Throw Like a Girl, Cheer Like a Boy. Robyn Ryle

with testosterone because their bodies cannot process the hormone.^[17] Having AIS confers no competitive advantage whatsoever, but was still the basis for barring Martínez-Patiño from participating as a woman.

      Being Intersex in Sports

      The further we delve into the history of gender testing in sports, the more confusing it seems to get. That’s because human biology is much more complicated than the simple categories of male and female imply. Chromosomal tests are problematic because our genetic makeup is more complex than the simple XX and XY that many of us presume to categorize us. Turner syndrome, Klinefelter syndrome, and AIS are some of the many conditions that fall under the umbrella term intersex. An intersex person is born with genitalia, chromosomes, internal anatomy, hormones, or some combination of the above that are outside the typical male/female binary. When all the different types of intersex variations are combined, it is estimated that as many as one or two in two thousand people are intersex, and these numbers may be higher among elite athletes. Some intersex variations are discovered at birth, but as the gender testing in elite sports reveals, many go undetected. Many intersex infants are altered at birth by doctors who argue that this saves these children the social and psychological distress of gender ambiguity. Intersex activists advocate for no surgery until children have reached an age to make their own decisions about their gender and their bodies. Being intersex is a naturally occurring phenomenon. Doctors often treat being intersex as a condition to be corrected, but in reality, it’s a simply a reflection of the natural biological diversity that exists around gender. Given that diversity, devising any biological criteria to definitively say who is and isn’t a woman is impossible.

      Looking Like the “Right” Kind of Woman:

      Gender Testing, Race, and Geography

      That it might be impossible to use any biological criteria to determine gender didn’t stop the IAAF and the IOC from trying, however. In a story similar to that of Caster Semenya, Dutee Chand, one of India’s fastest runners, was preparing for her first international adult track event when she got a call from the director of the Athletics Federation of India. The director was calling to ask Chand to undergo a series of medical tests to prove her gender. These tests forced Chand to demonstrate that she really was a woman rather than a man trying to gain a competitive advantage by competing as a woman. Chand had grown up never considering she was anything but female, so these demands that she prove her gender came as a complete surprise. By 2014, when Chand was informed she wouldn’t be able to compete, both the IAAF and the IOC had abandoned comprehensive gender testing. But the two organizations still retained the right to test “suspicious” individuals, despite widespread protests. In practice, this policy often meant targeting female athletes who didn’t fit notions of what a feminine body should look like or who were particularly successful in their sport.

      These policies raise questions about exactly what a “feminine” body looks like, and how that might intersect with notions of race. Many critics have pointed out the fact that the women who have been recently targeted for gender testing tend to be women of color from the global South. Supporters of both Semenya and Chand argue that their geography and race may be the real reason for being targeted by the IAAF. Katrina Karkazis is a Stanford University bioethicist and expert on intersex issues who has pointed to the role of race in these two cases. “All of these [efforts] seem to coincide with the recent dominance by women from Sub-Saharan Africa in certain track and field events, and that wasn’t the case before,” Karkazis said. “That is one way this is racialized. Who is winning those events? Who has won historically?”^[18] Supporters like Karkazis wonder if the IAAF would have pursued Semenya for nearly a decade if she were a white runner from the global North. These critics note that officials haven’t targeted any female athletes as “suspicious” in events with a demonstrated correlation between testosterone and performance (like the pole vault and the hammer throw). That’s because white women dominate in those sports, rather than women like Semenya or Chand.

      Semenya’s case also demonstrates the ways in which our ideas about femininity are racial and cultural. Bruce Kidd, a University of Toronto professor and longtime member of the Olympic movement, points out the way differences in men’s sports are celebrated. “We encourage nations to send athletes regardless of how they look, their size and shape, and we celebrate those athletes who are at the extreme, the outliers,” he said of men’s sports. “In women’s sport, the dominant discourse is that woman should look like the European, North American, Caucasian expectation of femininity and that they should conform to a hormonal requirement that belies the science and is not expected of the men.”^[19] In other words, Semenya and Chand weren’t targeted because they don’t look feminine, but because they don’t look like a very specific version of femininity.

      The Truth about Hormones

      After Semenya’s humiliation in 2009, IAAF officials released an ambiguous statement clearing Semenya for further competition. Speculation that Semenya had elected to take medication to lower her testosterone levels was later confirmed. In the wake of the controversy over Semenya and Chand’s cases and the support they received from the public, many fellow athletes, physicians, politicians, and legal counsel, in 2011 the IAAF announced that it would abandon all language of “gender testing” and “gender verification.”^[20] Instead, a test for hyperandrogenism (high testosterone) would be implemented, and only when the IAAF had “reasonable grounds for believing” that a woman may have the condition.^[21] Though officials argued this test had nothing to do with gender, the criteria for what constituted “high testosterone” were based on what was defined as “within the male range.” In other words, women who had testosterone levels that were similar to testosterone levels in men would be barred from competition. There were two exceptions to this rule: women like Martínez-Patiño, whose bodies were unable to process testosterone; and women who took drugs in order to reduce their testosterone. Because Semenya’s tests revealed levels of testosterone that were above this limit, she was told she would have to take medication to lower those levels before she could compete in the 800 meter event.

      Take a step back for a second to contemplate all the implications of this new policy. First, for all its fancy language, the test is still about gender. The “normal” reference range for men is defined as between 10 and 35 nanomoles of testosterone per liter. For women, the range is .35 to 2.0. So for the purposes of testing, a female athlete must have less than 10 nanomoles per liter. Even without using the language of “gender verification,” the test is based on a biological definition of what a woman is—this time hormonal instead of chromosomal.

      Second, the policy forces women whose testosterone is above the limit to either be barred from competition or undergo medical intervention in order to compete. That is, women must medically alter their natural bodies in order to count as women. At the least interventionist end of the spectrum, this might involve taking drugs to suppress their naturally high testosterone levels. At the most extreme end of medical intervention, some women had their internal testes surgically removed, even though the organs posed no health risk. In at least four other cases, sports officials referred female athletes with hyperandrogenism to a French hospital where these procedures took place. The doctors also suggested the athletes have surgery to reduce the size of their clitoris, making them appear more gender “typical.” In other words, the new policy led to at least some female athletes surgically altering their bodies in order to be able to compete.

      But perhaps the biggest flaw in the policy is that it is based on the assumption that a certain level of testosterone in these women’s bodies confers an unfair competitive advantage. If a woman has testosterone levels that are within the “male” range, she must be a better athlete than women with testosterone levels in the female range. But is that actually true?

      What’s the “Sex” in Sex Hormones?

      What is testosterone, anyway? Testosterone is a hormone, and hormones are essentially messengers in the chemical communication system in our bodies. They’re released by glands or cells in one part of the body and carry instructions to the rest