Gender struggles for women to find equality in sport – Kristen Worley

Kristen Worley, Advisory Chair, Researcher and Diversity Policy Development Adviser for the International Ethics & Research Centre

When the IOC has gone too far to determine a woman’s eligibility to compete

The recent Commonwealth Games in Glasgow showcased a significant shift in the games execution by incorporating the standard games format with the paralympic games format as one inclusive program, with a primary emphasis on human ability, performance and inclusion.  For 18 year old Dutee Chand from Orissa India, though, this was not meant to be as her dreams would be tragically altered just days before the opening ceremony. Here is why.
In 2012, the International Olympic Committee (IOC) and International Association of Athletics Federations (IAAF) released a blanket policy the Hyperandrogenism Rule. (1) The policy was presented to the world of sport, specifically targeting women as a required standard for eligibility to compete.  The purpose of the policy was to regulate an individual female athlete’s androgen level to compete under the umbrella of “fairness”.  The IOC and IAAF created this policy, with their own chosen expert medical panel, recommending that the athlete is not eligible to compete in women’s competition if she has normal androgen sensitivity and serum T levels above the lower normal male range (10nmol/L). They chose an arbitrary definition with the absence of normative statistics of androgen levels in a high-level female athlete population, completely ignoring science and multiple factors that define a successful high performance athlete.
Historically, the IOC have a horrible track record of gender testing the female athletes without sound scientific support and spanning over several decades, which has only harmed dozens of women.  However, prior to the 2000 Olympic Games in Sydney the IOC stated that the compulsory gender testing of all female athletes would be discontinued due to inadequate science and complaints by the athletes, and amid growing concerns over human rights and discrimination towards women. 
Though the IOC would like the world of sport to believe they have discontinued the gender testing of the female athletes, that is not exactly the case. The advancements in biosciences have allowed the screening to become more refined. The Hyperandrogenism rule is gender testing, only repackaged and rebranded. It is a tool designed to segregate and crystallize gender conformity, to eliminate the spectrum of natural occurring human form and assure maintenance of western femininity, having nothing to do with competitive performance or fairness. 
Elevated androgen levels in women are common and particularly in female athletes. This occurs, on average, to one out of five women during their reproductive years between the ages 8 and 45. Like men, women have varying natural occurring androgens in their bodies, which play an important role in proper regulation of the body and are particularly important in an athlete’s development.
Through the hyperandrogenism test, a healthy female athlete with raised androgen levels is forced to have her androgen levels lowered through invasive pharmaceutical hormone therapy, combined, with surgical removal of her reproductive organs, which will shock the athlete’s body into menopause making the athlete unwell, having to commit to lifelong Hormone Replacement Therapy (HRT), and causing a return to high performance competition, impossible.
In a most recent report, the IAAF has admitted to the lack of definitive research linking female hyperandrogenism and sporting performance. What is problematic is that there is no clear scientific evidence proving that a high level of testosterone is a significant determinant of performance in female sports. (2) The policy design has also allowed the IOC and IAAF to transfer the burden and liability onto national federations to ensure that athletes comply with pre-Games testing.  If an athlete is found to have elevated androgens, she will then become ineligible to compete in international competitions, even before leaving their country. 
Dutee has just finished a promising junior athletics career with a personal best, placing 6th at the 2013 World Youth Championships, and had she competed in Glasgow, would have never qualified for either the 100m or 200m women’s finals. Dutee is now overwhelmed, given little information, and has been left feeling that there is something wrong with her body and that she needs to be medically “fixed” in order to resume competition. To address Dutee’s eligibility, India Athletics had told her that if she wishes to continue to compete she must undergo treatment, now deemed by experts as a violation of medical ethics and abuse.
Sadly, this is not a unique occurrence. As recently as the 2012 London Olympics four young South Asian athletes were treated for elevated androgens. Like Dutee, they were persuaded by the IAAF and agreed to treatment, which took place last year in Montpellier, France. The leading physician who performed the surgeries published reports stating the intervention was “unnecessary” and these young Olympians were, in fact, “healthy”. (3) These women were 18, 19, 19, and 21 years of age.
In recent days, there has been an outpouring of support from within India, combined with international expertise to help Dutee.  With assistance, she now has greater clarity of the situation and understands what would occur if she were to agree to the suggested course of treatment and how it would impact her health and her athletic career.  With support from the Indian government and experts, a course of action through the Court of Arbitration in Sport (CAS) in Lausanne is being discussed to challenge the IOC on the validity of the policy, reclaiming Dutee’s eligibility to compete and removing the policy altogether from sport.
(1) IOC Regulations on Female Hyperandrogenism. Published June 2012. 
(2) Stéphane Bermon, Pierre Yves Garnier, Angelica Lindén Hirschberg, Neil Robinson, Sylvain Giraud, Raul Nicoli, Norbert Baume, Martial Saugy, Patrick Fénichel, Stephen J. Bruce.  Journal of Clinical Endocrinology and Metabolism JCEM Serum Androgen Levels in Elite Female Athletes, Published August 2014. 
(3) Patrick Fénichel, Françoise Paris, Pascal Philibert, Sylvie Hiéronimus, Laura Gaspari, Jean-Yves Kurzenne, Patrick Chevallier, Stéphane Bermon, Nicolas Chevalier, and Charles Sultan.  Journal of Clinical Endocrinology and Metabolism JCEM Molecular Diagnosis of 5_-Reductase Deficiency in 4 Elite Young Female Athletes Through Hormonal Screening for Hyperandrogenism, Published April 30th 2013. 
Article  published  by International Working Group on Women and Sport (IWG).

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