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

are often referred to as sex hormones, even though both androgen and estrogen have many effects in our bodies that have nothing to do with reproduction or other biological markers of sex. Androgen, the “male hormone,” is present in women’s bodies, and testosterone specifically is crucial for well-being in both women and men because it contributes to heart, brain, and liver function, among other things.^[22] Likewise, estrogen is in men’s bodies and, even though it’s a “female hormone,” it can have masculinizing effects. For example, some studies have shown an association between estrogen and dominant behavior in women. Estrogen and testosterone sometimes perform identical functions.^[23] As feminist biologist Anne Fausto-Sterling has pointed out, it would probably make more sense to call estrogen and androgen “growth hormones” as opposed to “sex hormones.”^[24]

      Testosterone may not be a sex hormone, but does it still provide a competitive advantage for female athletes? As far as current research tells us, the answer is no. There is no evidence that successful athletes have higher testosterone levels than less successful athletes.^[25] Studies do tell us that testosterone (in concert with many other factors) can help individuals increase their muscle size, strength, and endurance.^[26] All of that seems to imply that testosterone would confer a competitive advantage, but the reality is more complicated. For example, women with complete androgen insensitivity syndrome (CAIS) are unable to process testosterone, which means the testosterone in their body has no effect on their musculature or endurance. Yet, women with CAIS are overrepresented among elite athletes, with some estimates suggesting one in five hundred female athletes are affected by CAIS.^[27] That women who can’t process testosterone are more likely to be elite athletes doesn’t match with the argument that testosterone increases athletic ability. Additionally, women with congenital adrenal hyperplasia (CAH) have elevated levels of testosterone and therefore should have a competitive advantage. But women with CAH are more likely to have shorter stature, suffer from obesity, and face unpredictable, life-threatening crises due to loss of salt in their bodies.^[28] These effects hardly seem compatible with success as an elite athlete.

      The truth is that any single person is likely to have a very different reaction to the same amount of testosterone, and testosterone is just one element in a complex system of communication between hormones and our bodily processes. On top of that, competition itself, and especially winning, increases the level of testosterone in our bodies. This is true even for fans watching a game, or experimental subjects who are randomly assigned as winners. In fact, studies suggest that the relationship between testosterone and competitiveness might be the exact opposite of what we expect. In both male and female athletes, levels of testosterone in their bodies rise before a competition. The social situation of standing at the starting line has a biological effect in the form of increased testosterone. This finding is part of a growing body of research demonstrating that our hormones might be driven as much by social contexts as they are by biology.^[29]

      Dora or Heinrich?

      There is no corresponding story about the gender testing of male athletes because male athletes have never been tested for gender. Unlike “real” women who are seen as suspect if they succeed at sports, “real” men are expected to excel at sports. Assumptions about female and male athletic ability tell us that there’s no advantage to be gained by women trying to pass themselves off as men. All of the anxiety about sports and gender is directed at the phantom of the man passing himself off as a woman, but has that ever actually happened?

      In the known history of international athletic competition, there’s only one documented case of a man passing himself off as a woman, and even this story is more complicated than it first appears. At the same 1936 Berlin Olympics where Helen Stephens was accused of being a man, Dora Ratjen took fourth place in the high jump event. Ratjen was later accused of being a man and quietly returned his medal. Ratjen claimed that Nazis had forced him to pose as a woman for three years, “for the sake of honor and glory of Germany.”^[30] Dora’s real name was Heinrich, and when his story came out, it confirmed growing anxiety about gender fraud and international sports—despite the irony that Heinrich’s competitive advantage had only earned him fourth place, not a strong case for masculine superiority in sports.

      For years, this story of Heinrich competing as Dora went unquestioned. Then in 2009, a German magazine reported on their investigation of Ratjen’s medical and police records. Apparently, Ratjen had been born with ambiguous genitalia, or as an intersex person, and his family raised him as a girl. Ratjen dressed in girl’s clothing and went to an all-girls school. He lived as a woman until two years after the 1936 Olympics. In 1938, Ratjen showed up in police records when he was arrested on a train for looking suspiciously like a man dressed in women’s clothes. With relief, Ratjen informed the police that though his parents had raised him as a girl, he long suspected he was really a man. A police physician examined Ratjen and agreed with his assessment—Ratjen was a man—but also noted that his genitals were atypical. Ratjen changed his name from Dora to Heinrich, but all of those details were unknown until recently.^[31] Was Ratjen, then, a man passing as a woman?

      It all depends on how you define gender, and that is the critical question for sports. If you use the criteria of Ratjen’s own internalized sense of who he is—his gender identity—then, yes, he was a man. We’ll never know whether Ratjen would have passed any of the many versions of gender tests that have come and gone since then. But his case demonstrates one reason why attempts to determine once and for all who is a woman and who is a man are always bound to fail. The reality of human biology, as well as how that biology interacts with the social world, is much more complex than any simple test can explain. Any attempts to sort athletes into neat categories of female and male are bound to fail.

      What’s more, it is shortsighted to assume that the particular set of biological characteristics we think of as connected to gender are the most important in conferring athletic advantage. There are all kinds of ways in which some athletes are better equipped for their sports than others that have nothing to do with gender. Studies show that several elite runners and cyclists have rare conditions that give them extraordinary advantage when it comes to their muscles’ ability to absorb oxygen and their resistance to fatigue.^[32] Some basketball players have a condition called acromegaly, a hormonal condition that results in very large hands and feet. This condition is surely a genetic advantage in the sport, but these players are not banned.^[33] More baseball players have perfect vision compared to the average population, which allows them to see the ball better than the average person when they’re batting.^[34] Some speculate that elite athlete Michael Phelps may enjoy competitive advantage from having Marfan syndrome, a rare genetic mutation that results in long limbs and flexible joints, two features that would provide quite the advantage in the pool.^[35] In none of these sports are athletes tested for these conditions, which quite clearly confer competitive advantage. Why should hyperandrogenism be any different?

      Finding a Better Way

      As of this writing, Dutee Chand has been cleared to compete. The reworked IAAF regulations released in November 2018 apply only to those female athletes who compete in distances between 400 meters and a mile. As a sprinter who competes in the 100 meter and 200 meter races, Chand is safe.^[36] But under these new rules, Caster Semenya, whose event is the 800 meter race, would have to use medical intervention to lower her natural testosterone levels before she can compete. Her case went to the Court of Arbitration for Sport (CAS) and, in May 2019, the court ruled against her. This was despite the fact that Semenya revealed in her report that when she did take drugs to suppress her hormone levels between 2010 and 2015, they adversely affected her physical and mental health, and she suffered from regular fevers and constant internal abdominal pain.^[37] Semenya has stated that she will not use these medications again, saying, “I will not allow the IAAF to use me and my body again. But I am concerned that other female athletes will feel compelled to let the IAAF drug them and test the effectiveness and negative health effects of different hormonal drugs. This cannot be allowed to happen.”^[38]

      The newest regulations upheld by the CAS in 2019 are based on a French study, commissioned by the IAAF. The study of 2,127