Sex in Sport

Discussion in 'Women and Steroids - Open to Everyone' started by Michael Scally MD, Mar 15, 2018.

  1. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Sex in Sport

    Doriane Lambelet Coleman & Kimberly D. Krawiec, Foreword, 80 Law and Contemporary Problems 1-5 (2017). Available at: "Foreword" by Doriane Lambelet Coleman and Kimberly D. Krawiec

    Historically, debates about what it meant “to be a woman” for purposes of sport were largely confined to elite sports circles. That changed in 2009, when it was announced that South African runner Caster Semenya, the just-crowned world champion in the women’s 800 meters, had been subjected to gender verification testing. Fellow competitors were outspoken: Semenya was not a woman, they said, and it was unfair to allow her to compete in the women’s category. “These kind of people should not run with us,” said Italian runner Elisa Cusma, “For me, she is not a woman. She is a man.”1 “Just look at her,” said Russian runner Mariya Savinova.2

    The controversy set off debates around the world about whether and why sex segregated sports are justified and how eligibility determinations for the women’s category should be made. Suddenly, in social media and the popular press, at coffee shops, and in chats at the local grocery store, people who had rarely paused to question issues of biological sex, gender identity, or affirmative action in sports debated Semenya’s case, and what it meant for conceptions of binary sex categories. It also inspired this volume, in which scholars from gender studies, law, philosophy, and biology bring insights to bear on an issue that is important, not only to sport, but to cultural debates about gender and sex more broadly.



    Taken together, these multidisciplinary approaches to the common question of sex in sport should inform contemporary debates about the relative salience of biology in the different institutional spaces that comprise this world. The issue’s authors provide relevant factual background from their respective areas of expertise and offer arguments from those disciplines about how policymakers within and outside of sport should assess and resolve the debates. Because sport has significant cultural currency and cross-cultural significance, we expect that these contributions and the processes by which they are generated will also have salience as questions about sex and identity are addressed in the non-sporting contexts in which they also arise.

    Sex in Sport. Law and Contemporary Problems. 2017;80(4).
    Law and Contemporary Problems | Journals | Duke Law
     
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Is testosterone responsible for athletic success in female athletes?

    The aim of this study is to determine the interrelationship between the resting serum testosterone (T) levels (an inherited trait) of female athletes from different types of sporting events and their athletic success. The study involves 599 Russian international-level female athletes (95 highly elite, 190 elite, and 314 sub-elite) and 298 age-matched female controls. All subjects were age 16-35 years old and to the best of our knowledge have always tested negative for performance enhancing substances.

    The athlete cohort was stratified into four groups according to event duration, distance, and type of activity:
    1) endurance athletes,
    2) athletes with mixed activity,
    3) speed/strength athletes, and
    4) sprinters.

    Athletic success was measured by determining the level of achievement of each athlete. The mean (SD) T levels of athletes and controls were 1.65 (0.87) and 1.76 (0.6) nmol/L (P=0.057) with ranges of 0.08-5.80 and 0.38-2.83 nmol/L in athletes and controls, respectively. No significant differences in T levels were found between different groups of athletes.

    T levels were positively correlated (r=0.62, P<0.0001) with athletic success in sprinters (runners, cyclists, kayakers, speed skaters, swimmers). Moreover, none of the sub-elite sprinters had T > 1.9 nmol/L, while 50% of elite and highly elite sprinters had T > 1.9 nmol/L (95% CI: 2.562-862.34; OR=47.0; P<0.0001). We do not observe the benefits of having high T levels for success in other groups of athletes. Conversely, highly elite middle-distance (P=0.235) and mixed activity athletes (P=0.096) tended to have lower T levels than less successful athletes.

    Our data suggest that the measurement of the serum T levels significantly correlates with athletic success in sprinters but not other types of athletes and in the future may be useful in the prediction of sprinting ability.

    Ahmetov II, Roos TR, Stepanova AA, et al. Is testosterone responsible for athletic success in female athletes? bioRxiv 2019:557348. Is testosterone responsible for athletic success in female athletes?
     
  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Sex, Gender, and Sports

    In 2018, the International Association of Athletics Federations (IAAF) introduced new eligibility regulations for female athletes with differences of sex development, including those with congenital adrenal hyperplasia, androgen insensitivity syndrome, and 5α-reductase deficiency (box 1).1

    The regulations are based on the contention that women with high levels of endogenous testosterone and androgen sensitivity have a performance advantage over their peers. Athletics South Africa and Mokgadi Caster Semenya, the South African runner who won Olympic gold medals in 2012 and 2016, are contesting the legality of the new regulations.

    Box 1

    IAAF eligibility regulations for female athletes with differences of sex development1

    · The regulations apply to athletes in events from 400 m to 1 mile, including 400 m, hurdles races, 800 m, 1500 m, 1 mile races, and combined events over the same distances

    · Any athlete who has a difference of sexual development, defined by a circulating testosterone concentration ≥5 nmol/L, and who is androgen sensitive must meet the following criteria to be eligible to compete in restricted events in an international competition or to set a world record in a competition that is not international:

    · She must be recognised in law as either female or intersex (or equivalent)

    · She must reduce her blood testosterone concentration to below 5 nmol/L for a continuous period of at least six months (for example, by using hormonal contraceptives)

    · Thereafter she must maintain her blood testosterone concentration below 5 nmol/L continuously (whether she is in competition or out of competition) for as long as she wishes to remain eligible

    The basis for their claim is a lack of scientific evidence showing that endogenous testosterone concentrations substantially enhance sports performance. This is in alignment with the 2015 judgment of the Court of Arbitration for Sport on the case of Dutee Chand v Athletics Federation of India and the IAAF.2 The IAAF has delayed the implementation of the 2018 regulations until the outcome of the Court of Arbitration for Sport hearing on their legality is determined; this is expected on 26 March 2019.



    At their core, the 2018 regulations seek to identify athletes whose lifetime sex assignment as female—and gender identity as a girl or woman—does not match an imposed female serum testosterone level ≤5 nmol/L.

    Beyond issues of medical governance by sports federations, the 2019 Court of Arbitration for Sport case is garnering growing media attention around gender and race discrimination, binary stereotypes of men and women according to the presence or absence of testosterone, and implications for trans women in sports.

    These issues highlight the fact that although sports policies exist to serve the organisations that develop them, the effect of these policies on individuals, societies, and even medical science has far reaching implications.

    Sitting at the intersection of biological sex and gender identity, the 2018 IAAF regulations challenge the evidence based, benevolent ethos that underlies medical practice. The medical profession does not define biological sex or physical function by serum testosterone levels alone.

    If more science is needed to develop an objective measure of androgen sensitivity, then call for health research organisations to deliver on this mandate. In the meantime, complacence around the IAAF 2018 testosterone regulation for women with differences of sex development risks setting an unscientific precedent for other cases of genetic advantage.

    History compels us to ensure that decisions about genetic superiority are supported by objective, rigorous, and reproducible data. Although this is purely conjecture, we venture that the Olympian gods smile down on winners like Mokgadi Caster Semenya when they perform extraordinary feats of human endeavour.

    Tannenbaum C, Bekker S. Sex, gender, and sports. BMJ (Clinical research ed) 2019;364:l1120. Sex, gender, and sports
     
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  4. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Science's Place In Shaping Gender-Based Policies In Athletics

    In 2009, South African runner Caster Semenya, aged 18 years, won the 800 m at the World Championships in Athletics in Berlin, only to be rapidly declared “a woman, but maybe not 100%” by the general secretary of the International Association of Athletic Federations (IAAF), and barred from competing.

    After being reinstated, she won Olympic Gold in 2012 and 2016 and became the 800 m World Champion in London in 2017. However, by the time the World Championships in Athletics take place between Sept 28 and Oct 6, 2019, new eligibility regulations for female classification from the IAAF, based on the interpretation of data from studies of androgen concentrations in elite athletes, might have prevented Semenya from competing again.

    We have been deeply involved in shaping the rules of eligibility for female athletes throughout years of regulatory changes. We have now become unlikely partners: an athlete wronged by misuse of genetic data and a geneticist listening to an athlete's perspective—a rapprochement of sorts that has led to this common critique of the new regulations.



    Vilain E, Martinez-Patiño MJ. Science's place in shaping gender-based policies in athletics. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30473-8/fulltext
     
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  5. Praeceptorem

    Praeceptorem Member

    They should have they’re own category plain and simple. But that’s my opinion.
     
  6. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Statement of FISA Sports Medicine Commission: Biological Effects of testosterone

    After recent public discussions and a request of the CAS to justify the biological effects of testosterone on performance, the FISA Sports Medicine Commission summarizes in this short statement the effects of testosterone on development, sex differentiation, many bodily functions, and performance.

    Steinacker JM, Ackerman KE, Koubaa D, Nielsen HB, Hannafin J, Hiura M, Poli P, Smoljanovic T, Wilkinson M, Zupet P, Lacoste A. Statement of FISA sports medicine commission: biological effects of testosterone. Dtsch Z Sportmed. 2019; 70: 83-84. Statement of FISA Sports Medicine Commission: Biological Effects of Testosterone
     
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  7. Michael Scally MD

    Michael Scally MD Doctor of Medicine

     
  8. mands

    mands Member AnabolicLab.com Supporter

    How often would they be tested? Year around or specifically at the event they would be participating?

    mands
     
  9. Jspd

    Jspd Member

    His head is spinning over that
    Meanwhile my head is spinning after reading how they actually wanted to verify if testosterone enhances athletic ability.
    Society: testosterone should be illegal it gives you an unfair advantage
    Also society: but... does it?
     
  10. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    The Role of Androgens for Body Composition and Physical Performance in Women

    Androgens are considered beneficial for athletic performance by potent anabolic effects on muscle mass and bone tissue. testosterone also increases the formation of new blood cells and circulating hemoglobin, which will enhance oxygen uptake. Furthermore, androgens may exert behavioral and psychological effects of importance for athletic performance including increased mental drive and competitiveness.

    Studies in men have shown dose–dependent relationship between circulating testosterone with muscle mass and strength, as well as circulating hemoglobin. Experimental evidence in women is much more limited. However, recent studies in nonathletic and athletic women have demonstrated associations between endogenous testosterone levels, muscle mass, and muscle strength.

    Furthermore, it has been demonstrated that women with mild hyperandrogenism like polycystic ovary syndrome (PCOS) are overrepresented in elite athletes. PCOS, which has a genetic component, is associated with an anabolic body composition, and this syndrome may therefore confer an advantage for physical performance and could play a role in the recruitment of women to competitive sport activities.

    The prevalence of severe hyperandrogenism, such as disorders of sex development (DSD), is also increased among female athletes. DSD may cause a greatly increased production of testosterone in the male range. These results support a significant role of endogenous androgens for athletic performance in women.

    Linden-Hirschberg A. The Role of Androgens for Body Composition and Physical Performance in Women. In: Berga SL, Genazzani AR, Naftolin F, Petraglia F, eds. Menstrual Cycle Related Disorders: Volume 7: Frontiers in Gynecological Endocrinology. Cham: Springer International Publishing; 2019:43-54. https://link.springer.com/chapter/10.1007/978-3-030-14358-9_4
     
  11. Sparkyp

    Sparkyp Member

    I support transgender folks and the movement 100% for equality. I still don’t agree that a biological male should not compete with biological females and the other way around.

    Not fair to the biological women that should hold world records in their respective support yet are losing them to biological men.

    Just look at ufc transgender women Fallon Fox. Born a male and now a female. She cracked another fighters skull open.

    Transgender people are.....people. They are just like all of us but how can anyone possibly agree that mixing transgender athletes is fair to the other athletes?

    Idk. It’s a tricky one. It’s one that rarely gets anywhere because nobody can have conversations anymore
     
  12. master.on

    master.on Member

    Category 1: males
    Category 2: females
    Category 3: male to females transgenders
    Category 4: female to male transgenders

    but wait there's more
    Category 5: transgenders who regretted getting M2F hormone treatment/surgery and then tried to turn it back
    Category 6: transgenders who regretted getting F2M hormone treatment/surgery and then tried to turn it back

    But that's still discriminative in liberal eyes, so
    Category 7: transgenders who regretted getting M2F hormone treatment/surgery and then tried to turn it back, but then changed their mind and took female hormones and vagina-making surgery
    Category 8: transgenders who regretted getting F2M hormone treatment/surgery and then tried to turn it back, but then changed their mind and took male hormones and penis-making surgery
     
  13. Praeceptorem

    Praeceptorem Member

    I definitely see your point. Hopefully they can fix all that shit. It’s getting to ridiculous point in sports history.
     
    master.on likes this.
  14. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Would it be ethical or legal for doctors in South Africa to administer testosterone-reducing drugs to Caster Semenya?

    The Court of Arbitration for Sport recently confirmed that the decision by the International Association of Athletics Federations to require hyperandrogenic female athletes such as Caster Semenya to reduce their testosterone levels to compete in certain races has been widely condemned.

    The World Medical Association has warned doctors not to assist in implementing the decision, as it would be unethical. The same would apply in terms of the Health Professions Council of South Africa's rules of professional conduct.

    Such treatment is 'futile' in medical terms, and does not serve the purpose of providing healthcare. Therefore, doctors may lawfully refuse to prescribe it. The decision is a violation of Semenya's constitutional rights and would be regarded as unethical should doctors comply with it.

    However, the prescription of such drugs would not be unlawful if Semenya gave informed consent to taking them. Such consent would not be a defence to a disciplinary hearing on unprofessional conduct, but would be a good defence to any legal action arising from unpleasant side-effects - provided they were explained to her.

    McQuoid-Mason DJ. Would it be ethical or legal for doctors in South Africa to administer testosterone-reducing drugs to Caster Semenya? South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2019;109:552-4. Would it be ethical or legal for doctors in South Africa to administer testosterone-reducing drugs to Caster Semenya? | McQuoid-Mason | South African Medical Journal
     
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  15. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Global Injustice in Sport: The Caster Semenya Ordeal - Prejudice, Discrimination and Racial Bias

    The International Association of Athletics Federations (IAAF) requires the blood testosterone level of female athletes with differences of sex development to be reduced to below 5 nmol/L for a continuous period of at least 6 months, and thereafter to be maintained to below 5 nmol/L continuously for as long as the athlete wishes to remain eligible.

    Its ruling is based on questionable research findings. Medical decisions and interventions should be based on evidence from well-designed and well-conducted research and confirmatory studies. Caster Semenya, the reigning 800-meter Olympic champion since 2015, has challenged this ruling.

    Gender verification was instituted with women's participation in the Olympics in 1900, and female athletes were subjected to invasive, embarrassing and humiliating procedures. In its many decades of harsh scrutiny of successful female athletes, especially those from backgrounds similar to Semenya's, the IAAF has disrespected human rights and medical ethics and allowed prejudice, discrimination and injustice to infringe on their dignity and relentlessly obstruct their international sporting careers.

    Mahomed S, Dhai A. Global injustice in sport: The Caster Semenya ordeal - prejudice, discrimination and racial bias. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2019;109:548-51. Global injustice in sport: The Caster Semenya ordeal – prejudice, discrimination and racial bias | Mahomed | South African Medical Journal
     
  16. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Problems of Proof for the Ban on Female Athletes with Endogenously High testosterone Levels

    At the time of this writing, a new International Association of Athletics Federations regulation preventing women with naturally high testosterone from competing in certain international athletics events has reignited the controversy over the male-female distinction in sports and its implications on individuals’ right to compete.

    A recent case filed by runner Caster Semenya and Athletics South Africa challenging this regulation before the Court of Arbitration for Sport, an arbitral tribunal that adjudicates disputes in international sports, sought to have the regulation overturned as discriminatory against women with a genetic intersex condition.

    Drawing on established international arbitration law, international norms in arbitrations, and relevant precedent, this Comment explores the evidentiary issues before the Court of Arbitration for Sport in Semenya’s challenge.

    In particular, this Comment argues that, given the high stakes of the case as well as the inequity in resources between the parties, the Court of Arbitration for Sport should have adopted unconventional rules with respect to the allocation of the burden of proof, the requisite standard of proof, and the evaluation of scientific evidence to ensure a fair hearing on the matter.

    The Comment ultimately concludes that the suggested changes are well within the discretion and ability of the Court of Arbitration for Sport to implement, slight challenges to the adoption of each proposed measure notwithstanding.

    Lin S. Problems of Proof for the Ban on Female Athletes with Endogenously High Testosterone Levels. 20 Chi. J. Int'l L. 217 (2019). Problems of Proof for the Ban on Female Athletes with Endogenously High Testosterone Levels | Chicago Journal of International Law
     
  17. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Effects of Moderately Increased testosterone Concentration on Physical Performance in Young Women

    Objective To investigate the effects of a moderate increase in serum testosterone on physical performance in young, physically active, healthy women.

    Methods A double blind, randomised, placebo controlled trial was conducted between May 2017 and June 2018 (ClinicalTrials.gov ID: NCT03210558). 48 healthy, physically active women aged 18–35 years were randomised to 10 weeks of treatment with 10 mg of testosterone cream daily or placebo (1:1). All participants completed the study.

    The primary outcome measure was aerobic performance measured by running time to exhaustion (TTE). Secondary outcomes were anaerobic performance (Wingate test) and muscle strength (squat jump (SJ), counter movement jump (CMJ) and knee extension peak torque). Hormone levels were analysed and body composition assessed by dual energy X-ray absorptiometry.

    Results Serum levels of testosterone increased from 0.9 (0.4) nmol/L to 4.3 (2.8) nmol/L in the testosterone supplemented group. TTE increased significantly by 21.17 s (8.5%) in the testosterone group compared with the placebo group (mean difference 15.5 s; P=0.045).

    Wingate average power, which increased by 15.2 W in the testosterone group compared with 3.2 W in the placebo group, was not significantly different between the groups (P=0.084).

    There were no significant changes in CMJ, SJ and knee extension.

    Mean change from baseline in total lean mass was 923 g for the testosterone group and 135 g for the placebo group (P=0.040). Mean change in lean mass in the lower limbs was 398 g and 91 g, respectively (P=0.041).

    Conclusion The study supports a causal effect of testosterone in the increase in aerobic running time as well as lean mass in young, physically active women.

    Hirschberg AL, Elings Knutsson J, Helge T, et al. Effects of moderately increased testosterone concentration on physical performance in young women: a double blind, randomised, placebo controlled study. British Journal of Sports Medicine 2019:bjsports-2018-100525. https://bjsm.bmj.com/content/early/2019/09/26/bjsports-2018-100525.full
     
  18. Ophydian

    Ophydian Member

    I get some disappointed every time I see this thread title then open it to find a boob report and no sex.
     
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  19. SaneDog

    SaneDog Member

    You have the highest quality threads. Respect.
     
  20. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    [OA] Michelle Byczkow and Kirsty Thompson. testosterone Maketh the Man or Woman: Slowing down Caster Semenya. 3 NZWLJ 327 (2019). https://static1.squarespace.com/sta.../New+Zealand+Women's+Law+Journal+2019+(1).pdf

    In August 2009, South African runner Caster Semenya won gold in the women’s 800m International Association of Athletics Federations (IAAF) World Athletic Championships. Following her win, Semenya’s eligibility to compete as a woman was challenged. She was subjected to numerous tests to determine her eligibility to compete in women’s athletics, including gynaecological, genetic and endocrine “gender verification” testing. Additionally, she was subjected to the media describing her “muscular build”, “deep voice”, and “man-like style of running” in news reports. Semenya’s “gender testing” reportedly concluded that she was intersex.

    On 9 March 2018, the IAAF informed the Court of Arbitration of Sport (CAS) that it intended to withdraw and replace its “Hyperandrogenism Regulations” with the “Difference of Sexual Development Regulations” (DSD Regulations). The key and noteworthy point here is that these regulations are only applicable to women. The DSD Regulations established new rules relating to “women with certain differences in sex development and levels of endogenous testosterone above 5nmol/L” and their eligibility to participate in eight women’s events at international athletics competitions (the Restricted Events). Semenya regularly participates in three Restricted Events (being the 400m, 800m and 1500m races) at the international DSD level.

    The DSD Regulations were due to come into force on 1 November 2018. Before that date, Semenya and Athletics South Africa (ASA) commenced arbitral proceedings before the CAS against the IAAF, challenging the validity of the DSD Regulations and seeking declarations that the regulations were unlawful. Semenya and ASA claimed that the DSD Regulations discriminate against athletes on the basis of sex and/or gender because they only apply to female athletes, and they only apply to certain female athletes having particular physiological traits. They also asserted the DSD Regulations lack a strong evidential basis and are unnecessary to ensure fair competition within the female classification. They ultimately argued that the regulations are likely to cause serious, unjustified and severe harm to female athletes.

    The enforcement of the IAAF’s DSD Regulations was delayed pending the result of the challenge. Semenya and ASA were ultimately unsuccessful before the CAS; however, the CAS did express concern with how the DSD Regulations would work in practice. Throughout the CAS decision, Semenya and ASA contended that the DSD Regulations infringed fundamental human rights. While the DSD Regulations are not legislative provisions, they are rules imposed by a sport’s governing body and therefore should not have the ability to infringe human rights. Regardless of this, the CAS Panel concluded that the DSD Regulations are reasonable, necessary and proportionate and, in the authors’ view, skirted around the human rights issue entirely.

    On 3 June 2019, the Federal Supreme Court of Switzerland temporarily suspended the DSD Regulations with immediate effect until the Court issued a ruling on the substance of Semenya’s appeal. Due to the suspension of the DSD Regulations, Semenya was expected to defend her 800m title in Doha at the World Athletic Championships in September 2019. However, the Federal Supreme Court of Switzerland subsequently overturned its own decision and the DSD Regulations are now back in force. Due to this decision, Semenya has been blocked from competing in the 2019 IAAF World Athletic Championships.

    Throughout this commentary, we will provide a legal and ethical critique of the implications and issues in sport uncovered by the legal proceedings for Semenya. We intend to consider the legal issues raised in the CAS decision and critically assess Semenya’s legal arguments as to why the DSD Regulations are discriminatory and unnecessary. Each issue provides a complex discussion that will leave many questions unanswered, including issues of racial discrimination, which are at play here. ASA compared the decisions to the repressive and racist apartheid system in South Africa that ended 25 years ago. We recognise the importance of these issues, but cannot do justice to them within the space allowed and therefore do not propose to explore them in this commentary.

    Instead, we explore the evidential basis of the DSD Regulations, the legal proceedings and their implications for female athletes, and then offer a legal and ethical critique of the discriminatory nature of the DSD Regulations by considering whether it achieves ”fairness”, and how they limit the bodily autonomy of women competing in sport.