Questing for Fairness

Introduction

One of the characteristics that define sports is the existence of rules and regulations. These rules exist because of the fundamental belief that a fair environment is something that can be created, and that in a fair competition everyone has an equal chance at winning. Administrative bodies like the International Associations of Athletics Federations (IAAF) and the International Olympic Committee (IOC) spend a great deal of time trying to equalize competition, whether it’s through anti-doping rules, regulations on swimsuit material, or the male and female classifications in competitions. However, most of the time (especially at the elite level) races are won or lost because of physical differences. Training can only take you to a certain point, and past that it comes down to disparities in muscle mass, levels of hormones, or any number of inherent traits. Very few people have the physical capabilities to become an elite athlete, and the winners of events at an elite level are physically “mutants”; Michael Phelps, for example, has unique physical traits (his disproportionately long arms, large feet, flexible ankles) that reduce his drag and increase his speed in the water. His physique is certainly an advantage, but it is considered to be a “fair” one because it’s just the way he was born. An unfair advantage is something that is manufactured or artificial, like if Michael Phelps wore fins to increase the size of his feet. This debate over “fair” versus “unfair” makes sense to a point, but in reality competition will never be fair—everyone’s bodies are different, and there isn’t really any way around it. Fairness is not attainable, no matter how many rules and regulations are applied to competitions.  

However, fairness applies to more than just the physical attributes themselves; it’s the means by which you come to achieve them. Anti-doping rules and gender verification tests all came about because people were breaking the rules intentionally in order to improve their performance. Men were pretending to be women so that they could see greater success, athletes were injecting themselves with testosterone and other hormones to increase muscle mass, and all of these things were done solely for the purpose of gaining an advantage. This goes against the spirit of competition; indeed, it is considered to be unethical, cheating. The problem comes about when people break the rules unintentionally, like when female athletes present with characteristics that have always been considered male. Throughout this paper, I will look into the history of gender verification tests and the way that they have been changed, assess them through a feminist lens, and try to figure out a way to make competition as fair as possible for everyone.

History

Gender verification tests were introduced originally because of concerns that men were masquerading as women to improve their chances in competition. At the 1966 European Track and Field Championships, all female athletes were forced to strip naked in front of a panel of doctors so that their sex could be verified—a few years later, the IOC adopted the practice as well, and all female track and field athletes began to be subjected to gender verification testing prior to competing in the Olympics. Over time, it became evident that the physical examination was not an adequate test for determining gender, something that we realized in our discussions in class about the complexities surrounding gender determination. Varieties of chromosomal tests were tried, but those tests failed to find many of the conditions that the IAAF deemed would give a female a competitive advantage, mostly those that cause females to produce and use excess testosterone. In turn, even if an individual’s chromosomal make-up was male, various conditions could cause their bodies to develop female sex characteristics instead.

Intersexuality like this is often caused by androgen insensitivity, and these individuals are commonly raised socially as females. However, the original point of the gender testing (after all) was to determine if these individuals had an “unfair” advantage because of their bodies. Often intersex athletes didn’t have any physical advantage because their bodies couldn’t react to the excess hormones that were being produced, and so they were allowed to compete. Because of these complications, the IAAF and the IOC realized that the tests were not identifying cases of “sex fraud,” but medical conditions that the athletes themselves had no control over. Routine gender verification testing ceased before the Sydney Summer Games in 2000, but the IAAF retained the power to conduct tests on an individual if concern arose over the question of her gender, as occurred with the case of Caster Semenya in 2009 and which brought the problem back to the foreground. The problem of men intentionally posing as women for competitive gain has been eliminated today; now the issue of athletes with physical conditions that set them apart from the rest of the competitors in their field is the one that still needs to be addressed adequately.

Current Procedures

The IAAF very recently released new regulations concerning the eligibility of females with hyperandrogenism to compete in women’s competitions. Hyperandrogenism can result from a variety of medical conditions and results in testosterone levels in what experts have determined to be the normal male range instead of female. This statement itself is probematic because experts are all divided on what normal hormone ranges are; they vary widely on an individual basis. Some of these medical conditions can be serious, like Polycystic Ovarian Syndrome (PCOS), the most common diagnosis. PCOS can cause infertility and increase risk of cardiovascular problems later in life, as well as gynecological cancers. It is understandable that doctors would want to diagnose these conditions to protect athletes from harm, but I think the issue at hand is how athletes with intersex conditions that aren’t dangerous to their health. In turn, I wonder if the health risks have been exaggerated because these conditions fall outside the realm of what is considered to be normal, and are therefore considered to be dangerous.The document states:

"These Regulations set out to formulate a reasonable and suitably adapted approach by the IAAF to the management of such cases in Athletics and are predicated upon the following underlying principles…A respect for the very essence of the male and female classifications in Athletics (and) A respect for the fundamental notion of fairness of competition in female Athletics."

These amendments are in some ways a step in the right direction; the IAAF “has now abandoned all reference to the terminology ‘gender verification’ and ‘gender policy’ in its Rules,” which I think is an important distinction, as words and definitions are very important to people’s perceptions. They are still mostly treating the issue on a case-by-case basis, which is understandable because these conditions seem to be so rare, but I think that at this elite level, there are probably many cases that have gone undiagnosed.

The process of determining eligibility is a long and complicated one, and one that puts a large burden on the athlete herself to prove her eligibility. First, the athlete must notify the IAAF Medical Manager of her hyperandrogenous condition if she is aware of it, or the IAAF Medical Manager can initiate an investigation if he suspects that the athlete may be hyperandrogenous. After the identification of the case, the examination process begins. This examination has three stages to it. The first stage is the clinical examination, which also includes a family history. Some of the key clinical points that suggest hyperandrogenism are deep voice, breast atrophy, no menstruation, increased muscle mass, body hair of male type, no uterus, and clitoromegaly. After the clinical examination, the designated physician conducts an endocrine assessment of the athlete by taking urine and blood samples. They analyze the urine for several androgenic hormones, including testosterone, and the blood for testosterone as well as sex hormone binding globulin, which is to see if the athlete’s body can actually use the excess androgens she produces (which is what would put her at a competitive advantage).

After these examinations have been conducted, the IAAF Medical Manager makes sure that the results are not due to “exogenous” use, meaning use of steroids or other outside methods, and then usually refers the case to an expert medical panel. These experts come from a wide variety of fields: pediatrics, endocrinology, gynecology, obstetrics and psychology among the major ones. No physician who has been involved in the medical examination of the athlete can be on the panel, which I thought was interesting; I assume it is because the IAAF wants to avoid all possible conflicts of interest, and keep the panel as impartial as possible. Upon reviewing the case, the panel can decide that no further medical examination is needed, which is usually if they decide the athlete does not have hyperandrogenism. If they think the athlete has some form of hyperandrogenism, then another examination is required.

This examination involves physical, laboratory (including genetic testing), imaging and psychological assessment, and after this examination the panel makes their diagnosis of the athlete’s condition. Sometimes athletes diagnosed with this condition are not physically able to continue competing, and other times they choose to stop on their own, but if they declare an interest to continue competing, then the panel has to conduct a further review of their case to determine whether or not they are eligible to compete in women’s competition. The athlete is only eligible to continue competing in women’s competition if she has testosterone levels below the normal male range or she has testosterone levels within the normal male range but has an androgen resistance such that she derives no competitive advantage from having androgen levels in the normal male range. This last determining factor is where it gets tricky—how exactly do you determine competitive advantage? Do you have to bring the athlete’s testosterone levels down to a “normal” female range? I don’t think that their bodies themselves should be modified so that they will fit into the existing female classification.

Relevance

This is, for me, a very relevant feminist issue. Women like Caster Semenya and others are being banned from competitions because they are too masculine to compete with women, yet men are never told they are too feminine to compete with men. This parallel is intriguing, and points to patriarchal power structures that are still in place, even with the many opportunities that women have gained in athletics. This sexism may come from the fact that men feel threatened by women who appear masculine, as if they’re afraid of losing power. Women who “fail” the gender test are barred from competing with women until they can pass it, but in the meantime they can’t compete anywhere, and passing the test requires them to modify their hormone levels. I think that sports are the perfect site to challenge and expand our perceptions about gender, and also to clearly see the stigmas and problems that our society has surrounding gender, like this fear of women gaining too much power.

Athletes transcend gender through their performance. When you are doing something that demands so much from your body, you have to learn to trust it and accept it. In this way, it really doesn’t matter what your body looks like, but what your body can do. This is why it is so troubling to me that athletes who naturally have higher levels of androgens are being prevented from competing, because their bodies are capable of so much and yet they are being told it’s wrong. Sports expose the very basest definitions of gender in the male and female classifications; if we can expand these definitions in sports, I think that they will carry over to ever other aspect of society and our lives. Sports are global, and the questions that are being asked surrounding gender are global as well.

Even with the IAAF’s removal of the terms “gender verification” and “gender policy” in their documents, the examination and testing policies in place are still being used as gender verification for these female athletes who don’t conform. It perpetuates sexist thinking in an attempt to give some women more rights to fair competition while simultaneously denying those rights to other women, and is an attempt to work within the system. Like other feminist projects before, the cases of athletes like Caster Semenya have polarized women; the women who compete with Semenya feel that it’s unfair to let her compete, while some members of the intersex community identify with Semenya and are proud of her for her accomplishments.

This attempt by the IAAF to deal with cases of hyperandrogenism is one that bell hooks would classify as a reformist project, one that is designed to keep the existing limits and boundaries in place, but we have no use for reformist projects. Staying in this vein for a little while, I have thought about whether changing gender classifications at this level of competition would be considered power feminism or not, and I don’t think that it would. It is true that these athletes are visible, but they aren’t really in positions of power. They do not exploit or oppress others; in these cases, they are often the ones being exploited or oppressed. bell hooks asks us to “imagine living in a world where we can all be who we are, a world of peace and possibility”: this is the vision I see for the world of sports, a world where gender is not something that has to be verified, but something that accepted and accommodated in all of its different forms (hooks x). 

Moving Forward

Athletics is a somewhat complicated arena for a revolutionary project because it is by definition very structured and regulated; the structure can only be dissolved so much before sports become unrecognizable. On the other hand, I am worried that I won’t go far enough with my proposal. So, I will do my best to present the vision that I have for athletics (specifically track and field) in the hopes that it could begin to break into the distinct male and female classifications that have always existed.

It appears to me that the IAAF has determined that testosterone (and the body’s ability to use it) is the main factor in determining competitive advantage. Female athletes whose testosterone levels are in the range of men’s are banned from competing in the female classification, but their times and performances are still below those of men, so their abilities wouldn’t truly be recognized if they were competing in the men’s classification. Adding a third “intersex” classification isn’t exactly the right solution, because that’s identifying these athletes as being outside of what is normal, which is what has always been done to intersex people.

We need to change the classifications themselves into a system with more gradients, similar to weight classes. Levels of testosterone and other hormones would be the main determining factor, but muscle mass and body fat would also be helpful in determining the different factors. Consequently, every athlete would have to be tested, which would help to remove the stigma of only certain athletes being investigated. It is true that most men would fall into the upper end of the categories and most women would fall into the lower end, but I think that if we create opportunities for these athletes to compete, we will see that there are probably many more intersex athletes who had previously been excluded from competition or who had felt that they were too different to compete. These classifications could also help to better accommodate transsexual athletes.

Determining the ranges of hormone levels and muscle mass would be difficult for several reasons. First, hormone levels and muscle mass don’t directly correlate to faster speeds; also, each event in track and field is suited for different body types, so there would probably have to be different classifications for different events. Second, this could open the door to anabolic steroid use, and so there would have to be measures in place to make sure that there wasn’t cheating going on. Finally, hormones have different effects in different people, so the actual consequences of the hormones (like increased muscle mass, lower body fat, etc) would need to be measured as well.

To help determine the ranges, research would need to be conducted on athletes in each event to determine average muscle mass and hormone levels that correlated with better performances. The IAAF has a journal called “New Studies in Athletics” that is published quarterly—publishing the findings there would increase awareness and visibility among the athletes and supporters who these new regulations would affect, as well as gain the direct attention of the IAAF committees who would ultimately be responsible for putting them into place. As far as the direct process of getting new regulations approved, the IAAF holds a Congress every 2 years, which is when rules can be amended or new events/competitions introduced. These are suggested in a report that the Council submits; the Council is made up of 27 elected members and advised by 13 commissions and 5 committees.

The commissions that I feel would be most relevant are the Medical and Anti-Doping Commission and the Competition Commission. There is an option on the IAAF website to contact the association directly, but I’m not sure how much attention those submissions actually get (and maybe they’re intended to be suggestions for improving the website). However, all of the members of each of those commissions are listed on the website, as well as general instructions for contacting specific people within the IAAF—I recently sent them an email asking for any information on the success of the new legislation on female athletes with hyperandrogenism as well as any further plans they had for future legislation on the topic. Hopefully they will give me some answers, or direct me to someone who could. Depending on the success of this correspondence, I will see what would be the best way to move forward. One of the IAAF-approved specialist reference centers is at the Penn State College of Medicine in Hershey, Pennsylvania, which is under 2 hours from Bryn Mawr, so there are definitely people interested in the subject within a reasonable distance.

Implementing these new regulations would come with its own complexities. New records for each class would have to be established, and the existing world records would be invalidated, which would probably cause some anger. There also probably wouldn't be an even number of athletes in each category, so they might feel as if they didn't have the same level of competition as other categories, but I would hope that that would change as time went on. These are big changes, but all change is hard to implement initially, like when schools were desegregated or when competitive sports for women were first introduced. 

Final Thoughts

Thinking through this project has given me the opportunity to see how some of the things we discussed this semester could be applied to existing structures. In turn, while it has shown me the difficulty that comes with change, it has also given me hope. I think that the IAAF’s initial attempt to acknowledge and discuss cases of women with hyperandrogenism as well as transgendered people shows us that people are thinking about these issues, but the classifications in place are not adequate to accommodate people who are outside of existing gender norms. I’ve thought a lot about what Jack Halberstam said when he came to speak at Bryn Mawr, that he wasn’t interested in getting rid of categories—I think that I am with that sentiment in agreement in this project. Our bodies are certainly all different, but we can see connections between our bodies and those of others. It is these connections that become the basis for categorizations, so we have to go about finding and making new connections to change our existing categories. By changing how gender in athletes is defined into categories that are less black and white, I think that we would truly be fulfilling bell hooks' vision of a "world where we can all be who we are."  

Works Consulted

A.D.A.M. "Congenital Adrenal Hyperplasia." PubMed Health. U.S. National Library of Medicine, 21 Jan. 2010. Web. 03 May 2012. <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001448/>.

Hooks, Bell. Feminism Is for Everybody: Passionate Politics. Cambridge, MA: South End, 2000. Print.

Levy, Ariel. "Either/Or." The New Yorker. 30 Nov. 2009. Web. 03 May 2012. <http://www.newyorker.com/reporting/2009/11/30/091130fa_fact_levy?currentPage=all>.

"Medical Policy Statements and Advisories." Iaaf.org. International Association of Athletics Federations, 2011. Web. 04 May 2012. <http://www.iaaf.org/medical/policy/index.html>.

Reeser, JC. "Gender Identity and Sport: Is the Playing Field Level?" British Journal of Sports Medicine (2005): 695-99. PubMed. NCBI, US National Library of Medicine. Web. 3 May 2012.

Reis, Elizabeth. "Is Intersex a Disorder or a Competitive Advantage?" Women's Bioethics Project. Web. 05 May 2012. <http://www.womensbioethics.org/index.php?s=355>.

Additional thanks to Anne for the discussions we had on this subject and Amophrast for her notes on Halberstam’s lecture.