Monday, 14 September 2009

Segregation, Sex, Science and Sport

One of the most educated discussions on the segregation of the Sexes is over at Science and Sport.

While I don't agree with some of the premises, nor the conclusions, at least the discussion is rational and educated, based on science (mostly) and facts (most of which are accurate), rather than opinion, superstition, and misconception.

How at least some Intersexed people see the situation is elucidated in An Intersex Perspective on Caster Semanya. A sample (and you should really read the whole thing):
The main thing that saddens me about this story is the emotional tone of the commentaries. Other athletes, people on the street, and low media blogs are full of sneers and winks and nosewrinkled disgust. The major media bring in scientists and voice patronizing sympathy for how humiliating this must be for Caster, meanwhile capitalizing on the prurient interest in the story to gather viewer attention. Underneath it all is a widespread impulse to yank down Caster's pants and let everyone have a good look. It's a freakshow, with an intersex person the object of millions of prying eyes.

Some basic themes that will be familiar to anyone intersex arise over and over in the news coverage. There's ignorance of the very existence of intersex people, evinced in frequent speculation by laypeople that Caster must have had a sex change or engaged in doping. There's confusion of physical sex with gender identity, with detractors, including some of Caster's competitors, referring to her with male pronouns and speaking disparagingly of her butch appearance. There's racist scientific hubris, with Western sports scientists asserting that they can determine Caster's "true" dyadic sex after doing an exhaustive investigation of her chromosomes, hormone levels, anatomy, gonadal tissue, and psychology, while speaking derisively of the ASA's investigation as being unsophisticated. And most of all, there's the overwhelming belief in the myth of dyadic sex. Caster must be female or male; intersex cannot exist as a sex category.

One depressing sideline of this insistence that Caster must have a definitive dyadic sex is the regularity with which the term "pseudohermaphrodite" is raised by detractors. I've posted on how this term emerged in Western medical science to try to define away the existence of intersexuality ( see here.) Basically, in trying to erase the challenge intersex people place to the medical ideology of sex dyadism, doctors in the 20th century decided to call all intersex individuals who did not have ovotestes as their gonads "pseudohermaphrodites," no matter what their anatomy or experience. Somebody can be raised female, with average-looking genitalia and secondary sexual characteristics such as breasts, living a typical valorized heterosexual life, femme as can be (housewife, reader of romance novels, cookie-baker), yet all unaware, have internal testes and androgen insensitivity syndrome. If she goes to a doctor for treatment of infertility, suddenly she'll find herself labeled a "male pseudohermaphrodite." The medical term defines her as "really a man," not even intersex, let alone a woman. Anyone with testes is "really a man" according to this scheme of classification--which reveals the sex politics and semantics in supposedly "objective" science.

Those same politics emerge from the mouths of Caster's detractors. She is a "pseudohermaphrodite," they claim--not a woman, not even intersex, but a man trying to cheat honest female competitors.

Here's an irony for you. According to Western medical practice, the majority of infants discovered to be intersex are assigned female. This is done for surgical convenience (it being considered easier to remove an "inappropriate" penis than create an "appropriate" one), and due to a covert assumption about gender psychology, that women can deal better with gender ambiguity than can men. So we're assigned female, told we are "really women," subjected to mutilating infant surgery, expected to identify as female, not intersex, told to keep our medical history, if we know it, a secret, and sent out to live dyadic female lives. Many of us carefully live by the rules. But it turns out that if we do as we are told, we are still subject to being outed, discredited, mocked, and returned unceremoniously to the status of intersex oddity, as Caster's life illustrates--accused of breaking the rules.
A quick aside: the words "Hermaphrodite" and "Pseudohermaphrodite" are deprecated, just as are the words "Negro" and "Half-caste".

They can still be used as specific technical terms for a small number of IS conditions; "Hermaphrodite" meaning that both ovarian and testicular tissue is present, and "pseudohermaphrodite" meaning a person with cross-gendered fertility - a biological male capable only of female reproduction, or the reverse. And the latter term is not in general use.

Anyway... yes, this is how Intersexed people are treated, in general. The binary gender model is a good approximation, but it's treated as Revealed Truth, and anyone not fitting neatly and squarely into one or the other of the two recognised categories is anathematised. Even if that's very obviously the biological reality, with no question of "lifestyle choice".

Regarding the biology, and the mass ignorance thereof... in the comments section of the previous post, commenter "Sidney" wrote:
Hi Zoe,
After reading the Daily Telegraph of London, I read some of the 299 comments and per usual everybody has an opinion about something they know nothing about. All speculative! As a Urologist, who lectures on this very subject to medical doctors, let me tell you what I think I know from reading the AP from Pretoria, SA. Caster Semenya has a probable genetic Disorder of Sexual Development known as Partial Androgen Insensitivity Syndrome, probably Grade 5 or 6, where the external genitalia are female-like and the internal genitalia are vestigial testes, which produce Testosterone and Estrogen. I say probable because we cannot know if she has any ovarian tissue mixed with the testis tissue until these vestigial organs are examined under the microscope by a pathologist. This will probably never happen, unless it is presented to her as a condition for receiving female hormones. At this moment everyone is assuming she is an XY woman. Now somebody said she had three times the normal female Testosterone level, which according to this one lab gives her less than their normal male values. Now every lab has its own normal values and we have not seen any numbers. So here are the values from just one lab, not her testing lab.

Determination Normal Reference Value
Testosterone: Conventional units SI units
Female 6–86 ng/dl 0.21–3 nmol/L
Male 270–1070 ng/dl 9.3–37 nmol/L

But it doesn't matter what her serum Total or Free Testosterone is because the definition of PAIS implies that the cells which receive T cannot utilize it because their Androgen Receptors will not bind the T effectively. That's why she has female external genitalia at birth. Interestingly the research in this area is so complete that the Chromosomal mutation on the Androgen Receptor can be identified. Usually these women and I say women, because that is how they have been raised and gender identify as female, are diagnosed in their teens because they cannot menstruate or conceive. Now in truth I know no more about her physical condition than what I read in the newspapers. Is the London Daily Telegraph a tabloid or the cousin to the New York Daily News? Poor Girl !!!!
I'd put the UK Daily Telegraph at about the level of the LA Times. Not quite the WSJ, but not the late unlamented National Inquirer either. As is the Australian Daily Telegraph (which is the one with 299 comments).

To explain the grades of PAIS - partial androgen insensitivity syndrome - from the AIS Support Group :
Grades of Partial AIS

In AIS Grades 5 and 4, the clitoris is enlarged. In Grade 5, there may be partial fusion of the labia majora (outer vaginal lips), in which the posterior (back) portion of the labia form a web of tissue across the back part of the vaginal outlet. In Grade 4, this fusion extends further forward, covering both the vaginal opening and the true urethral opening. The cavity formed by the fused labia, through which urine exits, is called a urogenital sinus.

The labial fusion can be surgically divided, making the vaginal opening accessible for pressure dilation (a non-surgical way of lengthening the vagina). This division is a relatively minor operation, and is unlikely to adversely affect erotic sensitivity, but it should be performed by a physician familiar with this type of surgery. Vaginal dilation can be successful in Grade 4 AIS, and should always be attempted before surgical vaginoplasty is planned.

In Grade 3 and the more masculinized form of Grade 4, the labia are completely fused, so that the urethral opening is at the base of the clitoris/penis. The fused labia may have a rugose, or wrinkled appearance and form a bifid, or double, scrotum. The fusion is then more properly called 'labio-scrotal fusion'. The phallus has the appearance of a large clitoris, or a small, bent, penis, bound down in structures called chordee. The chordee is formed from the same tissues that form the labia minora in the female and the frenulum of the penis and the tissues surrounding the urethra (corpus spongiosum) on the underside of the penis in the male. It is not true that the presence of chordee makes erections painful.

In Grade 2, the genital appearance is that of a male with hypospadias, that is, with a urethral opening located somewhere on the underside of the penis. There may be an open gutter running from the urethral opening to the glans of the penis.
To say that Alice Dreger is a controversial character amongst IS and TS circles is like saying that the inside of the Sun is moderately warm. Certainly her spirited defence of Dr Bailey, her mentor, is, well, full of it.

Not so her article on Intersex generally. In fact, it's difficult to believe that it's been written by the same person. Another example of how opinions can differ between reasonable people, and that demonisation of one's opponents just because they obtusely differ from your own Perfect Opinion is almost always a mistake. One she's been guilty of too, I might add.

Anyway, her article is a polished summary of Intersex, one I'm going to keep as a reference for the layperson. One that's worth reading in toto1. And apart from going into the biology, she has something else to say too:
Why do you sound so grumpy about this sometimes?

Because honestly, this is not the first time these issues have come up. Why is Caster Semenya having her life tossed about in the international media like this? There’s no good excuse at this late date in history for sporting officials to still not have a clear policy about how they’re going to manage sex anomalies among athletes competing as women.

I’m also annoyed because the treatment of Semenya in a lot of the media has carried the message that “real” women are not powerful. It frustrates me that Semenya has had to get a pretty hair-do to compete as a woman in the court of public opinion.

Finally, I’m tired of seeing all my friends born with atypical sex have to face so much fear and stigma every time these issues hit the news. I wish that the media would realize, every time they cover these stories, they are impacting the psyches of every one out there who has a sex anomaly or who loves someone born with one. That includes lots of parents of wonderful little girls and boys who deserve to have their parents not worry so much about stupid public reactions to known conditions.

Which is to say: Please stop calling these people hermaphrodites! They’re our friends, neighbors, children, lovers, doctors, lawyers, teachers, military personnel, florists, counselors, bus drivers, and priests.
Not forgetting the odd (and sometimes very odd) Rocket Scientist.

Support for people with AIS:
AISSG - AIS Support Group
OII (Organisation Intersex International) Australia
Intersexnews Blog
Sophia Seidelberg (OII)
AISSG - Australia

1) For all fans of the Wizard of Oz, remember this: Outside of a Dog, a Book is Man's best friend. And inside a Dog, it's too dark to read.

UPDATE: Segregation, Sex, Science, Sport... and Suicide.
Lawmaker Butana Komphela, chair of South Africa's sports committee, was quoted as saying: "She is like a raped person. She is afraid of herself and does not want anyone near her. If she commits suicide, itwill be on all our heads. The best we can do is protect her and look out for her during this trying time."
ENOUGH! Even the strongest material has a breaking point.


Diana said...

I really appreciated your comments on Caster Semanaya, and I've appreciated your comments here.

I'm (at least to the very best of my medical knowledge) *NOT* intersexed, but my gods, this whole thing is such a nightmare.

If the rumours are true, if she has internal testes and that *does* provide her an "unfair athletic advantage" (which, frankly, it probably does), I surely hope they don't strip her of her medal. I can understand them telling her that she can't continue to compete with the women, but I think the FAIREST thing to do would be to let her keep her medals, then promote everyone up one. Whoever took silver should ALSO get a gold, whoever took bronze should get silver, and whoever got fourth should get a bronze. That seems like it would be the most fair to everyone involved. I sincerely doubt Semanya had any inkling, and it's not her fault, and I don't think she should be held accountable for things that were beyond her control in ANY case!

I don't suppose there's an international confederation of intersexed individuals? Such a thing would probably come in QUITE handy to Semanya right now, and if the statistics you gave of 1 in 60 are true, there probably NEEDS to be. With someone saying the right things to her at the right time, it's entirely possible that she could become an advocate and confident and relaxed with her condition, as opposed to the hysteria the media are foisting on her.

Poor girl.

Ross Tucker and Jonathan Dugas said...

Hello Zoe

Thought I'd return the favour and post on your site for a change!

Thanks again for all the clear and compassionate writing you've done on the subject. I read this post, and I'd like to think that as a scientist, I'm not one of those giving "patronizing sympathy" to the athlete. Though I'm pretty certain some of the quotes in that piece you've pasted refer to me (most notably, the criticism of ASA's handling of it - I hope that with the passage of time, it has become clear that this was the case. I must point out that, being in SA, I've known a few things before the media has).

However, for the most part, you've really added to the discussion, especially in your posts at my site.

I wonder though what should be done now? Obviously, there is the human issue, which you quite rightly represent and explain better than anyone else I've read. And hopefully, Semenya will be allowed to make a personal decision on this, away from political threats and burdens that to date have almost compelled her to follow the decisions of others.

However, in terms of the sport, where to now? A lot of people have said to just leave it alone, let her run no matter what. I confess I find this over-simplistic, and I'd like to get your thoughts on what you think should happen next? If there is a performance advantage (debatable, I know), how should authorities handle it?

I guess what I am getting at is that there has been a lot of criticism of the IAAF here, and much of it justified (especially for the leak). But what is the answer? What should be done?

Also, I don't think scientists are denying the presence of intersex cases. In the post, the piece says that science wants to believe only in males and females. Not so, as far as I can tell. But the question remains, what next?

For the sport, I mean. Semenya, of course, comes first and her decisions,both medical and otherwise. But what next for the sport? How should this be handled?

It's clear to me that my opinions, subject to my biases and beliefs, need to be balanced by someone with different 'biases'.


Zoe Brain said...

Hi Ross - glad you stopped by.

I'm even more glad you said *different* biases, not *better* or *more accurate*. I can't claim that my views are either. I try to be objective, but realise that my objectivity *has* to be questionable in cases like this.

In my view, the IAAA policy is actually pretty good, all things considered.

We have a traditional setup of segregation based on sex, using a simple binary model. When we knew *less* than we do now, it worked pretty well, with only one recorded case of successful and deliberate cheating, and that by the Nazis.

We don't know how many past successful athletes were advantaged by congenital anomalies. I say "congenital" rather than "genetic" as so many cases of IS are due to an anomalous environment in the womb, sometimes in conjunction with a genetic propensity, but often something that "just happens".

If we were starting from scratch, and had a far better handle on the human genome than we do now, then dividing coarsely on the basis of a binary sex model may not be the first and most important criterion.

That though is something for the 22nd century, and not very useful now.

OK so we have to live with the traditional sexual apartheid. I use that word deliberately, as some of the tests for sex and gender remind me of some of the tests for race in the ancient regime. As mentioned in a previous post :

"These tests included measurements of the nose, nostrils, and cheekbones, and an expert analysis of hair texture. The latter often included the ‘pencil test.’ It was thought that a white person’s hair is not so curly to hold a pencil, whereas a coloured person’s hair could. There were gradations of skin color to be measured in various places of the body including the fingernails and the eyelids; earlobes were squeezed to determine their degree of softness. (It was thought that Black person’s earlobes were softer than others.) Individuals challenging their racial classification before the board would also be asked what they had for breakfast (it was thought only blacks would eat mealie or cornmeal porridge), how they slept on a bed, and what sport they enjoyed (blacks were thought to favor soccer while coloured favored rugby)."

Anyone from Zuid Afrika is likely to feel more than a trace of squeamish embarrassment by this. But how different is it from measuring Testosterone levels, chromosomes, endocrinal metrics, width of hips, wingspan, clitoral length and vaginal depth, degree and pattern of pubic hair, presence of brow ridging and so on and so on in an attempt to ascertain sex? How different are the practices of the late and unlamented racial classification board from those of the IAAA? (contd)

Zoe Brain said...

There were days when the Olympic oath was:
We swear. We will take part in the Olympic Games in a spirit of chivalry, for the honour of our country and for the glory of sport.

"For the glory of sport..."

Competitive athletics ceased to be amateur a long time ago. It is as much now a matter of professional and industrialised training as, say, horse-racing. The days where an "inferior bloodlone" could have a hope of reaching the finals of the athletic events are long gone.

There's still a place for dedicated amateurs without congenital advantage in contests such as archery, rifle-shooting, even showjumping and bobsleigh. But not in swimming. Not in sprinting.

Olympic quality Athletes have to be congenitally all well beyond 3 standard deviations from the world human norm just to qualify. Some without access to industrial sports camps (such as the AIS - Australian Institute of Sport) have to be 4 or more.

The days when the only monetary recompense was the value of the metal in the gold, silver or bronze medals are also gone. There's a very good financial reason why the Olympic Oath now states:
In the name of all the competitors I promise that we shall take part in these Olympic Games, respecting and abiding by the rules which govern them, committing ourselves to a sport without doping and without drugs, in the true spirit of sportsmanship, for the glory of sport and the honour of our teams.

When the times between first and last are measured in hundredths of a second, and the financial difference between first and second is measured in tens or hundreds of thousands, if not more, then even the smallest advantage, gained by luck or dishonesty, is crucial.

Agromegaly is found in a number of women's basketball players. It is not considered against the rules to have such a congenital condition, and it's pretty darned obvious for the unfortunates afflicted with it.

Amounts of GH (growth hormone) that are beyond the norm but absent agromegaly have been found in Olympic Athletes, yet without doping.

The highest levels of athletic competition are now "for the Glory of Sports" - as in mutants - rather than the Glory of Sport. Thorpe's size 22 feet, for example.

I seriously wonder if there's anyone at the highest level whose abilities are not associated with some advantageous anomaly - rapid contraction/relaxation of long strand muscle cells for example. Or just feet that are as big as some of the smaller skindiving flippers.

So in theory, "sex testing" in sport should be confined to weeding out any "part-time" pretend woman. Someone whose soma is closer to the female norm than the male norm, or even equidistant, and whose gender identity is fulltime female should be considered who she says she is.

It gets more complex when you consider those whose soma is indubitably more male than female, yet who are "fulltime females". Under those circumstances, it would be pragmatic to require that body and mind match more closely.

Then there's *difficult* cases like mine, of dichogamy to a greater or lesser degree. I used to look far more male than female, by 100:1. Then that changed, so it was more like 3:10 the other way. But let's gloss over these cases for now....

Zoe Brain said...

That would be rational and consistent. But a reasonable compromise given the sex apartheid we're stuck with is to make sure that no Intersex condition gives a greater advantage than, say, acromegaly does in basketball, or any other allowable variation in the human physique.

Ms Semanya is nowhere near that level. ~ 1/3 average male T levels (and 1/10 those of male athletes), PLUS AIS.... she may even be disadvantaged. Her skeleton is somewhat masculinised, but her musculature appears little different from her peers, and rather less than say, Sirena Williams.

I think the test should not be "is she congenitally advantaged compared to top female athletes", but "is she congenitally advantaged to the level of an average male athlete". It certainly shouldn't be "is she congenitally advantaged compared with the average female non-athlete". Or even "average male non-athlete", since that's likely a lower degree than the congenital advantage top female athletes enjoy.

By the way - my own peculiar syndrome is illustrated by the triptych of photos in my post Annus Mirabilis. It's still Idiopathic, alas.

Feel free to traipse through the archives. There's a lot there.

Anonymous said...

Hey, don't you be bashing the National Enquirer, Zoe. The Enquirer was the forerunner of today's neoconservative movement. Give it the respect it deserves.


amanda said...

the only question in all this, is how will Caster ever make a normal life for herself? answer? she can't, because she's on the dissecting table of the world media and any semblance of normality has been blown out of the water for a few ozzi dollars.

unwarranted kneejerk?

Anonymous said...

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Sophie said...

Hello Zoe

"Not so her (Alice Dreger) article on Intersex generally. In fact, it's difficult to believe that it's been written by the same person."

That may be because she didn't actually produce the content of the article, I did, (As we both know) She rehashd it for her own ends, and as is good solid scientific practice, which has to be obeyed to the letter, Sophia Siedlberg never gets accredited (I Am again talking by city gates it would seem)

Zoe Brain said...

Only be sure to always call it please... Research.