The Grey Area of Gender

091130_r19062a_p233 Ariel Levy's article on Caster Semenya was outstanding. If
you're not a track and field geek like myself, let me briefly get you
up to speed. Semenya, a runner from South Africa, ran a half mile in 1:56. (My best time was a 2:34,
which sucks.) Her rapid improvement and her male-like appearance caused
officials to test her.

Caster doesn't have a uterus or ovaries and has
some boy bits, which means that she has three times the level of
testosterone as the average woman. 

Levy describes the latest research on Hermaphrodites. I still remember my old buddy, Pamela, calling me from medical school to tell me that she just learned that Jamie Lee Curtis was a hermaphrodite.

As a former female runner, I feel strongly that Caster
should not run with the women; the man hormones give her too much of an
edge. But she really can't run with the men either. Caster's case might force us to rethink gender dualities not just in sports.

The most tragic
thing about this story is the personal toll on Caster, who never
understood the grey area of her gender.

26 thoughts on “The Grey Area of Gender

  1. Had Semenya really never had a basic OB/GYN appointment with a competent doctor? I suppose it’s possible for someone from a developing country, but for a major athlete?

  2. I can’t find the article now, but I recall reading something last week describing her village in terms that made it extremely likely nobody every saw an OB/GYN for anything routine or preventative.

  3. An appointment with a competent gynecologist is not necessarily enough to determine a person’s sex, depending on how you are defining sex and/or gender.
    I highly recommend Sexing the Body by Anne Fausto-Sterling, a professor of biology and gender studies at Brown. I read the first few chapters a couple of years ago, then it was due at the library. After reading the Levy piece, I re-ordered it. It was fascinating to see how slippery the classifications of sex and gender truly are. It’s pretty clear that “male” and “female” are not enough to cover the variation that exists, and is more common than we tend to think.

  4. I think A F-S had an article in the NY Times when this issue first broke. It was indeed eye-opening. Laura is citing Semanya’s 3X testosterone levels, But F-S also mentioned syndromes where there’s resistance (or heightened sensitivity) to testosterone. The details of gender in intersex people is quite complicated. The numbers are also not negligible (i.e. people who could be considered intersex at birth, something like 1/3000 or so).
    Without details (and I don’t think anyone needs to be forthcoming) there’s no reason to presume that Semanya’s gender classification could have been easily detected in a “routine” OB exam. Given this population, I think the way that we draw lines between male and female for sports competition has to be given more attention than it has been. I used to think it easy — genetic male v genetic female. But, it turns out it’s a lot more complicated than that. And, as more people get access to competition (poor girls in Africa and elsewhere), the liklihood that women who hit elite levels of competition are atypical is not unlikely.
    I find it frustrating that the issue comes up *after* the women win. We need to figure out how to draw the line, and make sure athletes fit before they win the race, not make up the rules after they win. (And, I know that the issue is further complicated by actual cheating).

  5. “An appointment with a competent gynecologist is not necessarily enough to determine a person’s sex, depending on how you are defining sex and/or gender.”
    But surely (in the case at hand) a doctor would notice a missing uterus? I didn’t read the whole article, but presumably an individual missing ovaries and uterus would not be menstruating. OB/GYNs always ask “when was your last menstrual period?”
    OB/GYN aside, traditional societies tend to be very interested in menstruation, with regard to taboos, special cultural practices, etc.

  6. I think the amenorrhea rates among high school female athletes is as high as 25% (so many is really many, not just elite runners, but many others). And ballerinas, too (might be a combination of age & lack of body fat). And Semanya is only 18. Do most American girls have a ob/gyn exam by the time they’re 18?
    From the reports, it really seems to be the case that her intersex status was not suspected (as opposed to being hidden or a cheat). She (and her family) just that she was a girl.

  7. “Do most American girls have a ob/gyn exam by the time they’re 18?”
    OK, the age makes a big difference.
    I know about amenorrhea in female athletes, but wouldn’t never, ever having had a period be a pretty big red flag (sorry!) for female health, whether in Western countries or (actually even more so) in traditional non-Western cultures?

  8. I think I object to the assumption that a person has to “prove” she’s female in order to compete in female athletics. And, even more, I object to the fact that she does not have a uterus and does not menstruate leads one to conclude that she is “not female” and therefore should not compete.
    She does not have a uterus, but she does not have a penis either! And from what I can tell, she has “internal testicles,” so appears female from an standard external examination.
    I think people get the idea that there is a “right” answer. (Does she has a Y Chromosome? Then male. Does she have a uterus? Then female.) But it is not always that simple. The chromosomes tell your body what hormones to make, and the hormones then make the body parts. A Y-chromosome may tell your body to turn a lump of flesh into a penis instead of a clitoris, but if you have a hormone deficiency, then you are going to get a clitoris anyway (or, something between the two).
    If a blueprint says to build a two-story house, but the contractor and builders read it wrong and build a rancher instead, and you going to point to the rancher and say that it’s “really” a two-story house because the blueprints say so?
    This isn’t a case of a man wearing a dress to trick people. It seems to me that if you grew up thinking you were female, and aren’t trying to fool anyone about it, you get to be female and do all the female things that entitles you to.

  9. “This isn’t a case of a man wearing a dress to trick people. It seems to me that if you grew up thinking you were female, and aren’t trying to fool anyone about it, you get to be female and do all the female things that entitles you to.”
    In general, I agree with you, Ragtime. I’ve shared a bathroom with many drag queens over the years and I honestly don’t care who has what between their legs.
    It’s different when it comes to sports though. In every sport, except maybe long distant swimming, men have a HUGE advantage. Testosterone makes a really big difference. I still hold my high school record for the 2 mile race. In 25 years, no girl has beat that time. However, thousands of guys have run faster than I did. Caster has an unfair advantage over other female runner. Unless we let the other women get hormone injections (really not a good thing), it’s not going to be a fair race.

  10. It must be pretty hard to disambiguate natural testosterone from doping, too.
    I suspect (but don’t know) that this isn’t true. What makes me think this is that when male athletes are tested and have “elevated” testosterone levels, the testosterone is checked to see if it’s synthetic or natural. (This is what happened with Floyd Landis, among others.) There are drugs that can cause the body to produce natural testosterone at a higher rate, but these can be tested for fairly easily today, too. (That’s what happened to Manny Ramirez.)

  11. Two or three points about testosterone:
    1. Men have 50 times more testosterone than average women. Semenya had three times as much. She had been tested for testosterone before, and been found (under whatever standards were applied for those races) to be within the “female” range. Is “three times more!” a lot? I don’t know. At least, it’s not obviously too much. Not compared to the average guy down the street, it’s not. Sports authorities necessarily have to draw lines, but looking at the numbers objectively, “3 times” seems a lot closer to female than male.
    2. Along the same lines, what is the range in normal, non-intersexed women? I’m guessing that within the “normal range” (whatever that is), top female athletes are near the top of the range. Is a record set by a women with a testosterone level is 1.2 or 1.3 times average (and no internal testicles) suspect?
    3. Yes, making USE of testosterone gives men a big advantage over women in sports like running, but it is possible (maybe likely) that Caster Semenya can’t use the testosterone that’s in her body, due to Androgen Insensitivity Syndrome, which is common among intersex people. If she’s got testosterone coursing through her veins, but can’t make use of it to do things like produce male sexual organs, then it’s not really helping her — it’s more like carry a vial of anabolic steroids while you are running than being injected by it. So again, just like having a Y-Chromosome doesn’t make you “male” if it doesn’t produce testosterone, a Y-Chromosome that produces testosterone doesn’t make you “male” if your body is insensitive to it.

  12. Ragtime is being more forceful than me — but, I do think that the rules about what makes one eligible for competition as a woman have to be set ahead of time, and not later, and they have to be testable in some concrete way. There have been a number of stories now about women being excluded from competition *after* they start winning, a selective testing standard that seems unfair (my guess is that there are other atypical women among these populations, and they get by, because they don’t win).
    I don’t think that Ragtime’s standard can work, though, ’cause I think it depends too much on intent, which is just too difficult to test. I don’t think a more generous standard would mean that competition would be completely dominated by intersex women, and that a reasonable set of criteria could be developed.
    And, if adult 800 M competitions were unisex, they would indeed only include one sex. No woman can compete at international levels with men. For example, it looks like the 100th fastest American high school boy can beat the international woman’s world record in the 800 M race.

  13. “And, if adult 800 M competitions were unisex, they would indeed only include one sex.”
    Yep. That’s why it would be unpopular.
    Aside from gender issues, it may be that the entire idea of high level competitive sports is untenable, because it may just wind up becoming an arms race between dopers (as we have seen in baseball).

  14. It is possible to be intersexed in 32 different ways. Caster does not have AIS. I think the Levy article says that. Also, one look at Caster rules out AIS. Women with AIS often have huge, rounded breasts. No, it’s very clear that Caster is processing that testosterone and it is helping her performance on the track.
    If Caster is allowed to run with the women with her natural hormone boost, why should the artificial use of hormones be banned? Seems arbitrary. But do we really want to be in a world that allows and even expects its athletes to chemically change and permanently disfigure their bodies?
    We need more girls in sports. But that’s a rant for later. Have to drive Jonah to basketball practice.

  15. From the Levy article, regarding AIS:
    In fact, people with complete A.I.S. are less able to process testosterone than average women. Consequently, they tend to have exceptionally “smooth-skinned bodies with rounded hips and breasts and long limbs,” Dreger writes in “Hermaphrodites.” People with incomplete A.I.S., on the other hand, could end up looking and sounding like Caster Semenya. Their bodies hear some of the instructions that the testosterone inside them is issuing. But that does not necessarily mean that they would have an athletic advantage.
    So, again, Caster has about 6% of the testosterone of a normal male (but 3X more than a normal female), and likely has “incomplete AIS,” where testosterone is processed to some degree, but to a lesser degree than a male would, a condition that may or may not give him an athletic advantage relative to other females — but certainly gives him a huge competitive disadvantage biologically compared to other males.
    Given those facts, it strikes me as hardly being a gray area at all.

  16. “her”, right? Semenya has lived her life as a woman and girl (and, as far as we know, will continue to do so).
    Laura — are you proposing that testosterone levels be used as the categorical criterion for separating men and women for male/female sports? As Ragtime has pointed out, if you drew male/female tesosterone distributions, Semenya would probably fall on the female side of any reasonably drawn categorical boundary.
    We could use genotyping (I’m guessing from this discussion, though I don’t know if it’s been stated that Semenya is an XY intersex woman). Ultimately, this is arbirary — we’re going to draw lines somewhere. And, when we do, people are going to try to find the atypical humans (let’s face it, running the fastest in the world, by definition, means you are an atypical human) that falls within the boundary. They’re going to train/produce the atypical human (for example, it looks like girls can delay the onset of woman-like bodies by heavily training, an obvious benefit in some sports, but potentially producing different bodies even that affect performance into the future).
    I have sympathies for the point of view that “doping” of some sort (not necessarily steroids, but variations on different chemical interventions and training interventions that produce chemical effects and finding anomolous humans, with say hyper or hypo sensitivity to various chemicals) is the future of elite sports that’s truly open to all.

  17. The personal side of the Caster story is indeed a tragedy. She was obviously clueless about her genetic identity. Running is her only life and hope to rise out of poverty. It sounds like she never fully understood the tests that were done on her. Terrible and tragic.
    However, I do think that girls sports have to be exclusively for biological girls and women. If the doctors say that Caster’s performance on the track has nothing to do with her ambiguous gender than fine. Let her run with the girls. But if there’s something about her body chemistry that gives her an edge on the track, then the race isn’t fair.
    The only way that biologically average girls are going to be able win races and be competitive is if rules exist that exclude men or individuals who are in some ways male. I’m not proposed testosterone testing. I’m just saying that rules have to be put in place.
    I want young girls to look at track races on TV and say to themselves, “that could be me.” I want more girls getting dirty on the soccer fields and passing batons on the track. Girls need to freeze their asses off on the field and sweat their brains out in the summer. One of the reasons that no girl has beat my time in the two mile was because the 80s were the prime time for girls sports. Ever since the 80s, girls participation in sports has dropped. This is tragic on so many levels.

  18. I am instinctively very dubious of the “what about the children?” arguments. There certainly need to be more women in organized sports, but I don’t see how it is fair to exclude one group to prop up another.
    My daughters love playing Scrabble with me, even though they are aware of the insane “Word Freak” people who don’t even speak English but have the entire Scrabble dictionary memorized and win international competitions.
    In any event, there are huge variations in testosterone levels even in “normal” girls. It doesn’t look like there are strict standards, but the range looks to go anywhere from 20 to 70 as being “normal.” Why is it fair for the 20 ng/dl girls to race against the 70 ng/dl girls? Assuming a standard genetic bell curve, you’re really only going to have 10% of girls who will be able to become world class (or all-state, or whatever) no matter where you set the bar.
    Winners of high school track meets are generally very good athletes. Winners of international competitions are generally freaks — either genetically, or due to bizarrely excessive training rituals. Any attempt to set them up as role models in any way are bound to lead to disappointment.

  19. “Any attempt to set them up as role models in any way are bound to lead to disappointment.”
    Yes, in general, setting athletes up as heroes for children is not a good idea.

  20. If the rules regarding gender are eliminated from competition, then girls, even the freaky athletic types, will lose. No girl, even with high but average levels of testosterone, will be able to compete with guys. I like girls sports. I would like to see girls continue to win races. End of story.
    Later in the week, maybe on Friday, I’ll write something about why girls need sports. But right now, I’m thinking about other topics.

  21. Do you think that lets say, a man born with a syndrome that caused excessive height should be banned from playing basketball?
    There are all sorts of, parden the word, freakish, biological occurrences which give disadvantage in one area and advantage in anther. Unless we saw the entire arena of female sports dominated by intersex individuals I don’t see the issue.
    If she had been defrauding someone that would be different. But she has female genitalia and she identifies female, I say she’s female unless she decides otherwise.
    I feel terrible for this poor girl. And the individuals responsible for insuring the entire testing debacle was handled with so little sensitivity should be ashamed of themselves.

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