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Thursday, January 21, 2010

IOC calls for treatment in sex ambiguity cases

The complexities of gender verification:  Legal, medical and performance dilemmas

I thought I'd interrupt the weight management series for a day to cover very briefly the news being reported out of Miami, where a panel of medical experts met to discuss the complexities around gender verification.  The meeting, convened by the IOC in response to the huge controversy over Caster Semenya's win in the IAAF World Championships last year, addressed how authorities manage the minefield of equality of competition vs the rights of individuals and the medical concerns over such conditions.

It turns out, however, that fairness of competition didn't feature.  That's according to one delegate, Joe Leigh Simpson.  His words:  “We did not address fairness.  The entire concept was that these individuals should be allowed to compete.”

And the means to compete, according to news reports, is to treat the condition medically and not from the point of view of performance.  That is, if they wish to compete as females, but have a condition which gives them masculine characteristics, they should seek a diagnosis and treatment.  “Those who agree to be treated will be permitted to participate,” said Dr. Maria New, a panel participant and an expert on sexual development disorders. “Those who do not agree to be treated on a case-by-case basis will not be permitted.”

If this is the agreed upon approach, then fairness is very definitely an issue.  One cannot be forced into medical treatment as a condition for participation, surely?  The only reason to make medical treatment compulsory is to ensure fairness of competition, and so while delegates may say fairness was not an issue, it has to have been.

Other delegates have challenged this on the basis of fairness.  The previously mentioned Dr Simpson admitted that the guidelines would be deemed unfair by some female athletes, but that “we have to balance fairness to female athletes to fairness to other competitors."

The question is, does the right to compete with a possible advantage as a result of masculinization trump the right to fair competition for those without it?   Whose rights are more important, because balancing fairness requires that somebody assign a value to each side's arguments.

And legally, if an athlete decides not to seek medical treatment, can they be excluded from competing, unless some very clear guidelines are developed for how potential performance advantages can be evaluated.  Can medical treatment be bartered against competing?  As I see it, the only way this would be feasible is if athletic competition with such a sex ambiguity poses a risk - then authorities could say that they do not wish to be party to the increased risk and deny the athlete the right to participate.  The risk of having such a condition alone would not entitle the IOC to ban an athlete, surely?

This discussion may in fact be happening as we speak, with Caster Semenya's lawyers and the IAAF locked in negotiations.  Part of that discussion may involve terms for return to competition, and whether medical treatment is a pre-requisite.

As we've learned over the last few months, this is an incredibly difficult issue, with no obvious solution.  Regardless of which way you swing, there are going to be winners and losers in the debate - someone is either excluded, or large numbers of athletes are possibly disadvantaged.

My personal opinion agrees with that of Doriane Coleman, a law professor at Duke University, and a former elite 800-meter runner. “If you start to do this you are making a joke of the fact that there are two classifications — male and female.  They might as well open it up and have women competing with men.”

But that's because my paradigm is performance, advantage and fairness.  Unfortunately, it's never quite that simple.

I'll get back to other "weighty" issues next week - feeling rather burned out at this stage, I must confess.  Luckily the year is nearly over...



Ray said...

Oooh, Do I get the first comment?

I have to agree that the only issue should be balancing fairness to *all* the athletes.

The main injustice to Caster was having such a personal issue made public.

If ensuring fairness to one athlete comes at the expense of fairness to the rest of the field, everyone is worse off.

After all, Spock didn't say "the needs of the one outweigh the needs of the many"!

IMO, removing the male bits seems like the surest way to resolve the issue, and it is in everyone's interest, including Caster's.

Grant said...

This is tough and I don't think many of us can appreciate how difficult it must be to be told one is not the sex we thought we were.

Caster obviously enjoys running and wants to compete but it appears testosterone is giving an unfair advantage in a women's race but not enough of an advantage to compete against the elite men. It would also be a huge psychological hurdle for her to compete in a 'mens' race.

Her body works extremely well and far better than almost all of ours so why should she be asked to undergo surgery and accept a lifetime of pills? I for one would reject this option if it came up for my children and I hope Caster does too.

But Caster wants to compete and at this point the argument starts all over again with no solution unless Castor elects to stay as she is and compete in lower level men's races.

Zoe Brain said...

There's one obvious solution - just have one category. And anyone with an above-average level of testosterone for a female must have their male glands surgically removed.

Hmmm... I can see how some men might object to that.

Yet that's what's been advocated if the contestant is Intersexed.

I guess the rules about "basic human rights" are kinda malleable. Forcing people to have surgery that will certainly result in osteoporosis unless hormones are taken for the rest of their life.

Banning them from taking testosterone supplements to give them the normal levels produced by ovaries. Not taking into account any androgen insensitivity.

Ms Semanya's T levels appear to be no higher than many other women who are allowed to compete without a problem. At the high end, certainly. But not over the limit.

Now bear in mind that I'm Intersexed, so cannot be objective about this. Just consider though what your reaction would be if told that in order to pursue a sport, you'd have to have surgery with certain detrimental effects on your health.

If Ms Semenya has internal testes, there is a greatly increased chance of cancer in later life. But such conditions can be detected early.

We don't automatically require mastectomies for teenage girls whose families have a history of breast cancer, yet their risk is many times higher (5 times I believe) than Ms Semanya's long term risk, and early diagnosis far less certain.

Ross Tucker and Jonathan Dugas said...

Hi All

Thanks for the comments. Yes a tricky one indeed. A debate where one's opinion will be determined by whether you approach the issue from the performance or the medical aspect.

To respond to Zoe:

The difference is that if we have open competition, you would never require people to come DOWN a level, so asking males to remove their advantage is not going to happen - it's called 'open' because there is no "bar", which is what you'd be applying by forcing males to bring their testosterone levels down to female levels. Your "open" is effectively a female category in this case.

And also, there is no reason to believe that Semenya's testosterone is "no higher than many other women". For all we know, it's three times as high as anything ever measured, comparable to male ranges. That info has never been disclosed, so I'm not sure about that. Unless you know something nobody else does?

Where I agree is that bartering medical treatment off as a condition for sports participation is a very complex issue. I've said as much in the post.

however, as I said upfront, I'm also not impartial, and my focus in performance, and so maybe I am biased in the direction of those other athletes who participate. But granted, linking surgery to participation is a very dicey prospect, unless, as I said, someone can prove that competing as an intersexed individual increases the risk beyond normal. Then there would be grounds for it.

Having said that, I still think it's the solution, because of the equality of competition, but that's merely my opinion. I can fully see the problems with it. Just as there are problems with the position of letting people run with potentially large advantages.

Caster Semenya, just so that I've put it on record, will break the women's world record by 4 seconds by the time she is 24, if she is coached properly and allowed to compete in her 2009 condition. That, to me, is not on.


Tgirl said...

Zoe makes some valid points.

The assumed gender binary is very difficult for those of us who don't fall within one category or another.

While I'm transgender and not intersexed, I still have a lot of empathy for Zoe and presumably Caster.

However, it is also important to realize that women's sport has been extremely important in enriching the lives of the 3 billion women on the planet. Women deserve to be able compete on a level playing field as best as can be managed.

And it's important to note no one will be forced to take treatment against their will. But if one is to compete against women, then one should have female levels of hormones.

BTW I raced at a fairly high level as a male. After surgery I compete at almost the same level as a female. Thus, I think that the proposed suggestion is fair in terms of competition.

Anonymous said...

Guys, wonderfull analysis as always. Will you cover Gebrselassie Marathon WR attempt in Dubai?

Mike Russell said...

This is a very complex issue without any clear solution. There are human elements involved here and someone will end up getting hurt regardless of the decision. On one of the spectrum is genetic testing and basing the classification on sex instead of gender. On the other is an open invitation based on gender.

While neither sounds fair, it may eventually get to that point.

David said...

Tough issue. On the topic of fairness, what is at stake is the fairness of women's competition, which must be restricted to women, as defined by some set of rules.

No one is excluded from competition nor required to have medical treatment in order to compete. Technically non-female athletes simply will compete in the male or open category. That they might not be elite in that category is certainly possible, but being an elite athlete is a genetic gift (curse?) anyway.

Technically non-female athletes will no doubt organize their own events. Maybe someday the Olympics will have an intersex category (and some men will have to prove their right to compete in it).

Ross Tucker and Jonathan Dugas said...

Hi all

Thanks for the comments.

No time right now to respond, hopefully tomorrow, I'll be able to.

Just to anonymous, I hope we can cover some aspect of Dubai. The problem is that I don't get any coverage of it here in SA, so I kind of rely on news reports and can only really give second hand views.

The race is in a few hours though, we'll see what happens and get on it if anything significant goes down!


Roger said...

I've now read Doriane Coleman's statement in a couple of places and still can't figure out what the "this" in the "If you start to do this.." refers to. Any help?

Doriane said...

For Roger: "This" refers to the medical experts' recommendation to the IOC that intersex athletes who were assigned (or self-assigned) the female social sex be permitted to compete in the women's sport category even if their biology otehrwise takes them out of that category. Imagine, for example, a person who is 46,XY with 5-alpha reductase deficicienty who was assigned the female social sex at birth.

tgirl said...


Of course you are entitled to your opinion, but there is no reason that a 46,XY individual with 5-alpha reductase deficicienty could not compete as female with the correct treatment. I am certain that gonadectomy plus estrogen therapy would do the trick.

petergrasse said...

While we have competitions for male and females, age groups, and weight classes, what about compensating for other physical attributes that enhance performance. This takes us into one of the topics that you have previously explored regarding physical limits. If you sports scientists would get your act together(I'm kidding), we could normalize an athlete's performance at an event against their real physical performance limits.

Mianne Bagger said...

It's interesting to continually hear people talking/writing about 'fairness' or about creating a 'level playing field', but I have never known anyone to actually define 'fair' or explain what a 'level' playing field is? ...might be a good place to start.

For example; I would say someone with higher testosterone levels than other competitors (male OR female) would be competing with an advantage over other competitors.

So, let's say for example that Usain Bolt has higher levels of testosterone than all other male runners ....Would that be 'fair'? ...is that a 'level playing field'? (there is no truth to that comment, only using this as an example for clarification of a point. I use him as an example because he was competing at the same event as Caster and because of his numerous gold medals and world records.).

So if it's reasonable that people (IOC et al) think it reasonable to subject a woman to treatment because they deem her too 'masculine' (however that might be determined), would it not seem reasonable that Usain Bolt (or any other male athlete with higher levels than 'normal') should have to take medication to lower his testosterone to that of other competitors? To *what* level?

I have also seen numerous references to the elevated levels of Casters testosterone and then comparing them to those of males. From all the figures I have seen, 3 times the average level of testosterone for women still doesn't even equate to male testosterone on the LOW end of the scale!

So, where does this leave sport? It seems quite clear that anyone's definition of 'female', at this stage, is going to be an arbitrary one, quite possibly based solely on social stereotyping and physical attraction. What does 'too masculine' mean? How is that defined?

Caster didn't even break any world records so there have been other faster women before her. Oh, maybe they were 'pretty', so it was ok? :/

Yes there is a problem with the binary classification of male and female in sports, because we all know it isn't simply black and white, clear cut. So maybe sport should be defined on something else?

What about on androgen levels? There are weight classes for some sports. There are age categories. So why not androgen/testosterone levels?

If people continue to squabble about trying to define when someone is female, this debate is *never* going to end. Has anyone ever noticed that the discussion and tests are never about proving whether someone is actually male OR female. It is only ever about showing whether someone is female *or not*. And in our system, if someone is not female, they default to being male, even though it hasn't been proved conclusively that someone is actually male!

Tablet PC accessories said...

Many professional athletes are gifted in ways that the average population is not. To begin classifying some of these genetics gifts as "okay" and others as "not okay" is a slippery slope.

Shaquille O'Neal is genetically gifted to be as tall as he is. At a young age, he realized his height gave him an extraordinary advantage over other boys in the game of basketball. As a result he's earned millions of dollars as a professional basketball player.

Caster Semenya loves athletics. At some point, she realized she was faster than most women her age. As a result she's a World Championship Gold Medalist in the 800m.

What makes his situation so different than hers?

Anonymous said...

The difference is that Shaquille O'Neal isn't playing in the women's basketball league.

Roger said...

I've now read Doriane Coleman's statement in a couple of places and still can't figure out what the "this" in the "If you start to do this.." refers to. Any help?