'Sex tests' on athletes rely on faulty beliefs about testosterone as a magical strength hormone

·11 min read
'Sex tests' on athletes rely on faulty beliefs about testosterone as a magical strength hormone
The Olympic rings logo with the Transgender and Intersex flag colors on top of the first openly trans woman to compete in the Olympics, Laurel Hubbard, and Olympian and middle-distance runner Caster Semenya on a black background.
Hormone restrictions have created barriers to trans and intersex athletes like Olympic weightlifter Laurel Hubbard (left) and gold medalist Caster Semenya (right).Dan Mullan/Getty; Ian MacNicol/Getty

All Becky Pepper-Jackson ever wanted to do in middle school was to run alongside her classmates on the girls' cross-country team. Coming from a family of runners, Becky literally grew up with her feet in running shoes. After COVID-19 restrictions were lifted in her home state of West Virginia and her school reopened, she was ecstatic to try out for the team.

But if Republicans have their way, Becky will be barred from fulfilling her dream. In February, GOP lawmakers in West Virginia passed a bill that would bar Becky and other transgender children from participating in any school sports. Legislators argue that innate hormonal differences — particularly, higher natural levels of testosterone — give trans girls an inherent physical advantage over cisgender girls. This year, lawmakers in 28 states are voting on more than 100 anti-trans bills, many of which aim to bar trans kids from school sports.

It's deeply ironic that Republicans who have rejected the science around everything from climate change to COVID-19 vaccines are attempting to use medical "evidence" to gin up a new culture war. But when it comes to sports, the GOP is relying on science that simply doesn't exist. There are no studies that indicate that trans women's levels of testosterone — which vary widely — afford them an advantage over their cis competitors. What's more, many cis women have testosterone levels higher than what many consider to be the "female" average, meaning that wide hormonal variations are already an intrinsic element of women's sports.

Indeed, far from dominating sports, trans athletes remain woefully underrepresented in elite competitions. Of the 10,000 athletes in Tokyo for this year's Olympics, only three are trans — even though trans people make up approximately 1% of the world's population. When the New Zealand powerlifter Laurel Hubbard qualified for the games earlier this year, she became the first openly trans woman to earn the right to compete in the Olympics.

"The question shouldn't be 'Why are there three trans athletes in Tokyo?'," Joanna Harper, a medical physicist who has authored two studies on trans women in sports, told me. "The question should be 'Why aren't there a hundred?'"

The magical strength hormone

In the debate over trans athletes, testosterone is typically framed as the masculine sex hormone. The more testosterone someone is perceived to have, the stronger they're assumed to be. Often, the GOP ties this assertion to the age-old belief that men are stronger than women.

microdosing hormones trans
Science now understands that people of all sexes, not just cis men, have varying amounts of testosterone.PeopleImages/Getty Images

In fact, the study of sex hormones — including this assumption about testosterone — is relatively new. One of the first mentions of testosterone as a masculine hormone dates to 1889, when the physiologist Charles-Édouard Brown-Séquard claimed he had created a strength elixir using "juice extracted from a testicle." It wasn't until 1931 that testosterone was synthesized, making it available for scientific study. But by then, the idea that testosterone was a male sex hormone tied to vitality and strength had taken hold. In the popular imagination, there appeared to be a modern, scientific basis for the centuries-old assumption that women were the weaker sex.

There's one problem with this belief, according to Katrina Karkazis, a cultural anthropologist at the University of Amherst and co-author of "Testosterone: An Unauthorized Biography." "The root belief that testosterone is the miracle molecule of athleticism," Karkazis told me, "isn't supported by the science."

The idea that testosterone, or "T," is the main determinant of strength in a person stems from a time when scientists believed that estrogen was produced by only women and testosterone was produced by only men. Scientists have since found that people of all sexes have varying amounts of testosterone and estrogen. And frequently their amounts fall outside the bounds of what is considered "male" or "female."

Intersex people — an umbrella term for those born with bodies that don't fit neatly into traditional sex designations — are as common as people with red hair. In addition, certain medical conditions can alter a person's hormone levels throughout their life. According to the Centers for Disease Control and Prevention, up to 12% of cisgender women in the US have polycystic ovarian syndrome, which can produce testosterone levels higher than the "female" average.

The GOP's argument against trans athletes is founded almost entirely on false beliefs about testosterone. In the Republican worldview, trans women are trying to "trick" the general public about their gender in order to have an advantage in women's sports. If a trans woman athlete happens to have a naturally high level of testosterone, the thinking goes, she is essentially no different from Lance Armstrong or Barry Bonds, who both took performance enhancing drugs to gain an unfair advantage over their opponents.

"What we see is they base their information on myths, misconceptions, and stereotypes about the trans community," said Chris Mosier, an advocate and the first out trans member of Team USA. "They're largely comparing trans women to cisgender men."

The testosterone rule

The first time athletes were tested for testosterone was at the Pan American Games in 1983. Officials were looking for teams that were doping with unnatural levels of testosterone or anabolic steroids to improve their chances of winning. But in 2003, as part of its effort to verify the sex of athletes, the International Olympics Committee began imposing explicit restrictions on trans athletes, requiring anyone attempting to qualify outside of the sex they were assigned at birth to go through bottom surgery and hormone-replacement therapy.

caster semenya
Caster Semenya celebrates after winning the women's 800 meters in Doha, Qatar in 2019.Ibraheem Al Omari/Reuters

In 2011, when controversy arose over Caster Semenya, the South Africa runner who is intersex and has elevated levels of natural testosterone, international sports organizations began subjecting athletes, particularly intersex women, to testosterone testing. If they had too much of the magical "strength elixir," they would not be eligible to compete as women. What had begun as a means of identifying cheaters had morphed into a tool for excluding trans and intersex athletes.

After Mosier pushed back against the regulations during his bid to qualify for the 2016 Olympics in Rio de Janeiro, the IOC eliminated the requirement for bottom surgery. But it kept the hormone requirement for trans women, requiring them to be on estrogen and on testosterone blockers for two years in order to compete. World Athletics, the international governing body for track and field, passed similar regulations in 2018 that require intersex women, who often have naturally higher levels of T, to lower their natural testosterone levels to compete.

At this year's Olympics, the regulations were used to bar several world-class athletes from competing. Semenya, a two-time gold medalist who exceeded the allowable limit for T, spoke out against the decision, saying that the medication required to suppress her testosterone level had made her "constantly sick."

The rules contain a clear bias against trans women. Mosier, a who takes testosterone-based hormone replacement therapy, told me that he wasn't scrutinized in the same way that trans and intersex women are. "My experience largely was very easy," he said. "I think it was certainly because I was someone assigned female at birth competing with men. People didn't think I'd be competitive, so I was not seen as a threat."

The rules, and the anti-trans legislation being pushed by Republicans, aren't backed up by the science. The only two large-scale studies that measured testosterone in elite athletes actually undercut the idea that T is a reliable measure of gender differences. One showed a large overlap in testosterone levels between men and women: 16.5% of men exhibited "female" levels, and 13.7% of women had "male" levels. "The IOC definition of a woman as one who has a normal testosterone level," the researchers concluded, "is untenable." The other study excluded women with naturally higher levels of testosterone because of medical conditions, skewing the results.

Laurel Hubbard is the first transgender athlete ever to be selected for the Olympic Games
Laurel Hubbard of New Zealand, who competed in men's weightlifting competitions before transitioning in 2013, is the first openly trans athlete to qualify for the Olympics.Getty/Scott Barbour/Stringer

Almost all the research on testosterone, in fact, is based not on trans women but on cis men. "We don't really have data that supports any sort of findings about transgender athletes," Mosier said. Karkazis, the cultural anthropologist, told me there's yet to be a conclusive study of athletes that includes a statistically significant sample of trans women to analyze whether they have an advantage in sports.

Harper, the medical physicist and a trans runner herself, is one of the few researchers who have studied trans women in sports. The idea that trans athletes have an insurmountable advantage, she told me, is statistically false. "The real question is 'Can trans women and cis women compete against one another in meaningful sport?' These population studies are pretty good evidence that, yes, we can have meaningful sport between trans women and cis women."

The harm caused by discrimination

The attempts to regulate trans women in sports strike at the heart of society's deep-seated assumptions about gender. After all, the reason we separate cis men and women in athletic competitions is because men are held to be physically superior. In the name of making sports fair and entertaining, we practice an overt form of gender segregation, enshrined in law and upheld by "sex tests" at the highest levels of professional sports.

But even if higher levels of testosterone provide some level of competitive advantage, that wouldn't justify the exclusion of trans women from elite sports. We already permit plenty of "natural" advantages in athletic competition: think left-handed pitchers in baseball, or 7-foot centers in basketball. The real risk isn't that cis men will pose as trans women and undergo hormone therapy to trounce cis women on the field of play. The real risk is that our misplaced fixation on testosterone will cause serious harm to the trans women and girls being excluded from sports.

Becky Pepper-Jackson
Becky Pepper-Jackson, 11, sued the state of West Virginia from trying to block her and other trans kids from playing sports at school.ACLU/Raymond Thompson

Dr. Deanna Adkins, a pediatric endocrinologist and professor at Duke University, told me there is simply no basis for barring trans youth from school sports. Regardless of what sex someone is assigned at birth, there are minimal hormonal differences among children before puberty. And even after children start to produce estrogen and testosterone, there's no conclusive evidence that either hormone offers a physical advantage.

"Everybody deserves to be able to participate in sports," Adkins said. "School sports are not there to make Olympic athletes. School sports are there so that we all learn to love, to exercise, and are healthier adults."

On July 21, a federal court agreed. Judge Joseph Goodwin issued an injunction preventing West Virginia from barring trans athletes from school sports. Becky Pepper-Jackson, the 11-year-old who brought the suit, will be allowed to try out for the girls' cross-country team at her school. "When the government distinguishes between different groups of people, those distinctions must be supported by compelling reasons," Goodwin ruled, adding, "At this point, I have been provided with scant evidence that this law addresses any problem at all, let alone an important problem."

Avatara Smith-Carrington, an attorney for Lambda Legal and the lead attorney on Becky's case, hailed the injunction as a temporary victory on behalf of trans children. Studies have found that suicide rates increase dramatically among trans youth who face discrimination or harassment in their communities, and advocates are concerned that the GOP's push to bar trans kids from school sports will cause real and lasting harm. "They're impacting kids who just want to be out there playing with their peers," Smith-Carrigan said.

In the end, they added, the GOP's willingness to put children at risk exposes the true nature of its campaign over school sports. It's not about keeping sports competitive — it's about defending a narrow and hurtful definition of who is considered female.

"The messaging from these legislators who are trying to pass these really horrible and discriminatory laws is that they're advocating for fairness in sports," Smith-Carrington said. "We know that that's not the case."

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