The Olympic Struggle Over Sex

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Even as it hopes to clarify the difference between male and female athletes, a new rule from the International Olympic Committee inadvertently stirs the waters.

towerbridge-615a.jpgA set of Olympic rings hangs from London's Tower Bridge. (viks2/Flickr)

What is sport ultimately for? That fundamental philosophical question lies behind the debate over what to do with women athletes who were raised as girls but whose bodies seem to be unusually masculine. And in that debate, two clear philosophical camps have emerged.

One camp, led by the International Olympic Committee (IOC), believes the line imposed between putative male and putative female athletes must be biological. These folks -- let's call them the Anatomists -- fully admit that sex is really complicated. They acknowledge there's no one magical gene, chromosome, hormone, or body part that can do for us the hard work of sharp division into male and female leagues. Says the IOC in its latest declaration on the problem: "Human biology [...] allows for forms of intermediate levels between the conventional categories of male and female, sometimes referred to as intersex."

But the Anatomists still think we should base our sex division in sports on some sort of biological feature, even if it means we have to just pick one. They point out that sports require us to create all sorts of rules that aren't simply natural and self-evident, so why not do it here, too?

And so, the IOC has just decided that, for the London Olympic Games, the rule of sex will be based on something called "functional androgens" (or "functional testosterone"). This means that an athlete who was raised a girl and identifies as a woman will be allowed to play as a woman so long as the IOC does not discover that her body makes and responds to high levels of androgens. Androgens, of which testosterone is one type, naturally occur in both male and female bodies, but higher production usually means more male-typical development.

Notice that the IOC won't just be looking at how much androgens a woman's body makes, but also how much her cells respond. This is because some women are born with testes that make a lot of testosterone, but they lack androgen-sensitive receptors, so the androgens have little-to-no effect on their cells. This condition is called complete Androgen Insensitivity Syndrome. Those who have it -- women like Spanish hurdler Maria Patino -- develop essentially as girls and women.

The new IOC policy isn't meant to pick out these women. The athletes who are targeted by this policy on "female hyperandrogenism" include women born with conditions that can result in masculinization -- conditions including partial Androgen Insensitivity Syndrome and Congenital Adrenal Hyperplasia.

This hormone-honing approach to sex divisions in sports appalls the other camp, whom we might call the Identifiers. The Identifiers, led mostly by outsiders, believe the line between men and women athletes ought to be based in self-identity. The Identifiers take the messiness of sex development as a reason to give up on biology as the way to distinguish athletes by sex. They argue that, since the borders between sex categories are naturally open, we should not attempt to police them. Instead, we ought to go simply with an athlete's self-identity as man or woman (only requiring, perhaps, that it be confirmed by her or his legal status).

Make no mistake: there are problems with the new IOC biologically-oriented policy. For one, the policy doesn't actually specify what is the permissible level of functional testosterone for women athletes. As a result, there is no way for a woman to get herself tested in private, in advance of the games, to see if she should avoid the possibility of being plucked out of play for a sex crime, so to speak. It also seems odd that apparently the committee isn't going to decide a level until they get a case. That's like writing a criminal law after you've arrested a suspect.

The new policy gives away another problem in its title: "IOC Regulations on Female Hyperandrogenism." Why specify "female"? Because the IOC is allowing male athletes to play with conditions that cause them to be hyperandrogenized -- sometimes the very same conditions for which women will be disqualified! The result is that a woman's supposed disease is accepted by the IOC as a man's natural advantage. This hardly seems like a fair way to treat a lady, unless your goal is to keep her down.

Third, the policy appears to be out of whack with another IOC policy known as "the Stockholm Consensus," designed for dealing with male-to-female transsexual athletes. That policy requires transgender women -- women who were raised as boys -- to medically squash their androgen levels way down, seemingly well below where the policy on "female hyperandrogenism" would likely allow intersex women raised as girls to still play.

And whereas the female hyperandrogenism policy hints that a women with one of the "problem" intersex conditions might be chucked out if her medical records indicate she's benefitted from a lifetime of male-typical functional androgens, the Stockholm Consensus allows transgender women with those same lifetime androgen histories to play, so long as they have endocrinologically obeyed the IOC's rules for their womanhood for the previous couple of years.

In spite of these problems with the new IOC policy, and even though I fully support the right of any individual to self-identify socially as any gender she or he wishes, I find myself sympathetic to the Anatomists' philosophy in this case. Here's why:

Our history of liberal democracy demonstrates a grand trend with regard to the relationship between anatomy and identity, and that is the trend away from using anatomy to draw distinctions in identities where social and political rights are concerned. The Founding Fathers started this trend by challenging the idea that power must derive from bloodline. The women's rights movement, the civil rights movement, the disability rights movement -- all have successfully dismantled the idea that anatomical difference should mean some people are treated as more worthy of rights and resources than others. As Drs. King and Seuss taught us, in a just and rational world, having a star on your belly doesn't make you special.

Sport has been used as one way to push this liberalizing agenda -- with Title IX and major league racial integration standing as two good examples of the push. The Identifiers are now trying to do the same thing in the debate on sex testing, and in doing so, are making what might be the most extreme version of the anti-anatomy argument: we should not bother thinking about sex anatomy at all, and just let anyone who says she's a woman play as a woman.

But maybe here we've finally hit the limit of using sport for this kind of social agenda. I mean, sure, we could do it -- we could force sport to keep being the Joan of Arc of liberal democracy, and so we could decide common biological sex differences don't matter to gender divisions in sports. But if we do this, in the process we may be neutering sport itself.

Because at the end of the day, no matter how little we think anatomy should matter to one's social and political rights, surely we can't pretend biology doesn't matter in sports. Surely there's a reason we don't let adults play in the t-ball leagues, and a reason most women athletes want their own leagues.

And much as the IOC might try to make it sound like the Olympic Games represent the ultimate peace-and-justice movement on Earth, we're not actually talking about law and justice. We're talking about games -- games that have, as their necessary condition, bodies with bodily differences.

So, much as I am drawn, as a good political progressive, to the position of the Identifiers who want to just let athletes self-declare genders, and as frustrated as I am that the IOC still doesn't have an adequately clear policy on intersex -- nor one consistent with its policy on transsexualism -- part of me feels like we have to admit that the Anatomists are acting more true to the game.

Does that make me a traitor to progressivism -- acknowledging that people have some biological differences, such that some people have natural advantages or disadvantages in some realms of life? I don't think so. I know the Identifiers seem to fear that if we acknowledge any average differences between males and females, progress in women's rights and transgender rights will collapse. But I think we are actually mature enough, as a species, to know what is a game, and what is not.

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Alice Dreger is a professor of clinical medical humanities and bioethics at Northwestern University's Feinberg School of Medicine. She has written for The New York Times, The Wall Street Journal, and The Washington Post.

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