ACTIVE VOICE: GENDER AND ATHLETES

Active Voice is an occasional column by ACSM experts. These comments do not necessarily reflect the views or positions of ACSM.

Alan D. Rogol, M.D., Ph.D., FACSM, is a 25-year member of the American College of Sports Medicine. He is a pediatric endocrinologist at the University of Virginia and a teacher-mentor at Riley Children's Hospital in Indianapolis.

Athletic competition should start on a level playing field. That is why men, who presumably have a greater muscle mass (androgen-dependent), compete separately from women, who have a lower muscle mass and presumably less testosterone. This works more than 99.9 percent of the time.

The track and field world was awakened this summer to a new world class athlete, Ms. Caster Semenya from South Africa. Her accomplishments on the track were outstanding and worthy of a world-class athlete. Immediately there were questions about whether she should compete as a woman, given her muscular appearance and a voice deeper than the average woman. More

The issue of gender identity has come a long way since the old “chromosome test”—either one was 46, XX and competed as a woman, or 46, XY and competed as a male. There are a number of genetic conditions that just don’t fit into this easy classification. So much has been written since that time (see summary in Med Sci Sports Exerc. 2002; 34:1539-1542). I was privileged more than two decades ago to work with one of the authors of the statement made in the above referenced article from the Council on Scientific Affairs, American Medical Association noting that previous gender verification procedures had resulted in substantial harm to a number of women athletes born with relatively rare genetic conditions. The International Amateur Athletics Federation (IAAF) itself recommended that a “medical delegate” have the ultimate authority in arranging for the determination of gender, if necessary. This concept is fair and sensible.

I am a pediatric endocrinologist who has evaluated and treated children with disorders of sex differentiation, the modern, non-pejorative term for those who do not fit the anatomically usual state of male or female. The ultimate diagnosis, therapy and psychological counseling for these private and personal medical matters is undertaken by a gender medicine team that includes (at least for babies) of a pediatrician, geneticist, endocrinologist, urologist, pediatric surgeon and psychologist. The information obtained by a thorough evaluation is thoughtfully delivered to the parents (or older child or adolescent).

Ms. Semenya’s private and personal medical matters have been published in the sports press. However this information was disseminated, the disclosure is an outrage and may have most unfortunate consequences for this young athlete’s future. Local, national and international sports-related federations need to work together to maintain the most rigorous safeguards possible in handling of private medical matters.

I do not know precisely what condition Ms. Semenya may have, although I can guess among a few that are consistent with the information provided. In fact, it is immaterial. If the levels of testosterone are higher than those for reference women and her muscles are able to respond to them, she may have a genetically determined advantage for track events. However, Willie Shoemaker (jockey) and Wilt Chamberlain (basketball) had a genetically-determined advantage in their (non-randomly determined) choice of sports.