By: Bailey Frohlich  | 

Bioethics in Practice: Battle of the Sexes— Talent or Testosterone?

Gender, as both a means of identification and a sociological construct, is constantly evolving. The traditional two gender system has been supplanted by an expanding lexicon that includes nonconforming terms such as genderqueer, gender fluid and non-binary. In order to mitigate misgendering, it is now common in diverse workplaces to include in one’s email signature preferred gender pronouns, such as “he/him/his,” “she/her/hers” or the gender-neutral, “they/them/theirs.”

Whereas differential treatment by gender is illegal in many domains, such as medical care, employment and education, sports remains one of the few areas in which it is legal, and in fact necessary, to differentiate between males and females, consequently creating an international bioethics controversy.

Most recently, the controversy surrounds South African Olympic athlete Caster Semenya, who holds two 800-meter Olympic titles and three world titles. Semenya was born and raised as a female, as she has external female sexual characteristics and identifies as cisgender. Yet, after being forced to undergo “sex-determination testing” following her 2009 Berlin victory, Semenya was diagnosed with 46, XY disorder of sex development (DSD), a congenital condition in which her chromosomal makeup is XY, the normal male chromosomal pattern, yet her external anatomical development is typical of a female. Individuals with DSDs are often referred to as “intersex,” and conditions such as 46, XY DSD, in which a person’s reproductive anatomy or appearance is not consistent with their 23rd chromosomal pair, are termed “sex reversal”. 

In April 2018, the International Association of Athletics Federations (IAAF) issued new eligibility regulations for female athletes with DSDs, requiring them to reduce their blood testosterone levels to below 5 nMol/L — which the IAAF considers the upper limit of natural female levels — in order to be allowed to compete in certain female events. They were advised to do so via hormone therapy. Although the International Court of Arbitration for Sport (CAS) upheld the IAAF regulations in an Executive Summary they released this past May, Semenya refuses to take any hormone-suppressing drugs and continues to contest the decision in court.

According to CAS’s report, both parties agree on the necessity of gender division in sports, as “there is a substantial difference in elite sports performance between males and females.” This assumption is the basis of separate men’s and women’s teams in every athletic level, from Little League to the Olympics, and it is at the heart of the historically-famous “Battle of the Sexes” tennis match between Billie Jean King and Bobby Riggs.

However, the ethical issue surrounding CAS’s controversial policy hinges on the acceptability of using testosterone levels as the determining metric for gender categorization in DSD athletes. While varying levels of testosterone contribute to the differential performance of males and females in sports — such that testosterone contributes to the power and size of skeletal muscle and the number of red blood cells — the degree to which elevated testosterone levels confer a significant competitive edge is a matter of scientific debate. 

Proponents of the CAS ruling err on the side of caution: although the decision may be discriminatory to DSD athletes, as it bans them from competing in events based on a congenital condition that is beyond their control, it ensures athletic fairness and preserves the original purpose of gender divisions in sports. Since there must be a concrete basis on which to distinguish between male and female athletes, testosterone levels seem like the best option since it can be scientifically linked to athletically-superior traits. Thus, if a 46, XY DSD athlete can lower her blood testosterone level to 5 nMol/L, she would be allowed to compete, as her competitive advantage would be diminished.

However, the opposing opinion argues that testosterone cannot be used as a metric, since biologically, it is not the sole determinant of athletic prowess. High testosterone levels is just one single factor that contributes to athleticism, among others such as height, natural agility and coordination, body structure, and mental toughness. What distinguishes Usain’s Bolt’s height and Michael Phelps’s reduced lactic acid production from Caster Semenya’s advantageous physical traits? In fact, Eero Mäntyranta, a Finnish Olympian skier who won seven medals, had a condition called polycythemia, which causes abnormally elevated blood hemoglobin and red blood cell concentrations due to a mutation in the erythropoietin-receptor gene. Although his increased oxygen-carrying capacity undoubtedly conferred a competitive advantage, Mäntyranta competed without opposition. How is his case different than Semenya’s?

Furthermore, to take CAS’s decision to its natural conclusion, what would the policy be against XX females who naturally produce levels of testosterone that exceed 5nMol/L, such as with women who have the inherited disorder congenital adrenal hyperplasia? Although such a woman would have elevated testosterone levels akin to Semenya’s, the former would be allowed to compete simply because her inherent chromosomal makeup is typical of a female, regardless of the “substantial difference” in athletic performance that the IAAF and CAS claim is caused by testosterone.

As a female collegiate athlete, I appreciate the merits and shortcomings of both sides of the discussion. Although maintaining fairness in sports is a significant value, Semenya’s case begs us to consider the ethical implications of basing an international policy on controversial scientific evidence and such a decision’s ramifications for future gender-related policies.

Photo Caption: Caster Semenya
Photo Credit: Wikimedia Commons