Intersex Woman Out of the Olympics

Caster Semenya, the reigning Olympic 800-meter champion, was barred from defending her Olympic title because the level of testosterone in her blood is too high. According to the Swiss Court of Arbitration for Sport (CAS), her testosterone level gives her an unfair advantage in middle-distance events, which are 400 meters to a mile. She refused to take testosterone lowering drugs to compete in the 800 meters, leaving her only the 200 meters or the 5000 meters as realistic alternatives. But she’s not up to Olympic standards in either of these events.

The underlying problem is that Semenya is intersex. We normally assume that human beings come in just two distinct types, male and female. Males have both X and Y chromosomes, whereas females have two X chromosomes. The Y chromosome makes men generally stronger and faster than women largely through the production of testosterone. Organized competitive sports generally allow women to compete only with other women so that female accomplishments won’t be overshadowed by the testosterone-enhanced abilities of men.

But nature doesn’t conform perfectly to a clear distinction between males and females. Some people are born with only one X chromosome, others have two X’s and one Y. Still others have an X and a Y, like males, but lack many male characteristics because of androgen insensitivity. They lack completely or partially the androgen receptors needed for the body’s cells to take up and be influenced by androgens, including testosterone.

People with complete androgen insensitivity can have X and Y chromosomes and high blood testosterone levels while developing like women because their blood testosterone isn’t effective. These intersex individuals may have a competitive disadvantage compared to other women due to less testosterone influence on their development, as most other women manufacture and use at least some testosterone. Such intersex people with a Y chromosome can compete as females because sports-governing bodies rely on functional testosterone rather than on chromosomal analyses to determine eligibility for female competition.

Other intersex individuals, however, also typically classified as girls due to visible manifestations of sex at birth, do gain a competitive advantage at puberty. A gene on their Y chromosome causes the development of testes which can produce testosterone. However, because these individuals have a deficiency of the enzyme 5-alpha reductase (5-ar), the fetus develops genitals that look female. But during puberty, these young women have male-level functional testosterone in their blood due to the elevated activity of their testes. This gives them, Ms. Semenya included, the kind of advantage over other women which men usually enjoy.

To counteract this advantage, the International Amateur Athletic Federation (IAAF) and the International Olympic Committee (IOC) have set maximum testosterone levels for people competing as women in the 400-, 800-, and 1500-meter events. The normal range of T (as we call it) among men is 10-35 nmol/L (nanomole per liter), whereas the normal range for women is 0.35-2.0 nmol/L. The IAAF and the IOC chose the lowest level of testosterone that is common among men, 10 nmol/L as the maximum for those competing as women in these events. This is a generous level because no other woman would come close to it without doping.

Because her functional T is above this level, however, Ms. Semenya would have to have taken T-suppression medications to compete in the 800-meter race in the 2021 Olympics, which she refused to do. She is supported in her position by Human Rights Watch which views the requirement as “stigmatizing, stereotyping, and discriminatory.” The World Medical Association objects to mandated drugs which aren’t needed to address a medical need. Sports are trying to eliminate the use of medically unnecessary drugs, yet here they are promoting it.

Ms. Semenya clearly has a natural advantage over other female middle-distance runners, but natural advantage is common among Olympic champions. Malcolm Gladwell notes that a cross-country skier who won seven Olympic metals has a genetic anomaly that gives him 65 percent more red blood cells than normal, and a high-jumping champion was aided by unusually long Achilles’ tendons. So, what’s wrong with Ms. Semenya having unusually high levels of functional T?

The problem is competition among women. Many believe that not only Ms. Semenya, but the other two medal winners for the women’s 800 at the 2016 Olympics were also intersex, an extreme overrepresentation of people who constitute only .018 percent of the population. So, the inclusion of intersex women without steps to reduce their natural T advantage threatens women’s sports competition just as failure to require boxers to maintain their weight within certain limits would threaten boxing competition for everyone but heavyweights.

But if intersex women are allowed 10 nmol/L of T, shouldn’t other women be allowed that level through doping? Of course, doping to 10 isn’t natural for them, but it isn’t natural for Ms. Semenya either.