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Tuesday, August 25, 2009

Caster Semenya debate: Some physiology explained

How do you know the sex of a chromosome? Pull down its genes! If only it were that easy...

Today, Team SA arrived back in South Africa after the World Championships in Berlin. The welcome home ceremony was really about one person - Caster Semenya, and the scenes in Johannesburg were just extra-ordinary. We have never seen such a huge reception for an athletics team (or even Olympic team). What a pity the "congratulations" was clouded in the controversy and political rhetoric that has now come to dominate the story.

I have some science to put out there, but to introduce that scientific discussion, I first want to put out some quotes from Leonard Chuene, who is the president of Athletics South Africa:

“Let me warn professors and scientists that the only scientists I believe in are the parents of this child,” Chuene said. “One scientist from a stupid university somewhere is going to erase the entire life of this girl.” The IAAF is still awaiting the results of the tests but Chuene refused to clarify what the process was or what would happen depending on the results.

“Why should we worry about other people’s tests?” Chuene said. He also sent out a warning to the IAAF not to punish Semenya. “We are here and one thing they mustn’t do is suspend her.”

Honestly, I couldn't make this up if I tried, those were his exact words. So, I think it safe to say that everything from this point onwards is not of concern to anyone in Athletics South Africa, since it involves my attempt at explaining some of the science around this matter of sex testing and why it's so complex.

Intersex conditions and biological basics

Last week, when all this broke, I said that at some point, I'd pull together the basics of the biology of these conditions, and put it out there for you to read. I must stress that these are basics, and they don't nearly do justice to the complexity of disorders of sexual development, or DSDs.

DSDs are the disorders that are often responsible for producing what is known as the intersex condition, a condition where a person develops ambiguous genitalia, and often, their genetic sex (determined by the chromosome) differs from their phenotypic sex (their exernal appearance and physiological functions, to be broad). In other words, if you have thought that XX = female and XY = male, you are about to have your perception challenged!

If you thought that a simple observation, and the presence of genitalia was the clincher, you'd again be wrong. Sometimes, genitalia are so ambiguous, that trained medical doctors will disagree and debate for hours over whether someone is male or female, even when that person is already a teenager. Final year medical students, when shown pictures of ambiguous genitalia, and asked to vote "male" or "female", are often wrong! Unfortunately, then, examination of genitalia (the "pants test" or "shower check"), as advocated by the politicians, is not conclusive proof of anything!

Disorders of sexual development and intersex

Now, there are a multitude of DSDs and there is interaction, different levels, and a complex process of sexual development underlying them, and I can't cover all that in this format.

However, I have done my best, and you can read my article at this website. It is a site called Competitor Running, and I contribute to it from time to time (not as often as I'd like). They requested this story, and I put together a very high level summary of the situation. So that article is my crack at summarizing the scientific basics of the debate.

Please note that this is NOT an attempt at diagnosis of Semenya's case, and it does not represent my opinion on whether she has any condition of any sort. Unfortunately, the article was titled "What is Caster Semenya?", which kind of implies an opinion is coming. That is not the case.

Rather, it is meant to inform people of the basics, and maybe the complexities, of sex testing. If you read that article, and you're somewhat confused and bewildered at how complex it is, then you've started to appreciate the issue!

And, I dare say, you'll be a step or two ahead of those in South Africa who are steadfastly refusing to let facts confuse them, or get in the way of a story.

The summary version - short, sweet and grossly oversimplified...

If you don't have the time or energy, here is the very short, three paragraph summary, which fails miserably to answer any questions!

How do you know the sex of a chromosome? You pull down its genes! Unfortunately, this test fails on both counts - neither the genes nor the jeans hold the answer! We are all told that if you have two X-chromosomes, you're female, and if you have an X and a Y chromosome, you're male. Unfortunately, reality is often not so simple. In the undifferentiated foetus, there comes a point at which a "switch" must be flicked in order to switch on male sexual development. If that switch is not thrown, then the foetus will develop into a female, with ovaries and a uterus. Female is the "default" condition.

That "switch" is part of the Y-chromosome, and comprises a set of genes that is responsible for initiating male development. If it is present, testes are formed, testosterone is produced and male development occurs. However, for any number of reasons, sometimes the switch does not work. Or, it works, but there is a "short circuit" that prevents it from having its normal effect. The consequence is that even the presence of the Y-chromosome sometimes fails to turn on male development, and the foetus continues to develop as a female. The result? An XY female. Conversely, sometimes the switch is "faultily thrown" and an XX-foetus begins to develop as a male. This happens for chromosomal, gonadal and hormonal reasons. There are also other conditions which result from levels of hormone in the mother that can affect the foetus in the same way.

The end result is that ambiguous genitalia can develop, an XY can develop as a female, an XX can develop as a male, and a number of other physiological traits can be 'mixed up'. These people are intersex, and they present the challenge with regards to sporting participation. Even once identified, there is no clear standard as to what is done with them. Some conditions, like AIS, are permitted, others evaluated. The ethical debate around this is huge, and one that I have no answers to. Only time will tell whether Semenya has any of these, or none at all. Until then, if this challenges your 'binary' view of sex and gender, then I guess it has made the point!

Again, for the full article, you can click here to read my piece.


P.S. Last word on the stories today of Semenya's high testosterone levels

Today, some media outlets reported that Caster Semenya's testosterone levels were three times higher than those normally expected in a urine sample. Obviously, given the context of the case, a lot of people are now saying "See, it's proof".

Unfortunately, it's not that simple. It MAY turn out to be a piece of the puzzle, it MAY become significant when put in the context of all the other results, but by itself, it actually doesn't mean too much. The main problem is that "normal" is a moving target, and there is a pretty wide range of testosterone levels in any population. So we need to understand what "normal" means - is it the typical level in the female population? Is it the highest level in the athletic population? The difference is important.

Perhaps the best way to treat this report for now is to say that the raised level is possibly a flag for something else, and further testing could establish what this is. Regardless, the position, for now, remains the same - wait on the collection of tests before drawing conclusions.

What is interesting is that this measurement was apparently obtained weeks before Berlin, and prompted the IAAF to request further testing. It was also the catalyst for them requesting that Semenya not enter the 800m event, since further testing was deemed necessary. Note that this was a request that would have been made jointly by the medical officer in charge of the testing and the IAAF, not just the IAAF. ASA refused, and the rest is, well, massive controversy.

And finally, it's now emerged that the leak that saw this process made public came because a fax was sent to the wrong person. What a pity for such a sloppy mistake to have such repercussions, and the IAAF will hopefully take action there, because they've also got a great deal to answer for when it comes to the leak. Not for the process or their policy, mind you, but for this leak, which was a grave error.


Scott said...

Unfortunately she has made the news here in North America and the nuances concerning her situation are completely ignored in favour of a sensationalized story. I'm with you that ASA is responsible for this ugly situation because it failed to take every possible step available to avoid this disaster. No wonder Leonard Chuene is spluttering ridiculous statements about ignoring IAAF rulings. My sympathies go out to Miss Semenya and a profound hope that she is eventually found to be female.

Lisa French said...

I think while the ASA may have a part to play in the development of this situation, but the IAAF do have to answer for why this became public before the results of any of the tests. I read today that Semenya shows a higher level of testosterone than expected. I wonder if it would make a difference whether she was found part male on the issue of whether this is an unfair advantage or not. Say there was other reasons she had higher testosterone: would this disqualify you or is it only if you are found to be intersex that you would not be able to compete?

Ross Tucker and Jonathan Dugas said...

HI Scott

Too right. The consequence of all this talk is that the stakes are being raised ever higher. The test results, if at all equivocal, will simply be the next catalyst for another round of rhetoric. If those tests show she has some advantage and should NOT be running with women...well, that could well be explosive!

So I agree, I feel deeply sorry for Semenya, but I really do wish people would just stop propagating myths. And when that result arrives, I hope that everyone respects the decision. I would be amazed if they did...regardless of which way it goes!


Ross Tucker and Jonathan Dugas said...

HI Lisa

Good question, and good point. Certainly, the IAAF are to blame for that "leak". Just to correct you, they didn't actually release the testing information, rather, it was a case of a leak, and they have apologized and hopefully will deal with that severely. It has really hurt them, and rightly so, because that was poor on their behalf.

To respond, I saw the reports on the testosterone - for now, I'd say wait, because we don't really have a baseline for "normal", and so I wonder what "three times higher" actually means? Is it three times higher than the accepted ratio? If that is true, then it's quite different from "three times higher than most other women", because that would not be grounds for any action, at least not in isolation.

So again, I think we need to wait for all the test results, because only then can a complete picture be formed!


Giovanni Ciriani said...

I think the most important point Ross is making is "testosterone above normal" doesn't mean anything. The average doesn't mean much. One needs to look at the range around the average, or in biostatistical terms at standard deviation for that specific population (top female athletes). Does anybody have those numbers?

Unknown said...

Great stuff, Ross, love this website...

if, as may well be the case, Caster turns out to be a "masculinzed female" do you think she would be banned? Sounds to me like a grey area (ie what degree of masculinity is unacceptable) - this story could run and run

Alessandra said...

First, anything that comes out of Cheune's mouth just makes me shake my head.


Second, related paper - East Germany's monstrous doping program

This is the contextual historical background for Ekkart Arbeit (the current SA Athletics' head coach).

For a fascinating read on the subject:


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

Werner W. Franke1,a and Brigitte Berendonk2

1 Division of Cell Biology/0110, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany.

2 Hölderlin High School, Heidelberg, Germany.


Several classified documents saved after the collapse of the German Democratic Republic (GDR) in 1990 describe the promotion by the government of the use of drugs, notably androgenic steroids, in high-performance sports (doping). Top-secret doctoral theses, scientific reports, progress reports of grants, proceedings from symposia of experts, and reports of physicians and scientists who served as unofficial collaborators for the Ministry for State Security ("Stasi") reveal that from 1966 on, hundreds of physicians and scientists, including top-ranking professors, performed doping research and administered prescription drugs as well as unapproved experimental drug preparations. Several thousand athletes were treated with androgens every year, including minors of each sex. Special emphasis was placed on administering androgens to women and adolescent girls because this practice proved to be particularly effective for sports performance. Damaging side effects were recorded, some of which required surgical or medical intervention. In addition, several prominent scientists and sports physicians of the GDR contributed to the development of methods of drug administration that would evade detection by international doping controls.

Third, it was reported in the media that when Semenya was asked if she had been given drugs by Arbeit, s/he responded by giving a deep, guttural laugh.

The tests must go on...

Lisa French said...

I do think regardless of the results of testing Semenya is a 'she' rather than a he, because if you spend 18 years growing up as a female you will be psychologically female rather than a male.

It is definitely a problem with the media in general saying random figures like 'three times higher' and never telling you how they got to that number!

But if the testosterone is just three times higher than the average ratio, and if that is the only consequence of the intersex do you think that would be a reason for disqualification? I guess it would depend if it's much higher than any other female athlete.

Sam said...

Maybe the story was changed, but the link to BBC Sports reports that the testosterone levels were 3x higher than those that would be expected to be found in a female sample. That does not say "average".

This becomes a big issue as WADA still has a T:E ratio rule on the books. If Caster is found to be a female, then she might be in violation of the T:E rule (or subject to its follow ups).

Heck, no matter what the determination is Caster could exceed the T:E ration (4:1 BTW) that would trigger more testing.

That just adds another layer to whole onion.

The ASA director is on my short list for the dumbest person in a national or international sports organization.

I have no doubt Caster's parents love her (and I will use "her" until a determination is made a pronoun is needed), but the parents also have a stake in Caster being considered a female. Caster stands to make some good money if she is deemed to be a woman.

Are the hormone levels not one of the criteria that is checked along with the response to hormone levels?

Frans Rutten said...

From a perspective of performance profiling I wouldn't distinct the RISE of Pamela Jelimo from the RISE of Caster Semenya, although the latter is still quite more sensational and uncalled for.

We already saw Pamelo Jelimo FALL in a way which the athletics world probably never experienced before.

I wouldn't be surprised at all, if silent diplomacy did the "dirty" trick.

But why such a turmoil with Caster Semenya and not with Pamela Jelimo.

Could the answer lie in the way how our brain works? In one tenth of a second the brain evolutionary based judges the human face.

With Pamela Jelimo nothing peculiar seem to happen, but seeing Caster Semanya for the first time with the foreknowledge of going to see a girl, the brain flips. I already mentioned the paper which provoked the readers by only showing her feet.

I saw the interview with Caster Semanya and experienced even empathy to that very composed, attentive person, but I (or rather my brain) saw a boy.

I remember a scene out of the film Don't Look Now (1973) with Julie Christie and Donald Sutherland.

They pursuit a person and the very moment the face of that person is reveiled, the brain really get's overwhelmed or rather shocked, simply because the difference between what's expected and what is actually seen is too wide to comprehend.

With Caster Semenya the "shock" isn't even remotely that strong, but the impact is there.

I cannot see how she can escape if that's the right word.

Anonymous said...


Good point, "what degree of masculinity indeed"?

And...how many people we regard as females (and more importantly 'they themselves' regard as such) would 'fail' the testing procedures outlined by scientists??

Its more than just a grey area...which is why I said in an earlier comment, that all this in depth testing is fine for what it is...but either we test all for the 'fine detail'- the chemistry, biochemistry, molecular biology etc - or we accept what the "genes' and the "jeans" tell us.

Oh...and btw I am a bit disappointed if many people didn't already know how sex develops in the foetus and early development....its not rocket science...perhaps even Cheune knows it.

What is more important is how that person, having been designated a certain gender, then develops psychologically....and perhaps Cheune knows that too.

Owen Anderson said...

Wow Ross - Great insight on this controversy. My sociology prof in college, Dick Travisano, pointed out that there are actually more than 20 different sexes, taking into account combinations of chromosomes, genitalia appearance, hormones, psychological outlook, etc. So, here we are trying to classify Caster as one - or the other - but that's really impossible. It's possible for IAAF to define male/female, if it has the courage to do so, but that definition will have to take into account all the different factors you mention.

Shawn Syms said...

What is the solution for professional athletes who have intersex conditions (or at least those believed to confer advantage)? Are they simply not allowed to participate in competitive sports? Or since they are only outed when fellow athletes complain about them, should their strategy be to always come close but never win, so as to reduce their profile?

Anonymous said...

It's really a case-by-case but there's 3 main options if there's a definite advantage, like way higher testosterone than acceptable.

1) Let it go and do nothing. Probably not going to happen.

2) Let her have the gold but remove the extra advantage if possible, such as removing an androgen-producing tumor. Then, testosterone levels would fall back to the acceptable range and she would compete again after 2 years.

3) Similar to option 2. Give her the 2 year vacation immediately and strip the medal.

It would be a tough decision all around because she would be born with the advantage but the advantage is too similar to taking a lot of steroids. It's not really sex or gender that they care about but rather the hormone levels of people as they relate to performance in each group.

Anonymous said...

Don't forget that the arbitration panel in the Mary Decker case ruled that merely being out of bounds numbers-wise is sufficient for disqualification, the IAAF doesn't have to prove that it occurred due to doping.

Assuming you are holding Caster to the same standard Americans are held to (not a very robust assumption), if the tests show bad numbers she shouldn't get the benefit of any kind of test to prove she isn't doping. She should be immediately disqualified and be stripped of her medal.

Iwan said...

If gender identification in athletics is going to be a problem in the future with no simple solution and no clear lines between male and female, then maybe the only solution would be to combine men's and women's fields and may the best "man" win. The gender distinction in athletics is after all an artificial one made to distinguish an on average weaker group of humans from an on average stronger group of humans. I speak half jokingly of course and would miss watching all the women's events but at the same time I can also envision an even more confusing future of "designer" athletes with genetically engineered physical characteristics that may blur what we think of as human. It may not be as far in the future as we think.

Ross Tucker and Jonathan Dugas said...

Hi all

Thanks for the great comments on the post overnight.

Just to respond:

To many people:
I have not seen any mention of the T/E ratio in those reports. Some you brought up that if your T/E ratio exceeds a limit (4:1) then it is grounds for further investigation, since it is a flag for doping. And you're 100% correct, it is. That's why it should be pursued as a matter of doping AS WELL as the sex verification.

However, I gather from the article that this test was done in response to the IAAF's initial request to ASA to provide a report, which means that I think they have not measured the T/E ratio, but rather the amount of testosterone. In other words, it seems to me that the amount is higher, not that her T/E ratio is 12. I don't know if I'm misreading it.

Alternatively, the test may have been part of the IAAF's preliminary tests on Semenya, but that doesn't change that I think it's the amount.

That still makes it important to know what the 'normal' is? And while I hear you that they've said three times higher than female athletes, I still wonder if we have an established "normal range".

In any event, to answer a question down below from Shawn and Randian, I am looking into this, but I think that there are grounds to prevent participation if a person has an androgen-producing tumor, and so that would be the case her (though for different reasons), I suspect. I'll look into that and let you know!

Thanks again, I'll respond to more when I have the time!


Unknown said...

Only marginally related but nevertheless an interesting read on hormonal doping in the gdr and its personal consequences for female athletes that got testosteron treatment during their teenage years. Unfortunately the long version is in german and the shortened english one leaves out quite a lot:

So the question arises given "high" testosterone levels how could we distinguish if this is the effect of doping or alternatively due to some gender condition?

Ross Tucker and Jonathan Dugas said...

Hi Float

Thanks for this.

To answer your question - the test for testosterone is pretty easy. They just look for chemical differences between testosterone that is made naturally in the body and the artificial (or "exogenous) testosterone. If it's a more advanced form of the steroid, an androgen that is not detectable, then they have a problem, like in the case of THG.

However, the actual detection of artificial testosterone is not too challenging, as far as I know, and that's why few athletes are caught using it these days, at least in competition.

So if it was a gender issue, then all testosterone would be natural, if it were doping, some would be identifiable using these biochemical assays.


Anonymous said...

On the Testosterone issue:

As Ross correctly points out, the absolute Testosterone level is not a problem (it is highly variable), nor is the T/E ratio. A simple IRMS test can determine whether Testosterone is of natural or artificial origin. It is performed in all cases of elevated T/E ratios.

Alessandra said...

Lisa said...
"I do think regardless of the results of testing Semenya is a 'she' rather than a he, because if you spend 18 years growing up as a female you will be psychologically female rather than a male."

I most definitely disagree with this take on Semenya. She has not spent her 18 years growing up as a female. There isn't a lot of related biographical information in the media, but, even so, there are several contradicting accounts about Caster not thinking nor behaving as a girl. The principal of her school said he didn't know Caster was a girl for many years. What? She went to a school that had boy/girl uniforms and she refused to wear the girl's uniform, she insisted on dressing as a boy! Why? Reportedly, she is not interested in boys. All her immediate female relatives have full developed breasts, but it was written in the media that people around Caster all noticed she developed no breasts at all in her teen years. And this was before she was into any intense top-level sports training. Her idol is a male wrestler and there are more examples. Moreover, I find it very suspicious that no journalist has interviewed anyone at Caster's current uni, who interacts with her/him now. I'm speculating they would find people who would tell us that Caster behaves like (and possibly identifies with being) a guy. It was when s/he was small that, understandingly, she was brought up as a girl.

My guess is that Semenya changed quite a bit in the last few (and truly late adolescent) years. My guess is that she is some kind of intersex with at least somewhat female looking external genitalia. Thus her family, especially when she was a kid, thought of her as a girl.

If you observe everything about Semenya now, it screams "I am guy." Caster looks, speaks, acts, gestures, and dresses as a guy. The only exception is when it concerns enrolling in sports, all of a sudden, she says with a coy little smile, "but hey, I'm a girl." It stinks to me.

S/he's young, and easily manipulable, especially by greedy coaches and repugnant politicians, but s/he isn't blind. A lot of money in big-time sports these days, a lot of doping, and a lot of corruption. For a poor, young intersex kid from the boondocks of SA, playing the "girl" card might turn out to offer a much bumpier ride than she could have imagined.

Anonymous said...

From a human and ethical perspective, there is no question nor should there ever be a question about Mokgadi. She is just a girl different from the norm and that's it. That people have doubts about her confirms just how humans are conditioned, to think through their lazy brains and not to think and see differently. Like is sports, the more you push yourself, the more you discover more about yourself. You do not know what your brain is capable of.
Yes, she may have grown up doing and liking what could be considered boys' stuff, that is what she is and not who she is and cannot change the fact that she is a girl. The assertion that she and her parents may be scheming to make some bucks, is absurd and even more dispecable. Maybe people must appreciate conditions under which people grow up in rural areas, there is no sophistiation or glamour about her upbringing, from within her family or the village to scheme some biggest load of fraud committed in sporting history. That debate is a non-starter. Her dad is a grass-cutter, her mom worked at some store and now training as a care-giver. And yes, these are the only scientists to confirm that she is indeed a girl. Why she was not in the news, that's thanks to the media that was never interested in her, but now she's in the limelight for all the wrong reasons.
And to medical professionals and sports scientists, one wonders what question they are trying to find an aswer for that has no clear yes or no, nor right or wrong. She is just some wonder girl that has probably provided some 'breakthrough research' to them-pity they find another layer of onion!!
The explanation given on sex and gender here is too narrow and the view of human geneticists should have been considered, it is not only a male or female, there are many other variations.
Ross, I heard you on SAFM this morning and was equally disappointed about some your statements, eg that it is not only about genitalia- the human universal determination of man and woman, that counts. What a pity? But it is undestandable, let us leave human genetics to parents, powers beyond us and maybe the scholars

DrPete said...

Before doing any test, you should always know what you're going to do with the result (else don't do the test):

Two very important issues still need to be discussed to my satisfaction:
1. What is the IAAF definition of "entirely female".
2. Who are we going to test if testing is not just to exclude 'cheating males'?

Let's assume Caster isn't a chromosomal and phenotypic male that's cheating, isn't doping or has a tumour but in fact has a DSD.

Does DSD disqualify one? If not (and it seems that precident has already been set), then what is acceptable and what is not? We can't rely on chromosomes, hormone levels or genital phenotype to assess whether there is an athletic advantage. Furthermore, is there a limit to 'years of exposure' -is it OK to have high testo's for 20 years then to remove the testes and compete?

Even more problematic is if some DSDs disqualify one from competing - will we have to screen all women now, or only those with some muscles or deep voices or who?

The IAAF need to consider these issues very carefully before proceeding with tests.

Anonymous said...

The question is why shouldn't DSDs disqualify you from competing? You could always run the men's race.

Before you say "that's unfair", then answer this: why does a weak (in an absolute sense) XX athlete get to make a million bucks, while a weak XY athlete gets relegated, when they have the same ability? This is exactly the same question, coming from the other direction.

From the broader perspective, why are you segregating athletes for honors and money based on the infinitely arguable fuzzy logic of chromosomes, DNA, and psychological gender, rather than on the no-judgment-required measure of actual athletic ability?

Anonymous said...

To Anonymous at 9:07

You obviously have not read the content in this website...read first and get your facts straight and then comment.

Ross Tucker and Jonathan Dugas said...

To Anonymous at 9.07

I can only second what the next anonymous poster at 10.56 has said - you need to read and get your facts straight, because you're showing up a lack of 'stringency' in the argument.

You say "The explanation given on sex and gender here is too narrow and the view of human geneticists should have been considered, it is not only a male or female, there are many other variations."

I don't even know what that means, but if you read this article, you'll see plenty of facts on genetics, and the "view of human geneticists".

Then you go on to say that on a radio interview, I said that "it is not only about the genitalia".

So you basically contradict yourself. First you say I need to consider genetics, which I have explained in great detail. Then you criticize me for say it is "not only about the genitalia".

So are you saying it IS only about the genitalia? Or are you saying it's ONLY about the genes?

Either way, you'd be wrong. The answer is far more complex than that, and again, I can only say that you need to read the facts.

In fact, reading your statements, your position seems a lot like that of Leonard Chuene, against whom I had the radio debate. He has said that the only scientists he'll listen to are the parents. This is so ignorant, it's laughable. You are not by any chance Mr Chuene, are you?

You have also said that scientists are seeking to find an answer without a clear answer. You're wrong. The scientific testing produces a very, very clear answer. It will allow us to create a very accurate picture of the biology of a person. What is unclear is the ethics of it, but you haven't even gone near that debate.

And you're making essentially the same claim as Mr Chuene. Please, sir, read the article properly, and then form an opinion.


P.S. For the record, I have NEVER made the claim that she is out to make money. That is the opinion of readers of this site, who are more than entitled to their opinion.

Ross Tucker and Jonathan Dugas said...

To Randian and Dr Pete

Thanks for that debate, very interesting!

To Randian, I agree 100% with you, I have found that in this debate, people, especially here in SA, are asking the question from one direction only, and when you flip it around, it becomes very interesting indeed. I believe "fairness" depends on which side of the fence you sit, and I dare say that there every athlete would be unhappy with the idea of racing against someone who has super-elevated testosterone levels.

But to answer Dr Pete:

You raise some very good points. Yesterday I chatted with a local doctor who serves with FIFA and he was giving me some insight into how this huge governing bodies manage this issue and others like it.

They must, and will, treat each case on an individual basis, and so like you, I wish that we had nice clear numbers to base a verdict on. But we can't, I think it's unrealistic, so they will have to evaluate this based on the tests that they have, and then make a call based primarily on the levels of testosterone (which is a bit more advanced than simply measuring the amount once and saying it's high).

That is the crux of the matter, as stated in the IAAF policy document - the level of testosterone, and whether it is high because of some intersex condition, a DSD or maybe some other pathology (an androgenic tumor). I think it's fair to say that they will exclude someone if their testosterone levels are off the charts and there is a known reason for it - a woman with naturally high testosterone will be different from one who has high (very high) levels as a result of a DSD or pathology.

Time will tell...


Anonymous said...

3 times higher than an average female is 10 to 15 lower than an average male (males have 30 to 40, and according to some studies up to 60 times more testosterone than women). This data, if it proves anything, proves that she is much closer to a woman than a man

Ross Tucker and Jonathan Dugas said...

Hi Anonymous

I'm not sure which figures you're using. All the available research, plus textbooks, suggest that the range for women is 0.5 to 2.5nmol/L, while for men, it goes from 9 to 30nmol/L.

Using different units, it's 20 to 80 ng/dL for females, 300 to 1000ng/dL for males.

So, and I'm playing devil's advocate here, if she has a testosterone level of say 240ng/dL, then she is 300% more than females, but only 25% lower than males.

Of course, if you compare her to the highest males, then she's only 25% of male values. So I guess it all depends who you compare her to, which I guess illustrates why this value, and saying "three times higher" is actually quite meaningless by itself.

The other point I must make is that I don't think it's right to compare her testosterone to male values. You have to compare it to female values, because that, after all, is who she will compete against.

The best way to illustrate this is to ask what would be the case if a male came along with a LOW testosterone? Say of 250ng/dL, which is lower than any male range. Would he be allowed to compete as a woman? I suspect not. So the comparison must be made with the same gender.

It just goes to show how complex the issue is, and why a single testosterone value doesn't answer the question.


Anonymous said...

if she had 3x the testosterone and needle marks in her arm, she'd face a ban. if she has 3x the testosterone and people get curious, we're supposed to be sympathetic? it must be rough running against girls when your testosterone level surpasses that of many men

Ross Tucker and Jonathan Dugas said...

Hi Anonymous @ 4.34pm

Fair point. I agree, that if she has massively raised testosterone it should cause a ban until the source of that raised testosterone is either identified and treated, or identified as doping. If it's doping, then a two year ban is fair. I would say to wait on being sympathetic about that.

I would still say one has to be sympathetic at her having to deal with such a media spotlight when it really should have been done in confidentiality. That's a pity. But like you, if it's seen to be an obvious advantage, or if it's cheating through doping, then a ban would be entirely appropriate, in my opinion.


Gila said...

Great blog--your coverage of this story is shocking in how evenhanded and sensible it is. Don't see too much of that, unfortunately.

Alan said...

First of all, any athlete that can beat their top athletic "peers" on the world stage should have a history of athletic acheivements. If they "come out of nowhere", then they should be highly scrutinized and tested, without the need for appologies.

Secondly, at that high level of competition, I would expect to see small performance gains over time. Large gains that cause the athlete to far exceed the other competitors, break records or "cruise to victories" without top efforts should be highly scrutinized and tested, without the need for appologies.

Thirdly, directly relating to Castor, the multitude of testing factors should be considered to categorize the athlete as either male or female based on competitive fairness. For example, an athlete found to possess "natural" hormonal levels far in excess of athletic females and also has gender "ambiguities" such as those found in cases of DSD's that could reasonably support the position that the athlete be categorized as a male, then the athlete should be allowed to perform in the highest competitive category of males. My reasoning is that males and females race in separate categories in order to fairly match athletes based on the natural similarities found in each sex. When an athlete is found to not fit the category's criteria for the "weaker" category, then it would provide an unfair advantage to allow such an athlete to compete in the "weaker" category. Doubts should be "rounded" up to the highest level, not down.