In a critique published online today in The American Journal of Bioethics, a Stanford bioethicist and colleagues warn that proposed policies by the International Olympic Committee and the International Association of Athletics Federations for testing the testosterone levels of select female athletes are unfair and may result in female athletes undergoing unnecessary, and potentially harmful, treatments to continue competing.
The testing policies adopted last year call for using testosterone levels to decide whether an athlete is “feminine” enough to compete as a woman. But as Katrina Karkazis, PhD, a medical anthropologist and senior research scholar at Stanford’s Center for Biomedical Ethics, and others explain in the paper, (subscription required) this approach could discriminate against women who may not meet traditional notions of femininity and distort the scientific evidence on the relationship between testosterone, sex and athletic performance. My colleague Tracie White reports:
Although it is widely believed that chromosomal testing or genital exams can indicate definitively a person’s sex, such methods are flawed. Contrary to the general understanding that women have two X chromosomes and men have an X and a Y, there are actually too many variations on chromosomal markers to use the test accurately in all cases. While it is uncommon for women to have a Y chromosome, it does occur in a small number of women.
What’s more, regardless of chromosomes, female anatomy and physiology vary in ways that may make it difficult to quickly classify a person as male or female. There are individuals with intersex traits who are born with reproductive or sexual anatomy that doesn’t fit the typical definitions of female or male.
Of particular concern with the potential policies is the possible coercion of athletes into undergoing unnecessary and potentially harmful medical treatment if they are found to have hyperandrogenism. “If the athlete does not pass, she is banned from competition until she lowers her testosterone levels,” the authors write, noting that the treatment options would entail either pharmaceutical intervention or gonadectomy, both of which carry serious potential side effects.
Rather than adopting such policies, the authors recommend against gender policing by international sporting authorities. Karkazis recently discussed the issue of sex testing for elite female athletes in a recent 1:2:1 podcast.