Wednesday, April 16, 2014

Fixing advantage by fixing bodies?

If we thought the international sports community had learned something about gender and sex, biology, identity and athleticism after the debacle caused by the International Association of Athletics Federations in its process of “gender verification” in the case of South African runner Caster Semenya, an April New York Times op-ed about these issues has shocked the naiveté right out of us. I would have liked to believe that the humiliation Semenya underwent when members of the international track and field community questioned her sex thus triggering physical, medical, and psychological examinations would become an anomaly. Based on the information presented by co-authors Katrina Karkazis and Rebecca Jordan-Young, it was not. The difference: the process of accusing and testing Semenya was very public; the process of testing and “fixing” the bodies of athletes who do not conform to the IAAF’s new hormone level policies (also adopted by the IOC and FIFA) have been quite hidden. While the Semenya case was a clear violation of her privacy, the implementation of the new eligibility rules based on the level of testosterone individual women produce seems less about privacy and more about keeping secrets.
Karkazis and Jordan-Young, drawing on a 2013 Journal of Clinical Endocrinology and Metabolism article about the case of four athletes who did not meet the new eligibility rules, are exposing some of the little known facts about their application. Some sport governing bodies, we don’t know which ones, are testing “suspect” female athletes to determine their testosterone levels. If it is too high, in other words it exceeds the acceptable level for females according to the organization’s rules, they are referred to doctors for more tests and “therapies.”
There are three issues I want to raise here that stem from those last two sentences. First, quick background: the article in the medical journal is based on four cases of young (18-21) female athletes, all from developing countries, who were sent to doctors in France when their testosterone serum levels were deemed outside the normal female range.
I will start with the most shocking piece of the article. The therapies that, once completed, allowed these women back into competition included removing internal testes and reducing their clitorises; procedures that are both medically invasive and, according to the doctors who performed them, unnecessary. Here is the text from the June 1, 2013 volume of Clinical Endocrinology:
Although leaving male gonads in [these] patients carries no health risk, each athlete was informed that gonadectomy would most likely decrease their performance level but allow them to continue elite sport in the female category. We thus proposed a partial clitoridectomy with a bilateral gonadectomy, followed by a deferred feminizing vaginoplasty and estrogen replacement therapy, to which the 4 athletes agreed after informed consent on surgical and medical procedures. Sports authorities then allowed them to continue competing in the female category 1 year after gonadectomy.
The authors do not delve into the moral or ethical implications of this treatment. Rather their premise is it is medically interesting that these women made it to adulthood without diagnosis, had family genetic histories which include other sexual differentiation disorders, and that these and other factors point to the need for screening of all young athletes “with primary amenorrhea and hyperandrogenism to protect their health and privacy and ensure fairness in female competition.”
When African and Middle Eastern people engage in genital surgeries on women, westerners call it mutilation. When French doctors do it, it gets called therapy completed in the name of competitive fairness.
Second, the idea that there is a “normal” is highly problematic. A study from the same journal, published just a year before this one, found that testosterone levels in elite athletes do not always predict success. The study of nearly 700 male and female elite athletes found overlap in the ranges of testosterone, including 16.5% of men who had levels in the “female range.” This finding reinforces previous arguments in the debate over sex testing, fairness, and advantages. Why is advantage only being measured by hormones? Swimmer Michael Phelps’s size 14 feet and hyperflexibility fall outside the range of normal. Should doctors shave down his toes and shorten his ankle tendons? Sport governance bodies are not considering the many biological and cultural conditions that confer or decrease in individual athletes. They have zeroed in on hormones.
Finally, the concept of a suspect female athlete is, well, highly suspect. Though some sporting bodies are starting screening on every competitor in female categories, the possibility of discrimination based on race, performed femininity, nationalism, and class remains too high. Who is being brought in for testing and “therapy” is about more than countries with poor health care systems, as the French doctors suggest.
How does it come to pass that sport governing organizations, whose very existence is predicated on moving, achieving, striving bodies, know so little about bodies? I would suggest that it is ironic, but I fear that word might misrepresent the gravity of the present situation. What it appears to be is that these organizations are considering and assessing the politics and the policies more intently than the interests of the athletes whom they allegedly serve. And they are using the medical industry to help them do so.