IAAF Rules on DSD

May 2, 2018

The International Association of Athletics Federations (IAAF) recently made a controversial ruling regarding high testosterone levels in female athletes. According to a release, the new regulations will affect women in only certain events (400m to the mile, including 400m, hurdles races, 800m, 1500m, one mile races and combined events over the same distances) whose blood testosterone levels are above five nano-mols per liter (nm-L). A normal level is 0.12 to 1.79 nm-L.

An article from Wired explains that women with testosterone levels in this range have hyperandrogenism, a condition that is referred to as a difference of sexual development (DSD).

The IAAF’s ruling was made due to the advantage that testosterone presents for explosive muscle power, drawing on results from a study examining female athletes’ performance in certain track and field events. “Our evidence and data show that testosterone, either naturally produced or artificially inserted into the body, provides significant performance advantages in female athletes,” Sebastian Coe, IAAF President, said.

The study cited by Coe examined the performance of female and male competitors at the 2011 and 2013 world track championships. Although a performance difference was seen when comparing females who had normal testosterone levels with those with the highest levels, the most drastic difference was seen among female athletes competing in the pole vault and hammer throw events.

Neither of those events’ competitors will be affected by the new regulations. However, Olympic gold medalist Caster Semenya would have two options under the new ruling—either take medication to lower her testosterone levels, move to a longer distance event, or compete in the male classification.

Following her 2016 Olympic gold medal win in the 800-meter event, Semenya’s performance was criticized by competitors who said she isn’t a “real” woman. Semenya’s gold was won by 1.18 seconds—a difference of one percent when compared with the runner-up.

“It’s not that there’s no effect of testosterone on athletic performance, but it doesn’t provide the kind they complain about,” Katrina Karkasiz, PhD, a bioethicist and visiting fellow at the Yale University Global Health Justice Partnership, said. “This isn’t doping. Everyone agrees that doping is cheating. I don’t think we have got to the point where natural physiological traits are cheating.”

With the new regulations going into effect on November 1, any athlete with a DSD will be required to meet three criteria to compete. This includes being recognized as female or intersex; reducing the blood testosterone level to less than five nm-L continuously for at least six months; and maintain that level throughout her eligibility.

“The latest research we have undertaken, and data we have compiled, show that there is a performance advantage in female athletes with DSD over the track distances covered by this rule,” Stéphane Bermon, MD, PhD, Sport Physician and Exercise Physiologist at the Monaco Institute of Sports Medicine, and member of the IAAF Medical and Antidoping Commission, said. “We have seen in a decade and more of research that 7.1 in every 1000 elite female athletes in our sport have elevated testosterone levels, the majority are in the restricted events covered by these regulations. This is around 140 times what you will find in the general female population which demonstrates to us in statistical terms a recruitment bias. The treatment to reduce testosterone levels is a hormone supplement similar to the contraceptive pill taken by millions of women around the world. No athlete will be forced to undergo surgery. It is the athlete’s responsibility, in close consultation with her medical team, to decide on her treatment.”

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