Middle distance runner and two-time Olympic champion Caster Semenya has lost her battle against International Association of Athletics (IAAF) regulations that exclude her, and others, from competing as women because of their higher than typical testosterone levels.
The Court of Arbitration for Sport (CAS) upheld the associations restrictions in a 2-1 vote.
The landmark decision means female athletes with naturally elevated levels of testosterone cannot compete against other women in some track events unless they make efforts to reduce the testosterone in their bodies.
However, testosterone is not the male sex hormone and it’s not the key to performance, says anthropologist and bioethicist Katrina Karkazis.
Karkazis says some of the most complicated debates about sex, sexuality, gender presentation and gender identity are about hormones.
“Even if people don’t care about sport, it’s incredibly relevant in terms of the sort of socio-political kinds of debates that are happening and playing out in this grand international level.”
And, she says, the IAAF regulations aren’t backed by science.
In fact, the IAAF’s own analysis found women with lower testosterone did better in 6 out of 11 running events.
The regulations only apply to events of 400 metre to a mile. The biggest difference testosterone made, the IAAF found, was in pole vault and hammer throws – events that aren’t even included in the regulation.
“Why are they regulating events for which there is no evidence?”
Karkazis’ research aims to challenge entrenched scientific and medical beliefs about gender, sexuality, and the body.
She says the current regulations breach human rights law.
“Women who do lower their levels are required to do so through medically unnecessary interventions and the UN, among other bodies including the World Medical Association, have spoken out to say this is unethical and violates key human rights.”
The idea that testosterone is the male sex hormone is unscientific, she says.
In 1935, the testosterone hormone was isolated.
Before this, Karkazis says researchers were trying to understand the difference between males and females.
“They did these crude, gross experiments but even during that time what they were looking for was anything they understood to be masculine and they weren’t looking for anything they understood to be feminine, so the experiments in many ways, reconfirmed what they already thought.”
They also found a lot of puzzling results that didn’t fit this paradigm, she says.
“One of the more basic ones is that actually men and women both have testosterone.
“But rather than update our language and our thinking in many ways broadly, culturally, even in some of the science, instead what’s happened is its sort of become this sedimented idea that is used everywhere from the IAAF regulation, to newspapers to scientific research with this outdated an unscientific idea that this hormone is the male sex hormone.”
It’s helpful to think about testosterone like height, says Karkazis. While on average men’s levels might be higher, it’s not always the case.
“When people, even without thinking about science of averages, think about who they know in the world they understand that there’s an overlap between men’s and women’s heights… testosterone is the same.”
There are men with levels lower than the typical range for, for example.
The real question is not what level of testosterone someone like Semenya has, it’s what that hormone might be doing for performance, she says.
“If there’s no performance difference, or one that is not of significant magnitude between women of varying levels, then there really is not a problem here because these women belong in the category, indeed the whole reason they’re being regulated is that the regulation only applies to women and not to men.”
Karkazis says it appears that the IAAF are only targeting Semenya to people on the outside because only a small number of track and field events have regulations that impact intersex women.
“So many people point to Caster Semenya as evidence of what they call unfair advantage but Dutee Chand is also an athlete with higher than typical testosterone levels and people don’t point to her performances as example of unfair advantage in part because she is an extraordinary athlete, but she is not dominating in the way that Caster is.”
Chand, and any other women who specialise outside of the narrow range of events that are regulated, can still compete.
Female athletes have been sex-tested for decades, says Karkazis.
“Across these decades, what sports officials have done is to choose a biological criterion - it’s not really been testosterone before this most recent period – chromosomes, other kinds of markers to determine whether or not women belong in the female category.”
This was based on a false idea that there is one marker in the body that can be used to classify people as male and female, she says.
But as professional medical organisations and the athlete’s commission rallied to stop this, and mandatory testing was abandoned, an ad-hoc policy has remained in its wake, she says.
“Someone appears suspicious to organisations, they can investigate them.
“They’ve long known that there’s not a single trait they can rely on and testosterone was even proposed in the 1990s and rejected by sports governing bodies for precisely the reasons that it is being critiqued right now.”
The biology of humans is not as simple as society would like it to be, she says.
“Chromosomes are not determinative of one’s sex and in fact, that is uncontested in the broader endocrine and genetic in science.
“There are women, for example, that have XY chromosomes and high levels of testosterone, but their tissues can’t use that hormone at all, they have a completely female phenotype body, so it is really untenable to think about putting those women in the male category because everyone would find this socially and otherwise absurd.”
These women’s experiences are no different to their peers, they are legally women, and have lived their whole lives as women, says Karkazis.
“If the hormone wasn’t gendered, I truly believe we wouldn’t be having this debate as all, but it’s framed as masculine, as the driver of all things masculine in men it is in part a contributor to where we’re at right now.”
Testosterone regulations disproportionately affect women of colour from the global south.
“We know, both from the IAAF statements, but also from the women speaking up, that the vast majority, if not all of the women affected are women of colour from the global south.
“..It is not simply a matter of race, what is happening is that in the global south… what is really different is that the intervention paradigm that has been practiced in the global north for almost seven decades now, on women with intersex variations, where it involves very intensive interventions on babies and young children early in life, that has not been practised in the same way in other parts of the world.”
It’s not that more women in this area of the world are born with higher than typical levels of testosterone, it’s that their bodies aren’t being medically changed doing irrevocable damage and violating their bodily autonomy, she says.
“There are people around the world who have an intersex identity but that is not true of all people who have intersex variations. Many, many people with intersex variations identify as women and as men and they may have a physiological difference, but that’s not tied to their identity.”
Karkazis believes the president of the IAAF has an opportunity to educate people about some of the deep complexities of these issues; the complexities of sex traits, sex biology, the complexity of the relationship between testosterone and athleticism.
“The IAAF have not done that. Indeed, what they’ve done is actually stoke fear and misinformation.”
“I absolutely think this is pushing back the rights and acceptance and kind of inclusion that we need for LGBTI individuals in society and that these debates are not fostering this inclusion and indeed they’re creating individuals as others who don’t belong.”
Katrina Karkazis is a senior research visiting fellow in the Global Health Justice Partnership at Yale University and co-author of a soon to be published book: Testosterone: An Unauthorized Biography.