Transphobia and testosterone regulations in sports are hurting all women athletes

Misconceived notions about a woman’s ‘ideal’ testosterone level and society’s inherent transphobia have over the years led to persistent scrutiny on women athletes who do not fit the standard of a conventional female physicality.
Dutee Chand, Santhi Soundarrajan, Nandini Agasara
Dutee Chand, Santhi Soundarrajan, Nandini Agasara
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A controversy arose after Indian heptathlete Swapna Barman lost a bronze medal to Nandini Agasara at the 19th Asian Games, held at the beginning of October in Hangzhou, China. Swapna took to social media to declare she had lost the medal to a “transgender” woman, an allegation the Athletics Federation of India (AFI) was quick to dismiss. The athlete later tendered unconditional apologies, but her claim brought to light a long-standing, systemic problem in the field of sports — the irredeemable link between transphobia and the constant policing of all women athletes’ bodies. 

The problematic idea that a trans woman’s body has an inherent athletic advantage over that of a cisgender woman, has over the years led to persistent scrutiny on women athletes who do not fit the standard of a conventional female physicality. Many cis women athletes have been subjected to humiliating sex verification tests, often with serious consequences in their personal and professional lives.

What Swapna Barman said

A gold medallist of the 2018 Asian Games, Swapna was the big contender from India to win Gold in the 19th Asian games. According to reports, the 27-year-old was set to retire from sports due to a spinal injury, but had decided to participate in this year’s Asian Games. But on October 1, 20-year-old Nandini Agasara from Telangana won a bronze medal in the women’s heptathlon with an overall 5,712 points, just ahead of Swapna who scored 5,708 points. 

The day after the event, Swapna alleged on X (formerly Twitter) that she lost the medal to a “transgender women (sic)”, without naming any athlete. In the now deleted post, she said, “I have lost my Asian Games bronze medal to a transgender woman at the 19th Asian Games held in Hangzhou, China. I want my medal back as it is against the rules of our Athletics. Help me and support me please,” with the hashtag ‘protestforfairplay’.

Speaking to the Times of India, she reiterated her allegation against Nandini and questioned how she was able to deliver such a performance after training for only four months. “I have been training for more than 13 years and I know how much effort it takes to reach the level where I am today. Nandini started training only four months back. How could she win a medal, that too, at the level of the Asian Games? I doubt her gender and want the federation to look into the matter,” she told ToI.

Nandini, meanwhile, refuted the allegations and said she would take up the issue with the AFI. She also questioned why Barman did not raise the issue earlier. “Why did she not say anything when I started competing? How can someone say something like this about another woman?” she asked, alleging that people tend to pull others down when they start getting successful. The AFI also termed Swapna’s allegations as “baseless”, and said she would have to explain her conduct to the federation.

On October 5, Swapna Barman tendered an apology and said her allegation was the result of an “emotional outburst”. “I wish to tender my unconditional apology for my tweet the other day specially to my co-athlete was the sheer disappointment and momentous emotional outburst which made me react in this manner against the ethos of sports and deeply feels sorry everyone for my emotional reaction (sic),” she said.

Who has a ‘biological advantage’?

Swapna claimed that Nandini is a transgender woman because her performance ‘suddenly' improved with four months of training — a claim made based on the widespread assumption that trans women have a ‘biological advantage’ over cis women — someone who was marked female on their birth certificate and identifies as a woman. It is based on this same premise that World Athletics (WA), the governing body of track and field competitions, banned trans women athletes from competing under the women’s category in March this year. The ban is to be implemented based on the level of testosterone in an athlete’s body, for which there is a catch we will address later. First, let’s see what the WA has ruled.

“In regard to transgender athletes, the Council has agreed to exclude male-to-female transgender athletes who have been through male puberty from female World Rankings competition from 31 March 2023,” the WA said, adding that they prioritised “fairness and the integrity of the female competition before inclusion” of trans women athletes. They also said that a working group will be set up for 12 months to further consider the inclusion of trans women athletes.

A transgender woman or a trans woman refers to a person who was marked male in their birth certificate but identifies as a woman. It is to be noted that a person can be transgender whether or not they undergo gender affirmation procedures such as hormone therapy or surgery. Denying a person’s right to self identify their gender is in contradiction with the Supreme Court’s 2014 NALSA vs Union of India judgement, as well as the Transgender Persons (Protection of Rights) Act, 2019.

The WA has laid down separate guidelines for athletes with differences in sex development (DSD) or intersex variations. According to the WA guidelines, to compete as a woman, intersex athletes must have a testosterone level below 2.5 nanomoles per litre (nmol/L) for at least 24 months before an international competition.

To understand this logic, we will have to delve a bit deeper to understand the functioning of testosterone and other hormones. Testosterone is the hormone responsible for the development of sex characteristics in male bodies, which carry the XY karyotype (set of chromosomes). Men typically have 10 to 35 nmol/L of testosterone, causing physiological changes including vocal changes and skeletal muscle growth, as the hormone stimulates protein synthesis in our bodies. High testosterone levels can produce changes including more muscle mass and stronger bones, which is said to give them a competitive advantage in athletics and sports.

But testosterone is also present in female bodies with the XX karyotype, albeit to a smaller level. These are important hormones for women, helping produce new blood cells, maintaining bone health and libido, and boosting other reproductive hormones. Testosterone levels in women usually range from 0.5 to 2.4 nmol/L, but could go higher when there are underlying medical conditions such as congenital adrenal hyperplasia (CAH), polycystic ovarian syndrome (PCOS), thyroid issues, or even hyperandrogenism — a condition that arises when there is an excess amount of androgens (a group of sex hormones including testosterone) in one’s body. Among some women with PCOS, for instance, the testosterone value can go up to 5.2 nmol/L, or even more in case of additional medical conditions. So the bodies of cisgender women athletes with PCOS and other such conditions have been found to be more anabolic, (increased muscle building) with a greater amount of muscle mass and higher bone mineral density than other women athletes.

In 2018, the International Association of Athletics Federations (IAAF) issued a new set of regulations mandating that women runners whose bodies produce high levels of testosterone should take medication to lower those levels to less than 5 nmol/L. South African athlete Caster Semenya, an Olympic Gold medallist in the women’s 800-metre that year, was subsequently stopped from competing due to this reason. Semenya recently told CBC’s The Sunday Magazine that she took the medication for a period of time, but later stopped because it “tortured” her body.

Critics have repeatedly raised questions about the scientific precision and validity of restrictions placed on athlete eligibility in women’s sports. In 1986, for example, athlete Maria José Martínez-Patiño was dismissed from the Spanish Olympic team because she was found to possess the XY karyotype, instead of the XX karyotype typically seen in cisgender women. It was later found that though her body produced testosterone on par with that of cisgender male bodies, she had a condition called androgen insensitivity, which meant her androgen receptors — which bind androgens and take to muscles for them to execute their functions — did not respond properly to the testosterone her body produced. So even if the assumption that high levels of testosterone rendered a ‘biological advantage’ to athletes was true, Martínez-Patiño’s testosterone did not give her any undue advantage over other women athletes. As activists have since argued, a dismissal based on her testosterone levels was unfair and a blot on scientific integrity in sports.

In fact, how exactly sex hormones and their receptors impact an athlete’s body and their performance is an area of research that still remains largely unexplored. In a recent study conducted among 49 men who underwent resistance-training, for example, it was found that those who had built more muscle at the end of a 12-week training were those who had more androgen receptors, not more testosterone. A research paper published in the International Sports Law Journal, based on the testosterone regulations introduced by the International Association of Athletics Federations (IAAF) in 2018, has also thrown up data contradicting the testosterone superiority theory in athletic performance. The study, which involved more than 1,100 women competing in track and field events, showed that for up to three of the 11 running events, women with lower testosterone levels performed better than those with higher levels.

So if the aim is to differentiate between men’s and women’s sports and thereby ensure ‘fairness’ in general, existing research suggests that testosterone is a largely inconsistent variable and hence unlikely to be a good enough demarcator. Every athlete, whether cisgender or transgender, has been observed to differ in their ability to perform depending on several factors such as nutrition, training, strength, and genetic polymorphisms (slight changes in the genes). One might even argue that these differences are what makes sports more exciting, for sportspersons as well as their audience.

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The ‘sex testing’ of women athletes

Like Martínez-Patiño, many athletes have biological differences that they are often not aware of until allegations of ‘biological advantage’ are made against them, followed by undignified ‘sex verification tests’ or ‘sex texts’. Some intersex women, for instance, have XX chromosomes and ovaries, but are born with atypical genitalia. Some have XY chromosomes and testes that are undescended, but appear female at birth and are raised as girls. On attaining puberty, some of these intersex women may experience a rise in testosterone levels, an elongated clitoris, and increased muscle mass. Some individuals have XXY or XYY chromosomes and may appear male or female when they're born, according to what we generally believe an average male or female body should look like. Others might have low or no androgen receptors, might appear female their whole lives, and never know about their sex development until and unless they’re tested for infertility or to compete in such sports. 

Two such cases in point are of Indian athletes Dutee Chand and Santhi Soundarajan.

In 2014, soon after she won Gold at the Asian Junior Athletics Championships, Dutee Chand was asked to appear for a medical test. She had to undergo an ultrasound examination, after which the AFI said a “gender verification test” would be performed as there were “definite doubts regarding” Dutee’s gender. According to a report in The New York Times Magazine, Dutee was subjected to several blood tests, a chromosome analysis, an MRI, and “a gynaecological exam that she found mortifying.” It involved “measuring and palpating the clitoris, vagina and labia, as well as evaluating breast size and pubic hair scored on an illustrated five-grade scale.” A few days later, the federation barred her from racing, citing that she had more “male hormones”.

Santhi too was subjected to repeated tests and was found to have a condition called partial androgen insensitivity syndrome, says a report by The Caravan.

Intersex persons have a range of biological features atypical of what are widely understood as male or female sex characteristics, which are also congenital in nature. These differences, in many cases, are internal and hence not visible. In all these cases and many others, the individuals come to realise their ‘differences’ only at the time of such ‘sex texts’. Otherwise, they often do not interfere with their regular functioning as a woman in society.

It is also to be noted that in most of these cases, the athletes were subjected to the tests because of the way they look. Some media reports alleged that a person saw Santhi urinating and became suspicious. Dutee was said to have a physique that was “masculine”, her muscles “too pronounced”. In any case, women are expected to carry a conventional physique — dainty, ‘contained’, feminine as vaguely defined by different people at different points in time — and any small deviation is used to paint them as ‘less of a woman’ — a regressive tendency rooted in society’s inherent transphobia and sexism.

Regulation of female bodies

Society regulates all women's bodies, whether they're cisgender or transgender, rich or poor, black or white or brown. And these regulations are often contradictory. Cisgender women are told to look ‘feminine enough’ in the marriage market, but if they lean into their femininity, they're labelled ‘sluts’ or ‘attention seekers’. Trans women are expected to want to ‘pass’ — that is, look as much like a cisgender woman as possible. But if they do ‘pass’ they're accused of ‘cheating’ society and specifically men. 

Cis women athletes, when they have more strength, endurance, muscle mass, or any feature that is considered to be typical of a ‘masculine’ body, are questioned about the veracity of their womanhood. And yet, trans women who may fit into all these whimsical ‘rules’ for being a woman will still be questioned about their womanhood. 

Looking at a brief history of the ‘sex tests’, which all women athletes have mandatorily been asked to undergo since 1966, gives us a glimpse of how the practice is entirely entrenched in the male gaze of a female body. In the first ever formal ‘sex test’, women were asked to walk naked before a group of gynaecologists who calculated the length of their hair, size and shape of their breasts and vagina. Later, after widespread condemnation, a chromosome-based test was introduced in 1968, that calculated the karyotype of an athlete. As per the test, an XX karyotype renders one a woman, while XY indicates one is not a woman. Once again, having produced several false negatives and positives, the test turned controversial. Finally, in 1991, the International Association of Athletics Federations (IAAF) announced that there will be no mandatory sex tests for women, but that they will be conducted in case of need — that is, in the event that suspicions are raised.

Such constant scrutiny of their bodies have forced athletes to stay in a limbo between athletic success and having a ‘feminine enough’ body. Women athletes are often considered ‘manly’, which in turn extends to other spheres of their lives. This means they have to sculpt their body keeping in mind two opposite extremes — features of a strong, competitive athlete, that are also ‘feminine’ and ‘soft’ in nature. This regulation has multiple effects, starting from body image issues and psychological problems to a fixation with ‘fairness’ for women in sports.

Notably, the idea of fairness plays out differently in men’s sports. While women are shunned for not having ‘conventional’ features, men are often celebrated for their differences. While swimmer Michael Phelps’ extra-long wingspan is glorified, tennis legend Serena Williams’ body has been subjected to constant scrutiny for not adhering to traditional standards of femininity. 

Not only does this fixation with ‘fairness’ exclude trans and intersex women, but it also harms cis women, who are forced to look a certain way to avoid such public humiliation. It is also an endorsement of the male gaze, which dictates how a female body should look, based on a standard of beauty defined by their skin colour, body weight, height, facial features, breast size, hip width, sex drive, sexuality, etc. Anyone who does not tick all the checkboxes is constantly made to feel less of a woman, made to shrink and apologise for not meeting this standard. And the standards, of course, always keep changing.

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