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Jun 19, 2012

Olympics testing for testosterone a pragmatic step

Dr. Eric Vilain is a professor of human genetics, urology and pediatrics at the David Geffen School of Medicine at UCLA and director of the UCLA Center for Society and Genetics, exploring issues of gender and gender equality in sports. This op-ed was originally published in the New York Times on June 18.
 
 
  
 
Is LeBron James too tall and too fast to play basketball?
 
In times of extreme political correctness infiltrating almost every societal topic, sport stands out as an oddity. It captures the passion of billions of people around the world, yet it is grotesquely unequal. There are no remedial programs for ungifted athletes.
 
Yet when it comes to women in sports, everyone frets about equality.
 
This was particularly true in the outrage over the case of Caster Semenya, the South African athlete who won the 800 meters at the world championships in Berlin in 2009 and was accused of holding an unfair advantage because she was thought to compete unjustly in a women’s event. When men are more talented than others, it is an expression of the beauty of sports. But when women outcompete others, suspicions about eligibility and arguments for a level playing field often arise.
 
Sports officials are faced with an impossible quandary: a socially imposed sex division in sports (allowing half of the world’s population to have a chance at winning) with no clear objective way to draw a line between male and female.
 
So what should be done?
 
There are what could be called the social solutions, not involving biology.
 
A simple possibility would be not to segregate the sexes in sports. But female athletes would lose most, if not all, elite competitions. For all the brouhaha around Semenya’s eligibility as a female athlete and perceived advantage, one should remember that her time in the 800 meters at the world championships — 1 minute 55.45 seconds — would not have even qualified for the men’s final, in which the worst time was 1:47.80.
 
Another radical solution would simply be to accept the declared sex of each athlete. No other questions asked. No test. But in times of instant fame and wealth in sports, such an honor system seems unrealistic. It would allow for men to compete as women, unchallenged.
 
Another way would be to separate athletes by legal sex. Instead of trying to give a messy biological answer (with so many different biological parameters determining sex) to sports, why not just look at the sex written on the athlete’s government-issued identification? There is some attractiveness to that solution, as it would often correspond with whether the athletes were raised as boys or girls, which might be a fair way to go. Athletes raised as girls compete as girls. This would create barriers for transsexual athletes in many countries not open to such legal changes, and there would be a risk of forceful manipulation of the legal sex in nondemocratic states.
 
Historically, one-size-fits-all biological tests have attempted to define sex, with one biological parameter for systematic gender verification of athletes, from counting the number of X chromosomes to detecting SRY, a Y chromosome gene. All were fraught with the misconception that a single set of sex chromosomes or a single gene systematically leads to one gender.
 
In the midst of all these extreme options, there could be pragmatic, sport-centric answers. Let’s forget for a while about gender identity politics: Eligibility of women in sports has long been framed as a gender issue. It should not be. Let’s focus strictly on athletic performance and do a thought experiment.
 
What if there were one parameter that clearly provided an advantage in sports, with levels that did not overlap between men and women and could entirely explain why men did better than women in elite sports? Would this substance meet enough criteria to be a valid way of separating men and women on the field, and only on the field? And what should be the threshold for the level of this substance above which female athletes would have all the physical advantages of men and therefore would unfairly compete with other women?
 
The reality is that there is a pretty good candidate for such a substance: testosterone. We know that exogenous testosterone enhances performance and is therefore considered a doping substance, forbidden in all Olympic sports. We also know that there is practically no overlap between normal male and female ranges of endogenous testosterone levels.
 
Would levels of testosterone above the typical female range provide an athletic advantage in women? Probably. Would that be unfair? No more than other genetic traits that confer advantages to elite female athletes (height, number of red blood cells, etc.). Should there be a threshold above which athletes would not be eligible to compete with other women? If testosterone is the main explanation for sex differences in sports, the logical answer should be: yes, if the level reaches the male range.
 
Such a threshold would be extraordinarily difficult for women to reach, and most female athletes with testosterone levels higher than normal (whether they were born with a disorder of sex development, or have developed hyperandrogenic conditions) would be eligible, therefore recognizing and including the wide variations of what could influence abilities within one sex category.
 
Is it a perfect parameter? Of course not. There are problems with it. The main one is that the levels of testosterone are relevant to sports performance only if the body (and the muscles in particular) is fully responsive to it. A small number of individuals have some degree of resistance to it, and what really matters is not just the raw level of testosterone but a combination of its amount and a measure of its functionality, which is not always easy to test for.
 
Another issue is that, unlike in our thought experiment, testosterone is not the unique explanation for sex differences in athletic performance. Others could be direct, sex-specific, genetic effects on motivation to win, aggressiveness or shape of the bones and joints. These are more complex to reliably measure than testosterone, and it is still unclear what relative proportion of sex differences these other factors will influence. But sports authorities should pursue a more complex algorithm of parameters.
 
From a pragmatic standpoint, the International Olympic Committee’s new guidelines, which will identify functional testosterone as a key element for eligibility in women’s competition, are a step in the right direction. They are certainly imperfect, but they allow women to compete with a shot at winning and they allow such a wide range of genetic and hormonal differences within the women’s group that we are in for the exciting treat of watching women compete passionately with all their unjust, innate athletic abilities that make sports so exhilarating.
 
Let the (genetically unfair) Games begin.