been partially contradicted by the recent emails naming the psychologist who counseled Semenya on "her" intersex condition, and not just "doping" tests.

8)
Then there are so many other suspect actions in this case. For example, Semenya's past teachers were ordered not to speak to the media. Why? What do they have to tell us that SA authorities want to censor ? None of her past coaches, nor past or present athletes that are close to Semenya talk about anything. There is a lot of censorship, cover-up, lying, stonewalling, and silence in this case.

Tina said...

Alessandra-

Lots of speculation and character judgments based on little more than newspaper allegations (over tests results that have still not been made public, as far as I know)...but the fact remains-

the IAAF rules governing whether or not IS women can compete are very clear, except for the single phrase "almost complete" in reference to what degree of AIS is allowed.

Putting aside any issue of doping, if a person is XY with a profound degree of AIS, that person is *specifically* allowed to compete as a woman, period.

If she was tested before competing and those tests show that she was perfectly within the rules, then there was no reason to make them public or even to approach IAAF rules officials for comment- they have already commented when they addressed the issue of IS female athletes and decided to write the rules to *specifically* allow them to compete with non-IS women.

And it isn't just AIS- the IAAF rule committee has *specifically* addressed other "conditions that may accord some advantages but [are] nevertheless
acceptable", all of which involve heightened levels of androgenic hormones.

Again, they even use the word "advantages" and clearly acknowledge that they may exist, but still deem them "acceptable"...

those are the rules- your position seems to be that athletes who may fall under these specific rules need to anticipate the possibility that sanctioning officials might not honor their own rules as written (as many people are calling for them to do), and even if the athlete has been tested and found to be within those rules, they are still under some obligation to make those test results known to race officials...

but none of that appears anywhere in the rules that I've seen.

What does appear re: an athlete's obligation to submit to pre-race gender testing is this-

"Visual examination of the genitalia during the delivery of a urine
specimen in the women’s doping control station is a sufficient method
of determining whether the athlete is male or female
."

Bottom line is that in practically any sport, attempts to push the boundaries of the rules are part and parcel of competition, and sanctioning bodies are perfectly in order to change the rules to correct inadequacies and deal with unforeseen contingencies...it happens all the time in motorsports; gas turbines were effectively banned from Indy cars by insurmountable rule changes after threatening to dominate, Formula One cars are constantly mutating due to rule changes designed to level the playing field, etc.

but to do so retroactively and change the outcome of a competition is antithetical to the entire point of having rules- if officials can toss out what you *said* were the rules just because they didn't anticipate some scenario, then what is the point of having rules to begin with?

You say that the rules I posted-

"do not encompass all the different possibilities for biological make-ups that differ from what is normal. It is for this reason that the IAAF's current policy is to examine the cases that are not clearly addressed by the list of rules you copied in your email on a case-by-case basis."

What you disingenuously fail to acknowledge is that rules posted DO encompass what is alleged to be Semenya's condition, if as we have been led to believe she has AIS, and would still encompass other conditions that would produce the heightened androgen levels she is reported to have...

and they allow her to race as a woman.

None of this in any way speaks to whether or not those rules are fair to other competitors, or if they need to be changed- the point is that those are the rules Semenya ran under, and as written they are quite clear that an IS individual with the condition she is alleged to have qualifies to race as a woman.

All of the speculation, rumor and innuendo in the world cannot change that.

Tina said...

Ross-

In all seriousness and with all due respect-

if accusing an athlete of having exploited an "unfair advantage" and of having "cheated"- the latter being the absolute worst ethical violation an athlete can be accused of, that even if never substantiated can lay waste to their career and personal life- based on alleged leaked reports that are at this point speculation and rumor doesn't in your opinion rise to the level of "demonization", then could you please suggest a more "helpful" term to describe the act of calling them deceitful, fraudulent, deceptive and unjust in a public forum...all based on hearsay?

Would "maligned" be OK?

"Vilified"?..."Castigated"?..."Rebuked"?

Or is it your contention that for a winning athlete to be thus accused based on sour grapes comments from runners up, internet hearsay, and leaks that may never even have happened, all reported as fact- even when the rules are clear that the alleged condition that supposedly makes them a "cheater" does nothing of the sort- is something that all athletes should just expect and that observers should treat as entirely value neutral commentary?

To paraphrase another poster-

I'll be honest, it comes across that you are going to view everyone as overstating the case, regardless of what they say. So people are on thin ice all the time.

Alessandra said...

Tina wrote:

"Alessandra-

Lots of speculation and character judgments based on little more than newspaper allegations (over tests results that have still not been made public, as far as I know)...but the fact remains-"

Little more than newspaper allegations?

I guess you don't like to read what other people write.

Chuene has made a public declaration admiting that he lied.

This is no rumor, no allegation. And it will probably cost him his dearly beloved job.

Why did he lie about the tests, Tina?

you wrote:
"If she was tested before competing and those tests show that she was perfectly within the rules, then there was no reason to make them public or even to approach IAAF rules officials for comment-"

And there would also be no reason to lie about the existence of the tests either.

And since you like to talk about proof of allegations, what proof do you have to show that the tests prove your intersex condition theory?

Your argument here is nothing but a biased speculation, including the denial of very important facts.

In your argument, you dismissed all the allegations, the accepted emails, and Cheune's admitting of lying on based on your own fancy. Or can you show proof to support what you are claiming?

The other thing you fail to explain is why would so many people make false allegations, lie, and libel, if these tests prove Semenya should run with the women, having no advantages?

Doesn't that strike you as odd, comming from so many different professinals and sports authorities?

Are you suggesting an international conspiracy? Or is it all racism, as Chuene clamored?

Why would they all get together to conspire against Semenya, if the IAAF does allow certain intersex individuals to compete, as long as they comply with the established rules?

Zoe Brain said...

Because that's what's happened in the past.

Santhi Soundarajan was stripped of her medals even before testing that revealed she had allowable AIS.

Simply because she had 46xy chromosomes.

That's what happens to Intersexed people. The rules get ignored. They get labelled as cheats and disqualified whenever their condition is publicised.

When it's kept private, as in the 8 cases in 1996, they're not treated that way.

Why this should be so, one can only speculate.

Ross Tucker and Jonathan Dugas said...

Tina

You're doing the same thing again - making up your own arguments and then fighting them.

No one has accused Semenya of cheating, yet you want to believe this. You're very passionate, it's great, but you're dreadful to discuss things with, because you lack any level of objectivity.

Seriously, find where I have said she is 'cheating'. I am saying that I believe she has an unfair advantage, as a coach, as a follower of the sport, and as an exercise physiologist. That's so different from cheating, I wonder if you even read the post.

Really, you make every feel they're on thin ice. It's unpleasant.

Zoe has been great in her arguments, you're just accusing everyone.

Ross

Ross Tucker and Jonathan Dugas said...

Hi Zoe

Yes, Soundarajan, from what I've managed to read, sounds like a curious case.

If I read the IAAF policy correctly, they do allow partial AIS, but don't state what the criteria are when 'partial' becomes disallowed.

Interesting to note that the other day, the IAAF said that 8 athletes since 2005 had been tested, 4 had been asked to discontinue running. Soundarajan must be one, which leaves 3 others. I wonder why?

This is something I don't know the answer to. I would love to know the inner workings of those decisions. Certainly, the provision for "partial" AIS allows some, but not other AIS athlete to run.

So, 8 in Atlanta, as you point out, and 7 had AIS, all were allowed to run. 8 since 2005, according to the IAAF, and 4 were allowed to run.

I think it must come down to whether they believe a performance advantage exists. In this regard, this case is not dissimilar to that of Oscar Pistorius, which I've argued quite extensively on this blog in the past. But I must just make the point - they're not always ignored or discriminated against, there certainly seems to be some discretion.

I'll be the first to say that 'discretion' is probably not perfect, but I'm also not aware what criteria are used to assess the cases. But just have to point out that it's not entirely true to say "that's what happens to intersex people", because it seems that sometimes it does, sometimes it doesn't.

I suspect that will come under attack too, such is the nature of this debate. Which is fine, but I just see it being a little more complex than is being suggested.

Ross

Anonymous said...

Tina

I see someone referred to you as a "wing-nut" earlier. You're worse than that.

Honestly, you're just spraying bullets everywhere, so hostile. Like Ross said, your passion is great, but you're making what could be a good discussion into an unpleasant slanging match.

Try to be reasonable and objective. Ross is, Zoe is (sort of), you're a conspiracy theorist.

George

Ross Tucker and Jonathan Dugas said...

Hi all

Just another word - I think the facts of the case are helpful, and Alessandra has portrayed them accurately, I believe.

I know there was a lot of rumor, Tina, and maybe you've haven't caught the last 2 days in SA (I may be wrong), but it is now clear that tests were done, ASA was advised to withdraw her, and they did attempt a cover-up. Please don't accuse me of suggesting Semenya was cheating, but I think a reasonable case of fraud might be made against ASA.

I think that is also what Alessandra is pointing out is that there is much more to this than you may be basing your accusations on. To date, the unconfirmed rumor is that she has AIS - I guess we're all guilty of working with this assumptions, but it does seem increasingly that the problem is a large one.

However, I think we need to find out a lot more before adopting a solid position. The last person in this case who declared with "certainty" what he knew was Chuene, followed by Julius Malema, both who told us they "knew" Semenay was female. Didn't turn out great there.

So a lot of this debate is hypothetical, discussing the philosophical question of whether an intersex athlete with an advantage should compete or not. I think it's been a great discussion, just a request to stay on point, no slanging matches as the passion rises!

Ross

Zoe Brain said...

Ross - Tour father was a hamster, and your mother smelt of elderberries!

Or was that the reverse? Anyway now that I've engaged in the obligatory attacking and mudslinging, on to the real argument.

There were 3,512 female athletes in Atlanta, 1996. So my estimate of 4,000 was a little high.

1 had 5ARD, 7 had AIS, either CAIS or more likely, PAIS 5 or 6. Truly complete AIS means that they'd be disadvantaged compared with intrasexed women, who would have higher effective natural testosterone levels.

That's about 1 in 450.

What evidence do we have that would support the conjecture that allowing Intersexed women to compete would allow them to dominate the games? Do you think that Intersexed women who know of their condition - and many do not - would suddenly decide to travel the long, hard, gruelling path that is the lot of the "amateur" (Ha!) athlete these days, simply because they may have some advantage?

1 in 450 isn't exactly dominating - especially since the natural rate of AIS and 5ARD put together is about 1 in 18,000.

You know far more about sports medicine than I do. That wouldn't be hard, I know very little. So could you tell me what other congenital conditions cause someone to be automatically disqualified from competing, because they're naturally too good?

Are there any? Any at all?

Or is it that being naturally excellent is deemed praiseworthy?

It seems to me that the original intent of the "sex tests" was purely, as the IAAF put it in their 1992 policy, "to prevent males from attempting to compete as females."

Such a test was by visual inspection of genitalia.

Such tests would have prevented such cases as that of the Zmbabwe athlete "Samukeliso Sithole" AKA Mduduzi Ngwenya AKA Fadzai Fuzani, and Nazi Germany's "Dora" AKA Herman Ratjen. Unambiguous Men in every sense masquerading as women in a deliberate deception. (Have there ever been any other cases recorded apart from those two?)

So how did we get into this impasse? Well, women don't exactly like strangers examining their genitalia in public, as used to be the case in the notorious "meat market" parades. Chromosome tests by simple mouth-swabs seemed to be a foolproof way of determining sex, without violating dignity.

Except we now know that chromosomes, while a good guide, are not infallible.

Later, when urine tests became mandatory, the visual inspections were re-introduced anyway.

Chromosome tests had some use though - they could prove that a woman with CAH and masculinised genitalia wasn't "really" a man masquerading as a woman.

Ross, again I ask you - what other congenital medical conditions would cause an athletic organisation to request that an athlete cease competing (assumedly because they're too good, rather than it being unacceptably hazardous to their health)?

If there are none - if an athlete is allowed to have a naturally high level of testosterone, or human growth hormone, or more red blood cells, or greater cardiac capacity, or larger feet, or longer femurs than is usual - then why the exception for Intersexed women? I can understand it if their natural effective testosterone levels are in the same range as male athletes, but short of that.... why?

Parenthetically, a case like that of "Samukeliso Sithole" may turn out differently next time. Someone with 46XY chromosomes and either 5ARD or 17BHDD may indeed appear to "grow male genitalia" even though the rest of the body is somewhat feminised. No "traditional healer" casting spells need be involved.

Given my own idiopathic condition, human dichogamy is something I have particular interest in.

Anonymous said...

I've already read comments from a very decorated dr on intersex conditions, and he does not believe Semenya suffers from AIS, her dark voice and otherwise male features is not what you'd expect from someone with a high grade of AIS. I can see the logic in that argument. If I had to guess, I'd be willing to bet her case more like that of the Austrian skiier who had male genitals, intact inside the abdomen. If she had AIS like those other woman who were allowed to compete before her, there would not have been this long wait for experts to review the findings, there would have been nothing unique about it and the IAAF would see it as a clear cut case of another high grade AIS athlete, who does not benefit from her condition.

My two cents anyway. ..

Alessandra said...

Zoe Brain said...
"Because that's what's happened in the past.

Santhi Soundarajan was stripped of her medals even before testing that revealed she had allowable AIS.

Simply because she had 46xy chromosomes.

That's what happens to Intersexed people. The rules get ignored. They get labelled as cheats and disqualified whenever their condition is publicised.

When it's kept private, as in the 8 cases in 1996, they're not treated that way.

Why this should be so, one can only speculate."
==============
I don't know much about the Santhi case, but I don't think the two cases are anywhere similar. As far as I read in the press, the Indian Athletics people never did any testing, never claimed to have done any testing, and have never been found guilty of lying about having tested their own athlete.

In this sense, the Santhi case has not been disproved by further testing. (or do you have a link to further tests on Santhi?)

I also found this:
"Soundarajan was dumped by insensitive sports officials, who have yet to make public the findings of an investigation carried out to determine the Indian's gender."

Are you saying the tests have been made public? Do you have the link to the results?

If there was any dispute to the tests done in the Asian championship, wouldn't it be an easy for Indian Athletics to carry out their own tests and counter-prove that Santhi is eligible to run as a woman?

I didn't see any press articles reporting this (although it may just be that I didn't find more info). I hadn't read anything about it before anyways, so I didn't follow it.

Tina said...

Ross-

you say-

"No one has accused Semenya of cheating"

absolute unmitigated balderdash- commentators all over the world have done so, and even if you want to only consider what has been said in this blog, Allessandra posted this-

"But apparently Ms/Mr Semenya did cheat.

If what is being reported in various papers is true, SA officials knew the rules of the competition and Semenya did as well. They all knew about her intersex condition before Berlin (whatever it is), and they cheated by enrolling her/him in a category Semenya doesn't belong to. Whether they agree or not with the reasoning behind the two-sex sport division is irrelevant to their dishonest behavior.

Yet in spite of this black and white accusation of cheating you accuse *me* of being "dreadful to discuss things with, because you lack any level of objectivity".

not only does your assertion that "No one has accused Semenya of cheating" utterly fail under scrutiny, it betrays either a complete lack of objectivity and intellectual honesty, or monumentally poor reading skills.

as for this-

find where I have said she is 'cheating'

how's about you find where *I* have EVER accused *you* personally of doing so...

"making up your own arguments and then fighting them", indeed...that's rich.

It's not all about you, Ross.

Since you have once and for all proven an unwillingness to debate this matter in a fair and intellectually honest manner, I will abstain from any further interaction with you...

but thanks for illustrating so perfectly the FACT that when it comes to these matters, anyone speaking from a gender variant perspective will invariably be faced with personal attacks and character judgments, and that the people doing so will outright LIE in an attempt to discredit and marginalize opinions that differ from theirs, as you did when you claimed that "No one has accused Semenya of cheating" as a basis for speciously attacking my objectivity.

Unbelievable.

Zoe Brain said...

I think it would be a good idea to step back for a second and realise that we (and by that I mean myself too) are all speculating on the grounds of incomplete and unreliable information.

We have only 3 pieces of data of dubious accuracy.

1. That in the locker room, Ms Semenya excites no suspicion, anatomically. But then, close inspection of genitalia there is not the norm. We know not what any inspection during the urine tests revealed.

2. That she has "internal testes"

3. That she has "three times the norm" of testosterone, but whether that's three times the high 3SD range, or three times the average, we don't know.

From their track record, I wouldn't put any great weight on anything the ASA may say or not say about it. They are an unreliable source.

Zoe Brain said...

Indian 800m runner Santhi Soundarajan was stripped of her silver medal at the 2006 Asian Games after failing a gender test. She was later diagnosed with the Androgen Insensitivity Syndrome: a genetically male condition but resistant to androgens (male sex hormones) which makes the body appear externally female.

Source: AFP, Fox News, Times of India

Chromosome testing in the past has had some embarrassing results:

The first athlete to fail a sex test was Polish sprinter Eva Klobukowska in 1967, winner of a 4x100 relay gold at the 1964 Tokyo Olympics. She passed a gynecological sex test inspection in 1965 but failed a sex chromosome test introduced the next year. She had one chromosome too many to be declared a woman for the purposes of competition and she was banned.

A few years later, Klobukowska gave birth.


See how this might lead to the games falling into disrepute?

Tina said...

Alessandra-

you asked-

Why did he lie about the tests, Tina?

You also say, "I guess you don't like to read what other people write."

Well, I guess neither do you- Cheune has been quite clear and forthcoming in explaining his reasoning, in quotes that accompany practically every article on this development-

"Athletics South Africa president Leonard Cheune, admits that he was aware gender tests were carried out on South African running sensation Caster Semenya while she was in South Africa, before the recent World Championships, but publicly denied knowledge of the tests to protect the athlete.

"I believed at the time my consistent denials would help protect her," says Chuene reports the BBC.

"I have however realised that it was an error of judgment and that I could have been more forthcoming with this information, even if it was difficult."

Right or wrong, there's the answer you should be demanding from the source, not me....especially considering that I see you already quoted him as well...why on earth are you grilling me as to what his motivations were when the only person who could possibly know, and who is responsible for the explanation you are already WELL aware of, is NOT me?

Rhetorical question of course, it's because you are willing to toss logic and reason and fair play out the window in an attempt to discredit a differing opinion. Ironic, to say the least.

As for the rest of your post, Zoe has pretty well answered your question as to why any alleged tests were not made public or presented to the IAAF when she said-

"That's what happens to Intersexed people. The rules get ignored. They get labelled as cheats and disqualified whenever their condition is publicised".

As for your double standard where you claim that (in your own words) "allegations" "based on leaked emails" (that you have not produced and until then are 100% hearsay) somehow make an unassailable case that Semenya is a cheat because she is intersexed...but then turn around and demand that I "show that the tests prove [my] intersex condition theory"...

well, that's just silly- for the sake of argument I accept the idea that the reports are true and she's intersexed and by my reading of the rules state an opinion that she's likely not cheating, and you attack my having accepted (for the sake of argument) the exact same alleged IS test results that you are using to make the case that she did cheat........?

This makes no logical sense at all.

Zoe is absolutely correct when she says that none of us have anything to go on but "data of dubious accuracy" and that all of this is a matter of conjecture at this point...something I said long ago, that you keep disagreeing with when it supports your opinion, and agree with when you think it can discredit mine.

Tina said...

(contd. from previous post)

I have been careful to link to supporting evidence re: the actual IAAF rules I used to base my opinion on, yet you speak of "accepted emails" with no proof of their existence besides nebulous "leaks" and make comments like "We don't have these mysterious sex test results yet, but it just smells like Semenya has a significant advantage" as if "it just smells like" cheating should be accepted without question and is based on anything more than speculation over data of dubious accuracy.

I am more than willing to admit that I do not have all the information or answers and that it may turn out that Semenya did in fact cheat...I really don't think so based on what I have seen and heard (which is what you are going on), but I will admit the possibility that I may be wrong, it's happened before.

So my question to you is this- are you willing to admit that your assessment of what are by your own admission unsubstantiated allegations of Semenya being IS (or else you wouldn't have demanded that *I* substantiate them, would you?) might in fact be incorrect?

Other than a handful of qualifying phrases like "If the info below is correct" the bulk of your posts seem to indicate that you don't believe for a minute that it is possible that Semenya didn't cheat.

Zoe Brain said...

Another anomaly has just occurred to me.

I have dual nationality. My country of birth is the UK, my country of residence, Australia.

In 1985 I was diagnosed as an Intersexed male, in 2005 an Intersexed female. I've had both gonadectomy (possibly twice), and genital reconstruction surgery. So it's at least arguable that I should be covered by the rules on sex reassignment.

The Stockholm recommendations adopted by the IAAF say, in part:

The group recommends that individuals undergoing sex reassignment from male to female after puberty (and the converse) be eligible for participation in female or male competitions, respectively, under the following conditions:

- Surgical anatomical changes have been completed, including external
genitalia changes and gonadectomy

- Legal recognition of their assigned sex has been conferred by the appropriate official authorities

- Hormonal therapy appropriate for the assigned sex has been administered in a verifiable manner and for a sufficient length of time to minimise gender-related advantages in sport competitions.

In the opinion of the group, eligibility should begin no sooner than two years after gonadectomy.


All well and good. If I were competing for the UK, the "appropriate authorities" would seem to be the Public Records Office. If for Australia, the Department of Immigration. Plus possibly national sports bodies, but let's leave that aside.

In Australia, the "Cardinal Document", dictating what sex I am for all legal purposes, is my Immigration record. According to that, I'm female.

In the UK, the "Cardinal Document" is my Birth Certificate - which unless they change the law, will always say "Boy", as it's deemed to be a historical record, not reflecting current status. Nonetheless, it's used as such.

So for the purposes of sport, which sex I am depends on which country I'm competing for.

If Tina seems a little prickly, then perhaps you might just understand why. Because this is just the Same Old... Used Food... that Intersexed people have to put up with whenever we apply for a drivers license, a job, a passport, a marriage license....

And if you think Ms Semenya hasn't been accused of cheating, I suggest you look at what's been said by some of those she beat - before being silenced by their own athletic bodies. Or what's been said throughout the world in newspapers, TV reports, radio shows.... not forgetting comments on this very site. To say that she hasn't been formally accused of cheating would be equally disingenuous: even those who fail doping tests are not - they are merely disqualified without comment.

The WADA has a "strict liability" rule when it comes to even endrogenous controlled substances: for testosterone, it's the detection of 4 times the expected norm for that person. Anyone above that, for whatever reason is "deemed to have failed a doping test", regardless of cause or liability. Depending on how for that person and expected norm are interpreted, Ms Semenya may indeed have "failed a doping test". With all that that entails.

As regards drugs that "mask" testosterone, well, they don't. Such anti-androgens (temporarily) suppress the body's natural production.

I know, I have to take them myself - despite having no gonads, and a low testosterone count. It seems my "funny looking" adrenals are producing either DHT or some other androgenic substance not detected by the usual tests.

Cyproterone acetate is the usual. In Australia, it can only be prescribed to those who put themselves on a voluntary register of sex-offenders undergoing chemical castration to reduce their sentences, or to women with severe androgenisation. I had to take the stuff for my own health, but until the diagnosis was formally changed, I had to be put on the register.

And once on, you can never get off it.

Intersexed people have to go through such humiliations all the time. Ones those who are Intrasexed could never dream of.

Zoe Brain said...

In a South African context, until 2006 we were arguably not considered "natural persons". Damage to our bodies was arguably destruction of property - as persona ficta we owned our own bodies - and possibly cruelty to animals, but not assault or murder.

From the Mail and Guardian - Intersex and the Law :

Our Equality Clause rules discrimination on certain listed grounds, including sex, unfair unless and until proved fair, but "sex" was not defined in statute. The dictionary definition of "sex" -- male, female and nothing else -- therefore governed its interpretation. "Human being" and "[natural] person" are also defined as having a sex in exclusively binary terms. The intersexed, somewhere in between, could thus be argued to be neither human beings nor natural persons.

The potential consequences were terrifying.
...
In South African law, one needs locus standi, the right to address the court, to mount a legal challenge. Since the intersexed did not fit workaday definitions of "human beings" and "[natural] persons", arguably they lacked the locus standi to challenge this or any other type of discrimination. It followed that the intersexed, because they were intersexed, had no secure rights -- not even to dignity or to life itself.


This situation was quietly remedied as a matter of some urgency, before some canny lawyer picked up on it. While this legal theory was never tested in court, the danger was considered real enough for legislation to be hurriedly passed to prevent it.

You can see what we're up against.

Alessandra said...

Tina wrote:
You say that the rules I posted-

"do not encompass all the different possibilities for biological make-ups that differ from what is normal. It is for this reason that the IAAF's current policy is to examine the cases that are not clearly addressed by the list of rules you copied in your email on a case-by-case basis."

What you disingenuously fail to acknowledge is that rules posted DO encompass what is alleged to be Semenya's condition, if as we have been led to believe she has AIS, and would still encompass other conditions that would produce the heightened androgen levels she is reported to have...
=======

Why would my not acknowledging what you posted as encompassing all possibilities be disingenuous? You cannot make an argument without maligning and attacking other's people reasons for posting here? Are you so short of arguments, that you need to sling mud to try to feel like you are not slip-sliding away here?

There is *nothing* disingenuous about explaning that, although I am not an expert on the subject (which you erased from your quote), I am aware that the IAAF analyzes certains cases individually when they are not clearcut according to the rules.

I can't know all the different biological make-ups a person could have to end up with the visual appearance of Semenya, plus all the other intersex profile claims.

It's therefore totally logical for me to assume that, if the IAAF has these few rules, and there are cases where they still need to do a much more complex analysis, their rules don't encompass every possibility.

If you want to accuse others of being disingenuous, why don't you start by looking at your own characterization of what I fail to acknowledge? To characterize me as being "disingenuous" is lame at best.

you wrote:
"Complete or almost complete" AIS...it would all fall to the question of whether or not her AIS is complete enough...and the rules don't define that.

Can you read the end of your sentence, I wonder? The rules *don't define everything*, see? Therefore, they don't encompass possibility in a clearcut format. Let's hope you will have less trouble reading next time.

Alessandra said...

correction:
Therefore, they don't encompass -every- possibility in a clearcut format. Let's hope you will have less trouble reading next time.

Alessandra said...

"Indian 800m runner Santhi Soundarajan was stripped of her silver medal at the 2006 Asian Games after failing a gender test. She was later diagnosed with the Androgen Insensitivity Syndrome: a genetically male condition but resistant to androgens (male sex hormones) which makes the body appear externally female. "

What's the procedure with the official sex tests? Do the officials give the athlete the all the test results or do they just communicate their pass/fail decision without explaining the details of the test?

Alessandra said...

Tina wrote:

As for the rest of your post, Zoe has pretty well answered your question as to why any alleged tests were not made public or presented to the IAAF when she said-

"That's what happens to Intersexed people. The rules get ignored. They get labelled as cheats and disqualified whenever their condition is publicised".
========

As it has been reported in the media, some intersex athletes are allowed to compete and their identity has not been made public, and no one has labeled them cheats.

The Semenya case was made public because the South AFricans are being suspected of cheating or fraud or not complying with the rules, based on many factors. I doubt that all these same factors were present in these other Intersex cases and that's why they never became public in the first place.

I found Kessler's assertion discrediting the media leaks so far intriguing, but one has to look at the media leaks strategy from the IAAF's position. It doesn't make sense to leak false test results to the media, if the SA tests could easily disprove that.

That would certainly discredit the IAAF of all credibility. So, if they are going to leak, they need to leak the truth. Unless, of course, they are as bright as Chuene, then anything is possible.

On the other hand, the IAAF accepted her in the race, even though they counseled the ASA not to enroll Semenya.

However, this could be explained by the fact that maybe they were up against the wall.

If they needed to do tests which take longer than the time they had available, it meant they had no choice but to allow her in, even though she might be found ineligible later on.

From their actions, I think that they try to avoid being caught in this situation, but here we have the South Africans complicating things this time around.

Alessandra said...

Tina wrote:

As for your double standard where you claim that (in your own words) "allegations" "based on leaked emails" (that you have not produced and until then are 100% hearsay)
============

And why should *I* need to produce any emails, if the papers have already done so?

Wouldn't it be nice if you could read the news before posting here?

Would you like an example?

http://www.mg.co.za/article/2009-09-18-semenya-saga-chuenes-trail-of-lies

or:
http://www.brisbanetimes.com.au/sport/lying-for-semenya-athletics-boss-clambers-for-moral-high-ground-20090921-fx0k.html

Is it hearsay, or simply that you are really incompetent at following what the media is reporting?

Maybe you could apply to be Chuene's personal PR manager, what do you think?

Alessandra said...

Zoe:
And if you think Ms Semenya hasn't been accused of cheating, I suggest you look at what's been said by some of those she beat - before being silenced by their own athletic bodies. Or what's been said throughout the world in newspapers, TV reports, radio shows.... not forgetting comments on this very site. To say that she hasn't been formally accused of cheating would be equally disingenuous: even those who fail doping tests are not - they are merely disqualified without comment.
======
And you know why? Because we live in the world of Marion Jones, Nelson Piquet Jnr, the cycling guys, the football cheats, and not least of all, Madoff.

People cheat and scam all the time, specially when there is glory and monetary rewards involved. Is that news to you? When there are suspect circumstances, we suspect.

Just remember that Marion Jones passed every single doping test in her career before she went to prison. Would you have maligned all those people who suspected her of doping before her scandal broke?

And it's only the real stupid ones that didn't suspect Madoff's little scheme wasn't clean. Anyone who did their due diligence had their red flags raised with no concrete proof of anything.

I really don't see why you have all this wailing going on here, if there are plenty of reasons to suspect something is amiss with Semenya's case.

Alessandra said...

Tina wrote:
So my question to you is this- are you willing to admit that your assessment of what are by your own admission unsubstantiated allegations of Semenya being IS (or else you wouldn't have demanded that *I* substantiate them, would you?) might in fact be incorrect?
===========
There are some important allegations which are not unsubstantiated, they've been proven already.

Nevertheless, my assessement may be wrong. Or maybe it's partially wrong, or correct. It will remain to be seen.

However, until more information is revealed, I continue to suspect foul play.

Alessandra said...

And this was a very nice piece of opinion writing on what do about Chuene:

"South African High Commissioner in Kabul? The country's first cosmonaut (on a one-way trip)? Internal maintenance assistant at the shark tank at the aquarium in Cape Town? There are assorted possibilities, all of which have great appeal: whatever we do settle on, the one thing we certainly don't need is Leonard Chuene staying on as the head of Athletics South Africa, an institution he has dragged into the gutter with breathtaking success.

The sports administrator, by and large, is an unlovable beast, and a simple tenet holds true in most cases: anyone who wants to be a sports administrator generally, by definition, shouldn't be one. South African sport tends to succeed despite, rather than because of the administrators running assorted codes, and we've had some nightmare characters involved in the past (see South African rugby’s past decade for a slew of appropriate examples). But even by the consistently low standards of local sport, Chuene has proved particularly insidious.
"

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Anonymous said...

Why does she need medical treatment? I've seen other references to her "condition" being "threatening," but I've seen no explanation of what hazard her being intersex actually causes. Would she seek treatment simply to comply with the rules governing sport? You would help a lot of confused individuals by posting something to help us understand a little better.