The sins against Caster

There can be no reasonable justification for the ridiculous amount of time the IAAF has taken to dither and meditate over the results of Caster Semenya's tests, or to decide on her future as an athlete.

 Following fairly standard examinations and tests, the results should not be hard to interpret and announce. The issues are not extraordinarily complex, yet they have taken enough time to define and describe several entirely new species, not merely to clarify the gender of one young athlete. The behaviour of the sporting authorities continues to be at least as ambiguous as Caster's gender.

Oddly, when there was original testing, this produced a ridiculously hysterical and shrill storm of protest from many people in South Africa who really should have known better. And yet at that stage the IAAF was behaving responsibly and properly in response to the complaints they had received. Yet now while there has been unquestionably a continuing severe abuse of Caster's rights and interests and inexcusable waffling, there has been no protest at all.

Let me be absolutely clear. When any doubt arises about someone's gender, the process is not especially mysterious. She'd need to be interviewed, a competent physical examination done, and specimens taken for a number of fairly basic lab tests.

Generally the likely results would be clear within a day or two. Perhaps, if some tests took longer, allow a couple of weeks for full clarity. If there was any remaining doubt, it could only be resolved, not by further navel-gazing, but she'd need to be seen again, for further discussion, examination and tests to resolve any remaining doubts. And, as this has apparently not been done, it seems highly likely that the actual medical situation has been obvious for months.

 Amateurs inventing 'medical ethics'
The SA Sports Ministry last year announced that test results "will be treated as a confidential matter between patient and doctor", describing this as the "professional ethical and moral way of doing things", which we must all respect.

But the way the entire matter has been handled, has never yet been professional, ethical, or moral. Here amateurs are contriving what they claim to be laws of medical ethics. Caster, so far as we know did not seek medical advice privately from a doctor, and seems to have had, and complained of, no health problems. So this was not a matter covered by the normal rules of doctor-patient confidentiality.

The tests arose in an entirely different and unusual context. She chose to compete internationally as a female athlete, and her gender was questioned. She was tested according to recognised rules and procedures to settle the question one way or another. This is analogous to the situation where an accused in a court case is referred by the court for medical assessment - and then the full results of such assessments are almost always revealed and discussed in open court and become part of the public record.

Properly so, otherwise it'd be too easy for sneaky deals to be done behind the scenes. In athletics as in law, justice needs to be seen to be done. At least in athletics the person most affected has the right to withdraw from competition and avoid such assessments and the discussion of their results.

When no news is real news
Some obvious conclusions fail to be drawn. When Australian media leaked a story that she had been found to be hermaphrodite, and bearing two functioning testicles - understandably there was indignation and protest that her privacy was compromised by the unofficial release of such information. But nobody denied the accuracy of the reports. And the authorities have now trapped and locked themselves into a situation where their silence continues to damage her.

The situation just cannot be so complex that clear conclusions could not have been reached long ago. Even if she were discovered to have an entirely new gender anomaly, never before known to science, analysing the condition, its nature and implications would never take as long as this.

Normal results would not be kept secret
It is utterly obvious that if the examinations and tests revealed Caster to be, provably, an entirely normal woman, such results would not be kept secret. Everyone, presumably including Caster herself, would be keen to proclaim the facts and end the controversy - she could immediately resume competing, and everyone would be happy.

That this has not happened means that it is impossible to believe that the results didn't reveal at least some variety of anomaly which would render her unsuitable for ordinary competition. It is hard to see how Caster is benefited by continuing delay.

Her career in competitive running may be over, but she could be an excellent coach. The longer she is forced to spend in limbo, the more doubts and rumours circulate and this potentially limits her options.

Privacy is like virginity
Privacy is often like virginity - once it has been lost, it cannot be regained. Had Caster remained a kid growing up in a rural area, known locally as a good runner, she may have maintained privacy forever. If the situation is as the leaks claimed, that she has apparently normal external genitalia, it is likely that nobody would have suspected anything odd - why would they?

Extreme virilisation as is possible in such cases, might have drawn attention - a deep voice, dramatic muscles, even a beard, will get noticed, in any community. But some otherwise normal females may show similar degrees of virilisation and still enjoy a normal social and married life. If, as the leaks claimed, however, her internal anatomy is aberrant, including the presence of functional testicles, she would presumably not be fertile. Only if this was considered a problem and if this led to serious investigations of infertility at a major hospital, might the anomalies have been discovered, and they could then be expected to have been kept fully confidential.

Once she embarked on a career in competitive athletics, problems became inevitable. There have been cases over the years of male athletes surreptitiously competing as women (see side-bar) and it is entirely predictable that someone with Caster's characteristics would be challenged, as she was, by other competitors.

It is probably inevitable, given the different sporting abilities and strengths of normal men and women, that it will remain central to sporting competition to segregate the sexes/genders. If they competed in the same races, the winners would be men, and outstanding women athletes would be unfairly unable to succeed. This applies in all sports, and even in tennis the most integrated event is the mixed doubles - with the couples mixed in a highly specific fashion! 

Nature's doping, and the problem of Frankenathletes
Understandably there has been growing concern about recognising and preventing the doping of athletes with the assistance of unscrupulous doctors and trainers, because otherwise those who competed purely with the advantages of their normal physiology, would be routinely beaten by those chemically created by the pharmacist, and the real competition would become one between different labs, with the Frankenathletes competing as their proxies.

But sometimes Nature inadvertently creates a situation equivalent to doping. Where a woman has two effective testicles, she will be dosed with high amounts of testosterone, with benefits unfair to other women with whom she might compete, especially if this advantage had extended over a period of years. Presumably some people with hormonally active tumours may also receive effects similar to steroid doping, though in that case, other effects of the tumour might render them less able to compete athletically.

Natural athletes aren't like the rest of us
There's a slope, not usually slippery, between the fact that naturally talented athletes have normal advantages over the rest of us, as recent research has confirmed. They are anatomically, physiologically and psychologically better able to compete and succeed than the rest of us. Nobody seems to find that objectionable.

The possibilities of toxins
Caster's condition may indeed have been naturally occurring ( such situations can arise naturally, though uncommonly ). But there is also a very real possibility that it may be the result of her exposure, during pregnancy, or the earlier exposure of her mother, or both, to various toxins. Biologically relevant and harmful substances can arise from agricultural chemicals, or mining and factory residues leaking into streams and rivers, and could be highly relevant here.

I have heard various rumours that such conditions may be less than rare in the area from which she came. Where there are cultural traditions, such as pregnant women eating some clay from the side of a river - which in some circumstances might, long ago, have provided some value - if the streams and rivers contain toxic chemicals, some of these could be concentrated in the clay that gets consumed.

Looking for solutions
Sports authorities should be working on a thoroughly thought-through set of policies for gender/sexual qualification for competitive athletes, and to deal with such challenges to these policies as may turn up. Some have insisted that to compete as a woman, you need to have been born a woman, and presumably to be within the normal hormonal and anatomical range of a woman.

Nobody alleges that Caster did anything wrong. She did not cheat. Much could have been avoided had the SA authorities conducted proper full testing and dealt with those results, before encouraging her to compete internationally, which may have benefited others much more than it benefited her.

Apparently the IAAF requires transsexual women to have their hormone levels kept at levels more typical of females, by removal of the testes and the taking of female-typical hormones. That seems fair. But peculiarly it allows women born female, but who have adrenal tumours producing higher levels of testosterone than the average man, to compete as women.

If she has an intersex condition, should she be entirely excluded from competitive sport (which seems to be, effectively, what is happening)? Is she, on balance, female enough to still compete as a female - or male enough to compete as a man?  

The realities can't just be ignored. If the presence of a pair of testicles is compatible with being allowed to run as a woman, then both I and some rather noisy young politicians are equally qualified to join those races.

(Professor M.A Simpson, aka CyberShrink, July 2010)