Why Olympic testosterone debate remains a tricky balance of fairness vs. inclusion

Shortly after they raced across the finish line in Tokyo on Tuesday evening, the three fastest women in the world wrapped themselves in their country's flags and posed for television cameras.
The women in the Jamaican and American flags had trained for this moment for years. The one with the Namibian flag started focusing on the 200 meters just a month ago.
At a meeting in Poland in late June, the unannounced Namibian teenager Christine Mboma embarrassed a 400-meter field of well-known European professionals. No other runner was even close to Mboma as she crossed the finish line in a world-leading 48.54 seconds.
One of the only two women who have come within a second of this time this season is another Namibian 18-year-old. In April, Beatrice Masilingi destroyed an outplayed field in 49.53 seconds at a low-level meeting in Zambia.
Those glowing times had sparsely populated Namibia and dreamed of its first Olympic medals in a quarter of a century, but Mboma and Masilingi also caught the attention of the athletics governing body. World Athletics ordered "medical exams", including testosterone tests, for both Mboma and Masilingi.
Three weeks before the Tokyo Games kicked off, Mboma and Masilingi became the latest victims of the same controversial regulations that sidelined Caster Semenya. The Namibians were banned from running their signature 400 meters in the Olympics after their tests showed high natural testosterone levels.
While a statement by the Namibian government described the expulsion of Mboma and Masilingi as "regrettable", the sharpest allegations came from the president of the country's Olympic Committee. In an article in The Namibian, the country's largest newspaper, Abner beat Xoagub World Athletics for publishing a sensitive matter and not treating it "with the respect and confidentiality it deserves".
Mboma and Masilingi's exclusion from the Women's 400 is a reminder that the debate over the fairness of World Athletics' testosterone rule will not end if Semenya hung up her track spikes. This is an issue that will continue to affect sport until its governing body finds a way to protect the competitive balance without being exclusive.
While testosterone rules prevent Mboma and Masilingi from competing for distances of 400 meters to a mile in Tokyo, the rules do not apply to other races. This gave Namibian teenagers one last chance to make a name for themselves at these Olympic Games: They only had a few weeks to reinvent themselves as 200-meter specialists.
Namibia's Christine Mboma celebrates with the flag of Namibia after finishing second in the women's 200m final at the Tokyo 2020 Olympic Games on August 3, 2021 at the Tokyo Olympic Stadium. (Photo by Javier SORIANO / AFP) (Photo by JAVIER SORIANO / AFP via Getty Images)
Caster Semenya underwent invasive gender verification tests
The testosterone debate in athletics began more than a decade ago when another unknown African runner gained prominence.
In July 2009, a muscular 18-year-old Caster Semenya ran 800 faster than any other woman in the world that year. A month later, the South African teenager stormed a world championship title in the 800 and in the last lap on the way to victory distanced herself like a machine from her competitors by 2½ seconds.
Since her deep voice and powerful physique did not meet the expectations of western society for a woman, Semenya's dominance led to questions about her gender. She underwent invasive gender verification tests before and after the 2009 World Championships in Berlin to prove she was a woman.
The result of these tests was publicly leaked days before the 800-meter final, turning Semenya's glittering moment into a humiliation.
What we know today is that Semenya has a sex development difference, the umbrella term for diseases in which the development of sex chromosomes or genitals is atypical. In court documents, Semenya recently confirmed that her DSD is strain 46 XY, which means that she has XY chromosomes and testosterone levels typical of male but female external traits.
Semenya's condition made her the unruly face of a complex, emotionally charged argument about how sports authorities should treat athletes whose physiology defies preconceived notions of normality. The Athletics Board has repeatedly changed its eligibility rules.
The debate reached a climax after the women's 800 final at the Rio de Janeiro Olympics. The medal winners who shared the podium with Semenya had already been suspected and later confirmed that they had naturally high testosterone levels due to the difference in gender development.
Semenya devastated her competition that night, spinning past Francine Niyonsaba from Burundi 150 meters from the finish and taking a 15-meter lead as she crossed the finish line. Niyonsaba took silver and Margaret Wambui of Kenya defeated Canada's Melissa Bishop for bronze.
Heartbroken that her Canadian record time failed to produce a medal, Bishop collapsed after crossing the finish line and struggled to hold back tears as she passed the mixed zone. The fifth-placed Joanna Jozwik from Poland quipped: "I feel like the silver medalist." Sixth placed Lynsey Sharp from Great Britain described the final as "two separate races".
The 1-2-3 Olympic victory reinforced the arguments that athletes with DSD had an advantage and increased pressure on World Athletics to update its guidelines. Common sense dictated that it was no accident that the world's top three fastest 800 female runners all had rare genetic abnormalities that increased their testosterone levels.
Estimates of the DSD birth rate in the general population vary, but Michigan endocrinologist Richard Auchus estimates it to be "no more than 1 in 10,000". On that basis, the odds of three women with DSD winning the 800 medals would be 1 in 10 billion if there was no advantage.
"There are only 8 billion people on earth and only half of them are women," Auchus told Yahoo Sports. "So it is inconceivable that this could happen by accident."
In 2017, World Athletics examined the testosterone levels of elite athletes who competed in the 2011 World Athletics Championships in Daegu, South Korea. The study found that the prevalence of 46 XY DSD was approximately 7 per 1000, massively higher than expected in the general population, whichever estimate is used.
Bradley Anawalt, a Seattle-based endocrinologist, suggested that basic biology explains the over-representation of elite athletes with DSD in women's sports. Athletes born with an XY chromosome benefit from increased testosterone production in the womb, after childbirth and especially during and after puberty.
"All three of those periods when testosterone levels are higher seem to have an impact on anatomy and performance," Anawalt told Yahoo Sports.
Armed with evidence that athletes with DSD had an advantage over other female competitors, World Athletics introduced a rule in 2018 that women must undergo surgery or take hormone-suppressing medication if their testosterone levels exceed a certain threshold. For the umbrella organization of sport, the new regulation was something noble, "a progressive and fair compromise" between female athletes who wanted a separate competition category from men, and "the desire of certain biologically male athletes with female gender identity to compete in the female category". of competition. "
Caster Semenya saw it differently, to say the least. She vowed to fight the rule because it was blatant discrimination against her.
South African 800m Olympic champion Caster Semenya reacts after winning the women's 200m final at the Gauteng North Athletics Championships at the LC de Villiers Athletics Stadium in Pretoria on March 13, 2020. (Photo by Phill Magakoe / AFP) (Photo by PHILL MAGAKOE / AFP via Getty Images)
The verdict forced Semenya to change events
Raised female since birth in a small, impoverished South African village, Semenya took offense at World Athletics and suggested that she be "biologically male" or compete against men. She said it was "deeply hurtful" during her testimony before the Sports Arbitration Court, the independent international body tasked with resolving her complaints about the new testosterone regulation.
"I'm not a man," said Semenya. "I am a woman."
Semenya and her lawyers argued that the overrepresentation of athletes with DSD alone was not evidence that their high testosterone levels increased their performance. Discussing the difficulty of quantifying the effects of elevated testosterone levels in athletes, experts poked holes in the World Athletics study, which attempted to do so, and complained that conducting clinical trials in full is ethically impossible.
For Semenya, the benefit she got from her testosterone levels was no different from the genetic differences that make other athletes great. Nobody complains that Michael Phelps' hands the size of paddles, she noted, nor about Usain Bolt's fast-twitch muscle fibers.
Noting that the new World Athletics rule only applied to running events 400 meters to a mile in length, Semenya told the Sports Arbitration Tribunal, "It feels like this new rule was created for me." Endocrinologists speaking to Yahoo Sports unanimously agreed, saying that there is no reason that increased muscle mass or oxygen intake from testosterone would not be beneficial during shorter sprints or numerous field events.
Before discovering that she had the strength to fight rules she believed to be unfair, Semenya had previously agreed to take testosterone-suppressing drugs to compete. The drugs, according to Semenya, led to nausea, pain, fever and weight gain, which hindered her performance on the track and had an “enormous” impact on her mental state.
The World Medical Association supported Semenya and urged doctors “not to participate in the implementation of new licensing regulations for the classification of female athletes”. It would be against medical ethics, said WMA President Dr. Leonid Eidelman, "to prescribe unwarranted drugs that are not based on medical need so they can enter competitions".
Other medical experts who spoke before the tribunal on sports saw it differently. Auchus, the Michigan endocrinologist, argued that the standard of care depends on the gender identity of a 46-XY DSD patient. Someone who identifies as male, according to Auchus, does not need treatment. One who identifies as female, Auchus said, would receive hormone treatment.
"To me, it is incongruent for one of these patients to say I am a woman, but I don't want to have sex-affirming hormone treatment," Auchus told Yahoo Sports. "It makes no sense. Now they might be non-binary and not want treatment. That's okay for me. You might be male and not want treatment. That's okay for me. But if you say that you are a woman and you want to masculinize, then that doesn't suit me. I can't calculate that. "
The Sports Arbitration Court considered far-reaching opinions on both sides, but ultimately ruled against Semenya.
In its 2019 ruling, the court concluded that athletes with 46 XY DSD had "a significant performance advantage" over other female athletes because of their testosterone levels in the adult male area. The court also agreed with World Athletics that the imposition of restrictions on 46 XY DSD athletes was "necessary to maintain fair competition in female athletics." While recognizing that the new World Athletics rules were "discriminatory", the court argued that "such discrimination is a necessary, reasonable and proportionate means" to protect the integrity of female athletics.
The verdict was a devastating blow to Semenya and her 2016 800 meter medal winners. Rather than undergoing hormone treatment, all three tried to switch to non-testosterone running routes. Only Niyonsaba managed to qualify for the Olympics, but she still failed to make the 5,000 meter final.
TOKYO, JAPAN - AUGUST 03: Beatrice Masilingi of Team Namibia celebrates with her teammate and silver medalist Christine Mboma after the women's 200m final on the eleventh day of the Tokyo 2020 Olympic Games at the Olympic Stadium on August 03, 2021 in Tokyo, Japan . (Photo by Ryan Pierse / Getty Images)
Namibian runners have to prepare for other events
At the time of the Court of Justice ruling, Mboma and Masilingi were 16 years old and way off the Olympic radar. Little did the Namibian teenagers know that the court's decision two years later would change their path in life.
The Namibian Olympic Committee said last month that Mboma and Masilingi did not know they had high levels of natural testosterone before their tests. That gave them just a few weeks to recover emotionally from being locked out of their favorite 400 and take a crash course on how best to ride the 200.
While both were clearly in top form due to their 400 times, the speed with which Mboma and Masilingi adapted was eye-opening. Mboma broke the U20 world record twice in eight hours on Monday and qualified for the 200 meter Olympic final with the second fastest time. Masilingi was not far behind her teammate and also reduced her personal best twice on the way to a starting place in the Olympic final.
In a star-studded final that featured former Olympic medalists and national record holders, neither Mboma nor Masilingi looked remotely out of place. Mboma got out of the curve in fifth place, but blew past three other sprinters, took second place and secured Namibia's first Olympic medal from an athlete. Her time of 21.81 would have won gold in 2004 and would have been no worse than runner-up in any previous Olympic Games. Masilingi finished sixth with 22.28. She again lowered her personal best by more than a tenth of a second.
The overwhelming success of Mboma and Masilingi is a reminder why many medical experts see no easy solution to pursuing the testosterone dilemma. There may not be a quick fix that promotes competitive fairness without stigmatizing and marginalizing women with DSD and elevated testosterone levels.
"It's basically unsolvable," said Anawald, the Seattle endocrinologist. "You will never find a way to resolve the tension between fair competition and inclusiveness."
While Mboma smiled in disbelief after finishing second on Tuesday, it's likely that her success came with some complications. The women's 200s have yet to be banned from athletes with elevated testosterone levels for reasons most experts find difficult to explain. Could that change if she and Masilingi keep moving up?
For now, Mboma's Olympic silver medal was a joyous achievement for her and her country. The testosterone debate was put on hold for at least a day.
Read an exuberant tweet from Namibia's largest newspaper on Tuesday: "Congratulations, you've made your country proud!"
More from Yahoo Sports:
Australian athletes celebrate their way out of the Tokyo Games
Biles wins bronze medal on rousing return to the Olympics
Durant leads Team USA past the scorching hot Rubio in Spain
Bushnell: Why the USA is so bad at handball
In this article:
Games in Tokyo
Magician Semenya
South African middle distance runner
Christine Mboma
Namibian runner
Beatrice Masilingi
Namibian sprinter

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