Points of interest:
5. Reconstructive surgery and sex reassignment
- if sex change operations as well as appropriate hormone replacement
therapy are performed before puberty then the athlete is allowed to
compete as a female
- if the sex change and hormone therapy is done after puberty then the
athlete has to wait two years after gonadectomy before a physical and
endocrinological evaluation is conducted
(The crux of the matter is that the athlete should not be enjoying the
benefits of natural testosterone predominance normally seen in a male)
6. Conditions that should be allowed:
(a) Those conditions that accord no advantage over other females:
- Androgen insensitivity syndrome (Complete or almost complete -
previously called testicular feminization);
- Gonadal dysgenesis (gonads should be removed surgically to avoid
- Turner’s syndrome.
(b) Those conditions that may accord some advantages but nevertheless
- Congenital adrenal hyperplasia;
- Androgen producing tumors;
- Anovulatory androgen excess (polycystic ovary syndrome).
What is not covered in detail are the genetic Intersex conditions other than Turner's syndrome (45x). What if someone is a mosaic or chimera, 46xy/46xx? Hopefully, common sense will prevail, and the principle of The crux of the matter is that the athlete should not be enjoying the benefits of natural testosterone predominance normally seen in a male will be followed, regardless of exact cause. Conditions such as PCOS - polycystic ovarian syndrome - can easily cause a doubling or tripling of "normal" female testosterone levels, but not the 8-10 times seen in most men.
Male athletes often have natural values even higher, just as they tend to be larger than most other men. There are no skeletally ectomorphic (skinny) weight-lifters, regardless of how muscular they are, and no skeletally endomorphic (squat) sprinters, regardless of musculature, and athletes other than shooters etc tend to have more testosterone and human growth hormone than the average non-athlete. That's because when you get to the highest levels of competitive sport, you need a natural genetic advantage in addition to rigorous training.
I said "hopefully", because the treatment of some intersexed athletes who have "failed a gender test" has not always been in accordance with these principles. Moreover, they are guidelines, with no "bright line" saying "X amount of testosterone is OK, but X plus a smidgin is not". One has to take into account the natural variations over time too, a relatively smaller absolute amount, if constant, over a long period could be greatly more advantageous than a series of much higher peaks matched by troughs.
It's not simple.