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Finding the level

Finding the level

10 Aug 2017 by hhwdjwbphm.d hhwdjwbphm.d

Is there ever a time when knowledge, instead of helping us, does the opposite? Carlisle Baker-Jackson ponders this as sparks of suspicion fly around the contentious issue of female testosterone levels in sport

The role of hormones in sport has a long, varied and at times, confusing history. On average, males have higher levels of testosterone than female athletes, resulting in attributes such as increased aerobic capacity, muscle size and power.

To achieve this, as well as a reduction in body fat, some athletes illegally use synthetic versions of testosterone to gain an unfair advantage. But the role of natural testosterone in sport has been a lot harder to quantify. Scientists are still divided over whether synthetic testosterone has the same effect as if it was produced naturally in the body – an issue highlighted by hyperandrogenism, where large amounts of testosterone are naturally produced by women.

Hyperandrogenism goes global

The treatment of female runner Caster Semenya at the hands of the International Association of Athletics Federation (IAAF) in 2009 caused outrage across the globe. After winning the World Championship 800m final by a margin of more than two seconds, she was required to undergo sex verification tests by the IAAF. This news subsequently leaked to the press before additional information came out revealing that she was hyperandrogenic. Immediately, Semenya became the subject of intense scrutiny from journalists, sports officials and competitors alike, with many claiming this gave her an advantage over fellow competitors. Unwillingly, she became the face of hyperandrogenism for elite athletic sport. In 2011 the IAAF introduced Hyperandrogenism Regulations, requiring hyperandrogenic athletes to suppress their testosterone levels below 10nmol/l using drugs or surgery. This value was chosen as it is five standard deviations from the average hormonal readings of women with polycystic ovary syndrome, as they naturally possess higher androgen levels. While complying with this regulation, Semenya’s performances did slow – however, it is impossible to say that this is solely due to lower androgen levels.

There is no definitive consensus that high levels of testosterone in female athletes provide the uneven playing field the IAAF suggest

In 2014, Indian sprinter Dutee Chand was prevented from competing at that year’s Commonwealth Games based on analysis of her testosterone levels. On Chand’s behalf, the Indian government appealed to the Court of Arbitration for Sport (CAS), an independent institution responsible for settling sports-related disputes. A year later, CAS suspended the Hyperandrogenism Regulation for female track and field sports for two years – in part due to a lack of scientific evidence that hyperandrogenic athletes had an advantage over other competitors. Two years later and this is still an area of uncertainty – there is no definitive consensus that high levels of testosterone in female athletes provide the uneven playing field the IAAF suggest. Or is there?

Level playing field

In July, research was published in the British Journal of Sports Medicine³ that suggests higher levels of testosterone affects physical performances by female track and field athletes. Drs Stéphane Bermon and Pierre-Yves Garnier analysed more than 2100 observations of athletes and their androgen levels at IAAF World Championships in 2011 and 2013.

The study suggests female athletes with higher fT levels performed better in a number of events such as 400m, 400m hurdles, the hammer throw and pole vault

The researchers first arranged athletes into three tiers based on how much free testosterone (fT) was present in their blood, before collating an average of performance times. The study suggests female athletes with higher fT levels performed better in a number of events such as 400m, 400m hurdles, the hammer throw and pole vault. For example, the average time of 67 athletes running the 400m was 52.23s. This was reduced to 51.16s for athletes in the highest fT tier. But does having higher levels of testosterone confer as much of an advantage as some athletes, pundits and the IAAF think?

Dr Bermon, from the Institut Monégasque de Médecine et Chirurgie du Sport and first author of the study, says: “The magnitude of this advantage in females with androgen levels within the normal male range is likely to be large and certainly higher than what is usually observed with other anthropometric or biologic features.”

This advantage – and if it is significant – is something the IAAF will contest with CAS. In the IAAF v Chand tribunal, CAS said males enjoyed a performance advantage of between 10 and 12% on average over their fellow female counterparts. This study has shown an advantage of up to 5% amongst female athletes – and only in specific events. Whether this evidence will be enough for the adjudicator remains to be seen, especially as it is comparatively a small sample size.

[caption id="attachment_62707" align="alignnone" width="620"] Can you attribute Semenya's dominance in some track events to just testosterone levels? Credit: DC Press/Shutterstock.com[/caption]

Both Chand and Semenya are known to possess higher than average levels of testosterone, but does this automatically translate into an unfair advantage? Not every female athlete with higher than average levels of testosterone will be able to physically make use of it – and even if athletes were able to – it does not automatically confer sporting advantage. If we compare the sporting achievements of Chand and Semenya, there is quite a visible disparity. Chand, although breaking numerous national records, has placed third at the Asian Championships in 2013 and 2017 (although in different events). Semenya has won gold medals at a wide range of events from 2008 that include the World Championships, Olympics and African Championships. Testosterone levels in isolation cannot be taken as proof of a definitive advantage, it seems.

Paper tiger

Another point to highlight is that although there is a lot of fuss being made about the unfair advantages of testosterone – elite professional sport is not a level playing field. Let’s look at the Olympics. Of the 206 countries that compete, more than 70 have never won a medal. Vast differences in spending, infrastructure and training mean it can never be equal. Athletes picked to represent their country possess a smorgasbord of genetic and physical advantages over the average human, which is why they’re there – competing against the world’s best. For example, Finland’s Eero Mäntyranta is considered one of the all-time Nordic skiing greats. It was discovered later in his life that he possessed a genetic variant which caused his body to produce 65% more red blood cells than the average person.

Natural advantages can include a higher percentage of fast twitch muscles, a body specifically suited for swimming or weightlifting or genes such as ACE II and ACTN3 that are strongly associated with endurance events or power events. Is this any different from having extra levels of testosterone? According to Peter Sonksen, visiting Professor at the University of Southampton, natural hormone levels in athletics should be disregarded, just like height or weight is. “I believe that hyperandrogenism is a paper tiger and is something that should be ignored – it’s just part of life’s rich mixture,” he says.

Dr Sonksen says the newly published paper is targeted at CAS to try and convince them that they should re-instate the hyperandrogenism rule. “Scientifically it does not convince me at all,” he adds. “They show no relation between testosterone and performance and have to dredge a load of uninteresting hormones/metabolites for something that correlates. And it fails to convince me about anything other than they were desperately seeking something that was not there.”

Dr Bermon, who is also a medical and scientific consultant for the IAAF, takes a different view: “These results rather support the reinstatement of the IOC and IAAF rules on eligibility of females with functional hyperandrogenism. But of course, it is CAS which should decide.” This must be tempered with what the scientists say in their paper. Based on the study design, the links made cannot prove evidence for causality between androgen levels and athletic performance, it can only indicate an association between the two. This research has provided further evidence of the effect of testosterone in female sport, but is far from conclusive.

Many advantages for sports are accepted – why shouldn’t hyperandrogenism be?

Dr Bermon’s paper will form part of the evidence the IAAF will present to CAS. Many advantages for sports are accepted – why shouldn’t hyperandrogenism be? Judging by the intense scrutiny hyperandrogenic athletes are placed under, maybe it is better we don’t know. At the end of July, CAS granted the IAAF another two months to submit scientific evidence in favour of their argument. The clock is ticking – if no evidence is filed by the end of September, the Hyperandrogenism Regulations will be declared void. Perhaps this is the best solution for all involved.