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GUEST VIEWPOINT: Who decides who is normal?
It may be impossible to be fair to athletes born with an intersex condition
By Elizabeth Reis
For The Register-Guard
Appeared in print: Sunday 28 February 2010

The Winter Olympic games end today, but the International Olympic Committee has plenty of work left to do as it considers how to handle athletes who have an intersex condition — a discrepancy between genitals, internal sex anatomy (ovaries or testes), hormones or chromosomes. The IOC is obligated to achieve fairness with a policy that clearly and unambiguously sets out the criteria for gender verification. Yet any rules the committee imposes are likely to be unsatisfactory, perhaps even arbitrary. Here’s why:

Variation in the human body is natural and not as uncommon as we might believe: Approximately one in 2,000 people are born intersexed. Nonetheless we sort people into two distinct categories: male or female. When a baby is born with atypical genitalia, or when an adult woman discovers that her XY chromosomes don’t match her female genitals, then fitting into one of the male or female boxes becomes more difficult — particularly in sports, where the entire endeavor is divided along gender lines.

Caster Semenya of South Africa may be one such intersex athlete, though she was raised a girl and medical details about her body have not been released. She is the women’s 800-meter world champion whose sex was questioned by the International Association of Athletics Federations after a teammate complained that Semenya was more male than female.

Though whether Semenya can continue to compete as a woman is still undecided, the IOC met in January to set up guidelines for cases of indeterminate gender. The head of its Medical Commission, Arne Ljungqvist, recommended that “strategically located centers of excellence should be established to which athletes with a DSD (Disorders of Sex Development) could be referred and, if necessary, further investigated and treated.”

The IOC’s rulings are misguided, and will further perpetuate several myths about intersex. The most significant fiction is that there is a clear way to distinguish between the sexes. Though deciding who is male and who is female seems simple and obvious, it is not nearly so straightforward as we’d like to believe. Should someone born with typical external female anatomy but with internal male reproductive anatomy be considered female or male? What about someone with both XX and XY chromosomes? If a female athlete has excess levels of testosterone in her body, is there a threshold beyond which she should be considered male, despite her female genitals?

The second illusion is that intersex conditions are so obvious that they can be spotted visually. How will the committee know which athletes to refer to these centers? Many people are unaware of their own intersex condition, particularly if it involves only hormones or chromosomes and cannot be seen externally. Sending pictures of the suspected athletes to these expert centers, as was suggested, is not going to be conclusive, and could harm the athletes personally and professionally. Since the 1960s various forms of gender verification tests have been tried, but ultimately they have been deemed degrading and prone to yield false positives.

The third myth these recommendations promote is that intersex is a condition that needs to be corrected, even at the expense of the person’s basic health. The committee wants intersex athletes to be “treated,” which could mean hormone “therapy” or, as Ljungqvist told the BBC, “perhaps surgery, the removal of gonadal or testicular tissue.”

Should female athletes with high levels of testosterone have to take estrogen to make them more like “normal” women? Such tampering with hormones or tinkering with surgery might be dangerous to a person’s health, to say nothing of her psyche, and seems to be contrived solely to allow the athlete to fit more neatly into a male or female box so that competition can continue.

Further, we should question the ethics of chemically or surgically meddling with an athlete’s body. Isn’t that what the doping scandals have all been about?

The impulse to guarantee a level playing field is admirable (though perhaps unachievable), but to exclude or control those whose bodies are atypical in some way will mean that we miss the performance of many athletes. Should we also “treat” the bodies of those who can process oxygen more efficiently, who are inordinately tall, just to make things fair among the competitors?

It is ironic to consider the possibility that intersex could be a competitive advantage in the sports world, because intersex has long been seen as a serious problem. Since the mid-19th century, doctors have tried to treat and manage such patients, sometimes with hormones, sometimes with surgery, in an effort to “normalize” unusual bodies. These medical interventions do not typically cure the conditions. They are often simply cosmetic, and this unnecessary enhancement continues today, often with devastating results.

In fact, today the term “intersex” has been supplanted in medical contexts in favor of “disorders of sex development.” Though some argue that human bodies are full of natural disparities, including variant genitals and reproductive anatomies, others consider intersex something that needs fixing. Perhaps the new term, with the inclusion of the word “disorder,” encourages this perspective. Though many doctors and hospitals throughout the country have heeded the cautionary words of intersex activists about the harms of medical interventions, particularly on infant patients, efforts continue to make the genitals look “normal” and have their external and internal anatomy cohere.

The International Olympic Committee’s recent recommendations place intersex squarely in the “disordered” camp by suggesting treatment before an athlete could compete. Intersex thus becomes a disorder with an advantage.

But frankly, no one knows for sure if certain intersex conditions facilitate an athlete’s success. It is impossible to separate out that specific attribute from the myriad other factors that produce winning results. Unusually tall women have an advantage in basketball, and no one suggests that their extraordinary height be medically investigated as suspiciously male.

What is clear is that we continue to be profoundly unsettled by any body that falls outside the parameters of “normal,” particularly in terms of sex anatomy — and to me that’s what is unfair.
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