Dutee Chand and the Case Against Hyperandrogenism in Women’s Running

Dutee Chand in the heat of competition. Image via dnaindia.com

Back in the news again this week,  Indian Sprinter, Dutee Chand is appealing the Athletic Federation of India’s ban on her competing as a woman. Chand became a national champion last year in the 100m and 200m at the age of 18 but was barred from competition by the Athletics Federation of India when her testosterone tested in the male range. She has the option of lowering her testosterone level and returning to women’s competition. Instead, she filed an appeal with the Court of Arbitration for Sport in September fighting the ruling. It’s my view that if Chand’s appeal wins and she is allowed to compete without treatment, it erodes the integrity of women’s sports. Here’s why.

The International Association of Athletic Federations has a history of sex testing. In the early days of women competing in sports, before large cash prizes and endorsement contrasts, the pull-your-skirt-up method was used to verify men were not masquerading as women to claim an unfair advantage. In the sixties, it was replaced with genetic testing and for the next fifty years we saw just how hard it is to define the line between men and women in sports. Biological sex is not binary. When you try to draw the line all sorts of medical conditions get in the way. There are women with a Y chromosome, men with two X chromosomes, intersexed conditions and even women who simply lack the receptors for testosterone.  Women’s sports have come quite far since those days. Now the line is a single number, an athlete’s testosterone level, and in the case of transgender athletes, a two year wait after gender reassignment.

Chand is reported to have the condition hyperandrogenism, which results in her high levels of testosterone.  While we do not know the exact number, we know her testosterone level is in the male range, a line drawn by the IAAF at 10nmol/L. In the units we use in the US, that puts her testosterone level above 300ng/dL. To put that in perspective, mine was tested in my blood work last month at 22ng/dL and the normal range for a woman is about 20-60ng/dL

The gap in the testosterone range between healthy women and men is massive. Keep in mind it is illustrated here in a logarithm scale.
The gap in the testosterone range between healthy women and men is massive, much larger than it appears here.

Maybe instead of separating athletes into men or women, they should be classified as “high testosterone” and “low testosterone.” It doesn’t matter what her or any athlete’s gender identity is, that she has two X chromosomes, that there is an ‘F’ on her passport, or that she is most definitely a woman.  For the purpose of sports competition gender classification, the IAAF (and every other sports organization following IAAF’s rules) uses only testosterone level as the criterion. The gender identity, shape of body parts, external sex organs, and even physical size are all arbitrary and meaningless as classification of competition gender. The size and dimensions of competitive men and women are all over the board and certainly overlap. In some cases, it all adds up to winning a genetic lottery, but for the rest of us, it is the arbitrary variation we were born with. The one thing that doesn’t typically overlap is the massive gap between normal testosterone range in women and normal testosterone range in men.

Caster Semenya was also banned from competition, but suffered invasive and humiliating gender testing, not a simple blood testosterone test.

In every running and swimming event in the Olympics, the speed gap between men and women consistently remains about 10%. For whatever reason, women in these sports can’t compete with the men. While we might question the exact benefit testosterone plays for the men, there is no doubt that it has a significant role in endurance and strength.  Drawing the line with testosterone level is the best educated decision we can make right now. It would be unethical and impossible to do a large double blind scientific study swapping the testosterone levels of competitive men and women to see how their performance changes. In addition, the change in race performance for few transgender competitive women runners like Janet Furman Bowman and Johanna Harper support this measure of differentiation.

In short, if Chand wins her case, we wouldn’t have men and women’s sports, we’d have one field that women couldn’t compete in.

The red herring is that when we finally reached our modern criteria for our two classes of athletes, we continued to call the classes  “men” and “women.” What we really meant was “testosterone >10nmol/L” and “testosterone<10nmol/L.” We technically could have created five levels of testosterone classes, height classes, and so on. But because of the large gap between testosterone between healthy men and women, it was a logical start and end for the classification system in most sports. Calling the classes “men” and “women” has nothing to do with the gender identities of the athletes, though in healthy adults it is neatly correlated.

Second, there is the question of whether performance enhancing side effects of an untreated disease can be considered an unfair advantage. Consider whether a typical woman with this condition would treat it. Consider whether it would be unethical to withhold treatment from a child. I think the answers are yes.

I say let Ms. Chand compete as a women with medical treatment. If hyperandrogenism is treatable non-invasively with common, cheap and generally safe generic drugs, why is she appealing the ban? Because the truth of the matter is, as much as no one wants to admit it, she won’t be competitive anymore at the same level with her testosterone in the normal woman’s range. I agree with  the Athletics Federation of India on this one.

The opinions expressed in this article are mine and mine alone. What’s your opinion? 

I'm a subelite marathon runner, but I didn't come from a collegiate running background. Instead I'm trying to break into competitive running in my thirties. I write about chasing the dream of running with the elite girls and tell stories of adventures along the way. Watch me chase the next big thing.

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  1. You make a really compelling argument here, but what I keep getting hung up on is that we’re asking someone to go through a medical procedure to compete and the only people we’re asking to do this are women. Are there men with hyperandrogenism with off the charts testosterone? Must they also go through medical procedures to compete? Why don’t we make people of all genders who have unusually high blood volume take medical measures to get in the normal range out of fairness? The answer here is not an easy one any way you slice it, but I’m curious what you think about these issues.

    1. We’re only asking women to be tested because women are the underpreforming class. No one is being required to go through a medical procedure to compete. She is being required to seek treatment to compete in an underpreforming class.

      With the gender issues removed, this is sort of like a 135 lb women’s collegiate rower challenging the requirement of loosing five pounds if she wants to compete as a lightweight. (though weight classes in rowing are arbitrary).

      Under the IAAF 2012 rules, treatment doesn’t mean anything invasive like the scandals of surgeries prior to the 2012 Olympics. Her specific medical details have not been leaked, but as long as her testosterone levels are’t off the charts into the male range, it shouldn’t take much intervention to get her below 10nmol/L. Which raises the question: Why the challenge?

      1. Are you insinuating that she is challenging it because she would not be competitive with lower testosterone? Not saying that’s true or not true, just want to make sure I understand your point.

        Generally though I think both sides are right and both sides are wrong. There is no easy answer here, which makes it so interesting. I look at it from her perspective and I feel bad for her. I can’t imagine what it must be like to go through your life thinking you’re a world class athlete only for the authorities to come in and essentially say you’ve been cheating. Not to mention the attack on her sense of self, womanhood. I read an article from an Indian paper that was discussing how horrible it was that they made her name public and that she’s risking death because of it! Don’t know if that sensationalistic or true, but it’s just sad. Now that everyone on earth knows she has this condition can she ever compete without invasive scrutiny?

        At the same time, from a competitors vantage point it seems unfair. I can imagine competing for prize money against someone I know has this condition and it was bug me that she beat me, but not sure I’d go so far as to want her banned, but then again I’m not competing for loads of cash or for a spot on a world championship team.

        1. I don’t know the answer, or even if it would make any difference (though that is the premise behind why we ban doping substances and methods).

          But on the opposite side of the question, men who have lost their testicles to disease or cancer and were taking testosterone would apply to the world anti-doping agency for a therapeutic use exemption and their case would be evaluated against best medical practices.

  2. I agree with Salty on this one. If anyone is going to have to go through medical procedures to compete, it should be both sexes, not just women.

  3. Besides my discomfort with the very idea of telling women they must prove they are women (while men do not have to do the same), I think we are setting a dangerous tone and precedent here. In essence, this is telling a woman that she must get medical treatment to be be considered female enough and in doing that, reinforcing the use of gender testing. Gender testing is, quite simply, archaic, and is a remnant of a time where gender was supposed to fit neatly into two categories, and anyone who didn’t fit was ostracized and told to shape up or get out. In the past, this meant calling out women who didn’t look “female” enough, and whether the gender testing was deemed “successful” or not, the process was humiliating for the women involved. In some cases, it ruined lives and careers.

    I am aware that the very possibility that someone with higher testosterone levels might very well blow away the field of female runners, and as a competitive runner, that would be hard to see. But a medical condition is different than doping, and therefore must be treated differently. It is clear that every decade (or year?) or so a woman will emerge that may have characteristics different than her field of competitors and others will want to challenge her participation in their sport. But is gender testing and forced medical treatment the right way to respond?

    I don’t think so.

    1. We test only women because the class of athlete we call women exists only because they as a class underpreform men. Just to be clear though, under the modern 2012 IAAF rules, we don’t gender test anymore. We test testosterone level. This is not a gender identity issue. The argument isn’t whether gender fits neatly into categories, it is whether testosterone fits into neat ranges in healthy adults. It turns out that that it does.

      The idea of an athlete proving she or he belong in an underperforming class isn’t just isolated to our current gender classes. In rowing, for example, we have a lightweight class that underpreforms the rest of the field. Without it, small women and men wouldn’t be competitive in the sport. Lightweight rowers are weighed in before every race to prove they belong in the class, but We don’t weight the higher preforming class.

      The difference here is of course that the weight classes are arbitrarily set in the middle of a continuous spectrum of rowers’ weights. The testosterone levels used to define gender classes under the modern rules is derived from a huge biological gap. It is not arbitrary.

      1. Would a rose still smell as sweet if it was called by another name? Changing the semantics doesn’t change what it is.

        That being said, I do understand where you are coming from. I just think we need to change the system instead of reinforcing it and maybe that means changing the language and re-framing the discourse.

  4. What a complicated issue! Drawing categories based on gender or sex lines is really not helpful. In addition to humiliating testing, there’s the question of individual’s rights, labeling and whether those categories really mean anything.
    Testosterone plays a big role in ability, but it isn’t the only hormone or genetic component that does so. I understand the goal of the categories is to allow for different groups of competitors with roughly the same base advantages. This seems a naive goal since resources (financial, training etc.) will affect the outcome as well as day of performance.
    Testosterone level grouping is only one possibility, but it’s not without its own issues. So what’s the answer? I have no clue. Time trials to establish categories for races?
    Maybe the running community needs to look at what they are trying to achieve in creating race categories.

  5. Very interesting and thought-provoking post Jasmine! For more info on the subject and the history of intersex athletes in sport, see this very good article recently featured on Letsrun.com: http://www.letsrun.com/news/2014/09/brief-history-intersex-athletes-sport/ I think it’s such a slippery slope trying to draw the line between what natural-born traits confer an allowable advantage vs. an advantage that’s unfair. Is a naturally high T level that much different than someone born with the genetic potential to develop a very high VO2 max? Or what about those born with naturally high EPO levels, for example? Malcolm Gladwell wrote a fascinating piece in the New Yorker on this very subject: http://www.newyorker.com/magazine/2013/09/09/man-and-superman. Tough questions without easy answers, but thanks for sparking the debate!