RUTH GREEN

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A lack of legal consensus on the eligibility of women with naturally elevated levels of testosterone to compete in elite sport has caused a stir at the 2016 Olympic Games in Rio de Janeiro.

The issue of hyperandrogenism – the term used to describe the excessive production of androgens, the best known of which is testosterone – first erupted in the sporting world in 2009 when South African runner Caster Semenya won the 800m in record time at the World Championships in Berlin. She was subsequently prevented from competing while she underwent gender testing and was subjected to intense media scrutiny.

Caster Semenya

Semenya was eventually cleared to compete in July 2010 but only on the condition that she took medication to lower her testosterone levels. Following the Semenya debacle, in May 2011 the International Association of Athletics Federations (IAAF) introduced new regulations which required hyperandrogenic female athletes to limit their testosterone levels to below 10 nmol/L. The female range is typically between 0.1 nmol/L and 2.8 nmol/L, while the normal male range is above 10.5 nmol/L.

This all changed in July 2015 when a case brought by the Athletics Federation of India on behalf of hyperandrogenic runner Dutee Chand saw the Court of Arbitration for Sport (CAS) suspend the IAAF’s regulations pending the receipt of more evidence demonstrating the performance advantage of hyperandrogenic female athletes over female athletes with normal testosterone levels. Suddenly athletes like Chand and Semenya were eligible to compete at Rio and other international competitions without being required to artificially control their testosterone levels.

Michael Beloff discusses hyperandrogenism

The IAAF has until July 2017 to gather more evidence, but Dr Silvia Camporesi, a bioethicist and lecturer at King's College London, is unconvinced further research will resolve this contentious issue. ‘What are we trying to prove? Science is driven by research and the binary division between female and male. The current system for sports competition is based on two categories, male and female, but we must realise that the boundaries are not binary. We need to be careful and need to be inclusive. If we set a threshold for [naturally occurring] testosterone it’s problematic because there isn’t a threshold for men and in that sense it’s discriminatory and unfair.’

Despite the controversy over the IAAF’s regulations, Michael Beloff, Chair of the IAAF Ethics Board, who has advised both the International Olympic Committee and the IAAF on hyperandrogenism, told Global Insight in a recent interview that they sought to strike as fair a balance as possible. ‘It’s an incredibly difficult issue,’ he says. ‘It's not that they are not women. The question is something different: should they be able to compete as women in a sporting contest that's got a binary divide? So you're not, as it were, casting doubt on their femininity, you're simply setting some kind of levels in order to have a level playing field. But what the solution may be I'm not in a position to say.’

Camporesi rejects the notion that elite sport currently maintains a level playing field, citing the well documented example of US swimmer Michael Phelps whose prowess has been boosted by his double-jointedness and disproportionately long arms: ‘Athletes have all kinds of different body shapes and sizes, but can we say that some people, like Michael Phelps and others who smash world record after world record, have an unfair advantage over others?’ she says. ‘In that sense I don’t think there are any grounds to say that hyperandrogenic athletes have an unfair advantage.’

Indeed, there are other examples of athletes whose physiology has given them the edge. ‘There was the case of Finnish cross-country skier Eero Mäntyranta who won several medals at the 1964 Winter Olympics in Innsbruck,’ says Camporesi. ‘Later it was found out he had a genetic predisposition which allowed him to increase the oxygen-carrying capacity of his blood. This is a physiological condition which would definitely have provided a competitive advantage, but it was not considered unfair.’

Semenya won a silver medal in the 800m at the London 2012 Olympics, despite being tipped for gold. Many attributed her moderated performance to the androgen suppression medication she was taking. Now free of the burden of such medication, she won the gold in the event in Rio in 1 minute 55.28sec, marking a personal best and setting a new South African national record.

This debate on hyperandrogenism continues against the backdrop of the Russian doping scandal that has seen more than 100 Russians banned from competing in Rio Olympics. On 7 August the International Paralympic Committee announced an outright ban on Russia’s entire Paralympics team. Russia is appealing the decision.

Nevertheless, Camporesi does not feel the doping scandal and heightened public interest in performance enhancement have contributed to the interest in Semenya. ‘I wish it was about the concern for doping, but I think it’s actually more about how she looks and about the issue of gender in track and field. Dutee Chand, for example, doesn’t run fast enough to grab the media’s attention like Semenya. She also doesn’t look like Caster does and therefore doesn’t appear to pose a threat to our perception of femininity,’ she says.

The alternatives aren’t straightforward though. ‘There’s no perfect solution,’ she says. ‘One proposal is to construct categories based on different medical conditions, not just for testosterone levels but other levels such as oxygen-carrying capacity and so on. So we could develop a classification system like we have in the Paralympics, but that could also open up more complications than it would solve.’

Akira Kawamura, former IBA President and a member of the IAAF’s Ethics Board, told Global Insight he couldn’t comment specifically on the Chand or Semenya cases, but said there was an urgent need for elite athletics and sport generally to clarify its position on hyperandrogenism: ‘I think it is absolutely essential to establish as soon as possible the scientific standards which are commonly acceptable to the various sport communities throughout the world. I am sure that the CAS is mindful of this.’