But are you woman enough?

It’s only a week out to the Rio Olympics so I’m taking this opportunity to take a look at some of our assumptions around sex categorisation in sport and what this means for female intersex athletes!


When it comes to sport, we immediately assume that there is a necessity to separate men and women. This just seems like common sense – we generally think that men and women have different strengths and skills based on their physical capabilities, and while we recognise that this does not necessarily apply to all men or all women, as a general statement we believe this to be true. We also believe that these differences lie in the testosterone levels of men and women, and that this explains why men on average outperform women in comparable events.

Unfortunately things are never so simple.

Levels of testosterone vary incredibly even within male/female categories, and while it is true to say that on average men have a much higher level of testosterone than women, there is so much variation and crossover between the two that it is actually impossible to determine whether someone is a woman or a man solely based on their testosterone levels. A number of elite male athletes fall into the “normal female range” and, similarly, a number of elite female athletes fall into the “normal male range”. The differences in these athletes may be explained by intersex variations or simply just that some people naturally produce more or less testosterone. Interestingly, there appears to be a significant lack of evidence on the effects of naturally occurring testosterone on athletic performance, and no proven difference in performance between women with high levels of testosterone (high T) and “normal” levels. The Court of Arbitration for Sport has found that even if there is a difference, no evidence suggests that high T in women offers any greater advantage than that offered by any other biological variation. To put it simply – testosterone levels alone can’t predict an individual’s athletic performance.

Now, I’m not saying we shouldn’t divide sport by male and female categories. While it can get problematic for people who are trans** or intersex, it clearly is an easy division that also makes a lot of sense regarding general physical capabilities. The problem is that we can’t determine exactly what it is that provides athletic advantage. Natural levels of testosterone certainly may and probably do have some impact on athletic capabilities, but there are also so many other physical attributes that also impact performance – be it longer legs, bigger hands or feet, bigger lung capacity, faster reflexes, the number of fast twitch muscle fibres and more – and depending on the sport, different attributes will be more valued. Most of these are not really associated with a particular sex. Certainly some are – for example, men are on average taller than women and have leaner body mass – but there is still a huge degree of variation amongst those in a particular sex and crossing over into the other sex. So while I think it makes sense to divide men and women in sport, it’s important to recognise that there’s a fairly complicated interplay of attributes that contribute to an individual’s athleticism, which evidently can’t be solely reduced to their testosterone levels.

However, because of this binary division we’ve created, problems arise for those who don’t easily fit. By so strictly dividing everyone into two groups when we’re actually trying to accommodate a wide spectrum of people, we’re forcing some people into categories that don’t completely describe them. We then become surprised when it doesn’t, and our response is to change them to fit into one of these groups.

Lead sporting bodies have come up with various arbitrary rules to categorise athletes as men or women, but historically this hasn’t proven very successful at all. “Gender testing” first began by international sports bodies in the late 1960s to ensure that men weren’t pretending to be women to win medals, but from then until now it’s never once occurred. Instead, sex testing has operated solely to stigmatise and hurt women with intersex characteristics and/or high T. From the early years of rudimentary physical examinations of external sex characteristics, to chromosomal testing, to the latest iteration of sex testing based on testosterone levels, the International Olympic Committee (IOC) and International Association of Athletics Federation (IAAF) have consistently failed to find a single test to determine whether athletes should compete as men or women. And they never will. They won’t be able to find one simple test because biologically there’s no one simple distinction. I came across this cool interactive that places you as a medical examiner for the upcoming Games – check it out for a bit of an insight into some of the difficulties that can arise in determining sex!

Caster Semenya underwent gender testing in 2009 when her 'masculine' appearance raised concerns (photo from How Africa)
Caster Semenya underwent gender testing in 2009 when her ‘masculine’ appearance raised concerns (photo from How Africa)

The outcome of these unsuccessful attempts to easily place everyone into the binary is that we discriminate against and hurt those who don’t. We make them the problem, when surely the real problem is our inability to accommodate what is a natural variation of the human body. The recent high profile cases of Dutee Chand and Caster Semenya reflect the pressures placed on female intersex athletes and those with high T levels. What they’ve had to go through in the last few years is really upsetting and has hugely affected them emotionally and professionally. Both of them have been denied the opportunity to compete in events, subject to intimate examinations, publicly humiliated, had the success of their athleticism reduced to their “masculinity”, and essentially had their sex determination trialled in the media. These women are not drug cheats and don’t deserve to have their athletic careers forever associated with speculation about their bodies. If we’re going to try and divide everyone, we should do it respectfully, with sensitivity and in private, and without calling individuals’ gender identity into question. We also need to appreciate that some people will simply be difficult to place, and this does not mean we should make them change their bodies to fit in.

Of course, the concern inevitably arises that competitors with these variations have an unfair advantage, enough to warrant that they be excluded from participation altogether or should participate with the men. But is this actually true?

The main intersex variations we’re looking at when it comes to international competitions are variations involving hyperandrogenism. This refers to the excess of androgens in the body, including testosterone. As I’ve mentioned, as with any other human characteristic you can think of, even within a “normal female range” and a “normal male range” there is wide variation and also a natural degree of crossover between the two, and it may not relate to having an intersex condition at all. However, the IAAF decided to arbitrarily determine that to compete as a woman you must have testosterone levels of 10 nanomoles per litre or below. The IAAF (and the IOC) says they’re not trying to determine gender, although I feel like telling a woman she must compete with the men is effectively telling them that they’re not feminine enough to be a woman. The outcome of all this is that if you’re a woman with high T (above 10 nmol/L) you either have to compete with the men, take hormone-suppressing drugs, undergo surgery to remove hormone producing organs, or not compete.

The interesting part is that the IAAF has failed to bring any scientific evidence to the Court of Arbitration for Sport to show that naturally producing testosterone actually has much of an effect on your athleticism. This is in contrast to taking the synthetic hormone that does enhance performance, but this can and is tested for. What’s also interesting is that male athletes are not questioned over their levels of naturally occurring testosterone and don’t have their gender identity or suitability to compete called into question. This is where the sexist element of sex testing comes in, because we don’t check and scrutinise the sex of men in sport at all. Even if it’s found that they have exceptionally high levels of (naturally occurring) testosterone that’s entirely okay. The IAAF has said this is because there is no evidence that men with exceptionally high T have an advantage. Yet when it comes to women, we are automatically suspicious of those with high T (regardless of whether it actually improves their performance), subject them to embarrassing and invasive examinations, pressure them to change their bodies and cast doubt over whether they deserve to be there.

Dutee Chand returns to competition after the 2015 CAS ruling (photo from Indian Express)
Dutee Chand returns to competition after the 2015 CAS ruling (photo from Indian Express)

Fortunately there have been some recent positive changes to policies regarding hyperandrogenism in women. The IAAF policy initially saw Chand dropped from the Indian national team in 2014. She missed the Glasgow Commonwealth Games and was told to reduce her testosterone levels. Chand challenged this policy and in July last year, the Court of Arbitration for Sport suspended the IAAF’s regulation for two years on the basis of a lack of scientific evidence that naturally produced high T enhanced athletic performance. This is great news for Chand and Semenya, both of whom will be competing in the upcoming Games. However, while they can compete, speculation remains over their bodies and whether they have an unfair advantage, and this will surely escalate if either of them do particularly well in their events.

Disappointingly, too, in response to the Court decision the IOC issued guidelines last November supporting the IAAF regulation on hyperandrogenism. The IOC encouraged the IAAF to find the evidence and arguments to bring to the Court and reinstate their regulation. Essentially in doing this, the IOC has chosen to endorse an unsupported regulation and has also given no clear guidance on its approach for the upcoming Games (given this regulation is still suspended).

As it stands, presumably athletes with intersex variations who identify as women can compete as women, regardless of their testosterone levels. There are concerns though that given the lack of clear policy female athletes will try to bring down their natural levels of testosterone into a “normal female range” as occurred previously when the IOC had a similar rule to the IAAF in the London 2012 Games and Sochi 2014 Winter Games. This may involve taking hormone-suppressing drugs with the potential for harmful side effects, or undergoing surgical treatments. While the IOC does not actively encourage athletes to undertake these surgeries, the pressures on athletes to compete are huge and have seen athletes undertake medical interventions to “normalise” their otherwise healthy bodies in the past.

Also let’s be real – even if athletes choose not to bring down their natural testosterone levels, those that “look masculine” or where it is publicly known that they have high T, will continue to be subject to media speculation, identity questioning and assumptions about their bodies. The way we currently frame and discuss this issue continues to reinforce ideas of what a woman should look like.

Ultimately, I think we have to seriously reflect on our assumptions about dividing sports by sex, and more carefully consider the way we treat those who can’t easily be categorised in this way. Even if we do definitively find that naturally occurring testosterone does affect athletic performance, I think we’re creating a problem where none exists. We seem obsessed with protecting some idealised notion of a “level playing field”, but this simply doesn’t exist and nor should it. It’s the Olympics! Olympians are naturally outliers – that’s how they got to this level in the first place and why we like to watch them compete! So many factors operate to give athletes a competitive edge over others, and I’ve already mentioned a number of biological ones. But there are also a host of other non-biological factors that come into play, like how much money an athlete has, their coaching and training facilities and access to other resources. Yet we don’t try and equalise these other factors. While it makes sense on many levels to divide sport by sex as opposed to these other attributes or circumstances, even leading sporting bodies have not been able to find any one explanation as to why some people perform better than others. Instead, we’re stuck on this idea that we have to push people into a division that we’ve created, and when they don’t properly fit, we need to change their bodies to fit.

* Trans* usually refers to transgender however I have used the abbreviation to acknowledge the diversity of identities that exist in this space.

* Many barriers also exist for people who are trans* in sport due to our division of men and women. In this post though I’m only looking at intersex issues.

For more info on Chand’s case and the scientific evidence on testosterone, check out the judgment and current IOC response.