‘Gender Verification’ Based on Testosterone Shelved by Court of Arbitration for Sport

The Court of Arbitration for Sport (CAS) has overturned a guideline used by the International Association of Athletics Federations (IAAF) to define female competitors based on naturally-occurring testosterone levels. The decision has implications for other sports as well, with skiing relying on related IOC rules to define gender.

The case was brought by Indian sprinter Dutee Chand, who has hyperandrogenism, a syndrome where the body produces excess testosterone. This led her to test over the 10 nanomole per liter limit set by the IAAF for female athletes. That value falls on the low end of the range typical for men.

Chand successfully argued that because her high testosterone levels were naturally-occurring, not the result of doping, they were just the same as any other athletic gift someone might be born with: long legs, genetics that make it easier to add muscle, or a tendency towards aerobic fitness, for instance.

CAS agreed, saying that the IAAF must provide additional evidence that high testosterone levels provide a substantial advantage to women. If this is not the case, then testosterone should not be used as a guide to defining biological sex, because it would lead to the needless and harmful exclusion of some women who are, in fact, female.

In the meantime, Chand is cleared to compete.

“I have a right to run and compete,” Chand said in a statement released by her legal team. “But that right was taken away from me. I was humiliated for something that I can’t be blamed for. I am glad that no other female athlete will have to face what I have faced, thanks to this verdict.”

Implications for Nordic Sports

The decision has other implications as well, as the International Olympic Committee (IOC) uses similar guidelines to determine sex. For both the London 2012 and Sochi 2014 Olympics, the IOC mandated that panels be created to investigate “suspected cases of hyperandrogenism” with a potential end result of women being excluded if they had high testosterone levels.

Thus, athletes in other sports were also subject to so-called “gender verification” since 2011. And many other federations, even those without explicit policies about defining sex for competition, use the IOC guidelines.

The CAS verdict does not explicitly address other federations’ guidelines which use the same logic. However, it is doubtful that the IOC or other groups would continue using their rules stipulating testosterone as a definition of gender given that any athlete could appeal an exclusion with Chand’s precedent and win at that CAS level.

The International Biathlon Union (IBU) does not appear to have any published guidelines for how to define the sex of an athlete.

“We do not have a gender identity policy,” IBU Vice President for Medical Issues Dr. Jim Carrabre wrote in an email to FasterSkier. “We do not check or verify gender as a general pre-competition requirement. This idea is antiquated  in terms of sport and doping.”

The International Ski Federation (FIS) reserves the right to do gender verification. The current International Competition rules read, “If any question or protest arises as to the gender of the competitor, FIS shall assume responsibility for taking the necessary steps to determine the gender of the competitor.”

FIS used to have explicit procedures for gender verification, but Secretary General Sarah Lewis told FasterSkier in an email that the practice had been discontinued.

“The rules of the Olympic Movement were adopted by FIS and it was necessary to undertake a gender verification test at FIS World Championships and the Olympic Winter Games (I did so myself as an athlete),” she wrote. “I am not certain whether these were withdrawn first for the Games or for the FIS World Championships, but in any case since many years, I believe 2000, it has no longer been necessary to undergo gender verification.”

(Lewis was traveling en route to Kuala Lumpur, Malaysia, and did not have access to documents which would have confirmed exact dates.)

Still, FIS has the possibility to do gender verification tests and this responsibility is also listed in documents explaining hosting for events like World Junior Championships.

“Should it be necessary to arrange a gender verification – which has never been required since the change of rules – then the Olympic Movement rules would be applicable,” Lewis wrote. “If these have been suspended by CAS, then of course FIS respects this decision.”

The necessity is defined in FIS rules as as “If any question or protest arises as to the gender of the competitor”.

FIS has one high-profile gender verification case in its history, that of Austrian skier Erik Schinegger. As Erika, Schinegger was a World Champion alpine skier in 1966; gender testing before the 1968 Olympics revealed that Schinegger was intersex. He later fully transitioned to being a man and, in 1988, returned the medal he had won.

Is Hypoandrogenism an Advantage?

Finding the necessary evidence may be a difficult task for the IAAF. Although it is widely assumed that testosterone increases female athletic performance, it has actually rarely been researched and never definitively proven.

This may be in part because research on female athletes lags far behind the amount of research completed on male athletes, across all disciplines of sports science.

A 2012 paper authored by a team of international researchers from Stanford, Barnard, and Kings College London argued that the androgen/testosterone-based rules were scientifically unsound and also did not lead to improved fairness for female athletes. (You can read that critique here.)

Another paper, published in the Journal of Clinical Endocrinology and Metabolism just this year (and available here), agrees, stating that “Even if it can be shown that high levels of natural T predictably determine better athletic performance (which the research to date does not support), we do not accept that it would necessarily violate the ideals of sport… We must point out that for many years now, natural advantage among male athletes has not been policed and reduced in sports, but on the contrary has been admired and celebrated.”

More importantly, however, those authors raised ethical concerns about alerting unsuspecting athletes that they may have either an endrocrinological disorder , such as hypoandrogenism, or a genetic condition which made them intersex. Chromosome testing is another method used in gender verification, with syndromes such as XXY chromosomal composition falling in no-mans-land.

“The discovery and diagnosis of a [developmental sex disorder] will likely come as a severe shock, and the potential for harm is not a trivial matter,” the JCEM authors wrote. “It was this well-recognized harm that led the IAAF in 1991 and the IOC in 1999 to abandon their mandatory testing practices.”

While in Schinegger’s case, the discovery that he could be male led to a long and happy life as a man, this is definitely not always the case.

“If it wasn’t for my family, I don’t think I could have survived,” Caster Semenya, a South African runner whose gender was questioned before she was eventually reinstated to compete as a woman, recently told the BBC. “It was upsetting, you feel humiliated. You cannot control what people think.”

Female athletes who have been stripped of results because of hyperandrogenism have indeed taken drastic measures. One Indian runner tried to commit suicide, twice, after losing her athletic career.

In one of the most heartbreaking stories, some athletes were told to try to lower their testosterone levels either by surgery or by taking drugs. Four very young female athletes found to have hypoandrogenism through the pre-London 2012 testing appear to have consented to surgeries that they were told would lower their testosterone levels to an extent that they would be able to compete, but the surgeries ended up being plastic surgery on genitals or breasts, and did not have the desired affect because this was not the source of testosterone.

While the IAAF denies that this ever happened, it was reported in the International Business Times and in the medical journal article linked to above. All four women were rumored to be from rural areas of developing countries where the concepts of gender as not only a sociological but also a biological spectrum, which have only just begun to permeate the West, have not yet reached.