Guest Post: Track Authorities Are Wrong To Ban Women With Naturally High Testosterone levels

Michael S. Dauber, MA

 According to a story by Catherine Caruso published in STAT News this week, authorities at the International Association of Athletics Federations (IAAF) are getting set to debate whether or not women with hyperandrogenism, or higher-than-expected testosterone levels, should be restricted from competing against women with “normal” or “expected” levels. The debate over the IAAF rules began in 2011, when a rule was first created to prevent women with high testosterone levels competing because of the belief that their hormone levels gave them an unfair advantage. The rule was challenged in 2015, and the IAAF was given two years to provide further justification for its position.

As Caruso writes, the main focus of the current controversy is the legal case of Dutee Chand, an Indian athlete whose testosterone levels exceed “the 10 nanomoles per liter limit, the level deemed to be the lower end of the ‘male range,’” i.e., the amount of testosterone in the blood typically exhibited by male athletes. Testosterone is widely considered a hormone that assists in athletic performance, given that it increases the rate of muscle development and bone mass, among other traits. The idea behind the IAAF’s position is that “unnaturally” high levels of testosterone that exceed levels typical of one’s gender would give such athletes an unfair advantage over other competitiors. Insofar as the IAAF is concerned with creating the fairest competition possible, the presence of elevated testosterone levels in a select group of athletes, like Chand, presents a serious problem.

The problem with the IAAF’s position, however, is that it overlooks one of the central nuances of sporting ethics. It is true that sporting events are supposed to be fair in a wide sense: we would not consider the competition just if one athlete took some action that made it impossible for other athletes to win. This is why athletes are given certain rules to which they must conform. In basketball, for example, one is forbidden from reaching out and grabbing the opposing player’s arm to prevent them from dribbling; in hockey, players are forbidden from tripping each other; and soccer players cannot decide to randomly touch the ball with their hands (unless, of course, they are a goalie).

Many athletes, regulatory bodies, and ethicists have also long believed that taking certain substances gives an unfair advantage to some competitors if the competition is not also allowed to take them. Two of the most common culprits are testosterone (the hormone for which Chand is in hot water) and human growth hormone (HGH), both of which can aid in athletic performance. Some have suggested that a simple solution might be to allow any athlete to take any substance they want: if there are no limits on what one can take, no substance could truly be considered unfair.

Yet many writers have expressed concern over this view, myself included. The essence of sport seems to be to push oneself to the limits of one’s own capacities, to find what one is truly capable of. Bioethicist Maartje Schermer has written that in evaluating the fairness of advantages, rules, and enhancements in sports, we must ask ourselves “What exactly do we want to praise or celebrate?” In answer, he writes that “According to the President’s Council on Bioethics, what matters most is not even the competitive results but the specific type of human excellence displayed in a sport.” This “excellence” may be thought of as a measurement of what we can naturally achieve through individual effort, which explains why we institute rules prohibiting the use of substances that enhance one’s abilities beyond what one could naturally achieve.

The key to the debate over Chand and other athletes with naturally elevated testosterone levels is how we should define “natural.” While it is true that having an elevated testosterone level is unnatural in the sense that it is not considered “typical” of a human being of a specific gender, this fact alone does not seem to give an athlete an unfair advantage. If Chand and other athletes were choosing to inject themselves with testosterone to gain an advantage, they would have an unfair advantage because they were actively choosing to elevate their testosterone levels: they would be purposely trying to gain an edge. This conforms to the central criterion Schermer argues constitutes cheating: he writes that “Actions that involve the breaking of implicit or unwritten rules and offer an unfair advantage” constitute cheating, meaning one must act in order to cheat. For Chand and other athletes, this is simply not the case, and in that sense, they have not done anything “unnatural” or unfair. Their bodies simply work that way, and while their testosterone levels may not be typical of the average person, we do not normally restrict people from participating in sports just because they happen to be somewhat different than most people. There are many ways that athletes differ from the average person: this is what enables them to perform so well in the first place.

It seems that the IAAF is unfairly targeting a specific naturally-occuring advantage to the exclusion of others. Caruso writes that Georgiann Davis, a medical sociologist from the University of Nevada, has argued that the standards can seem very arbitrary, using the examples of very heavy sumo wrestlers and tall basketball players. Another helpful example might be athletes like Michael Phelps, whose attention deficit hyperactivity disorder (ADHD) and unusual body shape may have given him more energy to train and unique advantages when moving through the water. While these elements gave him a significant advantage over his competition, he was not forbidden from competing because he did not purposely cause these things to occur.

There are certainly appropriate circumstances in which athletic federations are justified in restricting athletes from competing. Athletes like Chand have not purposely broken any rules or elevated their testosterone levels to gain an edge, so they should be allowed to compete.

Michael S. Dauber is a bioethicist who has served as a clinical ethicist and currently works as an institutional review board coordinator. He is also a visiting scholar at Global Bioethics Initiative. His master’s thesis at NYU focused on the ethics of enhancement in doctors.