Caster Semenya first grabbed my attention in 2009 when she won the 800-meter race in Berlin — she bested her competition by over two full seconds and set a world-leading time for the year. Soon after her athletic successes, however, the sporting community challenged her sex/gender identity. The International Association of Athletics Federation (IAAF) policy at the time was called “gender verification,” though it was actually meant to create binary sex categories for competitive athletes, muddling binary sex and gender categories. The IAAF works on the assumption that binary sex categories are real, not socially constructed, and that these categories have implications for athletes competing as either male or female. This framework regards male athletes as stronger than female athletes, and, as such, seeks to protect female athletes from competition with male athletes due to the latter’s “natural” advantage. In other words, “gender verification” is meant to bar would-be male athletes from competing against female athletes. However, in practice “gender verfication” has prevented women who do not fit neatly into a binary sex category, women like Semenya, from competing at all. What drew my attention to Semenya was that I had a feeling she would be a sort of test case for how medicine, science, and sports combine to maintain or subvert the Patriarchy.
The Patriarchy is a set of dominant narratives within western mostly white cultures that places heterosexual, cisgender white men at the top of hierarchical structures. The general belief that men are better and/or stronger than women in sporting events exemplifies one such narrative — male dominance in sports. Hence, we must sex segregate sports to maintain fairness for women athletes. While this narrative contains some truth — men tend to possess more strength and muscle mass than women on the whole — this generalization fails to capture elite-level athletes, especially runners. Both female and male runners have low body mass and are strong compared to the general population. Male sprinters tend to fall between 8–10% body fat, while female sprinters fall tend to fall between 12–20% body fat. There is significant variation and overlap in both categories. The more accurate comparison is one made between female and male athletes competing in specific events. The Patriarchy works to make female athletes a category with more body fat, understood as the key ingredient for making female reproductive hormones work. This body fat version of essentialism is imbued with racialized overtones, such as inaccurate beliefs that black women’s muscularization is evidence of their masculinization as opposed to undoing the racial contexts that present black women’s bodies as different than white women’s bodies. Over the past decade, Semenya’s body has been the site of reproducing this patriarchy for trans-exclusionary radical feminists (TERFs) and the IAAF.
TERFs step aside, She’s NOT trans*
Recently, many TERFs — who do not think trans women are “real women” — have weighed in on Semenya’s case: they often take the position of testosterone realists, or people who believe that testosterone is a male hormone that allows men to be stronger than women. (Both male and female bodies contain testosterone.) Given that Semenya is not trans, why would TERFs care about this case? Then it hit me: Semenya defies the TERFs’ binary biological idealism. TERFs do not consider trans women to be “real” women because they often rely on a fictional biological essence of femininity. Woman’s ability to bear children or have a certain amount of circulating estrogen serves as grounding for this biological essence. For TERFs, people who defy this essentialism must alter themselves to fit within the strict biological binary to count, i.e. they must take hormones. But, by doing so, they still aren’t “real” women because “real” women do not take hormones to become women. For TERFs, women with disorders of sexual differentiation (DSD) are always non-women, either because they have too much naturally circulating testosterone or they are taking hormones to align with “real” women. It is estimated that 1 out of every 5,500 people have a DSD. By positioning women with DSD this way, TERFs work to either exclude or discriminate against anyone who falls outside of the fictional biological binary of “real men and real women.” TERFs reinforce the Patriarchy by upholding testosterone realism through this essentialism — they place Semenya and women like her in the “non-woman” category.
Testosterone Realism and the IAAF
On April 23, 2018, the IAAF set new “Eligibility Regulations for the Female Classification,” targeted rules clearly written for Caster Semenya alone. The rules only regulated mid-distance runners in restricted events from 400-meters to one mile (Semenya’s best race is the 800-meters). The rules applied to athletes with DSD who sufficiently uptake enough natural testosterone to experience material muscular and lean body mass performance gains.
How does one measure this, given that “material gains” is a highly subjective assessment? For example, NPR ran the headline, “IAAF Sets New Limits on Testosterone Levels in Women” and pictured Caster Semenya competing. The author asks, “What exactly makes a woman?” The IAAF rules created a team of experts who would determine who fit into this category. But they couldn’t define the category’s parameters. Sebastian Coe, the current head of the IAAF and previously a male mid-distance runner who represented the UK, failed to answer this question when he talked about the new testosterone rule. Instead, Coe asserted an appeal to fairness and leveling the playing field. He suggested that female athletes with high testosterone levels need to have those levels reduced to compete fairly. Coe took a testosterone realist position and used it to justify the new rule.
The IAAF views testosterone circulating through a woman’s body through the lens of cheating. But women with DSD are not testosterone cheats; they are women who may or may not have more circulating endogenous (naturally occurring) testosterone that their bodies may or may not uptake. For the past 20 years, female athletes with excess endogenous testosterone levels have undergone more tests and interventions than their male counterparts in general to prove both their femininity and their validity as athletes. In fact, men can receive medical exemptions for excess endogenous testosterone. Meanwhile, women with excess endogenous testosterone have to prove both that they are not cheating with drugs and that they are “women.” What counts as “proof,” however, has shifted over time. Previously, tests showed excess testosterone but were unable to discern between endogenous testosterone and synthetic testosterone. But now we can differentiate. We need to explicitly wrestle endogenous testosterone free from the current debate over cheating with synthetic hormones. But we also need to remove the gender transgressions paradigms from female sports doping tests so that athletes like Caster Semenya can compete.
Endogenous testosterone is qualitatively distinct from synthetic testosterone, which works through a myriad of complex processes and does not always enhance performance. However, synthetic testosterone should still be banned because it poses several health risks and can potentially enhance performance. Endogenous testosterone also works through a set of complex processes that do not always enhance an individual’s athletic performance. Some people with DSD have a condition called Androgen Insensitivity Syndrome (AIS), which is the result of their body being incapable of using androgens, including testosterone, effectively. Female athletes with both DSD and complete AIS are allowed to compete without medical intervention. They are viewed as having no advantages over their non-DSD female counterparts.
Most women with DSD gender identify as women and have been raised as women. But their biological sex often exists outside of the binary. We need to explicitly work towards inclusive policy for women with DSD and high endogenous testosterone levels so that fairness captures the reality of living with DSD. This policy needs to explicitly validate their sex/gender instead of forcing them to take unnecessary hormones to fit into a fictional binary that helps reproduce the Patriarchy.
Western science and medicine with all of its compliance to the Patriarchy bears witness to the “material gain” seen on Semenya’s body. Western science has a long history of colonizing the bodies of women and people of color to remake a very familiar social hierarchy. The current IAAF policy and its testosterone realism force Semenya either out of sports or into a narrow hormonal binary. To the IAAF, Semenya’s naturally “unruly” body must be fit into a hormonal gender binary because they believe her body disrupts their patriarchal status quo. If allowed to compete, Semenya will continue to win events, besting both her white competitors and those with more conforming sex/gender identities. The IAAF should recognize that her DSD body is a valid way of being a female athlete without medical intervention.
Recently, the CAS affirmed its decision to only allow Caster Semenya to compete if she takes testosterone lowering drugs. In the wake of this decision, Semenya signed with a South African soccer club. She hangs up her spikes for cleats this coming year after 31 straight victories in the 800-meter event. I, too, hope she contributes to soccer as she has athletics. Best of luck on the pitch.