IAAF releases new guidelines for intersex athletes

[TerfinUSA]

Context: the Court of Arbitration for Sport ordered the IAAF to suspend their 2011 rules which required a level of testosterone in female athletes below 10nmol/l after a protest by 100m runner, Dutee Chand en.wikipedia.org/wiki/Dutee_Chand www.insidethegames.biz/articles/1062306/iaaf-hope-to-have-revised-hyperandrogenism-regulations-in-place-by-november

These guidelines are pursuant to Rule 141, which reads simply that
"The Council shall approve Regulations to determine the eligibility
for women’s competition of
(a) females who have undergone male to female sex reassignment;
and
(b) females with hyperandrogenism.
An athlete who fails or refuses to comply with the applicable
regulations shall not be eligible to compete."

www.iaaf.org/download/download?filename=2ff4d966-f16f-4a76-b387-f4eeff6480b2.pdf&urlslug=pdf

"some individuals have congenital conditions that cause atypical development of their chromosomal, gonadal, and/or anatomic sex (known as differencesofsexdevelopment,orDSDs,andsometimesreferredtoas'intersex').

TheIAAFrespectsthedignityofallindividuals,includingindividualswithDSDs.Italsowishesthesportofathleticstobe asinclusiveaspossible,andtoencourage andprovide a clear path to participation in the sport for all. The IAAF therefore seeks to placeconditions on such participation only to the extent necessary to ensure fair and meaningfulcompetition.Asaresult,theIAAFhasissuedtheseRegulations,tofacilitate theparticipationinthesportofathleteswithDSDs."

"Thereisabroadmedicalandscientificconsensus, supportedbypeer‐revieweddataandevidencefromthefield, thatthehighlevelsofendogenoustestosteronecirculatingin
athleteswithcertainDSDscansignificantlyenhancetheirsportingperformance.TheseRegulationsaccordinglypermitsuchathletestocompeteinthefemaleclassificationinthe events that currently appear to be most clearly affected only if they meet theEligibilityConditionsdefinedbelow."

" These Regulations exist solely to ensure fair and meaningful competition within thefemaleclassification,forthebenefitofthebroadclassoffemaleathletes.Innowayarethey intended as any kind of judgement on or questioning of the sex or the genderidentityofanyathlete.Tothecontrary,theIAAFregardsitasessentialtorespectandpreserve the dignityandprivacyofathleteswithDSDs,and thereforeallcasesarisingunder these Regulations must be handled and resolved in a fair, consistent andconfidential manner, recognising the sensitive nature of such matters. Any breach ofconfidentiality, improper discrimination, and/or stigmatisation on grounds of sex or genderidentitywillamounttoaseriousbreachoftheIAAFIntegrityCodeofConductandwillresultinappropriatedisciplinaryactionagainsttheoffendingparty.
"

So they say that some events are 'clearly affected', and lists these as 'restricted events'. It then says that athletes are only banned from these restricted events in International Competitions, which is a long list of events, but not all. www.iaaf.org/download/download?filename=21209387-36cb-4ca8-a176-952004c718ed.pdf&urlslug=pdf However you still won't be eligible for WRs.

The events are 400m, 800m, 1500m, and 1 mile and others in between.

It then gives a list of DSDs (intersex conditions):

1. 5α‐reductasetype2deficiency (XY chromosome individuals who may have fertile sperm en.wikipedia.org/wiki/5α-Reductase_deficiency);
2. partialandrogeninsensitivitysyndrome(PAIS - XY undermasculinization);
3. 17β‐hydroxysteroiddehydrogenasetype3(17β‐HSD3)deficiency (en.wikipedia.org/wiki/17%CE%B2-Hydroxysteroid_dehydrogenase_III_deficiency this XY disorder results typically in female gender assignment but male gender identity after puberty);
4. congenitaladrenalhyperplasia (this describes a spectrum of conditions affecting both XX and XY individuals en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia);
5. 3β‐hydroxysteroiddehydrogenasedeficiency (this is a form ofCAH en.wikipedia.org/wiki/Congenital_adrenal_hyperplasia_due_to_3%CE%B2-hydroxysteroid_dehydrogenase_deficiency);
6. ovotesticularDSD (en.wikipedia.org/wiki/True_hermaphroditism)

7.anyothergeneticdisorderinvolvingdisorderedgonadalsteroidogenesis (i.e. a genetic condition causing disordered gonad formation);

subject to the condition of testosterone >5 nmol/l AND being androgen sensitive.

An athlete with this condition must reduce their testosterone below 5nmol/l for at least six months, and then maintain it at level continuously.

Athletes who DON'T meet this condition can compete in any other event (sprint, marathon, javelin, high jump, etc.)

According to their data the normal testosterone level is 0.12 to 1.79 nmol/l at 95% C.I. for women and with PCOS 3.1nmol at 95% C.I and 4.8 nmol at 99.99%. Whereas the male range at 95% is 7.7 to 29.4 nmol, but 'women' (and they are not making any judgement on this) with DSDs can have testosterone in the male range.

So it seems that they are saying that their position is that the 'fair' female range should be based on PCOS (which is not an intersex condition, but DOES result in elevated testosterone levels).

So women with malfunctioning ovaries are the benchmark.

And then the basis to restrict androgens in these events is that THIS bjsm.bmj.com/content/51/17/1309 study from the 2011 & 2013 WCs showed that female testosterone levels were correlated with performance in 400m, 400m hurdles, 800m, pole vault and hammer. However there was NO correlation for men, nor for the 100m (for example).

Here are the T data from that study:

ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/b47c6ed0c9b7380ca9ed203488bd0e7c9bdc7942/4-Table3-1.png

It shows that the top 33% for each was:

100m: 1.32 nmol/l - 37 athletes
100m hurdles: 0.92 nmol/l - 24 athletes
200m: 1.11 nmol/l - 24 athletes
400m: 7.08 (!) nmol/l - 22 athletes
400m hurdles: 1.68 nmol/l - 22 athletes
800m: 3.26 nmol/l - 21 athletes
1500m: 1.12 nmol/l - 22 athletes
3000m steeplechase: 1.2 nmol/l - 19 athletes
5000m: 1.07 nmol/l - 13 athletes
10000m: 0.85 nmol/l - 11 athletes
Marathon: 1.85 nmol/l - 31 athletes

As these are means it seems that the typical female athlete has testosterone of less than 1 nmol/l. And a male level would be around 20 nmol/l. Looking at the 400m, the mean was 7.08 nmol/l with a massive standard deviation of 11.64, which indicates

• multiple athletes were intersex (N.B. I think they count a performance by the same athlete in two games twice, but potentially this is three athletes being counted twice)
• some athletes had testosterone levels beyond the normal MALE level, as the s.d. is really high.

The standard deviation of T samples in the 100m hurdles suggests that NONE of the athletes had DSD or endocrine disorders, whereas the data for the 100m and 200m suggest that perhaps one athlete had PCOS or similar.

The data for the 400m hurdles show the highest T athletes being 1.6s faster on average than the lowest, but the data don't suggest any athlete had testosterone in the male range; the interesting question for me is whether the upper tertile for this class has generally slightly higher testosterone than at say 100m hurdles (where the modal woman has

I think the science is a bit confused, because they have essentially predicated their results on actual race results. Yet I don't think the samples here are particularly large. As is noted, testosterone from whatever cause, be it non-intersex in PCOS, intersex in various cases, or doping, builds muscle and thus in theory is beneficial.

Their results show an ACTUAL correlation between higher testosterone levels and performance in say 400m hurdles based on non-intersex women, but NO correlation in the 100 metres hurdles. However if you look at the interquartile range, there's no significant difference between sprint (0.52 - 0.99 nmol/l) and middle distance (0.46 to 0.92 nmol/l) ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/b47c6ed0c9b7380ca9ed203488bd0e7c9bdc7942/3-Table1-1.png in terms of testosterone. So most female athletes have roughly speaking 0.5 to 1 nmol/l of testosterone, and the data for some events show that being in the bottom third (0.1 to 0.7 nmol/l roughly), is no disadvantage over being in the top third (1 to 2 nmol/l roughly).

However in other events having 'a little' testosterone (1.5 nmol/l, say), is shown to be correlated with having 'almost no' testosterone (0.5 nmol/l, say).

However that correlation between normal females with 'high normal female', aka 'a little', testosterone and 'low female' testosterone doesn't really tell us anything about the difference between having 'almost no' testosterone and a DSD athlete with 'a lot' or 'male' testosterone.

And those tests CAN'T show that because the sample size is too small - we are talking about one athlete potentially. So how do we prove that it's not advantageous to have 30 nmol/l of testosterone over 1.5 nmol/l testosterone just because we know that 1.5 nmol/l is not correlated with better performance than 0.5 nmol/l ?

Sorry I've just noticed that it gives free testosterone ranges for each tertile, so you can see the actual level for each event, these all had fT (max) of around 30 pmol/l or less, where the normal 95th confidence interval is 22 pmol/l:

100m, 100m hurdles, 200m, 10000m, discus, javelin, long jump, high jump, pole vault, 20km walk, heptathlon

These had higher levels (note the average level for a 25 year old male is around 428 pmol/l)

400m 124.4
400m hurdles 174.5
800m 469.3
Marathon 363.6
Shot put 319.9
Triple jump 242.8

Hammer 50.4
1500m 48.7
3000m sc 43.2
5000m 51.8

So you can specifically see that an 800m athlete (possibly Semenya) had free testosterone levels HIGHER than the normal male range.

We don't know if this athlete is partially insensitive to this testosterone, however the suggestion is that in general androgen-suppression will result in a 3% performance drop the first year and another 3% the second year.

This does seem to be specifically targeting Semenya, as I find it rather extraordinary to say that because we can't see find a correlation between 20 pmol/l and 5 pmol/l of free testosterone (in the case of the 100m, where Dutee Chand is now apparently free to compete, though she was not included in the statistical analysis), there is therefore no advantage from having say 470 nmol/l over 5 or even 20 pmol/l.

Moreover while we can say that 'an athlete with male testosterone levels who has them reduced loses 3% in the first season and 3% more in the second season', it's not clear to me how it's supposed to be fair to do this, especially as the IAAF have set a qualification period of only six months. And especially it seems an arbitrary handicap, since if the athlete is said to be a woman then a handicap based by reducing her hormone levels seems entirely arbitrary. Either you say 'she is an exceptional woman, let her compete', or you say 'this person has XY chromosomes and male hormone levels and androgen sensitivity, they are male'.

It looks like fake political correctness - you are saying 'oh well we aren't going to pass any sort of judgement on whether we think you are a man or a woman, but can you cut down a bit on those man hormones'.

It seems that the fairness towards individual athletes is the overriding concern, obviously it's difficult if someone like Dutee Chand or Caster Semenya is unaware of their condition and pursues a career in athletics at the expense of other pursuits only to be told 'actually you're not an elite female, you're a mediocre male'.

I agree it's targeting Semenya; otherwise they would have dropped it across all sports and all events. To say "high levels are only relevant in middle distance runners" is not proven to be true - we only need one exceptional intersex athlete to compete at, for example, weight-lifting for the shit to hit the fan again, and it's unfair to make panic judgements on specific, named, athletes.

I'm finding the figures really interesting. I haven't read it all (I will tomorrow).

But the one thing that is blatantly obvious is that very few women, if any (excluding intersex women) get anywhere the current level of 5 nm/ml that trans athletes are allowed to have. Dropping the allowed level to 2 wouldn't appear (according to the figures in your first post) to exclude any actual women at all.

Not to mention the advantage of having had levels of 20 times the average women for 20 years or more which the IAAF seem to manage to completely ignore.

Terfin, could you manage a tldr version, please? What am I supposed to know? I read it all, but couldn't process it.

It’s just ridiculous, the limit should be across the board or not at all. It does seem personal and just adds more confusion.

I'm starting to think that people with DSD should be counted as a paraolympic category rather than competing in the women's competition. I don't want that to seem exclusionary or unfair as I do think the athletes in question are completing in good faith but it increasingly seems like this is the only way to resolve the booking.

picklemepopcorn, they studied the results of all the events in Athletic World Championships in 2011 and 2013 according to each athlete's testosterone level. Nearly all the athletes competing had testosterone between around 0.2 and 1.0 nmol/l, a normal female level. The normal male testosterone level is roughly 30 times higher than this, more-or-less 10 nmol/l to 30 nmol/l.

Perhaps two or three athletes out of the hundreds of athletes competing in 2011 and 2013 appear to have been intersex, but had unequivocally biologically male levels of testosterone, possibly due to the presence of internal testes (and possible male fertility), but female genitals.

Although it's well proven that testosterone doping increases athletic performance, and the world records in almost every female athletics event were set in the 80s by athletes believed to have taken testosterone, the IAAF were required by a court on behalf of an intersex athlete to prove that there's an advantage from NATURAL testosterone, in other words that athletes with higher natural testosterone will tend to do better on average than those with lower natural testosterone.

In neither male nor female cases is there in general a link between natural testosterone levels and performance - men with high testosterone did not do better on average than those with lower levels. However the statistics showed links ONLY for women and only for a small handful of events on track and field.

Because the number of intersex individuals with male testosterone competing is small across all the competitors, it's impossible to draw statistical conclusions based on them, and to an extent it might be possible for SOME athletes to have male hormone levels but not benefit from them, if they have partial or total androgen insensitivity.

So what they have done is found that biological women with slightly higher (but still completely female) levels did better in a few events than those with very low levels, and for SOME of these they have told the intersex athletes such as Caster Semenya to take testosterone suppression. It wasn't ONLY the events around Semenya's distance of 800m where this was found, but also pole vault and hammer, where there don't appear to have been any intersex athletes competing at all. As a result they haven't restricted pole vault and hammer even though it appears to be affected by natural testosterone levels.

So nobody is willing to step in and say that a particular athlete is not eligible to compete based on them having XY chromosomes, internal testes, and male hormone levels/response, and therefore being reasonably describable as 'male' rather than 'female', but instead they are saying 'we aren't willing to say if they are male or female but if their testosterone levels are in the male level, they need to suppress them to a level that XX females with polycystitic ovaries would have', but ONLY for the events that Caster Semenya might conceivably compete in.

The issue arises because poor athletes such as Dutee Chand may first become aware of their XY biology after becoming elite athletes, and competing may be extremely important to them personally.

Hence it seems some have had genital surgery in order to be allowed to compete. www.thestar.com/news/world/2016/07/31/why-the-olympics-cant-figure-out-who-is-a-man-and-who-is-a-woman.html (note that that article describes the procedure as clitoridectomy, however this condition is an XY condition resulting in genitals that may appear more male than female, i.e. micropenis, so it's not clear that is the correct word).

Genital plastic surgery and hormone suppression seem to me unethical in the sense that if it turns out that these individuals were incorrectly assigned at birth we shouldn't create incentives to coerce their male biology in order to win large sums of money in female athletics.

Thank you terfin. At an individual level, it is just so sad and distressing. At a class level though, it's outrageous.

I think the issue is that nobody is willing to taking a stand for biology. Dr. Money a radical doctor who was a paedophile and who invented trans medicine asserted that gender identity is socialised and NOT biological. In order to prove this he mutilated the genitals of a baby boy and molested him over many years, assigning this boy 'female' gender identity.

It seems that in fact prior to puberty that gender identity IS largely socialised, but the actions of sex hormones at puberty have a very strong biological effect.

There are a number of different intersex conditions, and far from what Dr. Money said, we can in fact say that an individual with a certain intersex biology will, with high certainty, develop a given (male or female respectively) gender identity after puberty..

Or to put it another way, while intersex babies born in areas with poor medical care may be assigned a sex based on the appearance of their genitals, that's NOT the best way to do things.

Some intersex babies assigned female, should have been assigned male at birth, but it's obviously not their fault they weren't. To an extent it doesn't matter - Caster Semenya got married, to a woman, in traditional men's wedding wear www.smh.com.au/sport/athletics/caster-semenya-shares-photos-from-her-wedding-to-violet-raseboya-20170109-gto0x4.html - does that make Caster a man? Of course it doesn't. Women can marry women and women can wear men's clothes without changing sex.

The issue for me more is that if a person has XY chromosomes, testosterone at an unequivocally male level, can father children, expresses a male gender identity, then exactly how are they female? Because they were socialized as female in their early years? Or because they have malformed male genitalia that appear to be female?

I don't think you can in any reasonableness INCLUDE people with such conditions but then EXCLUDE transgender people.

I would prefer to see a definition that excludes androgen-sensitive androgen-producing Y-chromosome possessing individuals from female sport. It is unfortunate for those individuals but there is no RIGHT to be an elite athlete, and to include individuals be they intersex or transsexual, with male biology, in female sport, is wrong.

Because if we can't ultimately say 'actually this is male BIOLOGY, this is female BIOLOGY' and have those as innate concepts it makes a mockery of female sport. Laurel Hubbard does not have innate female biology. An intersex individual who has internal testes producing normal levels of male sex hormones, but malformed genitals does not have innate female biology. A women who has malfunctioning ovaries (PCOS or ovarian tumour) that produce high amounts of testosterone has female biology.

So we do need some sort of line in the sand based on innate biology without any resort to drugs, excluding both MTF transsexuals and intersex individuals with male biology who were assigned female at birth.

Just to say, the boy in Dr. Money's experiment, went on to develop male gender identity after puberty, as a result of the natural work of testosterone, in spite of Money's insistence, and later killed himself.