 Hello, thank you for coming out. Please ignore this first slide because this is not the title of my talk. So what Constance said is correct. Thank you for inviting me. Thank you to everyone from the Institute, actually, because so many of you, Jocelyn, Matthew, and others were involved in bringing me here and creating a lovely afternoon. I'm going to do something a little different than what I normally do. When I first accepted this, I actually thought I would talk to you about my latest paper in this arena. And instead, what I want to do is tell you about all of my work leading up to this latest paper, because it's really a suite of arguments that have come together to culminate in the final paper. And so I'm going to give you a little bit of an overview of how I've gotten to the place that I did regarding this work. So very quickly, I didn't know anything, really, about sex testing in sport before I embarked on this topic. I'm somebody that's looked at paradigms around gender and sexuality and medicine in science and critique those and the actual impact of those on people's experiences in the health care system. Part of that included looking at people with atypical sex traits who have what are called intersex variations. So they don't have a male typical or female typical biology, and that led me to this work. And so part of what I came to was a lens of intersex in terms of looking at these regulations. But what I learned very quickly is that there's been some type of barrier to entry for women athletes since the beginning of elite sport. And so there, I'm thinking about the beginning of the 19th century and that at every stage, or sorry, the beginning, end of the 19th and beginning of the 20th century, at every stage there's been exclusion of some sort of people other than white men. And so it's a masculine enterprise that has tend to not limit participation from white men but to limit participation in certain ways from other groups. And so there's been a long history of sort of heteronormativity in terms of thinking about who can participate in women's sport and always prohibitions around restricted eligibility. So what has it been regarding sex testing? The idea is that it's really because of sex segregated sport that there needs to be some kind of eligibility of restricted criterion in the female category alone. And I'm gonna tack back and forth between women and females. So whereas sport categories are around male and female, I'm very often thinking about the category of women using a slightly odd term called women athletes because what I really wanna point to is people tend to think that women is a social category and female is not. And I'm coming from a place of thinking even our understanding of what is female involves social understanding of gender. And so that's why I use this slightly idiosyncratic term of women athletes. So in any event, from the earliest of times there's been a focus on people with atypical sex traits. And so this idea that there are hybrid beings or people with gender atypical traits and that that is in part who is of concern. Do they belong in the female category? Would men masquerade and try to enter into female competition in order to win? And part of the problem throughout all of this time with sex testing is that sex is not neat. Our categories can be, although I would argue in the last decade, they proliferated extraordinarily around understandings around intersex, transgender, proliferations of queer categories, but in sport it's male and female. And so the idea is that there are these clear defined categories, but nature is not so clear, right? And so we've imposed our social categories on what is really a very complex biology. And so because of that, what I wanna tell you is that there's no one single trait that you can use to classify all people as male or female. So when you think about the complexity of sex, just shout something out, what do you think about? How would you think about categorizing someone sex? Chromosomes, excellent, what else? Yes, genitals, who said that? That's probably one of the more obvious ones that people think about, what else? Mm-hmm, right, secondary sex traits. We didn't always have the ability to test for karyotype in the way that we do now. And so they used various ways of looking into the body, but starting really with very rudimentary things like certificates of femininity and other forms, which who knows what counts as being appropriately feminine that was left open to the determination of each country, all the way through to physical inspection, to genetic testing and other things, until finally what happened was there was a revolt on the part of medical professionals and also athletes because there is no one single trait. And so any trait that you try to use will unfairly exclude people from the category in which they belong. So you can't use chromosomes. There are women with XY chromosomes. You can't use testes. There are women with testes, hormonal levels, which we'll talk about more overlap between males and females. And so there's really no easy way to do this. And so finally, let me go back for one second. The part that I want you to notice is that there was a claim from sports governing bodies that after decades of doing this, basically seven or eight decades of trying to use a biological criterion to determine women's eligibility, that they had abandoned it under this sort of irreducibility of sex. And what they did was abandon mandatory sex testing of all female athletes. They always had a reserve clause that said somebody who they deemed suspicious could be tested on an ad hoc basis. So it wasn't, and reasonable doubt, right? So essentially what that would mean is that you might look at someone and decide that you're not sure that they're actually female and that could trigger testing and that's very relevant for what's happening now. So there was this period from about 2000 to about 2011, 2012, where there was this ad hoc policy where it was claimed to be abandoned. And then what happened in 2011 is that some of the major sports governing bodies, which includes the governing body for track and field, which is called the acronym is the IAAF, but also the International Olympic Committee, introduced new regulations and these were departure in some ways from the older regulations. The ways in which they weren't a departure is that it actually put into language and form a regulation that had essentially been their ad hoc policy. So rather than to have this more mysterious process, they brought this other policy back, disseminated it publicly and for that reason it went into place for 2011. There are some ways in which at least on the surface was different. And the surface difference is that it no longer claimed to verify someone's sex or gender. There are legal reasons for this, which is who is to say that these non-governmental bodies can argue that you are something other than what your legal and social identity are in your own country, right? So this presents a problem for them legally to be claiming that you aren't female when every paper that you have says that you are. So they moved away from that and they moved to testosterone. It was a really quick move. It happened in the space of one meeting. It happened because there were intersex activists at this meeting who were arguing that these regulations had been discriminatory. And basically this person said, stop focusing on people with intersex variations. You have to find a rationale for regulation of this category that doesn't discriminate against women with intersex variations. In the course of that meeting, the rationale switched to testosterone in the absence of evidence. So we're gonna talk about this more, but if the argument or the rationale for these regulations is such, and it continues to be such, there's differences between, I'm gonna use time a lot today because so much of this is about track and field, but obviously not all sports are timed. There are many other ways of thinking about this, but in terms of track and field, which is where the cases have been that I've been involved in, it's around time. So as male-female differences in athletic performance, the most likely reason for those differences is due to differing levels of testosterone between men and women, therefore women with higher natural testosterone. Okay, so we're not talking about doping. We're talking about the level that somebody is born with based on their own biology. They have an unfair advantage and in order to create a level playing field, they should lower their testosterone through medical interventions, okay? That is the basis and the rationale for the regulation. All right. This term T came up later in the later article. If it's something that you're more interested in, I'll point out the article where it came out, but it's been operating in my thinking a lot of this work has been done with Rebecca Jordan Young at Barnard and we use this a lot in the book that Constance mentioned. And essentially part of what I'm interested in is the power of testosterone to obviate the need for evidence. That there is such a strong mythology, a set of beliefs around this particular hormone that sometimes even to ask for evidence regarding what it actually does to and for female athletes can make one appear ridiculous, right? Well, of course, we all know. And so it's situated in a really interesting place culturally. So T-Talk, where T is short for testosterone, is a web of direct claims and indirect associations. So it's the indirect associations in part that I'm really interested in that circulate around this hormone. Both as a material substance is a real entity, but also as this cultural symbol, right? And all of the beliefs that come along with testosterone. And so on the one hand, what I'm not saying is that there isn't science, but what I'm saying what comes with a lot of that science is also folklore. And that folklore can be embedded in the science. Okay. And so T-Talk weaves both the scientific claims together and it's circular. So it validates cultural belief as well, right? And so it's working in a circle. So T-Talk is gonna be embedded in much of what we're talking about. And the reason I give it to you now is that we can already start to see it in these regulations. So this is the high, the IAAF regulation that was released in 2005 and was in place till 2015. What they're saying here is that even though there are not many women that have higher than typical levels of testosterone, the rationale and part of the reason that women with high T need to be regulated is that they often display masculine traits and have an uncommon athletic capacity in relationship to their fellow female competitors. So already we're getting ideas in here not simply about what testosterone does in terms of athletic capacity but what it does to women's bodies. And in particular how it makes women look, okay? So we'll get into this more with the idea that it doesn't really belong in women's bodies, right? That higher levels of testosterone is a problem. Okay, these are the IOC regulations. Same kind of thing. Usually intersex athletes can be placed in the male or female group on the basis of their legal sex. However, it's explained below. So already the idea that women with intersex variations are neither male nor female. And what I need to tell you is that it is very rare that someone with an intersex variation identifies as intersex. More often the vast majority identify as male or female. So while there have been a lot of strides around getting the I on driver's licenses, passports, getting them off birth certificates, that there is no one from the intersex community arguing for an intersex category in sport. That's not how they're understanding, you know, ensuring the rights of people with intersex variations. Okay, and so the performance of male and female athletes mainly due to the fact that men produce significantly more androgenic hormones than women. So again, that, okay. So this was the first paper that came out for taking these policies. It came out right around the 2012 Olympics in London. And part of what they did is rebrand sex testing. So they no longer called it that anymore. But what you can already see from the quotes that I pulled out for you is that there is this sense that people don't belong in male and female. There is this concern about masculine traits. So that those concerns are not gone. What I've argued is that testosterone is the Trojan horse by which, you know, through which these older concerns about women's gender presentation, their sexuality, how manly or masculine they are enters into this conversation. And it'll come in a couple of ways that I'll talk about. One is the idea that testosterone sex dimorphic, what does that mean? It simply means that male and female levels don't overlap, right? The other is that it is the primary driver of athleticism. Okay, so in that paper we made a couple of arguments. That essentially they had introduced a category of sex verification that was only valid in sport because where else in the social world, in the legal world, do you rely on hormone levels to categorize people as male or female? If you go for your driver's license, your passport, nowhere else does testosterone determine, right, one's identity legally, socially, or otherwise as male or female. And yet that's happening here. And so what it said to this particular group of women is your legal papers and your identity are not enough. There is now a higher threshold or bar and that you have to have a testosterone level below the threshold that they've created in order to be considered female for the purposes of competition. And that there was anxiety around drawing that line between male and female. In that paper we also looked at the science. I'm a firm believer in doing that. So I'm not somebody, I've spent a lot of time engaging with scientific and medical literature. And I'm not someone that is arguing that testosterone has no relationship to athleticism that's been attributed to some of my thinking. I don't believe that at all, it is related. But when looking at the scientific evidence, which we did more in the book, there are a couple of really easy claims that you can or myths rather than you can dispel with. One is that if you look at who wins in a competition, you cannot rank the winners by their testosterone levels. You cannot assume that people with higher testosterone levels will do better. And there is overlap between male and female testosterone levels. And having interviewed many people in sports science, this is eminently evident to people in that silo of knowledge. It is sort of heterodox to people who work in the field of endocrinology, which think about hormones. And I won't get into why that is, but that scientific knowledge varies depending upon the field that one is in. And so the other thing is that this, so we use the term cryogenic staffing here, which is this idea that with this new regulation, they brought back all of the experts that had been involved in sex testing regulations of the past. So there were no sports scientists developing these regulations at first that could answer the really basic question, what does testosterone do to and for the female athlete? It was filled with endocrinologists who tend to view high T in women as a clinical problem. And we'll talk a little bit more about that is, what that is. So they were interested then, they didn't have direct evidence at all that T, you know that there was any kind of dose response relationship, if you will, between higher levels of testosterone means a better performance outcome, but that's what was claimed. And then there were other questions in that article about fairness. And first of all, the evidence question, why only regulate this natural trait among all others, anything else that you might think about, other genetic differences, any other kind of physiological trait that you might recognize. That becomes a problem when you think about the evidence base not being there. I'll talk about this later, but the possibility of medical harm, so lowering testosterone is not benign, and I'll say more about that. The unfairness of excluding women from a category in which they've competed their whole lives, doesn't apply to men, it's coercive. The only way to continue your career is to comply with the regulations, otherwise you can't compete at all, right? So it's one choice or the other. And it can single out women who are gender non-conforming. So when we talked about that idea of women displaying masculine traits, that is in part what is happening. And with the athletes that I've worked with, that's one of the ways that the investigations around these particular athletes have been triggered. Concern that they have whatever this might be, a masculine gait that they look to masculine, and there's evidence of this in the regulations. So I won't go into the details, but they tell you all of the somatic, the physiological markers to look for that are signs of high testosterone. And then that's disseminated out, but we don't even need those because many of us think we know what high testosterone looks like in bodies, and especially then what it might look like in female bodies. So let me keep going. This has always been work that's been done in parallel with trying to reshape some of these ideas for a more popular audience. I think it's really been part of a dual-prong strategy of doing advocacy work around that. Another article that came back, so the sports governing bodies replied to us. We came back. Essentially, their reply was that, yes, it was correct that, here it is, that it was correct that there was no real evidence, but testosterone was the most likely reason for men's and women's performance differences. And so these are the policy makers themselves acknowledging this in 2014, three years after the implementation of the policy. There is no clear scientific evidence proving that a high level of T is a significant determinant of performance in female sports. So we have the cart coming before the horse, the policy coming before the evidence, and we'll continue to see more examples of this. Okay, so then there was another argument made. One was the unfair advantage. The second, though, is what I kind of call the medical colonialism, which is that these policy makers and others from the global north are going to be bringing their good medical care to women from the global south. So what we started to figure out really early on is that there's a regulation that primarily burdens and targets women from the global south. That's what the very last paper is about, and I'll talk a little bit more about why that is, but that has been acknowledged through multiple sources from sports policy makers. So this is not news to them. They know this. And so it created this sort of medical benevolence argument, right, that they were going to help women by bringing this care, the early prevention of problems associated with hyper-androgenism, which is just a medicalized term for high testosterone in women. Might not surprise you that there's no such thing as high testosterone in men. That's women, not a problem. You can never have too much, apparently, as a man. Okay, and I won't read you all of this, right, but just that you get the idea that now there was this health claim. Okay, so then T-talk, fourth tongue. On the one hand, it's giving you this miracle molecule of athleticism you women with high T. On the other hand, it makes you sick and you need medical care, that these two narratives are existing at the exact same time. Both of them providing rationale for the regulation. And they even went so far as to say, sports policy makers, that it was a duty within the context of medical ethics to offer this care. Now, for people, I mean, you all actually are thinking a lot about these kinds of issues, but the idea that you would have medically unnecessary interventions performed on women in order to continue in sport, I would say, raises a problem with medical ethics. So yes, in the context, it does create a problem, but it's not a duty. Okay, and more again, right, the medical colonialism, but the competence to deal with these conditions isn't available all over the world, right? And so what these policy makers need to do is identify the women, bring them to specialist centers around the world and lower their testosterone for their own medical benefit. Okay, let's leave that alone. Well, this article should not have ever been published. It is authored by people dealing with individuals in the IAAF, so medical doctors, policy makers, and others are authors on this article. It was an extremely problematic article on the one hand, because what it did was detail what happened to four women under this regulation. So up until this point, as I was calling people, doing interviews and other things, I didn't know how it was being implemented. And it shouldn't have been published because it releases women's private medical information to the point where one might be able to identify them. The women never gave consent for this particular publication, but it revealed the workings of the policy. And here's what we learned from this, which only confirmed, and has been reconfirmed later on, four women, young women aged 18 to 21, competing at the highest level of sports. So these are elite track and field athletes. Rural and mountainous regions of developing countries, which is really some of this language that you start to see and draw and to understand that it's women from the global south. This isn't certainly the only evidence I have that it's women from the global south. I have much more evidence, but it's already starting to come in right to this particular article. Okay, there's a little bit of medical language in here, but what the part that I want us to focus on here is that these are women that have gonads. They have testes. That does not mean that they're not women, but you see here, it says it carries no health risk. Women, testes in women in and of itself is not a health risk. It can become one, but there is no medical reason just to de facto remove women's testes. In fact, it's a natural source of testosterone, which is incredibly important. So these women all underwent gonadectomy, but they also underwent partial clitoridectomy, which means removal of the clitoris. And as somebody who has looked at and studied intersex for a long time, many people have asked me, I don't understand. The regulation has nothing to do with the clitoris, what's going on here. And if you understand the history of intersex and medical interventions for women with these particular kinds of intersex variations, it's always been a package set of treatments that have been offered to women in order to normalize the body as female typical. So it's not that the testes were a problem, it's that testes don't belong in women, right? And so they're removed. And same thing with the vaginal surgery, same thing with the clitoral surgery. So the clitoris has been deemed too large and in women with intersex variations, it's been removed. I have a whole book about this, if this is something that interests you, but that's where some of my work started. So here, they wanted that article to fade away. They were hoping no one would notice it. There were some interviews in Dutch newspapers where one of the authors of that article actually spoke about it and revealed yet even more information. And instead of the article going into the abyss, we decided to write about it. And this required going in to see what the actual harms are of lowering women's testosterone. And so in general, it's not true at all. So let me just sort of paint this in the most point blank way. You never lower a woman's testosterone simply because it's high. It's not like cholesterol, right? Where you have a sense that higher cholesterol is associated with something or a health problem down the road. There is no medical reason to lower women's testosterone unless women come complaining. And one of the primary complaints that they might have is infertility. They might complain about body hair patterns. They might complain about something else, but you don't lower it just to lower it. And so the ways that you lower testosterone in terms of these regulations are either pharmacologically, so you give women drugs. Or what you do is you perform the gonadal surgery. The gonadal surgery removes the women's natural source, not only of testosterone, but of estrogen. And it puts them at risk for many health issues down the line. And so that article, this article here, talks about what they are. There are short-term significant health effects, problems with mood, problems with metabolism, problems with energy levels. I mean, they're completely devastating health effects for an elite athlete. Gonadectomy will do the exact same thing, very similar kinds of problems from that intervention, but it has an added complication, which is that it requires lifelong hormonal supplementation. If you do not supplement these women's hormone levels, they will start to get osteoporosis in their 30s, and they will have extremely fragile bones. And so, and there's also with gonadectomy the risk of sterilization. So again, when you look at the idea that these women are 18 to 21 and are undergoing these interventions, right, from a context of the global South, which I would argue is different than the context in the global North, where sport is actually a route to a higher socioeconomic status in the global South, or it can be in the way that it very often isn't in track and field, right, in the global North, that it was risking not only their health, but also their livelihoods. Okay, so another article. All right, finally, third article. So one of the things, so this argument about testosterone levels and athletic advantage rests on the idea that men's and women's levels don't overlap and that higher levels necessarily improve performance, right? So you could almost draw a chart. Higher levels, the higher someone's level gets, the better her performance would be, the quicker her time. And so here, what we did was write an article in Science looking at two studies at that time that had come out. There were very few at that point looking at testosterone levels in male and female elite athletes. It's kind of hard to believe, really. Testosterone was isolated in 1935, which means it could have been measured at that point, but it wasn't until the late 2014, one of the first studies was done and then 2012, 2014, something like that, where these two studies came out actually looking at T-levels in elite athletes. One said that there's no overlap between men's and women's T-levels. That was the one coming from the IWF policymakers. The other one said there was an overlap. So they came to opposing conclusions. So what we did was look at the studies to try to figure out why. There were three points or three differences between these studies. The first two I'm not gonna focus on, but if you're interested in them, they're detailed in that science article. But the third point is really the one where it matters. One included women with intersex variations within the category of women and the policymakers excluded them. And this is persisting till now. So one of the arguments that I've made that we can talk about more later if you want is that a central core issue here is that policymakers are not viewing women with intersex variations as women. And that they're analogizing them with men and that's in part based on the fact that these women have testes, right? So they disagreed on whether or not the women with the higher testosterone belonged in the sample of women and they argued they didn't. What was interesting is that they excluded, when I say they, I mean the policymakers, they excluded women who don't. But they also, one of them excluded the women with intersex variations, not because they said they were male typical but because they said they were unhealthy. And what you need to know is that when you're doing an epidemiological study, you don't exclude anybody. You actually are trying to capture the entire population. So if you're doing a clinical study and trying to find out what typical levels are, you would want to exclude people that might have some health condition that would change it but that's not the case for an epi study and that's what this was. And so it's really about the boundaries between male and female and who belongs in the women's category. Around this time I started to get involved in the case of Dithi Chand who is India's best sprinter in the 100 meter who was criticized by fellow athletes for having a masculine gait and was brought under suspicion of being a male or being a woman with high T under these particular regulations and investigated in India. She was 18 at the time and decided to bring a case. I can't tell you how extraordinary this is. At the time, Dithi did not really speak any English. It was a five day case at the court of arbitration for sport where for five days for eight hours a day she listened to people decide her fate almost all from the global north in a language she didn't understand. And what she basically said is this discriminates against women because what they've done is create a category within a category, right? That they agreed. I just said that policymakers don't believe they're women. It's because although, well now they're increasingly saying this quite honestly. So we haven't caught up to the current moment where the arguments have gone. But that the idea that Dithi should lower her testosterone to continue to compete in the category she had created a special class of women within the category of women who would have to undergo these medical interventions in order to keep competing. Against all odds, it blew my mind but we ended up winning that case. If you don't know anything about the court of arbitration for sport, it's interesting, it's in Lausanne. All decisions are binding but it is a court only for sport and sport regulations that is funded by the IOC. So that is in part why it blew my mind that we won because we're actually sort of arguing in the house of big sport. And this is what the cast decision said. It is not enough simply to establish that the characteristic has some performance enhancing effect. Instead they need to establish that the characteristic in question confer such a significant performance advantage over other members of the category that allowing them to compete would subvert the very basis for having the separate category. Okay, so what the IAAF showed is that with their evidence there might be a performance difference of one to 3% but that that was nowhere near the 10 to 12% performance difference that's typically between males and females. So that if some of these women have testosterone levels considered to be in the male typical range all we need to do is look at their performances to understand that they're not clocking male performance time, right? That in and of itself tells us that testosterone alone is not what propels bodies, if you will, faster. Okay, so let's keep going. This is the last article it just came out finally after a year. It's been ready for a year but it took a long time to publish. It's a very long complicated article but it's designed to be the culmination of everything that I've talked about thus far to try to explain why is it women from the global south who are primarily burdened. In other words, if you understand testosterone to be a neutral criterion an objective criterion that you can measure in people around the world it doesn't on its surface make sense that it would be women from the global south who would be being tested and understood to have you know not understood but tested and have the highest levels. And so this argument, what it tries to do is build through the various arguments that I've just gone through to paint a picture. This was actually at the Rio Olympics and this is the first beginning of the article is this picture because it was like a shot heard round the world for people who saw this picture. Part of what happened at the Rio Olympics is that Caster Semenu is a very well known South African runner who is now bringing a legal case against the latest regulations I haven't talked about them yet but I will was criticized by these two women from the global north one of whom even said well at least I was the first white took the first white the first European to cross the line. And so there was a racialized aspect about the podium and who might belong there. Then we came back to the four women that I told you about from the rural and mountainous regions of developing countries and it started to paint a picture of okay that episode is racialized this is racialized we understand who these women are and to start to look at what was going on here and this was a Twitter exchange between several different people Ross Tucker's a prominent sports scientist from South Africa that is argued in favor the regulations for a long time but the end of the result of this Twitter exchange was this idea for him and so to me the introduction of race into this issue is an intellectually lazy approach and I have to tell you having written this paper it's one of the hardest papers I've ever written trying to write about race when it is not a work is incredibly difficult because what you have to do is look for resonances you have to look at the way different stories can be read alongside each other to create a picture as to who it is that they're actually talking about and that is part of what this last paper is about and so some of the stories that they talk about for example are the ones about health well just to give you one example what do I mean when I'm talking about narrative and resonance and how they rub up against each other it is not the case that in the global north you will find many women right now at this age that have higher than typical testosterone levels because for the better part of 50 years in the global north those women as babies were intervened upon and so they would have had gonadectomy they would have undergone various surgical and medical interventions so they already know with this narrative that they're bringing their good medical healthcare to women from the global south that it doesn't really apply to women from the global north because they've already undergone this this treatment paradigm if you will has been under incredible criticism and is now starting to change because adults with intersex variations have argued about the harm that these kinds of interventions have done to them including gonadectomy because it removes your natural source of hormones they've talked about ethnic and regional variation even Paula Radcliffe very well-known UK marathoners talked about the fact well know there's more women in the global south who have these variations no actually that's not borne out by the evidence but all of these stories are circulating the idea that T doesn't overlap so I'm gonna leave this out these images are in that talk because one of the head IAAF policy makers I'll just tell you this said that this was the typical female form this was the way that women the Mahajanudai 19th century I don't know many elite female athletes that look like this but this was at a sports conference where it said this is the typical female phenotype wait for it here's the typical male phenotype never shall the twins meet and therefore it took it out the third image that linked again remember we talked about resonances and linking of stories the third one was a Caucasian, a white woman who had dope to had a body closer to the flex wheeler than to the maha but it was also very dark and so right because of tanning and so through this series this is one section of the paper where he makes these associations then that women with big muscles is a breach of sexual dimorphism so that's a sign or something you have to look for for signs of high T so let me bring us to the current moment but let's just say the difference in intersex is not in prevalence but in response the global self has had different responses to people with intersex variations it's not that there are huge pockets of greater prevalence and that somehow although this has been suggested that people from those countries are going to particular places to find women with these variations because they think they will perform better another story also from that meeting was the idea there are a lot of people coming from Africa and Asia and merging at the highest level of sport and part of what they want to do is stop them before they reach that level stop them via treatment but we've talked about how the treatment is problematized I'm going to keep going so testosterone here is really the great distraction it's distracting us from the mythologies about T it's distracting us from beliefs about including actually racial differences in testosterone levels which I didn't talk a lot about so where are we right now? keep going quickly new regulations so where Cass left the decision I need about five minutes do I have that? okay I just want to bring us up to the current moment because it's actually quite an exciting and yet nerve-wracking moment when Cass gave that decision in 2015 what they said very generously to the IAAF is you have two years we're going to suspend the regulation so no sex testing for two years this is the first time this has happened in the better part of 70 decades so it was a historic moment in Rio that there wouldn't be some kind of biologically based eligibility criterion for women IAAF you go you find your evidence and you come back with evidence that women with higher than typical testosterone levels have that performance advantage in that 10 to 12% range that men typically do over women which is quite generous because we've already looked at the quote from the IAAF that the regulation came then in 2011 then in 2014 they acknowledged that they don't have the evidence and then Cass even says we'll give you two more years to come up with evidence they submitted some evidence and then what they did was decide that based on some of this evidence they were going to release a new regulation and not go back to Cass and so they did not go back to Cass for a complete hearing around their evidence and here's where things start to get I think for the first time less opaque and more transparent about what's going on you'll see here that now the regulation specifically mentioned differences of sex development so differences of sex development is a medicalized term for intersex so no more is it around women with high T per se it's now back to where we were with the hybrid beings and others near the beginning of sex testing a blatant and transparent concern around women with atypical sex traits so much so that there are many reasons women might have high T not simply intersex variations polycystic ovarian syndrome is one way there's also something called congenital adrenal hyperplasia which is often counted as intersex but some don't T-C-O-S which is for 46 sex women is excluded from the regulation even if the women's testosterone level is high so there's a threshold it's five nanomoles per liter if you have T above that threshold and you have T-C-O-S the regulation does not apply to you if you have T above that threshold and you have an intersex variation the regulation applies to you so it starts to reveal the politics of this now more blatantly because the source of the high T shouldn't matter right? it should be immaterial what it is that's causing you to have higher T they restricted the events 400 meter to the mile happens to be that duty runs in the 100 meter and the 200 meter shouldn't have standing bring a case anymore happens to be that Castor Semenya several slides ago that I showed you from South Africa runs in has talked about running in the 400 meter I don't think she has yet but definitely 800 meter, 1500 meter right? so these are the categories that she runs in and the idea that they would only apply to certain women with intersex variations one other piece of this is that and I don't quite have it here they had one study at the time that they released these regulations that has now been thoroughly thoroughly critiqued in the literature to the point where some scholars who got some of the raw data that the IAAF relied on have asked for a retraction of that paper so they had one study that basically was trying to correlate I should have put this up as a slide but trying to correlate testosterone levels in women with performance outcomes in 21 track and field events it also looked at men's events and they only showed a difference in five events of those five events let me think of a simplified way to say this but well let's say it the other way if only five show a performance difference between T and athletic performance it means the overwhelming number of events show no performance difference right? and so it's a problem the highest percentage that they could show of a performance difference is in hammer throw and pole vault which are not regulated events you saw back here right? it's 400 meter to the mile so this is also a problem that starts to reveal the politics there were also interesting things in the men's data that put sort of brought questions about men with lower T did better in quite a few of the men's events so the whole theory right just starts there's a lot of conflicting evidence that makes it impossible to make a flat footed statement that higher testosterone necessarily needs to better performance so this is an article I wrote with Morgan Carpenter because I wanted to explore we wanted to explore what we were calling these false or impossible choices the other piece that's new about this 2018 regulation and these again you'd have to know the case to understand but these are directly in response to the CAS decision and a work around to some of the criticisms that were raised by the panel in that decision it only applies actually that sort of stated funny in that way it only applies to the international level right so it's trying to keep women out of the international level you can change your event you can quit sport you can run with men this one in particular this is in the regulation actually is deeply problematic because it was made very clear at CAS that women with intersex variations absolutely cannot run with men why? because legal sex is still a criterion for eligibility in the category it's always been legal sex and then on top of legal sex they put this testosterone threshold so legally these women are not men they cannot run with men and then in this false deeply problematic intersex category which they suggested would be coming so what we argue in this paper is that these are all ways to punish and shame women and to get them out of sport who are not willing to comply with the medical interventions that are required for them to continue this case is going forward now and this is the final step that I'll tell you about and I can talk about this more later but finally the UN weighed in on these regulations and so this is the special rapporteur on torture special rapporteur on health and the working group on the elimination of discrimination against women and the key part of the letter this was released two well maybe three weeks ago now today this is a quote from the letter the eligibility criteria and the procedures for their implementation set forth in these regulations appear to contraven international human rights norms and standards including the right to equality and non-discrimination the right to the highest attainable standard of physical and mental health and the right to physical and bodily integrity and the right to freedom from torture and other cruel inhuman or degrading treatment and harmful practices so in the next year I would say because it takes so long this case will be decided again going to the court of arbitration for sport so okay I tried to I did okay I went over but there's so much more but how is there any discussion about if men intersect or otherwise who have low testosterone levels should have those grades to give a fair percentage of them? That's an interesting question in sport they have something called the therapeutic use exemption so that if people want to use a substance that's considered to be in performance enhancing they need to get permission to do that and there are certainly men who have requested a therapeutic use exemption for testosterone and then whether or not they're granted this you know so the idea would be that they have lower than typical testosterone the idea would be then that they would be allowed to supplement with that which we normally call building because they've been given right there's some clinical reason that they need that but the interesting thing about this is that it's never really been about men the only way that men inters sort of through this idea about gender and so one of the more ridiculous statements I think I've ever heard is the idea that men would masquerade as women in order to compete in the women's category and I was at an endocrine meeting once which was primarily men in the audience though not exclusively and I asked any man who would be willing to do that to raise his hand and you can imagine nobody did and in fact what they did was break out into nervous laughter because they understood right that this is like a completely false concern so no there's not a sense that men with low tier at a disadvantage they're not even willing to acknowledge that those men with lower T create a problem in terms of the overlap so men's and women's levels overlap not simply because some women have higher testosterone but the overlap at the other end because some men have lower testosterone and so one of those studies I told you about one of the people in those studies was a gold medalist male with low testosterone so no no idea then of this is really transgression in one direction women who are too masculine, right? That was really wonderful, thank you. I'm left perplexed about something at more than one day but I won't speak to one for the moment. So in the first instance I think we still want men not being competing with women overall because of the whatever percentage you said is in terms of strength so what can we then should we be doing? That's a great question. You know I'd love to get us for a second to think about your first comment because there's a wonderful scholar here in Canada Sarah Titzel who has done interesting work asking questions about when might it make sense to sex segregate and not and I think because of this idea very early on of women's inherent weakness inferiority, athletically and otherwise that all sport should be sex segregated not all are and I think there's a really interesting conversation to be had about when it might make sense and when it might not and it may not be uniform across sport, right? It may make sense to segregate at certain ages and not others and who knows? So I actually, I mean I don't have the expertise to do some of that thinking but I think that's a conversation worth happening and even saying that there are going to be absolutely sports activities and others where it makes sense, continued sense to have sex segregation and track and field I think is one of those. So I get asked this question a lot so okay you're crabby and say this isn't the solution so what's the solution? And I don't mean this to be at all sort of flip it to what you're saying but when I talk about this what I say is here's the solution now what was the problem? Because it isn't a problem of advantage. We, you know I've looked at the science I've even looked at it more closely in the book and that's not worn out. It's also not a problem of men masquerading as women so even though that was a stated concern for decades there's no evidence that men were trying to do that. Is it actually then the only other possible problem which is that we have a problem distinguishing men from women? Now we might say yes but we also really might say no because for the women that I know in terms of this regulation they are legally and socially women and have been their whole lives no different than me. So if we start from that place which is a pragmatic approach then I don't see a problem. If you do what many people do which is to start from the place of how do you separate male from female? What is the difference? That's actually an intractable problem that will never be solved because humans are not sex dimorphic around most traits for example height. Height is another great example where men's and women's height overlaps. So I don't see a problem in that way because I think we start or the policy makers are starting from the wrong place which is how do you distinguish male from female? I don't actually think that's a pragmatic problem for sport, you may disagree but that's where I've landed. Do you wanna follow up or push back? I'm totally open to that. You don't have to agree with me. Well, I go back to, so if we have a category of women and I agree that not every sport should have that category of women in some way but for the present, if we have a difference in strength for in particular certain track and field sports concentrating on, then how do we decide who should be able to compete in the female category? How should we compete? How should we compete? Well, for me, so are you maybe also thinking of trans athletes? Yeah. I think it's a really good and hard question. I don't know how many people here know Bruce Kidd. Lovely, he's one of your Canadian Olympians and an extraordinary advocate for women in sport. He just left Toronto retired but Bruce argues that it should be identity-based and there are others as well. In other words, if you identify as male or identify as female, that is sufficient. There are many in, so here then we get into a pragmatic issue, right? Because whereas I think there might be, well, I know that there are sports organizations, especially women's sports advocate organizations that are not on board with that yet. They might get there, but they're not there now. And I think it leads to some really interesting questions because part of what's happened in terms of trying to draw these lines is what I would say is this kind of scientization of the issue. And so what do I mean when I say that? The IAAF is making a scientific argument, right? Everything comes down to science. Science can only answer whether there's a performance difference. It can't tell us what to do about that performance difference, right? That is a social question that brings into account values and other things. So my values center on inclusion and I'm not interested in trying to get down to the most minute place. What is the muscle mass and what percentage of that? I don't actually think we can answer that because of the complexity of athleticism. So I haven't come down in one sort of particular place around inclusion of transgender athletes, but I absolutely believe that people should not be required to undergo medically unnecessary interventions in order to compete. That creates a problem for my value system. So I assume among just the general population there must be a range of testosterone levels. And so do we know whether elite athletes or elite athletes and athletics, which is a little perhaps, as a whole tend to have higher testosterone levels than, say, in comfort in the case of women than the sort of general population of women? Here's the reason I asked this. Let's say there's a spectrum. And it turns out that either within a class of elite athletes or relative to a general community population, that isn't like a two or 3% advantage based on their higher testosterone levels. Not much different than maybe you're taller, maybe you have broader shoulders, maybe you have particular muscle structure that absolutely they manage to do as well. Yeah, I mean, and here's where it gets really complex because people talk about athleticism as if it's one thing. If you look at the body of a power lifter and the body of a rock climber, that rock climber is not gonna do well in power lifting and that power lifter is going to do less well than that rock climber. And so what are you talking about when you're talking about athleticism? Is it strength? Is it speed? Is it sort of a competitive drive, if you will? Is it just persistence, stubbornness? Who knows and how could you possibly desegregate that? So again, these studies are, there are very good studies about what testosterone is in non-elite athlete women, right? There are a lot of those. They tend to skew lower because they're not including women with intersex variations. And so for example, in the latest IAAF paper that they've put out to support the regulations, they said that women's testosterone levels never go above two nanomoles. And you can only make that claim by excluding a large number of women, including women without intersex variations, right? Women with PCOSA, women with adrenal tumors, any number of women. So where I think people get, I'm sort of talking around what you're saying because where people get stuck sometimes is it any advantage? Well, who could possibly, I mean, well, that one hundredths of a second is due to your extra three quarters of an inch height. You can't desegregate in that way. And so it's not any advantage because if it is, then you'd have to be thinking about socioeconomic status and write an all manner of non-physiological trait, which of course the global North doesn't think about because we're fully advantaged in that way. So we're blind to our own advantage. So what I like to say is, there are so many other ways to conceptualize fairness. And if you think about it from a global South perspective, you actually might require people to switch resources, right? And that's your notion of fairness. You wouldn't use it on physiological traits because the way that you feel disadvantaged is around nutrition, food, even Caster Semenya said that when she got better at age 19, the reason is that she comes from a very poor village in northern part of South Africa that she went to a training center where she got three meals a day, right? So we don't think about that in the US. So it's not any advantage. It's an advantage that requires excluding you from the category. And all we have to do is look at the times to understand that these women are fully in line with their fellow competitors. And if you look across all women's sports that are timed, except for long, long endurance events where the gaps really start to close, right? Like these 100 mile things that women are not getting anywhere near men's times, right? And so then how do you think about dealing with a one to 2% advantage of things like women? What is that? Yeah, yeah. I have a question. I'm just curious whether the policies that you're talking about apply to the Olympic environment or competition sports like tennis and those sorts of things because women tennis players are endosomes. And I don't think they'd be very high on that show. But do they separate them in enterprise sports? Yeah, so here's how it works. The Olympic regulations are actually only enforced during the Olympics. So a two or so week period every couple of years. So while they get a lot of attention because the Olympics is a bigger brand, they're actually less troublesome from a regulatory standpoint because they're not enforced very long. So what the Olympic, but nevertheless, during that two week period, they apply to every sport within the Olympics, right? Any Olympic sport winter or summer. Then the international federations create their own regulations. And so track and field happens to be very concerned about this issue. They have a fair amount of money. And so they have brought together their own people sometimes in concert with the Olympic policymakers to make regulations. And then what happens very often because these seem to be the two primary policymakers is that other sports will adopt these regulations or even try to create their own. So swimming have had some, rugby have had some, FIFA had some that actually just required, this one was really crazy. This one was they were getting the gynecological records of the female athletes to prove that they were women. That was the way that they went around this. So I don't know if tennis does. On my computer, I have a file. I could look it up if you were really curious and see because I've collected the regulations. But the ones that have gotten the most attention are the Olympic ones and the IAAF. And then whether or not another rugby, I think that I say rugby, rugby I think has. No, okay. But to know, there's probably not many people in the world that are as curious as I might be about that. I'm just wondering where all of this scientific information of facts would go when you get a major association on U-Sports, which is NCLA according to University of Sports, coming out with a policy saying anybody identifying as female will have an equal opportunity to compete as a male varsity athlete. So I'm just wondering, like, is that just gonna stay on the U-Sports level or what is the NCLA policy or what are they doing about people who are identifying as female? So it's interesting because sort of coming back to your comment, even at that level, whether it's NCLA, even at the high school level, you have those organizations responsible for those policies looking to the policies coming from the elite sport and sometimes simply rejecting them, right? Because it's, I mean, it wasn't until very recently that the transgender policy required genital surgery, which is, you know, I think most people, even the Olympic policy got rid of the requirement for genital surgery. And so the Olympics are about to come out with a new policy and I'm very curious to see what that is. I can conjecture in my head what I think it will be. I think it'll probably come out in the next month or so. But I think what you're seeing, what you've mentioned is where regulations are going at that level and you sound quite knowledgeable, so you probably know more than I do, but I think it's viewed as sort of a gulf between that level and the elite level, which is not to say there aren't cantankerous debates in the U.S. and elsewhere, like Canada, Australia, about sort of sport leagues that are more amateur and sort of what to do about those. Those who are concerned about the ethics of the team here can have different individuals, whether it's coaches looking for somebody that absolutely looking for a sixth, five-center player who might be able to really help, like how people, whether they're going to be able to, whether it's leaders in the sport area or the athletes themselves. That's always the question. Yeah, so this is interesting, because when you said behave ethically, my brain went somewhere totally different. So let me address what you said and then tell you where my brain went. So I really believe that men are not going to identify as women in order to compete. I think patriarchy and the fact that masculinity is higher on our gender, hierarchy is enough to stop that happening for almost any man on the planet. Meaning who doesn't have a female gender identity, right? I also think it's deeply disrespectful to people's deeply felt sense of gender identity to assume that they will change it the way they change their underwear or their clothing, that you just sort of willy-nilly do this. So I think it betrays an understanding of the development of gender identity and how that affects people. So where I thought you were going is, I would be worried, for example, in basketball with scrutiny of women who appear to masculine and my concern about that being unethical because we already know that all women athletes are scrutinized around norms of femininity, whether it's Serena Williams, Caster Semenya, anybody, and that women understand that they need to conform in certain ways or if they don't, they will be scrutinized. And so there's a lot of reading of the body in this particular case for signs of high testosterone. In fact, one of the tidbits I didn't tell you that's in that article is that when I was at this big sport meeting right before the 2012 Olympics, the head IWF policymaker suggested that the clitoral size is the most trusted indicator of high testosterone, right, signs of high testosterone. And so for that reason, all female athletes should undergo a gynecological exam as part of their pre-participation health exam to route out the women with the unfair advantage. So that's what I worry about, right, looking for the gait, looking for musculature, looking at small breasts and deciding that that means someone's not female, which of course the athletic body conforms to the sport that one is doing, which means that in many sports, some of these signs are because you have a phenotype from participating in the sport. It's not about masculinity. I don't worry about that because there is no screening or you don't need to prove that, like there is no sex testing or gender testing. It's just the opportunity is there for anybody who identifies as female. Like there is no, you don't have to prove it. You don't have to, you go through a series of interviews and if you're transgender. And I think if you're gonna do that, like you have to really feel. Oh, I agree, I agree with that. But I'm just saying, this is for all of this evidence and testing and screening, you have to be able to do that. Yeah. Right, whoever identifies as female is exactly the same. Yeah. That may be where these are going, but oh my goodness, given the policy makers, I cannot, I mean, I don't know. Is that recorded? I didn't say anything. I implied. Is there one more great question? Or did I confuse, I've had journalists tell me this is the most complicated issue they've ever written about. So I wouldn't be surprised if people were confused. I'm happy to hear that you're, I'm not happy to hear you're confused about something. I'm happy to clarify how I've confused you. Yeah. I know that you have a lawyer say that's not the best route to start with, if what's the difference we create is a massive email. But I think, if we don't accept representation for transgender individuals or for an object of time, or if we get to the issue of people who are gender non-reforming and they are sent off their birth certificate and documentation, then we're gonna have to get that question unless we tell, like, if there's a gender non-reforming person who doesn't have documentation of any female or male, and we say, now do you want to participate in the Olympics? Do you choose male or female or do you assign them somehow? I feel like we can assign, right? Because I'm gonna take away their autonomy. But here's where I do think, so one of the issues that I think will sort of crop up more and more is that countries, in the same way that you're talking about sort of sports, governing bodies, if you will, at that level are deciding to approach this differently. Countries are too. So for example, in Argentina, you can change your documentation outside of a medicalized system to gender transition the way that you still have to do, let's say in the United States, right, where you need a medical doctor to sort of supervise and authorize. And so there, that's interesting because now countries' different approaches to what your legal documents will say are now very different, right, where some still require medical intervention and some don't at all. They're more just identity-based and you walk in and the doctor's completely taken out of the system. So I'm not gonna say it's easy, but I also know that if we come from that space, I'm going to get to a place where there's gonna be a suggestion where I'm gonna be not happy because I feel like it's violating somebody's rights. And so I tend to come from a rights-based approach more than a line-splicing approach, but I imagine that there will be athletes angry with me or wanting to quibble with me because it feels unfair. I don't think the way out of the unfairness is to do more scientific studies about what that person's body might be doing or not doing because it will always be so variable. But I do think we have a lot to do around education and I wonder if we did more around education if maybe this wouldn't be less of an issue because the one thing the IAAF does not do around this is education at all. For complexity of sex, relationship of testosterone to athleticism, people's normative ideas about gender, they don't, I don't know why I would argue they're not qualified to educate around that, but they could find people who could do more around that and they don't. So it's probably an unsatisfying answer, but this really starts to rub up against where I get. Yeah, I just wanna throw a line because we're not talking about assigned people. If we're going to, I know it's like on the margins and if you're gonna get to like gender non-performing on binary people, you're gonna ask them are you gonna be an male or female category? Which is a problem. It does require, it does, yeah. And yet the interesting thing is they're using this so-called non-existent intersex category punitively. If, if, so intersex people have argued for an I on various documents and things because it represents their identity. There are not athletes who identify as intersex clamoring to be in a category because they don't understand themselves to belong in one or the other. Now, if people start arguing for that, you know, I'm open for, I mean, it's not my, you know, that's like outside of my wheelhouse of knowledge but why not if people want that? I don't know what it would look like and how it would work because what are you competing against two people? Maybe by yourself one, you know, sometimes, at least for a long, you know, a while ahead. So I don't know, but here I, you know, I tend to get focused in that way of the punitive use of what's ostensibly an effort towards greater human rights and recognition of people with intersex variations to co-op that and use it as a kind of a punishment especially for people who don't identify as intersex. It may not even know they have an intersex variation. That's a huge piece of this. Many people may not know and yet fall under the regulation. Yeah, are you coming? I just thought you wanted to dance. Okay, no, okay.