The illusory "level playing field".
Article Type: Letter to the editor
Authors: Genel, Myron
Ljungqvist, Arne
Simpson, Joe Leigh
Ferris, Elizabeth
Carlson, Alison
Pub Date: 11/01/2010
Publication: Name: The Hastings Center Report Publisher: Hastings Center Audience: Academic; Professional Format: Magazine/Journal Subject: Biological sciences; Health Copyright: COPYRIGHT 2010 Hastings Center ISSN: 0093-0334
Issue: Date: Nov-Dec, 2010 Source Volume: 40 Source Issue: 6
Accession Number: 268403526
Full Text: To the Editor: We applaud the Report for its recent set of essays on sports (Mar-Apr 2010). These essays attempt to address the complex issues and challenges that competition in sports can raise to ensure that all athletes are provided an appropriate opportunity to excel in a manner understood to be "fair."

Collectively the signers of this letter have been engaged for more than twenty years in just the sort of effort regarding "gender verification" (or, more appropriately, sex verification) of athletes competing in high-level, women-only events that Alice Dreger mentions in her essay, "Sex Typing for Sport." Collectively we represent acknowledged expertise in the understanding and treatment of disorders of sex development, as well as the governance--and politics--of international sports and the women's sports movement. Two of us (AL and EF) are former Olympians, and one (AL) is chair of the International Olympic Committee's Medical Commission and former chair of the International Association of Athletics Federations. The other (EF) is a member of the IOC's Women and Sport Commission. Reports from our group have been published in medical journals such as the Journal of the American Medical Association and the Lancet, and in sports specialty journals. Comprehensive reviews have appeared in review journals and textbooks like The Olympic Encyclopedia of Sports Medicine (AL). One member of our group (AC) has published a number of articles in popular media, especially those related to women's sports, and has been a consultant for the U.S.-based Women's Sports Foundation.

Thus, we find it regrettable that Dreger chose to ignore the long and well-documented history of these efforts, which have significantly changed the conditions under which women athletes compete. (Moreover, she uses one participant's comments in a media report to criticize not-yet-released conclusions from a conference held two months earlier). Sports no longer require the "nude parades" that characterized early efforts to ensure the femininity of women competitors, nor the sex chromatin testing and "certificates of femininity" that replaced these in the late 1960s. The IAAF eliminated laboratory-based "gender verification" in 1991 based on recommendations from an expert working group in which we participated in 1990. The IOC then followed suit in 1999. Policies explicitly permitting competition by postpubertal transsexual athletes were developed by the IOC in 2003--the so-called Stockholm Consensus. These policies may not be ideal, as Dreger points out, but they reflect significant effort and consensus-building within the athletic community to achieve fairness for all women athletes, including those afflicted with disorders of sex development.

In "Making Sense of Fairness in Sports," Tom Murray has it right--the "level playing field" is illusory, since specific genetic endowment provides an advantage to excel in specific athletic events. This "endowment" could include recognized medical disorders such as Marfan Syndrome, which augments height, or gonadal dysgenesis or Turner Syndrome, both of which cause shortness and delay maturation. It can even include simple genetic variations, such as a higher percentage of fast-twitch or slow-twitch muscle fibers. A Finnish athlete with exceptional success in endurance Nordic skiing was found to have extraordinarily high levels of hemoglobin (and thus, increased oxygen-carrying capacity) because of a familial mutation in the cellular receptor for erythropoietin. Even having longer toes has been associated with a greater "lift-off" capacity and success in sprinting events.

Murray also makes the valid point that "the rules of sport are arbitrary" but still must satisfy "those who play and love that sport." We could not agree more. The challenge is to inform and educate both the athletic community and the various international and national sports sanctioning bodies about the complexity of the birth defects we identify as disorders of sex development. We need to stress that, though some may provide competitive advantage, fundamentally it is no different than the advantage other athletes have because of their genetically endowed height or fast- or slow-twitch muscle ratio or the misfortune of having a genetic disorder such as Marfan Syndrome.

Myron Genel

Yale University School of Medicine

Arne Ljungqvist

Karolinska Institute

Joe Leigh Simpson

Florida International University

Elizabeth Ferris

King's College

Alison Carlson

San Francisco, California

Alice Dreger replies:

In "Sex Typing for Sport," I did not meant to imply that the IAAF and IOC commissions have not been working hard on their sex typing policies. Nevertheless, as those of us who are professors know well, we must grade based on final quality, not on effort. It is time for those given this power to come up with sex policies that are at least complete and clear, if not universally judged fair. As it is, the incompleteness of the policies and the "I know it when I see it" approach to individual cases continues to leave athletes like Caster Semenya dangerously vulnerable. Every time I look at the existing IAAF policy, the old Borscht Belt joke comes to mind: "The food is so bad, and the portions are so small!" Such smart cooks can do better, and must. Soon.
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