On this week’s episode of Slate’s sports podcast Hang Up and Listen, Josh Levin and Stefan Fatsis spoke with David Epstein, author of the books The Sports Gene and Range, about the controversial ruling that could end the career of two-time Olympic gold medalist Caster Semenya. Last week, the Court of Arbitration for Sport in Switzerland declared that some female track athletes—including Semenya—with naturally elevated testosterone levels may not compete in certain events if they don’t reduce how much of the hormone is in their bodies. Levin, Fatsis, and Epstein discussed the implications of that ruling, the argument for why the CAS got it wrong, and what’s next for Semenya and other athletes. A transcript of that discussion is below. The conversation has been condensed and edited. You can listen to the full conversation by clicking on the player below.
Josh Levin: Why don’t you start, Dave, by explaining what the Court of Arbitration for Sport just ruled, and what its explanation was for making that ruling?
David Epstein: What they ruled was that women with a specific DSD, which is a difference of sex development, in which they have XY chromosomes but still develop as women and are partially sensitive to testosterone, must lower their testosterone. That excludes women with XX chromosomes but who have other conditions that raised their testosterone anyway, and it excludes women who have XY chromosomes but are insensitive to testosterone. So actually this ruling is very narrowly applied to women with XY chromosomes and elevated testosterone to which they are at least partially sensitive, and only if they are competing in a small range of events from the 400-meters to the mile.
Stefan Fatsis: There seems to be some disagreement over the quality and consistency of the science being applied here. Can you help walk us through some of the complaints?
Epstein: We know that testosterone impacts performance. For example, nobody’s arguing, for the most part, about the rules for transgender athletes. Athletes that were designated male at birth and transitioned to female and undergo testosterone suppression—there are studies that have tracked the performance deterioration as they undergo that suppression. But in this case, with athletes of differences of sex development, where they have testosterone levels that are basically between the typical female range and the typical male range, we don’t know a lot about exactly how that impacts performance.
In 2015, the IAAF [International Association of Athletics Federations], the governing body for track and field, put into place regulations that said that athletes with this condition need to lower their testosterone below a certain level. Those regulations were thrown out by the Court of Arbitration for Sport, which said basically, Go away for two years. Come back with evidence of exactly what the performance benefit is.
The IAAF did the study, but it’s not very good. It actually did not look at athletes with differences of sex development. It looked at testosterone just in female athletes and tried to correlate that to performance. But the data is a mess.
Levin: There’s a lot of polarization about what the CAS should’ve ruled. On one side of that debate is Paula Radcliffe, who holds the world record in the women’s marathon. She says she respected the court “for ruling that women’s sport needs rules to protect it.” On the other side, Caster Semenya herself said, according to the New York Times, that the rules are “medically unnecessary as well as ‘discriminatory, irrational, unjustifiable’ and a violation of the rules of sport and universally recognized human rights.”
Epstein: On Twitter, a lot of people were sharing a picture of Michael Phelps’ arms, with people saying, “He’s got long arms, and that’s natural. So why would we regulate Caster Semenya for high levels of testosterone?” Well, on the Paula Radcliffe side, the problem with that argument is that we don’t divide sports by arm length. We do divide it by sex. If you’re going to have a female classification, it has to mean something. The reason we have the female classification is because there’s tremendous value in having women’s sports. If we only had one competitive classification for all comers, then the best women wouldn’t be able to compete with the best man. The question is, how do you define who is allowed entry into that female classification? Again, we don’t divide sports by arm length or height. But testosterone is not height. A man in the low level of the typical male testosterone range still has testosterone several hundred percent higher than a woman at the top of the typical female range. I think the Paula Radcliffe side is saying, We need the women’s classification to mean something. Testosterone is a reasonable surrogate marker for differences of biological sex.
On the other side is the argument that this is a natural advantage. And you’re putting an athlete here, a perfectly healthy person, in the position of being medicated. I think there’s a strong argument to be made that let’s err toward not forcing healthy people to be medicated.
Fatsis: That’s one of the great ironies here, isn’t it, Dave? We’ve spent decades now arguing and debating and regulating and testing against the consumption of drugs that enhance an athlete’s performance. And here, the highest judicial authority in sport is effectively mandating that certain athletes be drugged. When we talk about clean sport, and wanting athletes to be just natural, that’s one thing that really leaped out at me here.
Epstein: The World Medical Association actually said after the ruling that they’re advising doctors not to cooperate, because this is essentially saying that they should be prescribing medication for an unapproved off-label use.
Levin: An important thing to remember here is Semenya’s personal history. When she first came on the scene, it was in 2009 at the track and field World Championships. This was a historically great performance, both in terms of the time and how striking it was to watch. After that, there was what was supposed to be a secret assessment of her biology that kind of harkened back to the old times of how sex assessment happened—just a very intrusive biological exam. Then this shift to the testosterone standard happened. It was a way for these sports governing bodies to say, We’re not saying you’re not a woman. We’re using this marker that’s associated with performance.
Epstein: One of the very common responses I’ve seen online is just go with the chromosomes. But one of the seminal cases in sex testing in sports came in the 1980s and involved a Spanish hurdler named Maria José Martínez-Patiño. She was given what was then the standard sex test. She turned out to have XY chromosomes and was essentially banned from athletics. She was eventually reinstated because it turned out that she had total androgen sensitivity, meaning her body could not use testosterone at all. There are all these nuances. You run into these incredible layers of classification problems.
Fatsis: You also run into the problem of, where do you apply this? This is limited right now, according to the CAS ruling, to some middle-distance running events. But isn’t there risk here that every sport could do this? That a woman that has a naturally elevated level of testosterone in ice hockey or soccer or volleyball could wind up facing some sort of medical regulation?
Epstein: Definitely. Rulings from the Court of Arbitration for Sport are not supposed to establish precedent, but in practice that is how it has worked. I think every sporting body will be looking to what’s going on here, to think about what they’ll do when the ball’s in their court.
Levin: Semenya does have the right to appeal this ruling, and it seems that she will. She seems very adamant that she will not suppress her natural testosterone levels, and she also seems very adamant that she’s not going to stop competing. So there’s a fundamental conflict there.
Epstein: Well, maybe. Lots of middle-distance runners have moved up and tried the steeplechase, the 3,000-meter steeplechase. When she said, “Hell no, I’m not going to lower my testosterone,” we don’t know if that means she’s planning on moving up to the steeplechase or the 5K. If she does that, then what? Are we going to see them just regulate whatever event she runs in?
Fatsis: It could get ugly. If they start chasing Caster Semenya to regulate her and her alone, then we’ll know what the purpose of all of this was.