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Steroids, ‘Gender,’ and Fair Play
We are still wrestling with the controversy over trans-identifying male athletes in women’s sports. Just recently, the Georgia High School Association (GHSA) joined other states in requiring students to participate on teams consistent with their sex despite the fact that there are few transgender athletes within their jurisdiction. Not surprisingly, the GHSA’s justification was that there are substantial “imbalances” between biological male and female athletes. These obvious “imbalances” have been noted by others who argue that the controversy over trans-athletes should really be about fair play, not gender identity. I agree.
One reason that the controversy remains ongoing (and seemingly insoluble) is that the issues of gender identity and fair play have not been convincingly untangled. Separating the more emotionally charged issue of gender identity from the commonsensical issue of fairness in women’s athletes would allow for a more reasoned discussion of both topics.
Intellectually separating these two issues requires an understanding of some basic biology and some history. The biology part has to do with the effects of certain hormones, called anabolic steroids, on the human body. The history part has to do with the introduction of anabolic steroids into competitive athletics, especially women’s athletics.
Anabolic steroids are naturally occurring (androgenic) hormones such as the “male” sex hormone testosterone and its more potent metabolic derivative, dihydrotestosterone (DHT). These hormones are produced naturally by both sexes but at much higher quantities in males. Hence, the obvious physical differences (i.e., “imbalances”) between the sexes. However, the effects of anabolic steroids actually begin months before birth.
Prior to the seventh week of embryonic development, the human fetus has what are called “bi-potential” tissues. That means there are both internal and external embryonic structures that can develop into the typical female (if it has only X chromosomes), or the typical male body type (if it has a Y chromosome). Without a Y chromosome and its protein-coding SRY gene, the embryo will develop as a female. However, under the influence of a hormone cascade elicited by the SRY gene, the embryo undergoes “defeminization” and “masculinization.” In embryology, these terms refer (among other things) to the regression of anatomical structures that would have developed into the ovaries, fallopian tubes, and uterus, and the development of structures that will become the internal (and external) male reproductive organs including the testes. In turn, testosterone produced by the testes and its derivative, DHT, play an essential role in the development of both primary and, later, secondary male sexual characteristics.
There are two points to keep in mind here. First, masculinization begins prior to birth. The second is that the anabolic steroids, testosterone and DHT, have similar masculinizing effects on the body whether they occur naturally (if you have a Y chromosome), or are administered (by pill or injection), irrespective of what chromosomes you have.
Anabolic steroids were synthesized in the 1930s, and are now used therapeutically to treat a variety of medical conditions including chronic wasting diseases such as cancer and AIDS. However, because anabolic steroids increase muscle mass, shorten recovery time from exercise, and augment exercise-induced gains in strength, they can be used to enhance athletic performance irrespective of one’s sex (or self-identified “gender”).
For instance, recall the doping scandal surrounding the 1976 Montréal Summer Olympics. Tragically, East German women athletes (most notably, swimmers) had been the unwitting victims of a systematic government-sponsored regime of anabolic steroid administration by their coaches and trainers. Some girls as young as 11 years old were started on the drug regimen without parental consent. It goes without saying that this was a despicable program and has been universally condemned.
Testosterone administration had a number of effects on the East German women, the same effects that it has on young men. First, of course, it dramatically enhanced their athletic ability. The East Germans were stronger, faster, and bigger than the other women athletes, and they dominated their competitors. This was devastating for the other women, and universally viewed as both deeply unethical and grossly unfair.
In addition, testosterone had other, irreversible effects on the East Germans. It deepened their voices, increased their facial and body hair, masculinized their physiques, and (because they were women) caused a number of other very serious physiological problems.
There are two pertinent points here. First, all of the Olympic athletes who had been victimized by the surreptitious administration of anabolic steroids were biological women (i.e. female). The more serious ethical issues aside, it is clear that we can both recognize an athlete as a “woman” and recognize the fact that her body is sufficiently different from other women’s bodies, due to the supplementation of exogenous hormones, that competition between them is unfair. This has nothing to do with anyone’s gender identity, and it has nothing to do with denying or affirming anyone’s womanhood (however one defines it). The issue has to do with the effects of anabolic steroids on human bodies that confer advantages an athlete would not enjoy otherwise. The second point is that testosterone, per se, does not determine gender identity. In later interviews, the East German swimmers still identified as female athletes.
Interestingly and conversely, men who undergo testosterone suppression as a therapy for prostate cancer do not come to identify as women despite the fact that their testosterone is suppressed to one fifth the level allowed for trans-women athletes. Again, testosterone does not determine gender identity.
So, it seems well established that anabolic steroids confer an unfair competitive advantage under several circumstances. The first is when a male athlete who has been shaped by naturally occurring anabolics competes against someone who has never had that advantage, such as MMA transgender fighter Alana McLaughlin fighting biological women. Interestingly, an analogous situation could occur between two genetically male athletes if one has the rare condition called, complete androgen insensitivity syndrome. In this syndrome, a person is genetically male (has a Y chromosome) and possesses male primary sex organs (testes), but is insensitive to the masculinizing effects of testosterone due to impaired steroid receptors on their cells. Consequently, the affected athlete would not have developed the typical male physical characteristics of their opponent despite them both having a Y chromosome. Competition between two such athletes would also be unfair. The third unfair circumstance is when an athlete of either sex artificially increases their testosterone level above that of their peer competitors, for instance, Lance Armstrong (male), or Marion Jones (female).
Under all of these circumstances, the gender of the athletes and the route of steroid administration make absolutely no difference. If the athlete has been enhanced by anabolic steroids, he or she has an unfair advantage over athletes whose bodies have not been so enhanced.
Further, as evidenced by the 1976 Olympic East German women swimmers, men who have undergone therapeutic testosterone suppression, athletes who cycle anabolic steroid use to avoid detection, and the enhanced performance of trans women athletes, the effects of anabolic steroids do not completely disappear even when hormone levels are reduced.
As a biologist and former competitive weightlifter, three things seem clear to me. First, testosterone matters. It irrevocably changes body structure and physiology whether it occurs naturally or is administered, and, in the former case, those changes begin before birth. Second, athletes who have significant structural and physiological differences from women due to natural male puberty or the administering of exogenous testosterone should compete in different divisions, not against each other. It is a matter of fair play. Both a 220-pound and a 105-pound woman weightlifter are women, but they compete in different weight classes. That’s just fair. Likewise, a woman who is competing in the women’s division of a drug-tested weightlifting competition is explicitly choosing to compete against other athletes who have not been artificially enhanced by testosterone. If she chooses to compete in a competition that does not drug test, she knows that she may be competing against athletes who are enhanced by anabolic steroids. The important point is that—unlike the women in the 1976 Olympics—she is free to make the choice about whom she competes against.
Athletic divisions based on physical structure or physiology have nothing to do with gender identification, per se. These are two completely separate issues. Athletics can—and should—respect and include all varieties of people while still expecting them to compete fairly and within an appropriate division. For instance, any sport could designate a “Female Division” (biological females), and an “Open Women’s Division” (anyone identifying as a woman). Under these circumstances, everyone would still compete together, but winners would be designated within divisions. This is analogous to the “Novice,” “Open,” and “Masters” divisions used in weightlifting. Everyone is included but competition is fair.
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FR Prete is a Biological Psychologist who writes about a variety of topics including neuroscience, education, and the use (and misuse) of biology to inform public policy. He can be reached at EverythingIsBiology@gmail.com and EverythingIsBiology.substack.com.
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