An Olympics inclusive of all

The Olympic Games appear to be edging towards a radical shakeup that could be a bold "heart and mind" exemplar of inclusion. Bruce Munro looks back over 125 years of sex testing in elite sport and talks to two Otago academics proposing a visionary way ahead.

Lynley Anderson and Alison Heather have an innovative, indeed radical, suggestion for those who run global sports’ pinnacle event.

The University of Otago academics are proposing an entirely new way of categorising athletes who compete in the Olympic Games. It is an approach that does away with male and female categories, applying heart and mind to solve a problem that has vexed and plagued elite sport since the Olympic flame was first re-lit 125 years ago. If adopted, it would be a shakeup that could also make the Olympics a shining light for inclusion throughout society.

"Perhaps we’ve got our sporting categories wrong," bioethics professor Lynley Anderson says by way of introducing the idea she and physiology professor Alison Heather are championing.

"To be simultaneously inclusive and fair at the elite level, the male-female binary must be discarded in favour of a more nuanced approach."

It is revolutionary, but it could be the solution Olympic bosses desperately need in order to get them out of their latest bind.

In just over a week’s time, Laurel Hubbard will represent New Zealand in the women's +87kg weightlifting competition; the first transgender athlete in the history of the modern Olympics.

Hubbard’s selection is a cause for celebration in many quarters, where it is seen as a ground-breaking step forward for inclusion. At the same time, it has caused controversy and triggered criticism of the International Olympic Committee (IOC) by those who view the move as trampling on hard-won women’s rights and a violation of the basic sporting tenet of fairness.

As so often since the first modern Olympic Games were held in Athens, Greece, in 1896, it is a pickle of the IOC’s own making. The track record, no pun intended, of Olympic administrators is patchy at best.

Pierre, Baron de Coubertin, the founder of the modern Olympics — a man of profoundly reactionary politics, nominated for a Nobel Peace Prize by the Nazis — believed "an Olympiad with females would be impractical, uninteresting, unaesthetic and improper". It was not until the second Olympics that women were allowed to compete, in a limited range of events. Through the years, the IOC has repeatedly displayed a mix of sexism and ignorance, dragging its feet on opening elite sport to women. It was 1984, in Los Angeles, before women were allowed to compete in the Olympic marathon.

Women’s sport has often been the locus of the Olympics’ harm of itself and others.

Sex testing is a case in point, a proverbial road to hell.

Sex testing of female competitors at the Olympics started in the 1920s and 1930s. In those early days, it was done a handful of times on the basis of suspicion that the woman was in fact a man. From 1948, the IOC required all female competitors to provide a doctor’s note verifying their sex.

During the 1960s the East Germans began giving performance-enhancing drugs, testosterone and then anabolic steroids, to its elite athletes. This was done secretly, sometimes without the athletes themselves knowing.

Knowing something was up, but not sure what, a "nude parade" for female track and field athletes in front of doctors was used by the International Amateur Athletic Federation (IAAF) in 1966. It was a blunt, demeaning and ineffectual tool.

The next year, the IAAF dropped the parade in favour of employing the latest technology, chromosome tests. The IOC followed suit in 1968.

But the tests proved problematic.

Among the IOC’s concerns — given its insistence on a male/female binary — was that intersex athletes might have an unfair advantage if competing in women’s events. Intersex, also known as Differences in Sexual Development (DSD), people have rare genetic inheritances that can affect hormones. It can give female athletes male levels of testosterone, the hormone that gives male brains, bones and muscles a demonstrable advantage in some competitive sports.

By the early 1990s, it was clear the chromosome tests were not up to the job. They were screening out some women with genetic differences that gave them no physical advantage and were missing other women with conditions that boosted their testosterone.

The IOC, to its discredit, did not drop the tests until 1999.

While the IOC’s focus had ostensibly been on ensuring fairness for women athletes, there were growing societal concerns about what that meant for the rights of all people to compete irrespective of whether they met the IOC’s rules.

This clash of fairness and inclusion came to the fore in 2009 when South African athlete Caster Semenya won gold in the 800m race at the World Championships, in Berlin, Germany.

Two years later, the IAAF and IOC brought in a hyperandrogenism test, limiting qualifying women’s testosterone to 10nanomoles per litre (10nmol/L).

The "average" female has 0.7nmol/L of testosterone, whereas for males it is typically much higher, at an average of 20nmol/L.

In 2014, Indian athlete Dutee Chand won two gold medals at the Asian Junior Athletics Championships but then was dropped for the Commonwealth Games because her testosterone level was too high.

Chand appealed the regulations to the Court of Arbitration for Sport (CAS). Sports’ supreme court ruled the hyperandrogenism regulations should be laid aside, saying more proof was needed that elevated testosterone gave women an unfair advantage.

On that basis, Chand and Semenya competed in the 2016 Rio Olympics. Semenya won the gold medial in the women’s 800m race.

Two years later the IAAF, based on new evidence, imposed a revised testosterone threshold, 5nmol/L. The testosterone test only applied in five track events, the five Semenya excelled in.

She appealed, arguing primarily on the basis of her rights rather than on the science. The court acknowledged the regulation was discriminatory but rejected her challenge. She appealed to the Swiss Federal Supreme Court. Last year, the Swiss Court upheld the CAS ruling "in order to guarantee fair competition for certain running disciplines in female athletics". This despite objections raised by the UN Human Rights Council.

Semenya, who said pre-2015 treatment to reduce her testosterone level had made her ill, is not competing at the Tokyo Olympics.

That is where the issue stands for athletes caught by the IOC’s DSD rules.

In the meantime, another head-on clash was brewing, this time over transgender athletes.

Hubbard, now 43, had competed in weightlifting before transitioning to a woman, setting New Zealand junior men’s records in 1998. She transitioned in 2012.

In 2015, trying to get ahead of the game, the IOC set new guidelines for transgender athletes. Attempting to balance the growing "importance of autonomy of gender identity in society" with the "overriding sporting objective ... of fair competition" the committee decided a transgender athlete could compete as a women if her testosterone levels were below 10nmol/L for at least 12 months before their first competition.

Hubbard met those requirements and also won the gold medal in the women's +87kg event at the Roma World Cup, in Italy, last year. She has been selected for the New Zealand team and is a medal contender at Tokyo.

It is already a win for inclusion.

"The whole nation should support Laurel," Prof Anderson says. "She has done what she was asked to do."

But the wider issue remains live.

Gender and biological sex are two quite different things, Prof Heather explains.

Male and female are biological sex terms, whereas women and men are among a fluid variety of gender terms including non-binary and transgender.

Prof Heather says the difference between male and female is important in sport, especially elite sport.

Males, as a population, are built to be better athletically than females; a difference largely driven by the hormone testosterone.

A male who transitions to become a woman after puberty still gets most of the benefits of those years of testosterone that shaped their body and their brain.

"All of these things are not reformatted by one year of estrogen and an androgen blocker," Prof Heather says.

"Gold medals at the Olympics are decided by less than 0.1% of an advantage in many events."

So that is where it stands a day after the opening of the Covid-delayed 2020 Summer Olympic Games. The past 125 years has seen the Olympics go from outright exclusion of half of the population to appearance tests, DNA tests and now testosterone tests. The status quo is an uneven attempt to approximate fairness that risks exclusion and an effort at inclusion that raises questions of advantage in some sports.

How will the Olympic Games meet this inclusion-fairness challenge? Can it?

Profs Anderson and Heather think they have cracked it.

Their solution is a complete rethink of sporting categories. Instead of male and female, they propose a system based primarily on physiological parameters, but including gender identity.

Athletes in each sport would compete in categories accounting for the person’s size, haemoglobin levels, maximal oxygen uptake, bone strength, lung capacity, heart size, past and present testosterone levels, the presence of testes, and, if they had transitioned, whether it was before, during or well-after puberty.

Men and women, including intersex and transgender athletes, could end up competing in the same event, sorted according to similar potential rather than sex.

It is a heart and mind approach that the two professors say celebrates diversity while maintaining fairness for females in sport.

Others have come to similar conclusions.

Sociologist Assoc Prof Roslyn Kerr says the Paralympics provide a working model of this new approach.

Paralympic athletes are placed in racing categories based on the movements their bodies can perform that are relevant to the event they are competing in, Prof Kerr, of Lincoln University, Christchurch, says.

In able-bodied sports, Prof Kerr says, "it would be possible to identify the characteristics that make up a successful athlete and create categories based on those rather than on sex".

For example, 100m sprinters could run in categories based on their muscle mass and fast-twitch fibres. High jump, volleyball and basketball athletes could be classified according to height and muscle mass.

Prof Kerr thinks it is the way of the future but believes it will be a hard sell to the public. She advocates more mixed-sex sport training to lower people’s objections to sex segregation in sport.

"What I’ve found is that people who have participated in sports where men and women train together regularly, for example, martial arts and long distance running, don’t find this idea all that troubling."

Those who sit atop global sports administration admit they are struggling to find the right way ahead on inclusion and fairness. But change is on its way, they say.

In response to questions by The Weekend Mix, an IOC spokesperson based at the Olympic headquarters, in Lausanne, Switzerland, says that since the 2015 testosterone guidelines were issued there have been "new developments, data, research, and learnings in the scientific and human rights sectors".

As a result, the IOC is developing a new framework to ensure "athletes — regardless of their gender identity and/or sex characteristics — can engage in safe and fair competition".

But there is still a long way to go, the spokesperson admits.

"The discussions so far have confirmed the considerable tension between the notions of fairness and inclusion, and the desire and need to protect the women’s category. Opinions are very diverse and difficult to reconcile, and perceptions differ strongly."

The goal, however, sounds like a comprehensive overhaul of Olympic sport.

"It will lead to the development of a framework which will acknowledge the differences that exist between sports in order to find suitable mechanisms, policies, and approaches to ensure inclusion, non-discrimination, fairness, proportionality, and safety for all athletes in each sport."