2009年8月25日 星期二

Where’s the Rulebook for Sex Verification?

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Where's the Rulebook for Sex Verification?

Olivier Morin/Agence France-Presse — Getty Images

The fact is, sex is messy. This is demonstrated in the I.A.A.F.'s process for determining whether Caster Semenya is in fact a woman.

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Published: August 21, 2009

The only thing we know for sure about Caster Semenya, the world-champion runner from South Africa, is that she will live the rest of her life under a cloud of suspicion after track and field's governing body announced it was investigating her sex.

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The I.A.A.F.'s process for determining whether Caster Semenya, second from left, is a woman will involve at least a geneticist, an endocrinologist, a gynecologist and a psychologist.

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Why? Because the track organization, the I.A.A.F., has not sorted out the rules for sex typing and is relying on unstated, shifting standards.

To be fair, the biology of sex is a lot more complicated than the average fan believes. Many think you can simply look at a person's "sex chromosomes." If the person has XY chromosomes, you declare him a man. If XX, she's a woman. Right?

Wrong. A little biology: On the Y chromosome, a gene called SRY usually makes a fetus grow as a male. It turns out, though, that SRY can show up on an X, turning an XX fetus essentially male. And if the SRY gene does not work on the Y, the fetus develops essentially female.

Even an XY fetus with a functioning SRY can essentially develop female. In the case of Androgen Insensitivity Syndrome, the ability of cells to "hear" the masculinizing hormones known as androgens is lacking. That means the genitals and the rest of the external body look female-typical, except that these women lack body hair (which depends on androgen-sensitivity).

Women with complete Androgen Insensitivity Syndrome are less "masculinized" in their muscles and brains than the average woman, because the average woman makes and "hears" some androgens. Want to tell women with Androgen Insensitivity Syndrome they have to compete as men, just because they have a Y chromosome? That makes no sense.

So, some say, just look at genitals. Forget the genes — pull down the jeans! The I.A.A.F. asks drug testers to do this. But because male and female genitals start from the same stuff, a person can have something between a penis and a clitoris, and still legitimately be thought of as a man or a woman.

Moreover, a person can look male-typical on the outside but be female-typical on the inside, or vice versa. A few years ago, I got a call from Matthew, a 19-year-old who was born looking obviously male, was raised a boy, and had a girlfriend and a male-typical life. Then he found out, by way of some medical problems, that he had ovaries and a uterus.

Matthew had an extreme form of Congenital Adrenal Hyperplasia. His adrenal glands made so many androgens, even though he had XX chromosomes and ovaries, that his body developed to look male-typical. In fact, his body is mostly male-typical, including his muscle development and his self identity.

O.K., you say, if chromosomes and genitals do not work, how about hormones? We might assume that it is hormones that really matter in terms of whether someone has an athletic advantage.

Well, women and men make the same hormones, just in different quantities, on average. The average man has more androgens than the average woman. But to state the obvious, the average female athlete is not the average woman. In some sports, she is likely to have naturally high levels of androgens. That is probably part of why she has succeeded athletically.

By the way, that is also why she is often flat-chested, boyish looking and may have a bigger-than-average clitoris. High levels of androgens can do all that.

Sure, in certain sports, a woman with naturally high levels of androgens has an advantage. But is it an unfair advantage? I don't think so. Some men naturally have higher levels of androgens than other men. Is that unfair?

Consider an analogy: Men on average are taller than women. But do we stop women from competing if a male-typical height gives them an advantage over shorter women? Can we imagine a Michele Phelps or a Patricia Ewing being told, "You're too tall to compete as a woman?" So why would we want to tell some women, "You naturally have too high a level of androgens to compete as a woman?" There seems to be nothing wrong with this kind of natural advantage.

So where do we draw the line between men and women in athletics? I don't know. The fact is, sex is messy. This is demonstrated in the I.A.A.F.'s process for determining whether Semenya is in fact a woman. The organization has called upon a geneticist, an endocrinologist, a gynecologist, a psychologist and so forth.

Sex is so messy that in the end, these doctors are not going to be able to run a test that will answer the question. Science can and will inform their decision, but they are going to have to decide which of the dozens of characteristics of sex matter to them.

Their decision will be like the consensus regarding how many points are awarded for a touchdown and a field goal — it will be a sporting decision, not a natural one, about how we choose to play the game of sex.

These officials should — finally — come up with a clear set of rules for sex typing, one open to scientific review, one that will allow athletes like Semenya, in the privacy of their doctors' offices, to find out, before publicly competing, whether they will be allowed to win in the crazy sport of sex. I bet that's a sport no one ever told Semenya she would have to play.

Alice Dreger is professor of clinical medical humanities and bioethics in the Feinberg School of Medicine at Northwestern University, and the author of "Hermaphrodites and the Medical Invention of Sex" (Harvard University Press, 1998).

 

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