By Amanda Grigg
Earlier this month Dutee Chand, a sprinter from India, was barred from international competition following an evaluation of her testosterone levels. Chand has a condition called hyperandrogenism, which is characterized by excessive levels of testosterone. The condition puts Chand’s (naturally occurring) testosterone levels in the male range according to the standards of the International Association of Athletics Federation (IAAF), the governing body of track and field. Both the IAAF and the International Olympic Committee (IOC) now use testosterone levels to determine whether female athletes can compete as females. Though they have moved away from the language of “sex determination” testing, and now suggest that their efforts are designed to ensure fairness because (though this is highly contested) having testosterone levels in the typical male range give some women an “unfair” advantage.
It’s unclear what prompted the request that Chand be tested, which was reportedly made by someone at the Asian Junior Athletics Championships in June. In a prominent past case, South African runner Caster Semenya was required to undergo sex-verification testing after she somewhat suddenly improved her times and began winning races. Though Chand has exhibited no such sudden changes, she acknowledges that she has a masculine build, which might have motivated someone to request that she be tested.
This might seem odd (and sexist, and draconian) but it’s actually a return to normal for international athletics. Sex-determination testing used to be required for female olympians, a result of regular allegations that men were posing as female athletes. Testing was, thankfully, phased out in 1999 but in the past several years has come back to international track and field with a bang.
In 2009 then 18 year old South African runner Caster Semenya was required to undergo sex-verification tests after questions were raised “about her muscular physique and drastic improvement.” A description of the testing required for sex verification featured in the NYT suggests that it is invasive and extensive.
The testing done on Semenya takes weeks to complete. It requires a physical medical evaluation, and includes reports from a gynecologist, an endocrinologist, a psychologist, an internal medicine specialist and an expert on gender. The effort, coordinated by Dr. Harold Adams, a South African on the I.A.A.F. medical panel, was conducted at hospitals in Berlin and South Africa.
Eventually Semenya was reinstated. By this time her initial test results had been made public without her consent, she had been sidelined from the sport for a year, missing out on an estimated $250,000 in prize money, had been forced to undergo a bevy of tests, and was embroiled in an international controversy. The shift from sex-verification testing to a testosterone standard was in large part a result of the mishandling of Semenya’s case.
Non-binary sex traits are actually surprisingly common. The Intersex Society of North America estimates that in one in 100 births children exhibit sex traits that differ from the standard male or female and that in one or two in 1,000 births children receive surgery to “normalize” their genital appearance. There are also several chromosomal conditions that result in non-binary sex traits which do not become evident until puberty. Anne Fausto-Sterling famously argued that roughly 1.7% of the population is intersex. The figure is disputed based on her broad definition of intersex, but works for our purposes of non-binary sex/sex presentation that would raise the suspicions of the IOC and IAAF.
According to a case study released in an academic endocrinology journal, at least four female athletes at the 2012 London Olympics tested beyond the female limits for testosterone. All four reported an absences of menstruation and were found to have enlarged clitorises and undescended testes. Genetic testing revealed that the athletes had various genetic mutations resulting in XY (male) chromosomes presenting with an outwardly female body. According to the authors all four athletes expressed the desire to maintain their female identity:
We thus proposed a partial clitoridectomy with a bilateral gonadectomy, followed by a deferred feminizing vaginoplasty and estrogen replacement therapy, to which the 4 athletes agreed after informed consent on surgical and medical procedures.
These women opted to undergo procedures to feminize/normalize their bodies, though purportedly, thanks to the end of “sex-verification” and the instatement of the testosterone standard, in order to compete they were only required to lower their testosterone levels. Similarly women like Chand who exhibit hyperandrogenism are offered the choice of having surgery or taking pills to artificially lower their testosterone levels.
Problematically, science on the benefits of testosterone does not make it clear that heightened levels confer an inherent advantage. Testosterone is just one part of the body’s complex physiology and the importance of skill, training, and psychology further complicate the potential potency of testosterone. Chand’s case suggests as much. In fact, if you compare Chand’s personal best times to the top times at the 2012 Olympics, she places outside of the top 24 in all three of the events in which she competes (100m, 200m and 400m).
In the case of the IOC testosterone testing is mandatory for all female athletes. In the case of the IAAF, monitoring occurs by request and is thus based largely on physical appearance and comportment, meaning that one’s gender presentation is fundamentally mixed up in observers’ attempts to ferret out the not-sufficiently female athletes. And competitors appear to be more than happy to evaluate one another’s sex based solely on appearance. Speaking to journalists after the initial announcement that Semenya would undergo testing, fellow competitor Elisa Cusma of Italy, said “These kind of people should not run with us…For me, she’s not a woman. She’s a man.” Russian runner Mariya Savinova told reporters that she did not believe Semenya would be able to pass a test, saying “Just look at her.”
These procedures seem drastic but in fact they mimic and formalize the kind of informal gender policing that plagues women’s sports in the US and often targets women of color. Female athletes tend to challenge cultural ideals of femininity and what female bodies should look like. And the blurring of gender and sex boundaries tends to make people anxious (cue Judith Butler). If these anxiety-inducing athletes fail to counter their nonconformity with adequate kowtowing to femininity and heterosexuality they’re publicly ridiculed. For ridicule in particularly racialized terms and despite regular expression of traditionally feminine traits see Serena Williams. Notably and problematically this often takes the form of accusing women of being trans, as these charming men employing trans-slurs to criticize Serena Williams on twitter demonstrate (I excluded the worst of the tweets, which included more slurs and threats of violence against trans women).
Let’s recap: In order to compete at the international female athletes – and for the IAAF particularly those who appear masculine – must meet an arbitrary standard of female-ness. If they do not, they are required to normalize themselves until they do. If you teach Judith Butler this is like mana sent from the how-to-explain-social-construction-to-freshman heavens.
These procedures have historically been referred to as “sex-verification” but they are irrevocably tied up with gender. They are a great illustration of how closely linked sex and gender are and offer powerful evidence in support of Butler’s argument that sex is both socially constructed and that the binary construction of sex is forcibly enforced (in part because it is vital that it appear to be a clear, pre-existing, natural division from which gender (masculine/feminine) and sexuality (attraction to women/men) stem).
“sex” is an ideal construct which is forcibly materialized through time. It is not a simple fact or static condition of a body, but a process whereby regulatory norms materialize “sex” and achieve this materialization through a forcible reiteration of those norms…”Sex” is thus, not simply what one has, or a static description of what one is: it will be one of the norms by which the “one” becomes viable at all, that which qualifies a body for life within the domain of cultural intelligibility.
– Butler, Bodies That Matter p. 4
For those who aren’t fans of academese, here’s Alice Drager, professor medical humanities and bioethics at Northwestern on the IAAF’s sex determination processes:
at the end of the day, they are going to have to make a social decision on what counts as male and female, and they will wrap it up as if it is simply a scientific decision…And the science actually tells us sex is messy. Or as I like to say, ‘Humans like categories neat, but nature is a slob.’
These cases raise all kinds of interesting and important and infuriating issues. First, the emphasis on testosterone in determining sex eligibility is not only scientifically unsound but reinforces the notion that testosterone belongs to men (in fact it occurs naturally in both women and men though at varying levels) and that this inherently male trait is associated with and even the primary determinant of athletic prowess (can you say scientific sexism)?
Second, it is beyond suspicious that the majority of the women embroiled in sex determination scandals have been women of color. In the US, black women in particular have historically been deemed inherently less feminine than white women and in many meaningful ways have not considered to be “women” at all. As noted, in the IAAF, requests for sex-determination testing can be made based solely on an observer’s (coach or athlete)’s perception that the female athlete in question might not be adequately female. Insofar as race shapes perceptions of femininity and masculinity, it would likely play a role in decisions to request sex-determination testing .
In addition to IOC and IAAF policies exposing women to invasive testing and forced hormone therapy and even surgery, the IAAF’s request-based testing would seem to incentivize female athletes to make efforts to present themselves in as female and feminine a way as possible. There is no such incentive or requirement for male athletes, nor is there an equivalent test to ensure that they have adequate levels of testosterone, the right chromosomes, the right genitals. The argument that applying these invasive tests and requiring these life-changing procedures of women and not men isn’t discriminatory is based on the notion that these policies are only required to level the playing field among women, not men. Accordingly, both organizations are shifting away from declaring that their tests determine sex and instead suggesting that the tests ensure that no one has an “unfair” advantage. But if these athletes identify as women, and if the tests no longer claim to prove that they are not women, then the playing field is no less level than it would be if another female athlete had a natural difference that might make her more competitive, let’s say particularly long legs or large lungs. This would seem to be particularly true if, as is the case, women with high testosterone levels are not swamping the medal stands.
There are also compelling arguments that equal access to sports, particularly at the elite levels, is vital for ensuring social, economic and political equality. Thus excluding intersex and non-binary women from elite athletic competitions is a troubling act of discrimination on multiple fronts. And requiring that women alone conform to a certain standard of sex (to pass testing) and gender presentation (to avoid undergoing testing) in order to access this opportunity is equally disturbing.
Finally, we should ask where these policies leave transgender athletes. Trans women who take hormone pills might be allowed to compete, though in light of competitor’s responses to Semenya this would almost certainly lead to controversy over the insufficiency of the testosterone standard. And those who choose not to or who cannot undergo hormone therapy would seemingly find no place in international track and field.
Happily, Chand’s case offers a glimmer of hope. In the past female athletes subject to sex-verification have given in to the IOC and IAAF, “quietly” consenting to surgery to lower testosterone or leaving the sport. Some, like the four identified at the 2012 Olympics, have undergone plastic surgery recommended to further feminize their bodies. This history makes Chand’s decision to fight the ban particularly momentous. According to Juliet Macur who profiled Chand for the New York Times, “Dutee Chand loves her body just the way it is…She believes that the body she was born with — every chromosome, cell and organ — makes her the woman she is.”
 This is always the hardest thing to convince undergraduates of when you’re teaching Butler. Or maybe second hardest after convincing them to muddle through her…unique writing style.
 In the cases of Chand and Semenya, these requests have come during international competitions and not from competitions within their own country, where they would have both been part of the majority race.