Returning to the
CAS ruling.
Before presenting the expert witness on the IAAF's side, I think we need to summarize IAAF's claims on this case, because various things targeted by Semenya's team have seemed baffling to me.
From Sections 284-312
Issue #I - About the rationale of the IAAF regulation:
1. The IAAF's stance on gender is already extremely progressive, yet fair. (284). The fairness is a balance between:
i) Female athletes' right to excel as their male counterparts.
ii) The wish of certain biologically males with female identity (Rhys) to participate in female events
2. Males have substantial athletic advantages over women; the best men in track events beats the best female by 10-12%. In addition, thousands of male athletes performed better than the very best female athlete.
3. IAAF is tasked with formulating a basis of dividing athletes into male and female categories, which they did based on scientific evidence.
4. Legal sex and gender identity have no bearing on athletic performance (297). Legal sex is in conflict with fairness under two conditions:
i) XY, male gonad, male T-level. i.e. the likes of Rhys McKinnon
ii) 5-ARD patients, who like the above category are XY, have testes, and have male T-level. They however might have external genitalia that are not fully masculinized at birth and hence might have been diagnosed male or female.
5. There are cases where "biology has to trump identity". (289)
6. There are two reasons why the IAAF is interested in 46XY DSD:
i) The prevalence of 46XY DSD in the general population is 1:20000 (0.005%); that among "female" athletes is 7:1000, a 140x over-representation, which suggest they have a definite edge over genuine females.
ii) (This is where IAAF paints a target behind their backs) Athletes with 5-ARD are "biologically the same in any material respects as male athletes without DSDs: same chromosomes, same gonads, same T-levels, same virilization effects, same bone and muscle strengths, same hemoglobin levels. The fact that no 5-ARD males have prevailed over females with a 10-12% margin simply say that, individually, they happen not to be the best the male sex has to offer.
7. The IAAF boils down the male-female differences in athleticism to Testosterone, with the support of 42 scientists.
8. The IAAF regulation only applies in a handful of conditions: 5-ARD,
17-β HD3 Deficiency, Partial androgen insensitivity syndrome (PAIS), and disorders in gonadal steroid genesis (301, bullet point 3). It does not apply to women with PCOS.
Issue #2 - Is Semenya "being forced" to suffer the side effects of androgen blockade?
9. Gonadectomy and androgen blockade are recognized treatments of 46XY DSD.
10. The IAAF have consulted many doctors who have experiences treating 46XY DSD. They are not aware of any significant side effects of reducing T to normal female levels.
11. Semenya and such kind can continue to participate as female, without androgen blockade, in local events. It is the International events held by IAAF that they are banned.
Issue #3 - Legality and human rights:
12. The IAAF is not a states body, but a private party, so they have no obligation to observe bullshit such as the Universal Declaration of Human Rights, or the European Convention on Human Rights.
13. The IAAF claims (
another big red target) that setting the female category in sport is tantamount to "positive discrimination" practiced in UK, US and Australia (Section 293, bullet point 4).
14. There is no law that forbid the IAAF to exclude 46XY DSDs from the female category.
15. To preempt smarty-pants like Rhys, who question "why don't you group according to lung capacity, etc?", the IAAF posits:
i) Variations among attributes like height and lung capacities, I quote, "[do] not make it unfair for athletes to compete against each other, nor do they undermine the essential characteristics that are valued by the sports of athletics" (This is very poorly worded and poorly defined, and is not going to please Rhys. It sure doesn't please me.)
ii) Yet because the testes produce 15x more testosterone than the ovaries, competition between men and women are not going to be fair or meaningful.
+ + +
Without further ado, let's welcome IAAF's team of expert witnesses.
Section 313-350
Dr. Stéphane Beaumont, Director of Health and Science of IAAF and half of BG17. He avers there is "no debate among experienced sports scientists" that the difference between men and women are because, starting from puberty, men are taller (better leverage) and have higher muscle-to-mass ratio. These in turn are the effect of testosterone. On the subject of 5-ARD and similar forms of 46XY DSD, Beaumont points out that the gonads of these individuals pumps out just as much T as normal males since puberty, ant the virilizating effects are the same. He claims the only difference between a 5-ARD athlete and a normal male athlete is their external genitalia, which has no bearing on sports performance.
He puts to rest a common contention of IAAF's critics: why don't the IAAF ban women with PCOS in women events too? The answer should be very familiar to us at this point: PCOS almost never gives a woman 5 nmol/l of T. Indeed, 99% of PCOS women have a T level of less than 3.47 nmol/l, and Beaumount thinks this level is insufficient to give them ergogenic advantage.
As for why the regulation are restricted to 400m and 800m women events, Beaumont points out that these events are where 46XYs won the most, hence the restriction is sensible, and is presumably not a targeted attack against Semenya (331)
Beaumont apparently also lists 5 instances in which 46XYs are over-represented among top performers across various athletic events. Unfortunately that part was redacted.
On androgen suppression, Beaumont points out that androgen suppression is a standard treatment of 46XY DSD, and no significant side effects have been reported. Also the IAAF does not force anyone to undergo androgen suppression: Semenya and his ilk can continue to compete as women without T-limits, just not in IAAF-organized events.
As expected there are technical discussion of BG17 and Beaumount address the question raised by his critics (338-345). He also deals with the libelous sort, who have accused him of misogyny and racism (336-7). During the cross-exam, Beaumount admits that he has commited several factual errors (349), which in my opinion are not damning.
Sections 351-367
Dr. David Handlesman, Professor of Reproductive Medicine Andrology at U of Sydney. He reiterates the fact that adult males have an average level of T 15 times as much as adult females, and this accounts for many differences in anatomy and physiology relevant to sports. Thanks to their high T level, males enjoy at least a 8-12%, perhaps as much as 20%, ergogenic advantage over women. Furthermore, it has been established that T has a dose-dependent effect on muscle mass and strength, both in observational studies and in studies where T has been administered.
Against Prof. Richard Holt, he believes Testosterone is the determining factor, not the Y-chromosome or the differential response to Growth Hormone. His reason is the chronological concordance between puberty and the onset of the "gender gap" in athletic performance. Indeed Holt's Growth Hormone hypothesis has been shown to be false (young women have been shown to have twice as much GH as young men), and the Y-chromosome doesn't do jack squat unless it causes the development of testes.
Finally, Handlesman express his opinion that the IAAF's stipulation of having athletes in female events to maintain a low T-level for 6 months might not be enough; he would prefer 12 months.
Sections 368-375
Dr. Angela Lindén Hirschberg, Prof. of Ob-Gyn at Karolinska Instituet, Stockholm. She comments on the
Eklund 2017 paper, which is a case-control study comparing the body composition, physical performance, and androgen profiles between female Olympians and age-and-BMI matched sedentary controls. The finding is that female athletes uniformly have a very low T.
Hirschberg has conducted her own double-blind randomized trial where Testosterone cream was administered on healthy women. The cream raised their T level to the average of 4.3 nmol/l (± 2.8 ), ie. just around the IAAF regulation level of 5. There was significant increase in both aerobic and anaerobic performance, increase in lean body mass, and reduction of body fat. She believes that a woman's body will just respond to T pretty much as a male body would, and it does not matter whether the T is endogenous or exogenous (c.f. Rhys, who thinks that the T produced in Semenya's own testes is somehow different from what dopers take)
Hirschberg also agrees with the medical consensus that severe hyperandrogenism in women calls for treatment, and that the common types of management, such as OC pills, have a very low side effect, are actually protective against certain cancers, and are widely used among normal women anyway. She is not aware that androgen suppression can cause renal or cardiovascular diseases.
Sections 376-382
Professor Aaron Baggish, founder and director of Cardiovascular Performance at the Massachusetts General Hospital, Boston.
Professor Benjamin Levine, founder and director of Institute of Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, Texas.
The two professors explain the physiological bases of elite athletic performance, and how these physiological bases are affected by sex. What are the most relevant to the subject at hand:
- There is no question Testosterone improves sports performance.
- Observations of women who dope show that Testosterone "underlie a substantial proportion of the sex-based gap between male and female elites".
- One does not expect exogenous and endogenous Testosterone to act differently.
- There is no consensus whether Growth Hormone improves athletic performance; the professors expect it does, but its effect is almost certainly dwarfed by that of Testosterone.
- Given that XY females with complete androgen insensitivity are often taller than XX females, The Y-chromosome might carry non-androgenic genes that might affect athleticism, although no example of such genes has so far been identified.
Sections 383-388
Professor Richard Auchus, Endocrinologist at U of Michigen and specialist in steroid biogenesis and its disorders. He gives a lowdown on 5-ARD. The gist is that the physiological effect of Testosterone is the same in a 5-ARD patient as in a normal male (386, bullet point 6). Contrary to Richard Holt, Auchus points out that DHT is produced in abundance in post-pubertal patients with 5-ARD.
A patient with 5-ARD who wishes to live as female is customarily prescribed androgen suppressors, with the goal of lowering the T-level to the normal female range (<2 nmol/l)
Auchus also gives briefer treatises on other types of 46XY DSDs. In summary, he finds the IAAF regulation based on sound endocrine principles, although he cautions that patients with Partial Androgen Insensitivity Syndrome, which is basically a diagnosis by exclusion (388, Bullet Point 4), should be handled on a case-by-case basis.
Sections 400-409
Joanna Harper, transwoman, a former national level track athlete, and a Medical Physicist. Harper has competed as female since 2005.
Harper has compiled data from 8 other troon runners and concluded that androgen suppression has caused them to run slower, and none, post-suppression, has any edge over genuine female contestant. Thus the conclusion is that T-suppression is both necessary and sufficient to make men eligible for women's events. Harper's own study, with two troon subjects, showed that a marked reduction in aerobic capacity can be achieved within 9 moths of T-suppression. Harper also questions the experience Semenya allegedly felt during androgen suppression, as he himself only felt mild discomfort.
Harper's data is torn to shreds during cross-examination.
Section 410-414
Jan Kowlawski, Biostatistician and member of the IAAF Health and Science Commission. Defends BG17.
+ + +
The term that came to me reading this part of the ruling is "conflict of interest". Beaumont and Kowlawski are employed by IAFF; Handlesman admits that how much money he would receive will depends on whether IAAF wins or loses (367); Hirschberg is chummy with Handlesman and is a frequent collaborator. The science may be legit but this situation is, not to mince words, messy.
I won't be free during the next 3 days but I hope to finish reading the doc when I come back. The rest of the document seems full of legalese but I'll see what I can find.
