On 27 June this year, an 18-year-old sprinter was subjected to a test to determine the level of androgens—masculinising hormones that include testosterone—in her body. On 16 July, the Sports Authority of India announced that they had barred her from competing as a woman. SAI’s press release on the issue stated that “Preliminary investigations indicate that the athlete is not fit for participation in a female event due to female hyperandrogenism.”
But the world over, many fundamental scientific and ethical questions about these sex determination tests remain unanswered. In this extract from ‘Santhi Soundarajan and the Flawed Science of Sex’ in the February 2013 issue of The Caravan’s science supplement, Periscope, Rakesh Kalshian examined the cases of Santhi Soundarajan and other female athletes who were put through similar questionable tests.
In December 2006, Santhi Soundarajan became the first woman athlete to be screened for sex since the abolishing of compulsory testing in 1999. The obvious question is, why was she singled out?
By most accounts, there was nothing terribly anomalous about Santhi—nothing to suggest that she was not a woman. Santhi was nudged into sports and athletics by her grandfather, himself a one-time athlete. She showed promise early on and was soon winning medals in school competitions.
“She may have been a little tomboyish, but we brought her up as a girl,” said her mother, Manimekalai, whom I visited in Kathakurichi. She showed me Santhi’s birth certificate, which declared Santhi to be female. “Everybody in the village and school treated her as a girl,” Manimekalai added. “We don’t understand why she is being persecuted like this.”
Santhi herself claimed that she had a normal childhood and adolescence. A physical instructor who trained her during her teenage years echoed her opinion. “She was aggressive and assertive. Besides, I also came to know through a female colleague that she had not started her periods,” said A Xavier, who coached Santhi at St Joseph’s Higher Secondary School in Venkatakulam, a couple of kilometres from her village. “But it never became a big issue. We accepted her as any other girl.”
After high school, Santhi joined the JJ School of Arts and Sciences in Pudukkottai where she continued to compete and win. She also began to notice subtle dissimilarities between herself and fellow female athletes. “It was only in college that I became aware that I was a little different from other girls, in the sense that I had never had periods,” she told me. But nothing about her seemed so odd as to call her sex into question. Soon, she was racing at larger meets. By the time she crossed the line in her stunning second-place finish in Doha, she had already graced, and garnered several medals in national and international events—without anyone questioning her sex. Except, perhaps, when she was refused a job by the Indian Railways because she couldn’t clear the medical test. She wasn’t informed as to why she had been rejected but she did entertain the innuendo that someone jealous of her success may have squealed on her about her ‘different’ body.
It was in 2006, however, that her femaleness had been formally called into question for the first time. Why individual suspicion fell on her is not clear. Some media reports carried an anonymous allegation that a chaperone from the anti-doping team saw Santhi urinating and became suspicious; another report claimed that it was most likely a rival athlete from the Indian camp who turned her in. As Santhi told me, the truth is still anybody’s guess.
But suspicion fell on Santhi nonetheless, and her body became a sort of crime scene, in which a team of at least five scientific detectives searched for the smoking gun of her sex. Santhi doesn’t know exactly who the investigators were, but they likely included a gynaecologist, an endocrinologist, a psychologist, an internal medicine specialist, and possibly an expert on gender or transgender issues.
The precise details of all athletic sex tests are kept confidential. Rumour has it, however, that the doctors who examined Santhi found the Y chromosome cohabiting with the X on the sly. It is thought by many that Santhi’s body could process a certain amount of testosterone—a condition called partial androgen insensitivity syndrome. As a result of this syndrome, a person who appears relatively feminine from the outside—the degree of femininity varies depending on the level of the person’s insensitivity to the male hormone—may have the genetic make-up and some of the sexual anatomy of a man.
It was only after Santhi had been publicly humiliated by the television reports that she got a call from Lalit Bhanot, joint secretary with the Indian Olympic Association—he was later tried for corruption charges in connection with the 2010 Commonwealth Games—telling her that her athletic career was over, that she had been barred from participating in sports, and that her name had been struck from the record books.
The most controversial recent instance of sex testing involved Caster Semenya, the South African 800m runner who, at 19, won gold in the 2009 IAAF World Championships in Berlin, outpacing the reigning world champion by over two seconds. After her incredible win in Berlin, her deep voice and finely hewn musculature—especially her six-pack abs—sparked off a frenzy of media speculation about whether she was really a woman. She became the butt of popular ridicule. Even the usually restrained New Yorker described her as “breathtakingly butch”. The world champion she beat to the finish line told reporters that Semenya would not pass the sex test.
Before the World Championship, Semenya had been told to report for a doping test in South Africa. But “this test was unlike any other drug test,” said Katrina Karkazis, a researcher at the Center for Biomedical Ethics, Stanford University. “Without her permission or consent [she was 18 years old at the time], Semenya was examined physically—her legs were put in stirrups and her genitalia examined; this was not a doping test, this was a sex test.”
The test in South Africa had been inconclusive, so the IAAF ordered a second one. This took place in a Berlin hospital the day before the 800m final. Information about Semenya’s test was leaked to the media (apparently through a misdirected fax) a few hours before the race.
Unlike Santhi’s case in India, the news of Semenya’s screening provoked a furore in South Africa. Prominent politicians and human rights activists called the incident scandalous and racist. The IAAF, in its defence, denied charges of racism and said the test was prompted by Semenya’s incredible performance at such a young age, as well as her “ambiguous” looks. They wanted to find out if she had a “rare medical condition” that conferred on her an unfair advantage.
A month later, Semenya’s coach resigned, alleging that South Africa’s national athletics association “did not advise Ms. Semenya properly”. He also tendered a personal apology for not protecting her as her coach. The government arranged for top lawyers to fight her case pro bono.
Eleven months later, in July 2010, the IAAF cleared Semenya of all suspicions so that she could return to international competition. For privacy reasons, however, the results of her sex tests were not released. This prompted rumours that she had been taking hormonal treatments. Nevertheless, as a final celebration of her triumphant return, Semenya was chosen to carry her country’s flag during the opening ceremony of the 2012 London Olympics, where she later won a silver medal in the women’s 800 metres.
In the wake of the international embarrassment over the treatment of Caster Semenya, the IOC and IAAF were once again forced to reconsider their sex verification policies. In 2010, they announced a new policy whose purpose, they claimed, was not to determine whether someone was ‘really’ a woman, as earlier screenings were meant to do, but to make natural levels of testosterone the litmus test for deciding whether someone was eligible to contest in women’s events. The new guidelines came into effect at the 2012 London Olympics.
Although males and females alike produce testosterone, women typically produce about one-tenth the level of males. Only female athletes who have testosterone levels below the “normal male range”, or who, like Maria José Martinez-Patiño—the Spanish hurdler prevented from competing in the World University Games in Kobe, Japan, whose cells carried the Y chromosome—are insensitive to testosterone, would pass muster.
The new guidelines have provoked ire and criticism from many quarters. The most vocal detractors have been feminist scientists. In a paper titled ‘Out of Bounds: A Critique of the New Policies on Hyperandrogenism in Elite Female Athletes’, Karkazis and colleagues argued that “despite the many assumptions about the relationship between testosterone and athletic advantage, there is no evidence showing that successful athletes have higher testosterone levels than less successful athletes”. Most studies backing IOC’s latest approach have been done on men, but very few studies have focused on the testosterone levels of elite athletes. This, according to Karkazis, implies that the grounds for making testosterone the yardstick for determining a female athlete’s eligibility are not only flimsy but also simplistic.
Even if a definite link between testosterone and performance had been established, Karkazis asks, is it fair to treat abnormally high testosterone differently from other biological traits that may confer a similar advantage in elite athletes? Excess male hormones may provide some advantage, she says, but, as a report in one US newspaper put it, “no more than other traits like the cavernous lung capacity of British rower Pete Reed, who can take in nearly twice as much oxygen as Lance Armstrong, and the hyper-flexible joints of American swimmer Michael Phelps”.
Some scientists have been even bolder in their criticisms. In an interview to the Los Angeles Times, Andrew Sinclair, a professor of genetics at the University of Melbourne who identified one of the genes used in an Olympic sex test, averred that it is often difficult scientifically to categorise people as male or female. “It’s very hard to come up with a single measure that will put you in one group or the other,” he said. Part of the reason for this, according to Sinclair, is that sex is not entirely binary; it’s more like a continuum. “That understanding has to come first, and then people will realize that sex testing in general is misguided,” he added.
An extract from ‘Santhi Soundarajan and the Flawed Science of Sex,’ published in Periscope, TheCaravan's science supplement, in February 2013. Read the story in full here.