Hyperandrogenism Regulations in Sport

Dutee Chand plans on running in the 2016 Rio Olympic Games. After a year of withstanding intense public scrutiny, during which she remained sidelined, the nineteen-year-old Indian sprinter can now lace up her spikes and return to the international track and field scene.

Women’s 200 meters respective silver and bronze medal winners from India Asha Roy (R) and Dutee Chand flash victory signs after their race on the fifth and the final day of the Asian Athletics Championship.

Chand first rose to prominence in 2012 when she clocked in at 11.8 seconds in the 100-meter sprint, becoming India’s under-18 champion. The following year she continued to demonstrate her athletic capabilities by winning a bronze medal in the 200-meters of the Asian Championships. Chand then finished first in the 100-meter and 200-meter races, with finishes of 11.73 and 23.73, respectively, in the 2013 National Senior Athletics Championships. After this brief taste of victory, however, her athletic career abruptly skidded to a halt.

Days before the 2014 Glasgow Commonwealth Games, the Athletics Federation of India (AFI) deemed Chand ineligible to compete. The organization had conducted an examination on the athlete, without informing her of the test’s purpose, requesting her consent, or disclosing the results. Following the International Association of Athletics Federations’ (IAAF) regulations on hyperandrogenism, the AFI informed Chand that she could either retire from racing or undergo medical “treatment” necessitated by the guidelines.

Chand opted to fight the policy instead. She filed suit against the IAAF in the Court of Arbitration for Sport (CAS), an independent organization that facilitates the settlement of sports-related disputes. On July 24, 2015, after four months of consideration, the CAS permitted Chand’s return to competition. “I’ve been through a lot but I’m happy with the judgement,” she said. “My immediate aim is to qualify for the Rio Olympics.”

Chand’s plight adds yet another chapter to the long history of sex/gender testing in elite competition. The IAAF’s and IOC’s sex/gender policies, from anatomical inspections in the interwar era to the hyperandrogenism regulations in the new millennium, continuously targeted women who did not outwardly present Western notions of femininity, unfairly excluded female athletes from competition, and regularly discriminated against women from less affluent nations. Although Chand’s victory does not provide a definitive end to testing, it has, at least momentarily, stopped the practice and cast doubt on the validity of such controls.

Sex/Gender Testing: A Brief History

Throughout much of the twentieth century, the IAAF and the International Olympic Committee (IOC) implemented medico-scientific technologies to identify potential male imposters in women’s competition and uphold fair play. Starting in the interwar era, the two organizations required “suspicious” women—those who did not subscribe to normative notions of Western femininity—to undergo an anatomical investigation. Neither the IAAF nor the IOC ever uncovered a single example of a male masquerader. Nonetheless, fearful of the potential for inauthentic participants, sport officials increased the sex/gender control measures. In 1946, the IAAF mandated that all female athletes submit a doctor’s note verifying their sex prior to competition. The IOC instituted a similar policy for the 1948 London Summer Olympics.

IAAF regulations for women's eligibility in the 1966 European Athletics Championships.

IAAF regulations for women’s eligibility in the 1966 European Athletics Championships.

Yet, with the heightening of the Cold War, and the increased cultural capital awarded to international sport, practitioners worried that unscrupulous individuals could provide fraudulent documentation. Therefore, at the 1966 British Empire & Commonwealth Games, the IAAF implemented a “nude parade” where physicians inspected female athletes prior to competition. The practice continued in the 1966 European Athletics Championships, 1966 Asian Games, and 1967 Pan American Games.

To further increase policing, the IAAF instituted a buccal smear test at the 1967 European Cup Track and Field Event. The buccal smear test, also known as the Barr Body test, identifies chromosomal composition. Although endocrinologists and geneticists immediately pointed out the incorrectness of using chromosomes as a singular identifier of sex, the IOC adopted a similar practice. At the 1968 Grenoble Winter Olympics, officials instituted a check based on a lottery system; one-out-of-five female athletes underwent the control. Finding the method valid to determine sex, the IOC required all female Olympians undergo the check at the 1968 Mexico City Summer Olympics. The IAAF and IOC thereby chromosomally circumscribed womanhood for over twenty years.

However, the existence of chromosomal varieties led the medical community to protest the IAAF and IOC’s sex/gender policies. Opposition peaked in the 1980s and eventually convinced the IAAF to abandon compulsory controls in 1992. Yet, the athletics federation retained the right to check any “suspicious” competitors, those who did not perform Western femininity. When the IAAF terminated all mandatory pre-competition testing, the IOC switched tactics. In 1992, Olympic officials implemented PCR testing, which used DNA to determine sex. Immediately, the method proved erroneous in the determination of sex and highly susceptible to false positives, forcing the IOC to drop all sex/gender testing in 1999.

For just over a decade, then, female athletes competed unhindered. But yet again, the physical appearances of female athletes convinced sport authorities that unfairness plagued women’s sport. To combat this supposed injustice, the IAAF and IOC introduced regulations on hyperandrogenism.

Hyperandrogenism Regulations in Sport

In 2011, the IAAF and IOC targeted “suspicious” female athletes through hyperandrogenism testing. This time, the IAAF and IOC besieged women who naturally produced higher-than-average levels of endogenous testosterone. In the 2011 “Regulations on Female Hyperandrogenism,” the IOC explained that “androgenic hormones have performance-enhancing effects, particularly on strength, power and speed, which may provide a competitive advantage in sports.” In other words, the policy targeted characteristics conventionally defined as “masculine.” To curb this supposed threat in sport, Olympic officials required all National Olympic Committees to “actively investigate any perceived deviations in sex characteristics.” Echoing these concerns, the IAAF implemented a similar policy.

IAAF Hyperandrogenism Regulations, 2011.

IAAF Hyperandrogenism Regulations, 2011.

The track and field federation adopted the “IAAF Regulations Governing Eligibility of Females with Hyperandrogenism to Compete in Women’s Competition.” According to this policy, the successes of women with hyperandrogenism in international competitions “has proved to be controversial since the individuals concerned often display masculine traits and have an uncommon athletic capacity.” Once more, the anxieties stemmed from Western norms of femininity and athleticism. Significantly, the IAAF drew a line in the sand and decided that any female competitor with endogenous testosterone above 10 nanomole per liter (10 nmol/L) could not participate in track and field unless she could either prove she was resistant to androgens or agreed to undergo medical intervention to suppress her hormones. The IAAF suggested that because most women have levels of endogenous testosterone between 0.1 and 3.08 nmol/L, and the lower threshold of testosterone in men starts at 10.5 nmol/L, the 10 nmol/L standard served as a dividing point between women and men.

The IOC embraced a similar approach for the 2012 London Olympics. Four Olympic hopefuls—all aged twenty-one-years and younger—were identified as having hyperandrogenism. After barring them from competition in London, the IOC ordered them to Nice and Montpellier, France, for treatment. The medical practitioners responsible for the intervention noted that the women were muscular, slim, and tall, and all hailed from “rural or mountainous regions of developing countries.”

To ensure the athletes’ future participation in sport, the doctors recommended they undergo a corrective measure. Importantly, as noted in the report, skipping the surgery “carries no health risks.” Undergoing the procedure “would most likely decrease their performance” but “allow them to continue elite sport in the female category.” The specialists also conducted “feminizing vaginoplasty,” an aesthetic (re)construction of the vagina. In other words, the practitioners performed an unnecessary operation that did not address a health issue, then followed it up with plastic surgery to align the women’s genitals with contemporary ideals of anatomical compositions.

Protests ensued and issues continued.

Court of Arbitration for Sport

Refusing to undergo an operation that did not aim to address a health issue, Chand fought the IAAF’s policy. In a letter to the AFI penned in September 2014, she explained that the “androgen level produced by my body is natural. I have not doped or cheated. . . . I feel perfectly healthy and I have no health complaints so I do not want to undergo these procedures.” The Sports Authority of India, the central sporting body of the country, agreed with Chand. According to the SAI, “the IAAF policy on hyperandrogenism is unscientific, unfair and unethical. The medical intervention recommended to reduce an athlete’s natural androgen is also invasive, irreversible, and harmful.” With the SAI’s support, Chand took the IAAF to court.

The CAS identified three significant issues underlining the case. First, the court debated if the Hyperandrogenism Regulations impermissibly discriminated against female athletes on the basis of a natural biological characteristic and/or sex. Second, CAS examined whether or not scientific evidence exists that proves testosterone improves athletic performance. The court also questioned if the 10 nmol/L designated by the IAAF is the correct dividing point between men and women. Finally, the court weighed the proposed fairness of the policy against the harm caused to the excluded athletes.

Chand argued that the IAAF’s Hyperandrogenism Regulations were founded upon two significant flaws. Endocrinologist Richard Holt, biomedical ethicist Katrina Karkazis, and psychology and women’s studies professor Sari van Anders provided the main testimony to support her claims. Foremost, Chand disagreed that elevated levels of naturally-produced testosterone automatically creates an athletic advantage. According to Holt, scientific studies fail to conclusively point to testosterone as the singular determining factor for athletic success. “The best available science does not support the assertion that differences in endogenous testosterone levels explain differences in performance,” Holt explained. Other factors, such as affluence, height, and training also come into play.

Second, Chand posited that medical science is incapable of distinguishing testosterone thresholds for men and women; hence, the 10 nmol/L division point is arbitrary and inaccurate. Holt and van Anders explained that significant overlaps exist between men’s and women’s endogenous testosterone levels, similar to overlaps in men’s and women’s heights. Just as it would be inappropriate to separate men and women on the basis of height, they argued, it is inappropriate to separate men and women on the basis of testosterone levels. Moreover, noted van Anders, a variety of factors influence testosterone levels, such as age, body composition, exercise, health, medication, relationship status, seasonality, sexual activity, sleep pattern and duration, and time of day. As such, no scientific norms for testosterone levels in men and women exist. Finally, Karkazis pointed out the tendency of sport organizations to criminalize female competitors based on Western notions of masculinity and femininity.

Courtesy of WikiMedia.

Courtesy of Wikimedia Commons.

To counter Chand’s arguments, paediatrician Martin Ritzen testified on behalf of the IAAF. He contended that Holt and van Anders had incorrectly interpreted the policy as an effort to distinguish women from men. Rather, Ritzen explained, the Hyperandrogenism Regulations seek to curb a biological advantage. Along those lines, he argued that testosterone is “the most important factor” when explaining differences in athletic performances between male and female participants. Therefore, it is logical to use testosterone levels as the distinguishing factor. Ritzen also disagreed with Holt and van Anders that overlap exists between male and female levels of testosterone. In Ritzen’s view, no commonality occurs between the two thresholds.

The CAS took the conflicting testimony into consideration and concluded that while men and women have different testosterone levels, the actual benefits of possessing higher testosterone remain murky. According to the court, the evidence presented did not illustrate the “quantitative effect” on performance when an athlete was above the 10nmol/L level. Put simply, no scientific study conclusively demonstrated that higher-than-average testosterone levels result in an unfair athletic advantage. “[T]here is presently insufficient evidence about the degree of the advantage that androgen-sensitive hyperandrogenic females enjoy over non-hyperandrogenic females,” explained the CAS. “In it not self-evident that a female athlete with a level of testosterone above 10 nmol/L would enjoy the competitive advantage of a male athlete.”

Therefore, the court ruled that the IAAF needed to establish the degree of competitive advantage conferred by a higher endogenous testosterone level. Until then, the CAS suspended the Hyperandrogenism Regulations for two years. The IAAF now has the opportunity to submit such evidence; however, if the federation does not, the regulations will be voided.

Although her victory in court may only be brief, Chand celebrated the CAS decision. “My mother told me that no matter what people said, God was always with us,” she said. “She is relieved and happy that I can continue to run.” The IAAF’s ability to conclusively verify the competitive advantages of endogenous testosterone remains debatable. Nevertheless, as the federation attempts to locate scientific evidence to support its policy, Chand will return to the track.

Yesterday, she resumed racing in the 55th National Open Athletics Championship in Kolkata, India. Two years ago, she won the 100-meter and 200-meter races in the 53rd Championship, but had to sit out of the events in New Delhi. “Through this meet, I want to put my best foot forward and hope I can get back into the Top scheme,” said Chand, referring to the Sport Ministry’s Target Olympic Podium (TOP) scheme. The program identifies potential medal prospects for the Olympics.

If she does, her next stop? Rio.

Lindsay Parks Pieper is an Assistant Professor of Sport Management at Lynchburg College and author of the forthcoming book Sex Testing: Gender Policing in Women’s Sports (University of Illinois Press, June 2016). She can be reached at pieper.l@lynchburg.edu and can be followed on Twitter @LindsayPieper. Check out her website at www.lindsayparkspieper.com.

One thought on “Hyperandrogenism Regulations in Sport

  1. Pingback: Fair play at the Olympics: testosterone and female athletes | Em News

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