Sex At The Olympics: New Rules

Just the other day, the International Olympic Committee (IOC) issued a memo detailing their new policy for genetic verification of athletes (called ” sex-verification test”).  The new policy was summarized in a NYT article published yesterday and entitled “I.O.C. adopts policy for deciding whether an athlete can compete as a woman,” and writtten by Juliet Macur (the article was also in the sports section of the NYT today).   I find the new policy interesting, but clearly lacking a sound physiological basis.  On the other hand, the new policy might just be the best way to deal with a very sticky problem?

The history of gender verification testing at the Olympics

It was not until the 1968 Winter Olympics in Grenoble, France that the IOC started mandatory testing for gender.  I am not sure how the testing was actually performed, but I think it was a type of chromosome testing.   This decision was based on a long series of reports that some countries, such as  East Germany and the USSR were using androgens in female athletes to gain competitive advantage.  The IOC discontinued the testing as a general policy  in 1999, but reserved the right to test any athlete.  The situation became quite complicated with the emergence of a South African middle-distance runner, Caster Sememya, who had won gold in the 800 metres at the 2009 World Championships.  To make a long story short, she was thought to be very “masculine-looking” and had gender testing performed, after which she withdrew from international competition; in mid-2010 she was cleared to return to competition and won the silver medal in the 800 meters in the 2011 World Championships.  The precise details of her gender testing results are not known but it is widely thought that she was not a male masquerading as a female but rather, a person with an intersex condition.  She has a long Wikipedia entry which I encourage you to read (there is also a lengthy New Yorker piece about her).  Anyway, this case brought the question of gender verification testing back into the spotlight.

Sex and athletic performance

Before puberty, male and female athletes perform at about the same level.  Once puberty kicks in and male testosterone levels climb, it is a whole different thing.  There is no question that beginning in puberty, males consistently outperfom females in sports that require strength and endurance.  It is all about testosterone.   The average adult male serum testosterone level is about 7-8 times higher than in females.  In males, the daily testosterone production is about 20-fold that in females.  Basically, guys are awash in testosterone.  This makes them stronger and faster than the gals and that’s why no one is very excited about a person with male testosterone levels competing as a female athlete, whether the person is a male or is a female who happens to have a male testosterone level.

What is the new IOC policy?

The new IOC rules do not actually address sex-verification, but rather, serum testosterone levels. To compete in the Olympics as a female, a person’s serum testosterone level must not be in the normal range for a male.  The IOC has not published what specific levels they will use, but the usual upper limit of normal serum testosterone in adult females is about 75 ng/ml.   The lower limit for adult males is about 300 ng/ml.  The idea is that anatomic and/or genetic criteria are not so important, but rather,  it is having a serum testosterone level in the normal male range that gives a competitive advantage to individuals who wish to compete in female events.  It is a very interesting approach which has its limits but which may actually be as good as any other approach that has been proposed.

What’s wrong (maybe) with the IOC approach?

As I see it, the big problem with the new IOC appraoch is that it takes an overly simplistic view of the role of testosterone in athletic performance.  For example, female children born with a genetic condition called congenital adrenal hyperplasia (CAH) are typically exposed to high levels of testosterone (from their adrenal glands) throughout the pregnancy.  These genetic females may have external genitalia that can range from appearing mildly masculinized to appearing completely masculine but without testes.  The disorder can be treated with various hormones and the genital abnormalities can be repaired,  yet even if the male hormone levels are kept within the normal female range from near birth onward, these young ladies may not be your typical female child.  They often have male-like play patterns (i.e., they like cars and such better than dolls) and are well known to be excellent athletes, presumably the result of prenatal testosterone effects on muscle development (NOTE: their gender identification is definitely female).  I am not saying that females with CAH shouldn’t be allowed to compete in the Olympics as females, but only that competitive advantage from testosterone can be more complicated than just what one’s serum testosterone level is at the time of the sports competition.

What’s the bottom line?

When I first read about the new IOC policy, I thought it was misguided.  But the more  I think about it, the more I think it is an imperfect but reasonable way to deal with a very complicated problem.  Time will tell.

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