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.
