A furore has erupted around a biologically male boxer being permitted to compete in the female category at the Olympics. There are questions around whether it is a wise idea to let a male punch a female in the face in the name of ‘competition’. I have no strong feelings around fairness in boxing and think a more pertinent question is whether any sport should involve punching another person in the face. But the situation of men in women’s sport isn’t confined to boxing and has become a more pressing issue as more sports are affected. In this case, it is not a man who has declared himself a trans-woman. The athlete in question has a disorder of sexual development (DSD) which affects the development of male genitalia in the foetus and results in a baby being born which either has ambiguous genitalia, or which appears to be a female. In developed countries the condition is often investigated at birth, however in underdeveloped countries without access to medical specialists, the children can grow up believing they are girls. Their true sex is often not suspected until they reach puberty when the high levels of testosterone their gonads produce make them stronger and more masculinised than their female peers.
Males with 5α-Reductase 2 deficiency who are allowed to compete with females dominate the sport due to male-equivalent levels of testosterone. Caster Semenya is the most notable athlete with this condition and won the women’s 800m gold medal at the 2016 Olympics. What is less known is that both the silver and bronze medallists in that event are also males who have DSD. Results such as this have led to international sports bodies preventing these athletes from competing in certain events where they would have an extreme advantage, or competing at all. The boxer in question was disqualified from international competition for failing two gender tests, in that the tests revealed an XY chromosome. The Y chromosome designates a male, particularly one which contains the sex determining region Y gene (SRY). These men are able to father children with sperm from their internal testes, something a female is unable to do as they don’t produce sperm.
Females with DSD can also have increased testosterone levels, although they don’t approach male range. Those with congenital adrenal hyperplasia (CAH) are genetically female, but can have ambiguous genitalia when born due to exposure to higher levels of androgens. They can be more masculinised, but also suffer other health problems such as obesity, cardiovascular disease, polycystic ovarian syndrome and infertility. While they may have some advantages from higher androgen levels, they may also suffer disadvantages due to their cortisol deficiency. More severe types of this condition lead to life threatening electrolyte imbalance and require supplementation with synthetic cortisone. Taking of cortisone is generally banned for athletes, however those with CAH can receive an exemption to allow them to compete. This raises the question of the use of therapeutic use exemptions (TUEs) in athletes, not just in sex disorders, but in other conditions which many athletes suffer from.
Many would argue the pinnacle of ultra-distance trail running is Ultra Trail Mont Blanc. It is very difficult to qualify and then apply for a lottery entry to reach the start line of the brutal 171m race through the French mountains. In an effort to ensure clean sport, UTMB and other trail races adopted the Quartz ‘athlete wellness’ regulations which banned everything on the world anti-doping agency (WADA) list, as well as commonly permitted medications like paracetamol, ibuprofen and asthma inhalers. While some decried the exclusion of athletes with medical conditions, I did wonder if this had validity. Most athletes don’t have asthma. Should people with asthma be permitted to ‘level the playing field’ by using salbutamol? Isn’t improving breathing a performance enhancement in an athlete if their ‘natural’ level of ability is compromised? What do we mean by ‘cheating’ when so many of the medications we use day to day are designed to enhance our performance?
As someone who has benefited greatly from the separation of sport into male and female categories, I have a natural bias to supporting that status quo. Biological sex is not a genetic mutation. Women make up more than 50% of the population, so creating this separate category affords equality of opportunity to a large portion of society. Those who are intersex or transgender are a very small proportion who have an outsized impact on women when they are permitted to compete in the female category. If the purpose of women’s sport is primarily to have a category for women, my view is that we cannot allow men to compete, period. Even those with conditions which make them uncompetitive in the men’s category. They merely join the majority of men whose genes make them unlikely to reach the pinnacle of sport. However, I think we must also allow athletes, in their correct sex categories, to compete as they are, unassisted by exogenous substances of any type. Introducing a nebulous value such as ‘fairness’ may lead to arbitrary biological thresholds which are exceeded by biological women, but satisfied by biological men through suppression. Before we start getting into a heated discussion of ‘real’ versus ‘fake’ women, I have said it before but women are NOT men with low testosterone. Simultaneously, women with high testosterone are ‘real’ women if they have a XX chromosome, and I don’t believe they should be made to artificially lower their levels to make them ‘normal’ women.
Despite some misunderstandings by the public, I don’t believe any of the controversial athletes in question have been shown to be women with high testosterone. Nor have I been able to find any examples of exceptional biologically female athletes with DSD and high androgens. If someone has an example of such an athlete, please let me know. Every single athlete which has been subject to this controversy has been a biological man with DSD who has competed against women. The arguments regarding the Algerian boxer have been framed as differences in power and the danger to the female athletes. But would people be happy to see a ‘real’ woman, who is physically superior due to training or a natural androgen elevation, breaking the nose of another woman in competition? How does this change the outcome or the ‘fairness’? What if the male boxer had won on a close points decision? Would this have made it OK? Some part of me wonders whether the public are just not ready to see women physically whaling on each other. Although the growing popularity of women’s MMA possibly rebuts that notion. I recall watching Rhonda Rousey lose her title, with a kick to the head, with my 13 year old daughter who was enthralled with her at the time. While I agree that the male boxer should not be fighting a female, it is not for the same reasons that people are arguing. It’s because I value diversity in women’s sport, as long as the athletes are female. I believe the value of ‘fairness’ should apply across the board, and that the granting of ‘exemptions’ for athletes to fit into a ‘normal’ box has been an incredibly slippery slope. As Charlie Munger said “show me the incentives and I’ll show you the outcome”.
Back in the days when drug taking was rife in cycling, a 50% haematocrit threshold was set by the federation to prevent rampant abuse of EPO. Those who were cheating ensured their levels were close to the acceptable threshold. While those who had naturally high haematocrit were unfairly discriminated against. Whenever targets are set, people will strive to game the system to fit within them. Newer technologies aim to track athlete values over time and also directly detect exogenous EPO. Similarly with biological sex, where we previously used indirect methods to identify a person as male or female, we are now able to use more advanced genetic methods to detect a person’s actual sex, which is leading to some athletes being made ineligible for women’s sport.
While it pains me to say, it is difficult to mount a strong argument for the existence of a women’s category in sport. The athletes are slower and less powerful than men, on average, which is why they are separate. Is there an argument for having only one category which includes everyone? If so, we would never see a woman on the podium. And nor would we see transgender women or male athletes with DSD. Which is probably why they are not arguing for this solution. If we are to continue to have two categories, but allow biological men into both, then I don’t know what we have, but it isn’t women’s sport. And we should just be honest about that.
