TESTED

EPISODE FIVE: UNFAIR ADVANTAGE?

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by

rose
in

A battle over science and ethics unfolds. World Athletics releases and then tweaks multiple policies impacting DSD athletes, while critics cry foul. In this episode, World Athletics doubles down on its claims, Caster Semenya challenges the rules again, and we dig deep on a big question: what constitutes an “unfair” advantage on the track?

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TRANSCRIPT

Rose Eveleth: In March of this year, Christine Mboma finally hit a major milestone.

According to World Athletics, she had to keep her testosterone down for six months. And after tinkering with the meds — and a lot of close monitoring — she hit the mark. Henk and Elize Botha, her coach and doctor, sent off the proof, and waited.

And a few weeks later, they got a letter from World Athletics. Christine was cleared to compete.1

With the letter in hand, the race was well and truly on. The Paris Olympics were just four months away. If Christine wanted to be there, there was just one more step: she had to actually qualify — she had to run a qualifying time at a World Athletics-accredited meet.2

Christine’s coach Henk considered competitions all over the world. The one place he didn’t want Christine’s first race back to be was the Kip Keino Classic in Nairobi.

Henk Botha: It’s also emotional. That’s where she was injured.

Rose Eveleth: Plus, she would already have all eyes on her because of the saga with her medication and DSD status.3

But because of visas and scheduling issues, Henk couldn’t avoid it. So in April, Christine traveled to Kenya, and faced down the Kip Keino Classic once again. This was her first chance to hit a qualifying time.

Before the race, I called her.

Rose: Are you excited to run tomorrow?
Christine Mboma: Yeah. I’m excited.
Rose: Are you nervous at all?
Christine: Yeah, I do, I like, I am nervous. Because I got injured here in Kenya, so, yeah. But I’m managing.

Rose Eveleth: I spoke with Henk before the race, too.

Henk Botha: My plan is to tell her, “Listen, the world are telling you you are not a woman. The world are telling you you’re not good enough. The world are telling you it’s not your talent. It’s now time to show the world, whether they’re right or wrong.”

Rose Eveleth: And on April 20th, in front of a packed stadium in Nairobi, Christine lined up for the 100m. To qualify for Paris, she needed to cross the finish line 11.07 seconds or less.

FloTrack Announcer: Christine Mboma! And the top athletes in this field from Namibia. Christine Mboma, Olympic silver medalist, finally getting back on the track this year. You know, really excited to see what she can do. [starting gun fires] Off they go. And Gina Bass had a good start to the day. And Christine Mboma… Gina Bass. What a wonderful run. 11.34. It could have been a bit faster, but, a good win for Gina Bass, from the Gambia.

Rose Eveleth: Christine… came in last.4

FloTrack 2024 Announcer: Christine Mboma didn’t have a good outing. But, you know, understandably, because she’s just getting this first race back this year….

Henk Botha: Everything that could go wrong went wrong with this race. So the poor child, it was an awful first session on the track,and suddenly, just, it was just too much for her.

Rose Eveleth: On that day at Kip Keino, there was someone sitting in the stands with a very particular interest in watching Christine race: Max Imali, the Kenyan sprinter.

Last time Christine raced at Kip Keino, Max ran beside her. But now, Max wasn’t competing, because she refused to take medications to lower her testosterone.

I called Max after the event, and asked how it felt to watch the race.

Max Imali: I told you it was bad for me because I wanted to run, and I was, I was not able to run. And seeing Mboma, after using the medicine, she was, she was not in a shape to run a good time. It was so bad for me.

Rose Eveleth: Max was just a month away from bringing her case to the Court of Arbitration for Sport, where she would take on World Athletics over the rules that led to Christine taking these medications.

Max Imali: I felt that World Athletics has neglected us, World Athletics wants us to destroy ourselves. Because if she can use the medicine and be the way she was — that was not good at all.

Rose Eveleth: Max wasn’t the only one drawing conclusions based on Christine’s performance that day. In the comments and discussion online, you see two kinds of responses. Some people are cheering Christine on, with comments like “Mboma, you are still our champion! It’s just a matter of time — we gonna win.”

But others saw this race as proof. One commenter wrote, “This is like expecting a bull to produce after castration.”

Those commenters were saying, essentially, the same thing World Athletics had been saying for years: That Christine and Max and other so-called “DSD athletes” like them have an unfair advantage on the track because of their testosterone. And now that Christine’s testosterone was down, “Look!” they said. “Advantage gone.”

Over the last fifteen years, this idea has been the focus of a heated debate — a debate that includes allegations of dubious science, multiple cases at the Court of Arbitration for Sport, experts switching sides, and a whole parade of ever-changing policies.

And at the heart of it, lies a question that is incredibly hard to answer: what does it mean, in sports, to have an unfair advantage?

From CBC and NPR’s Embedded, this is TESTED. I’m Rose Eveleth.

Advantage. It’s an interesting word, when it comes to sports. Because in some ways, it’s what sports are all about, right? Who is faster, or stronger, or smarter.

And the idea of advantage is the foundation of DSD policies. This claim that some women with DSDs have an advantage over other women. But what does advantage actually mean?

Step into my laboratory, will you?

Imagine that the walls of this purely hypothetical lab are lined with little vials, each labeled with tiny, precise script. And within each of these little test tubes, is some element of athletic advantage. If we combine them… we can create athletic alchemy. The perfect athlete.

First you’re going to want the vials labeled time, and money — those are key to hire coaches, eat right, travel for competition, have the best training facility, the newest shoes. Next let’s add something a little more ineffable — mentality. Determination, that single-minded focus.

Our perfect athlete beaker is now half full — but on top of all this stuff, you need the body. Depending on what sport this imaginary athlete might compete in, you’ll want to tweak things like height, weight, and body proportions. For example: Michael Phelps has an incredibly long torso, and comparatively short legs — perfect for swimming.

There’s also a whole section of this lab’s wall of vials dedicated to genetic mutations that an elite athlete might want. There are at least 20 different genetic factors that researchers have identified as being potentially correlated with athletic performance.5

So go back to the wall and grab the vial labeled EPOR, an acronym for erythropoietin receptor. This gene determines how good the body is at making red blood cells. People with this mutation can carry more oxygen in their blood, which helps with aerobic exercise. A Finnish skier named Eero Mäntyranta had this exact mutation, and he won seven Olympic medals.6

And while you’re over there, grab the vial labeled ACT-3. That one will be handy too. People with this mutation have a slight advantage in powerful sprinting events.

You might also grab smaller tweaks from our wall of beneficial mutations — ACE insertion/deletion, angiotensinogen, AMPD1, homeostatic iron regulator, interleukin-6, endothelial nitric oxide synthase 3, peroxisome proliferator-activated receptor alpha, peroxisome proliferator-activated receptor gamma, mitochondrial uncoupling protein 2.

Some athletes with these kinds of mutations are viewed as icons in their sport. Like that Finnish skier I mentioned. Here’s Morgan Campbell, a sports writer at CBC.

Morgan Campbell: We just sort of celebrate him as a medical marvel, right? Whereas in any, in a different context, we would say he is a natural-born cheater. That’s what we did with Mboma and Masilingi, you know? It depends on, you know, who’s lucky enough to get born with the right set of characteristics that fit, you know, with where we decided to draw a line between somebody with a genetic advantage or somebody who we decide is born a cheater.7

Rose Eveleth: World Athletics says they don’t think these athletes are cheating, per se, but they still can’t be allowed to compete as is. But why is it that some kinds of biological advantages are fine… and others require a whole new rule to be written to remove the alleged advantage?

The answer to this question, according to those in favor of regulations, is simple. We don’t divide sports by blood oxygen, or fast twitch muscles. But we do divide sports by sex. And so, these folks argue, advantages that might be connected to sex are fair game.8

In 2015, when Dutee Chand’s case was decided, the Court of Arbitration for Sport actually agreed with this idea that sex-based advantages might warrant regulation. But they said that before World Athletics could actually put rules into place, they had to prove just how big this advantage was. If it was big, like 10 or 12 percent, then sure, that might call for rules like this. But if it was small, like 2 or 3 percent, then that’s a lot harder to justify, because that would put the advantage in the realm of those other things we just discussed.9

World Athletics lost their case in 2015, because at the time, they didn’t have any evidence to actually show how big this advantage might be.10 But the ruling was provisional. It suspended the testosterone regulations for two years. And it said that sports officials had those two years to go off and find evidence to justify their policies.11

This directive alone raised some red flags, among researchers following this topic:

Roger Pielke: And it’d be a little bit like, you know, a regulatory agency saying to a tobacco company, hey, you got two years, go gin up some research and tell us that smoking doesn’t cause cancer.

Rose Eveleth: That’s Roger Pielke, a professor of science policy at the University of Colorado Boulder with a special interest in how data is used to shape policy.

CAS asked World Athletics to answer a fairly straightforward question: how much of an advantage do athletes like Caster Semenya or Dutee Chand have? And the ideal study you would do, to answer this question, is pretty simple. You’d want to compare the testosterone level and performances of DSD athletes, with non DSD athletes.

But that’s not the study World Athletics did.

Roger Pielke: There are no studies — peer reviewed or not peer reviewed — of the relative performance of female athletes with certain DSD conditions, as compared to female athletes without those conditions. There’s just no studies.

Rose Eveleth: Instead… they did something slightly different.

In 2017, two World Athletics researchers published a paper in the British Journal of Sports Medicine.12 The study looked at the testosterone level of all athletes — regardless of their DSD status. And the paper argued that they did actually find evidence that higher testosterone levels meant better performance. But only for some events — mostly the so-called middle distances: the 400, the 400 hurdles, and the 800.13

But critics of World Athletics noticed a few things about this study. They pointed out that its authors were not independent researchers. They were both associated with World Athletics.

And experts like Roger also found the actual results kind of weird. Why would testosterone only impact middle distance events?

Roger Pielke: I don’t know, my bullshit detector kind of went, went nuts. Ding, ding, ding ding! Let’s go look at this data and figure out what’s going on.

Rose Eveleth: Roger made his misgivings public on his blog.14 Other researchers piled on as well. One called the study “a mess.”15

And then — in April of 2018 — World Athletics announced a new policy.16

Sebastian Coe: The first decision this morning was a very, very big decision.

Rose Eveleth: World Athletics President Sebastian Coe said the policy was based, at least in part, on the study it had done.

Sebastian Coe: We were asked by the Court of Arbitration for Sport to provide the evidence regarding the magnitude of this advantage, which we now have….

Rose Eveleth: And Coe said this was one of the organization’s “toughest subjects.”

Sebastian Coe: And I want to make one point really clear, crystal clear up front. This is not about cheating. No H.A. athletes have cheated. This is about our responsibility as a sports international federation to ensure, in simple terms, a level playing field. It is our sport and it is up to us to decide the rules and the regulations.

Rose Eveleth: The new rules restored the eligibility restrictions. Once again, women with high testosterone would have to lower it, in order to run in the women’s category. This time, the threshold was cut in half – from 10 nm/L to 5. And the rules only applied to some of the events in which the paper found an advantage — those middle distance races.17

Roger Pielke had been hoping to get a look at the paper’s data — and a few months after the new policy was released, the study’s authors finally allowed him to see some of it.

And when they looked closely, Roger and his collaborators found all kinds of errors.18

Roger Pielke: I mean, it was stunning. There was between, I think the number’s like 17 and 32% of the data, was erroneous. So they had duplicated data. They had phantom data that didn’t exist anywhere. They duplicated athletes. They had athletes who doped. Hugely problematic.

Rose Eveleth: Eventually, the authors of the original study published a response to the critiques, admitting that there were some issues with the data, and offering up a new analysis.19

And in that new analysis, the results changed. Only one of the running events cited in the original, maintained the level of advantage they claimed. But still — World Athletics stuck with its new regulations. No changes, corrections, or updates.

Roger Pielke: The homework that IAAF turned in was returned with a big fat F on it. They actually didn’t complete their homework.

Rose Eveleth: The only way to change the rules, would be to challenge them — again — in court. And this time, the challenger would be the South African star, Caster Semenya.

☀︎ ☀︎ ☀︎ BREAK ☀︎ ☀︎ ☀︎

Rose Eveleth: In February of 2019, the Court of Arbitration for Sport opened its doors to the parties of a new case over the lastest regulations. This time it would be the IAAF — which is now known as World Athletics — versus Caster Semenya.

Caster arrived wearing a sharp black suit and white sneakers.

Reporter: Hello Ms. Semenya, how are you? Good morning. Can we get a quick comment from you about heading in?

Rose Eveleth: She smiles, and shakes her head no.

Sebastian Coe, the President of World Athletics, on the other hand, did stop to answer press questions before going into the building.

Sebastian Coe: It’s a very, very important day, you know. The core value for the IAAF is the empowerment of girls and women through athletics. The regulations that we are introducing are there to protect the sanctity of fair and open competition. That’s really what we are to defend.

Rose Eveleth: World Athletics declined to do an interview for this series, and it says it can’t comment on specific cases. But I did talk to someone who was in the room on the World Athletics side of things. Dr. Richard Auchus is an endocrinologist at the University of Michigan. In this 2019 case, he served as an expert witness for World Athletics. Here’s how he described to me the need for these rules.

Richard Auchus: There is a women’s category, all right? And we call it women’s, for better or for worse. And this women’s category, the sport has, you know, taken the position that it is a protected category, for people for whom they would not have a level playing field if they were to compete against male-bodied athletes in the sports covered in World Athletics. All right? So if you’re going to do that, you have to have a definition and you have to have some means of determining who belongs in that protected category.
Rose: Can you say more about protected? What does that mean to you?
Richard Auchus: That there you — that not anybody can go into that. Like I can’t compete in the women’s category. Like I may want to, you know, but I can’t.
Rose: Would you want to?
Richard Auchus: [Pauses] You know, I’d win a medal. You know, the last triathlon I did, I was third in my age group, but I would have, you know, won the overall women’s. So, you know, it depends if I want to win a medal or not.

Rose Eveleth: Again, as far as I can tell from all my research, this has never happened at the elite level. No male athlete has snuck into a women’s race and won a medal.20 But the idea here is that DSD athletes, like Caster, are, in Richard’s terms, “male-bodied.” Essentially, too male to run against other women.

Richard Auchus: You can’t just compete in the protected category by saying that I’m one of them. You understand? There’s a medical definition of that protected category.21

Rose Eveleth: And here is where we get to a thing that can be really confusing. On the one hand, World Athletics says that it would never question an athlete’s sex or gender. The most recent policies specifically say that the rules are in no way, quote, “intended as any kind of judgment on or questioning of the sex or the gender identity of any athlete.”

But in Switzerland, in 2019, the World Athletics team argued in the Court of Arbitration for Sport that the women impacted by these policies are, in their words, “biologically… the same in every material respect as male athletes without DSDs.”22 The rules even say that they would allow these women to compete in the male category.

Katrina Karkazis: After World Athletics lost their first case, which was Dutee Chand’s case, they started to double down on the language they used to talk about women with intersex variations. They started using language like “biological males,” which they had never used before.

Rose Eveleth: This is Katrina Karkazis, a cultural anthropologist at Amherst College, and the author of Testosterone: An Unauthorized Biography.

Katrina Karkazis: They started emphasizing the chromosomes that the women had. They started talking about testes. These were all, in my mind, dog whistles meant to signal to the public: “You might think this person is a woman. She might say she’s a woman. But let me tell you about all of these biological traits she has. And our hope is that that will help you to see her as a male.”

Rose Eveleth: In my reporting, I learned that some critics of World Athletics believe there is another reason the organization is making this “biological male” argument. Because if you think that these women are “biological males,” you don’t need to do studies comparing different women to each other. You can just compare men and women.

And there is lots of literature already showing that men have a 10 to 12 percent advantage over women on the track.23 If they can use that evidence, they don’t have to go out and get any more. They’ve already got plenty.

Eric Vilain: But they don’t, they do not have any evidence on athletes with an intersex condition.

Rose Eveleth: This is Dr. Eric Vilain, a pediatrician at UC Irvine who specializes in treating patients with differences of sex development.

Eric Vilain: And then they’re saying, well, intersex individuals, intersex athletes, are exactly the same as biological male athletes. So we don’t need to redo this evidence.

Rose Eveleth: Eric testified for Caster’s side in the 2019 case. But before that, he worked with the International Olympic Committee and World Athletics to set that original 10nm/L threshold. He says he’s not necessarily opposed to regulating these athletes, but the regulations, in his words, have to make sense. They have to be based on the appropriate science. Like the “ideal” study I mentioned earlier — the one that would directly compare DSD and non-DSD athletes. Eric says you can’t just compare two very different populations, and call it evidence.

Eric Vilain: This is not how evidence is built. There are many differences between a biological male who does not have a DSD and a woman with a DSD.24

Rose Eveleth: Caster and her team argued that even if DSD women had some advantage, it was nowhere near the level of advantage that a cis male might have.

In fact, Caster doesn’t even have the women’s world record in the 800. She is the fourth fastest 800m runner in women’s history.25 In 2019, in court, Caster rejected a suggestion by a World Athletics representative that she didn’t always try as hard as she could in her races.

The core question in the 2019 case was about balance. Or, in fancy lawyer terms, proportionality. Was the potential advantage Caster had big enough to justify the pain that the regulations put her through?

In the 2019 case, Caster spoke to the court about her terrible experience taking the medications. The side effects — like nausea, fevers, and sleep problems.26 Here’s Carlos Sayao, one of the lawyers.

Carlos Sayao: We had evidence of the harms caused by the regulations. And so we said, even if, you know, there is some performance advantage of testosterone, well, the, the whatever benefit of the rules is greatly outweighed by the awful experiences you’re forcing these women to go through for the purpose, sole purposes of eligibility.

Rose Eveleth: After the hearing was over, World Athletics would go on to make a puzzling argument. It has said that, quote, “These medications are gender-affirming.”27 That women like Caster, Max, and Christine should want to take them, if they really are women.

The Director of the Health and Science Department at World Athletics, Dr. Stéphane Bermon, said in an interview: “If a person claims to be a woman and wants to compete in this protected female category, then she should be happy to lower her testosterone level. If this is not the case then one must ask questions about her true sexual identity.”28

Dr. Stéphane Bermon was one of the authors of that disputed study. He declined to do an interview with us, though he wrote in an email that he thought my questions were quote “deliberately provocative.”29

But I asked Dr. Richard Auchus about this claim that the meds are gender-affirming. He’s the endocrinologist who testified on behalf of World Athletics in that 2019 case, and he treats trans and intersex patients.

Rose: What about patients who would identify as women and don’t want to undertake treatment in this group?
Richard Auchus: So I don’t understand that. Can you explain that to me?
Rose: So someone who was assigned female at birth, let’s say.
Richard Auchus: Right.
Rose: Raised as a girl. And who now still is, like, living as a woman, is a woman, sees herself as a woman, but doesn’t want to necessarily take anything, any medications to change her body.
Richard Auchus: You see, to me… I mean, I know what you’re saying, but to me, that doesn’t make any sense. Now, they could be nonbinary. So, I think what you’re describing is a nonbinary individual.
Rose: But if they don’t identify as nonbinary, I don’t feel like I can say they’re nonbinary, right?
Richard Auchus: Well, only they can say what they are and, you know, but, but I think, to me, that’s not consistent with, what, at least, my understanding of what the, the field considers a female gender identity. You know, and that’s just what our, um, what our field would consider when we’re talking about hormone replacement therapy.

Rose Eveleth: We talked with other doctors who work in intersex and trans healthcare, and who strongly disagree with World Athletics’ claims about gender-affirming care. Here’s Dr. Casey Orozco-Poore, who wasn’t involved in any of these cases:

Casey Orozco-Poore: It’s insane of them to say they’re offering gender affirming care and it makes me so angry. Only the individual themselves can determine if it’s gender affirming.30

Rose Eveleth: And Casey says that even if these women did want some kind of medication, the idea of having to hit a specific number just isn’t how this is supposed to work.

Casey Orozco-Poore: As a doctor, like, there’s a saying we don’t treat labs, we treat patients. We don’t just artificially obsess over a number. We use the labs as one piece of information, but we are never treating the lab. And that’s why this is such an artificial thing that they’re asking Caster to do, is that they’re forcing her to become a laboratory value when bodies just don’t work like that.31

Rose Eveleth: Henk Botha, Christine’s coach, is watching this happen, as Christine takes the medications and tries to stay below that magic number — the official limit for her testosterone levels.

Henk Botha: Every evening, when I put my head down and sleep, um, I’m still not happy. I’m still, I don’t feel it’s fair. And, yes, I have been very vocal about the word fairness. What is fairness? But, um, my heart is just bleeding. Bleeding every day. And I must see this. This woman being, um, pulled apart by, by somebody that’s sitting somewhere in an office in Europe and just make a decision that is just really crazy.

Silvia Camporesi: The federation always talks in terms of fairness. “We are protecting the fairness of competition. We are protecting the female category. We are protecting the integrity of our sport.” This is a language of values.

Rose Eveleth: This is Silvia Camporesi, a bioethicist at King’s College London.

Rose: Is the question of fairness and this unfair advantage question — how much of that can be answered by just the data?
Silvia Camporesi: No. It can’t be answered just by the data. When certain federation says we are following the science, science can only get you that far. And then you decide, what do I do with this data?32

Rose Eveleth: In an email to me declining to do an interview, a World Athletics representative wrote that the organization, quote, “has only ever been interested in protecting the female category. If we don’t, then women and young girls will not choose sport. That is, and has always been, the Federation’s sole motivation.”

But which women get protected? And which ones don’t?

So when you’re making choices about these rules, you’re choosing which kinds of fairness and protection you think are most important. And that’s a choice that isn’t new. Here’s Alison Carlson, the journalist who worked to end mandatory chromosome screening in the 1990’s.

Alison Carlson: When we think about difference, athletically on lots of scales, it gets celebrated. But when the difference emanates from sex related chromosomes, it’s like we can’t think straight. And maybe it’s threatening to people if we don’t fit into these neat categories, the binary that exists in our minds, but not in reality, biologically.

Rose Eveleth: On May 1st, 2019, the Court of Arbitration for Sport released its verdict33 — here read by Matthieu Reeb, the court’s secretary.

Matthieu Reeb: The panel is aware and, um, realizes that the rules are discriminatory, but they find this discrimination is acceptable, is necessary and proportionate, to achieve the objective which is sought.34

Rose Eveleth: Carlos Sayao, one of Caster’s lawyers, was sitting in his office in Toronto when he got the news.

Carlos Sayao: I was devastated. I was just absolutely shocked that we didn’t win on anything. So it was, it was devastating to read that, the whole regulations had been, had been upheld.

Rose Eveleth: Here’s World Athletics President Sebastian Coe talking to CNN about the case:

Sebastian Coe: It was really important that the concept of free and fair, open competition and on a level playing field was adopted. It may be in 30 years, 40 years time, society takes a different view and we, you know, we have other classifications, I don’t know, but at this point, my responsibility was to protect two classifications, and that’s what we feel we’ve done.35

Rose Eveleth: And so, World Athletics had the green light to proceed. To keep these DSD regulations and potentially even expand them. Which is exactly what they did in the spring of 2023, when they announced that new rules would apply to ALL events in track and field. And on top of that, they dropped the testosterone limit again, from five… down to 2.5.36

Which brings us to today. Christine, taking these medications, and trying to make it to Paris. Max, trying to fight the rules in court.

And next time… you’ll hear how they both fared.

Max Imali: Now I’m so nervous and nervous because, you know, it’s my first time to go and contest the case.

Payoshni Mitra: I would say that I have witnessed the most powerful moments of my career in that week.

Henk Botha: We will have a nice chat tomorrow. And, and I need to tell her: You are still a human being. You are not an object. So I’ll, I’ll have the talk with her tomorrow, and I’ll let you know.

CREDITS

You’ve been listening to Tested, from CBC, NPR’s Embedded, and Bucket of Eels. The show is written, reported, and hosted by me, Rose Eveleth.

Editing by Alison MacAdam and Veronica Simmonds. Production by Ozzy Llinas Goodman, Andrew Mambo, and Rhaina Cohen. Additional development, reporting, producing, and editing by Lisa Pollak. Sound design by Mitra Kaboli. Our production manager is Michael Kamel. Anna Ashitey is our digital producer. This series was mixed by Robert Rodriguez. Fact checking by Dania Suleman. Our intersex script consultant is Hans Lindahl. Legal support from Beverly Davis. Archival research by Hillary Dann.

At CBC, Chris Oke and Cesil Fernandes are Executive Producers, Tanya Springer is the Senior Manager, and Arif Noorani is the Director of CBC Podcasts.

At NPR, Katie Simon is Supervising Editor for Embedded. Irene Noguchi is Executive Producer. NPR’s senior vice president for podcasting is Collin Campbell. We got legal support from Micah Ratner. And specials thanks to NPR’s Managing Editor for Standards and Practices, Tony Cavin.

This series was created with support from a New America fellowship.

  1. For more information on the World Athletics policy that applies to Christine, see this 2023 press release, which includes a link to download a full copy of the current DSD regulations. ↩︎
  2. For more details, see the World Athletics qualification system for the Paris 2024 Olympic Games. ↩︎
  3. There was a bunch of media coverage of Christine around this time — see here, here, and here, for example. ↩︎
  4. You can watch the race here. ↩︎
  5. For more details, see this paper. ↩︎
  6. For more on Eero Mäntyranta’s story, see this paper. ↩︎
  7. For more of Morgan’s perspective on this topic, see this article. ↩︎
  8. In a 2019 press release, World Athletics wrote, “It is correct that elite sport celebrates and rewards genetic differences (height, wing span, fast twitch muscles, etc). The only genetic difference that elite sport does not celebrate is the genetic difference between men (with male chromosomes, XY) and women (with female chromosomes, XX).” ↩︎
  9. For more information, see CAS documentation of the case. ↩︎
  10. Interestingly, a 2014 study – funded in part by the IOC — had actually found that in a group of 693 elite athletes, “16.5% of men had low testosterone levels, whereas 13.7% of women had high levels.” ↩︎
  11. For more information, see the last page of the CAS decision in the case. ↩︎
  12. See here. ↩︎
  13. The paper also found advantage in two field events, the hammer throw and the pole vault. ↩︎
  14. You can read the blog post here. ↩︎
  15. See this blog post. ↩︎
  16. See this 2018 press release, which includes a link to download a full copy of the 2018 DSD regulations. For one critique of the 2018 regulations, see this paper coauthored by Katrina Karkazis, who you heard in episode 4. ↩︎
  17. It’s interesting to note that the 2018 regulations don’t apply to the hammer throw or the pole vault. Which is odd, because in the original paper, the biggest effect of testosterone they found — out of all the events — was in the hammer throw. But those athletes were not asked to moderate their testosterone. And in the original paper, they didn’t find much advantage in the mile — but the mile was regulated in this new policy. ↩︎
  18. They eventually published the results of their analysis — you can read the full paper here. ↩︎
  19. See this paper. Here, the authors are responding both to Roger’s critique, and to another critique — coauthored by Katrina Karkazis and Malcolm Ferguson-Smith, who you heard in previous episodes — of a 2017 study coauthored by an IAAF and IOC medical advisor. Both 2017 papers by IAAF-affiliated researchers eventually received corrections, but not until 2021 — see here and here. Roger also wrote a blog post responding to one of the corrections. ↩︎
  20. For more information, see Rose’s CBC article on Heinrich Ratjen. ↩︎
  21. For more on Auchus’s perspective, see this 2017 article he wrote — though note that this was published in a legal journal, not a medical journal. ↩︎
  22. For more information, see CAS documentation of the case. ↩︎
  23. See, for example, this paper. ↩︎
  24. For more on Eric’s perspective, see this 2021 paper he co-wrote with Maria Patiño. ↩︎
  25. One thing I always think is worth noting: A year before Caster’s World Championships win in Berlin, Pamela Jelimo won an 800m race by a bigger margin than Caster did. This was the third fastest 800m time in women’s history — faster than Caster ever ran it. But Jelimo has never been accused of having an unfair advantage, as far as I know. ↩︎
  26. For more on the toll these drugs took on Caster, see her memoir. ↩︎
  27. See this press release. ↩︎
  28. See this article. ↩︎
  29. For more on Bermon’s perspective, see this 2023 consensus statement he worked on for the American College of Sports Medicine. ↩︎
  30. For more information about this “gender-affirming care” idea, see this 2024 paper coauthored by Katrina Karkazis. ↩︎
  31. For more of Casey’s work, check out this interview about their research on medical treatment of intersex children. ↩︎
  32. For more on Silvia’s perspective, see this 2018 paper and this 2016 paper. ↩︎
  33. See the press release here. ↩︎
  34. For more information, see CAS documentation of the case. ↩︎
  35. You can watch more of this interview here. ↩︎
  36. See the World Athletics press release. ↩︎