Intended for healthcare professionals

Rapid response to:


Sex, gender, and sports

BMJ 2019; 364 doi: (Published 20 March 2019) Cite this as: BMJ 2019;364:l1120

Rapid Response:

Re: Sex, gender, and sports

As a BMA member, GP and woman who competes in sport I am concerned at the BMJ publishing only one side of this very important issue for female sport.
I think that if the current IAAF threshold of 5 for female sport is waived for women with naturally high levels of testosterone (who are usually intersex athletes with a Y chromosome) this will be hugely disadvantageous to the 99% of women with testosterone levels well under 5.
If Caster Semenya really believed that her high endogenous testosterone level didn't improve her sporting performance then why is she so opposed to reducing it to get below the limit? The fairness to the other competitors should outweigh her reluctance to take testosterone reducing medication.
Intersex people or people with Disorders of Sexual Development (DSD) are a tiny proportion of the population (0.1% BBC More or Less) but are much more common in women's elite sport. The 3 medal winners in the 800m final at the last olympics are widely believed to have a DSD although public information on these private medical matters is hard to come by.
Male records for nearly all sports are "better" than the female equivalents.
If we want female sport to continue to exist and women with no Y chromosomes to continue to feel they have a fair chance of winning women's races then insisting all female athletes reduce their testosterone down to below 5nmol/L is fair. The greatest good of the greatest number principle has to be applied here.
There are other advantages people with Y chromosomes who have had male levels of testosterone since puberty have over XX people even if the testosterone levels are later suppressed but the IAAF is not currently considering those.
If Caster Semenya wins her case I think it will be a very sad and disappointing day for female sport.

Competing interests: No competing interests

24 March 2019
Angela Dixon