The IAAF is imposing an upper limit on female testosterone levels, but the scientific foundation of the decision looks shaky
There’s been a development in professional track and field’s divisive debate on whether hyperandrogenic women, who have unusually high levels of natural testosterone, should be allowed to compete against non-hyperandrogenic women. On Thursday, the International Association of Athletics Federations (IAAF) announced that “new eligibility regulations for female classification” would be taking effect on November 1. The criteria, which only applies to women seeking to race middle distance events from the 400-meters to the mile at international competitions, states that for a woman to be eligible:
(a) she must be recognized at law either as female or as intersex (or equivalent);
(b) she must reduce her blood testosterone level to below five (5) nmol/L for a continuous period of at least six months (e.g., by use of hormonal contraceptives); and
(c) thereafter she must maintain her blood testosterone level below five (5) nmol/L continuously (ie: whether she is in competition or out of competition) for so long as she wishes to remain eligible.
In effect, this announcement is a resurrection of a previous IAAF regulation, which was put in place in 2011, but there are some key differences. (Which we’ll get to below.) In 2015, the Indian sprinter Dutee Chand successfully challenged that initial regulation through the Court of Arbitration for Sport (CAS). The court ruled that until the IAAF could provide more conclusive evidence on the performance enhancing effect of testosterone (and the degree of that performance enhancement), imposing a T-limit was discriminatory. The IAAF couldn’t force female athletes like Chand and, most prominently in this debate, South African mid-distance runner Caster Semenya to take testosterone suppressants if they wished to compete.
The IAAF now believes it has that evidence, the most prominent piece of which is a 2017 study in the British Journal of Sports Medicine.
When the news came out earlier this week, prior to an official statement from the IAAF on Thursday, the arguments that have raged around this topic for at least a decade roiled the social media waters once again. Central to the debate is whether or not track and field’s world governing body is acting in good faith.
For its part, the IAAF maintains that the “regulations exist solely to ensure fair and meaningful competition within the female classification, for the benefit of the broad class of female athletes.” In Thursday's press release, the governing body also takes pains to emphasize that it is not suggesting that hyperandrogenic women have done anything wrong (the new guidelines refer to such women as athletes with a “difference of sexual development”) and that the regulations are in no way “intended as any kind of judgment on or questioning of the sex or the gender identity of any athlete.”
This position has struck many critics of the new restrictions as a glib masking of what ultimately amounts to further discrimination. Bioethicist and cultural anthropologist Katrina Karkazis co-wrote a Guardian op-ed that pointed out glaring inconsistencies in the IAAF’s methodology. She states, unequivocally, that “this regulation is about targeting and impeding a few exceptional women of color from the global south, especially Caster Semenya.”
Last year, I wrote an article that seeks to elucidate some of the key aspects of this debate. Rather than covering the same ground, here are some answers to the new questions prompted by Thursday’s news.
How are the latest regulations different from the 2011 rules?
For one thing, the testosterone threshold has been lowered. In 2011, the upper limit for testosterone in female athletes was set at 10 nmol/L, whereas now it is half of that. While in 2011 that upper limit applied to all track and field events, the new ruling only applies to the 400-meters, the 400-meter hurdles, the 800-meters, the 1,500-meters, and the mile.
Why are the new regulations different from the old ones?
Truth be told, a definitive answer to this question is hard to come by. I emailed Joanna Harper, a medical physicist and trans athlete who has advised the International Olympic Committee (IOC) on gender-based issues, to ask about this. She responded that she expects the IOC to soon announce that it will be lowering the testosterone limit for trans athletes who identify as female from 10 nmol/L to 5 nmol/L, and that this has likely influenced the IAAF’s decision. Harper speculated that the lower limit could be the result of changes since 2011 in the way T-levels are measured; according to Harper, the current method, mass spectronomy, produces lower average testosterone readings.
As for confining the T-limit to specific events, the study that the IAAF is citing (which was based on athlete data from the 2011 and 2013 IAAF World Championships) concluded that: “Female athletes with high T levels have a significant competitive advantage over those with low T in 400 m, 400 m hurdles, 800 m, hammer throw, and pole vault.”
From this list, the IAAF decided to narrow the events that would require an upper testosterone limit.
Why aren’t the hammer throw and pole vault also subject to the new regulations?
This is a principal criticism of the new ruling. Also, why is the 1,500-meters subject to a testosterone-limit, if the study didn’t find a conspicuous correlation between high testosterone and high performance in that event? As critics like Karkazis have pointed out, this should make it clear that the IAAF is targeting specific middle distance athletes like Caster Semenya (who also races the 1,500) by implementing this new rule.
It’s possible that the significance of the aforementioned study has been exaggerated, in other words that the IAAF isn’t basing its new rule solely on those findings. In the press release, the governing body alludes to a “medical and scientific consensus, supported by peer‐reviewed data and evidence from the field, that the high levels of endogenous testosterone circulating in athletes with certain DSDs can significantly enhance their sporting performance.”
How will the new regulations be enforced?
Part of Karkazis’s (and other’s) extended argument is that the IAAF is (whether intentionally or not) discriminating against those who don’t conform to traditional norms of what a woman should look like. The IAAF appears to address this in 3.4 (b) of the Assessment of Cases section of the new ruling, which states:
No stigmatization or improper discrimination on grounds of sex or gender identity will be tolerated. In particular (but without limitation), persecution or campaigns against athletes simply on the basis that their appearance does not conform to gender stereotypes are unacceptable.
It’s still far from clear, however, on what basis female athletes will be tested for potentially being over the testosterone limit. It still seems to be at the discretion of the IAAF medical manager, who could presumably use blood samples from mandatory doping tests to measure testosterone levels. However, the new IAAF rule also states that if a woman believes herself to be a “relevant athlete” it is her responsibility to, in effect, turn herself in for testosterone testing. The same obligation is being placed on national governing bodies.
How will this all play out?
The initial 2011 rule was suspended in the wake of a legal challenge from Dutee Chand. As a 100 and 200-meter sprinter, the new regulations don’t apply to her. But that doesn’t mean that another athlete can’t contest the latest ruling. Both Katrina Karkazis, who is against implementing testosterone limits, and exercise physiologist Ross Tucker, who is in favor, have pointed out that the scientific foundation of the IAAF’s latest announcement looks rather shaky. In part because hyperandrogenic athletes still make up a relatively small percentage of the competition in elite female athletics, it is very difficult to prove the degree of advantage that high testosterone confers. In other words, a new challenge to the IAAF’s latest rule has a good chance of succeeding.
A final thought
Regardless of what happens, a central conundrum remains: If we believe that it’s necessary to have separate categories for men and women in elite sport, there needs to be some objective measure for determining who is eligible to compete under what classification. Proponents of testosterone limits for women believe that, while hardly a perfect solution, it might be best option available at the moment.
And I see their point. But, as I’ve said previously, it’s worth remembering that most of those making the rules for women are, in fact, men. If the continuing controversy over sex classification isn’t an argument for more female leaders in sports, I don’t know what is.