tag:theconversation.com,2011:/au/topics/testosterone-564/articlesTestosterone – The Conversation2024-03-18T17:08:07Ztag:theconversation.com,2011:article/2247742024-03-18T17:08:07Z2024-03-18T17:08:07ZWhat your hair can tell you about your health<figure><img src="https://images.theconversation.com/files/579862/original/file-20240305-20-96aic6.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4684%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Genetics, hormones and age can all affect our hair growth.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/damaged-hair-frustrated-asian-young-woman-2403657911">Kmpzzz/ Shutterstock</a></span></figcaption></figure><p>Hair speaks volumes. The way we cut, style and colour often acts as a representation of who we are.</p>
<p>But hair is more than just aesthetic. It also has many important functions – preventing heat loss from the skin for instance, or (in the case of our eyebrows) stopping sweat dripping into the eyes. </p>
<p>Hair can be a reflection of what’s going on inside our body, too. Many diseases can alter the quality and appearance of our hair. Paying attention to the way it looks can give us clues to the state of our health. </p>
<h2>The hair cycle</h2>
<p>Some of the tiniest organs in our bodies are the follicles which produce and nourish hairs. Hair can only grow where follicles exist. </p>
<p>Hair growth is a complex process. Each tiny follicle goes through different <a href="https://www.sciencedirect.com/science/article/abs/pii/S1064740618300270?via%3Dihub">cyclical stages</a>. The first is the stage of active hair growth (the “anogen” phase), before growth is arrested (the “catagen” phase). This then progresses to the stage when the hair is lost or shed from the follicle (the “telogen” phase). </p>
<p>Many factors – from our genetics to our hormones to our age – can affect these follicles and their growth.</p>
<h2>Excess hair growth</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK534854/#:%7E:text=Introduction-,Hypertrichosis%20is%20defined%20as%20excessive%20hair%20growth%20anywhere%20on%20the,%5D%5B2%5D%5B3%5D">Hypertrichosis</a> is a condition where hair grows in excess all over the body. In most cases, this is a reaction to starting a new medication, such as phenytoin, which is used to treat epilepsy. But it may also be caused by diseases, such as <a href="https://www.sciencedirect.com/science/article/pii/S0738081X23000329?via%3Dihub">anorexia</a> and HIV. </p>
<p>Some conditions also cause hair to grow in places where it shouldn’t. In newborn babies, tufts of hair near the base of the spine may indicate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657727/pdf/cureus-0015-00000047396.pdf">spina bifida occulta</a>. This occurs when the lower vertebrae of the spine haven’t formed properly, leaving the delicate spinal cord covered only by skin. </p>
<p>The hows and whys of these conditions and their ability to trigger hypertrichosis remain poorly understood.</p>
<p>Hirsutism is another condition where hair grows excessively, but in a typically male pattern – on the face, lips, chest and arms. This is driven by androgen hormones, namely testosterone, which in high levels promotes hair growth in these regions. This may be observed in <a href="https://pubmed.ncbi.nlm.nih.gov/27510481/">polycystic ovary syndrome</a>.</p>
<h2>Hair loss</h2>
<p>Hair may also start to fall out in abnormal amounts, making it thinner or absent in certain body regions. The medical term for hair loss is <a href="https://cks.nice.org.uk/topics/alopecia-areata/">alopecia</a> and may either be localised or widespread. <a href="https://www.pcds.org.uk/clinical-guidance/alopecia-an-overview">Causes of alopecia</a> are manifold and include fungal infections, iron-deficiency anaemia, low thyroid hormone levels and use of medications (including chemotherapy). </p>
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<img alt="A man with hair loss." src="https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579864/original/file-20240305-28-7sscn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Male pattern baldness begins in the mid-20s.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caucasian-man-hair-loss-problem-2335225091">ANDRANIK HAKOBYAN/ Shutterstock</a></span>
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<p>Age, gender and genetics are also to blame. <a href="https://cks.nice.org.uk/topics/male-pattern-hair-loss-male-androgenetic-alopecia/">Male pattern baldness</a>, occurs at the hairline and the crown of the head. It’s influenced by the hormone testosterone, which shortens the growth phase of hairs and makes them finer. Most men with male pattern baldness will begin to observe hair loss by the age of 20-25. </p>
<p><a href="https://cks.nice.org.uk/topics/female-pattern-hair-loss-female-androgenetic-alopecia/">Female pattern baldness</a>, on the other hand, usually affects the front hairline first and causes thinning rather than complete loss. The role of testosterone is more debatable in women, but a hormonal cause is implicated since thinning is more common around and after the menopause. </p>
<p>Hair loss may also arise as a result of hair pulling. Styling hair tightly can cause <a href="https://knowyourskin.britishskinfoundation.org.uk/condition/traction-alopecia/#:%7E:text=Traction%20Alopecia%20is%20a%20type,pulled%20repeatedly%20by%20tight%20hairstyles.">traction</a> on the follicle and loss of hair integrity. Some people may also pull or pluck their hairs out of habit. This is called <a href="https://www.nhs.uk/mental-health/conditions/trichotillomania/">trichotillomania</a>.</p>
<h2>Treating hair problems</h2>
<p>Helping hair to regrow could be as simple as treating the underlying condition causing it. Another treatment to consider is the medication <a href="https://pubmed.ncbi.nlm.nih.gov/31496654/">minoxidil</a> – the active ingredient of Rogaine. It was initially developed as a treatment for high blood pressure, but was observed to also promote hair growth. This may be through a direct effect on hair follicles, or by improving blood flow to the scalp. These uncertainties may explain why some patients see good improvement, and others not. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0190962221009014?via%3Dihub">Hair transplants</a> are also a possibility, relocating crops of hairs to bald patches. There are two ways of performing them – you can either relocate multiple small “punched-out” grafts, or a larger strip of skin. The grafts are taken from hairy skin on the patient’s own body – this is an example of an autograft.</p>
<p>Sometimes the presence of hair in visible areas is not desirable, and there are certain treatments available to stop excessive growth. Aside from traditional hair removal methods, the contraceptive pill and other medications that <a href="https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html">regulate hormonal influence</a> on hair (such as finasteride), can be considered in cases where a hormonal condition is the cause (such as PCOS). </p>
<h2>Test your own hair</h2>
<p>In order to get a better sense of your hair’s health you can perform a simple test at home yourself, known as a <a href="https://dermnetnz.org/cme/principles/examination-of-hair-and-scalp">hair pull</a>. </p>
<p>Select a group of between 30-50 hairs (a small clump) and run your fingers from the base of the hairs at the scalp, up to the ends. You don’t need to pull hard – gentle traction is all that’s needed to dislodge a shedding hair. Look to see how many you’ve pulled out. </p>
<p>It’s normally only one or two hairs that will come out with one pull – but this can vary between people. Greater than ten hairs and your scalp is likely to be shedding more hairs than normal. This could be suggestive of alopecia – though having a dermatologist perform a <a href="https://pubmed.ncbi.nlm.nih.gov/31479564">more detailed inspection</a> may help you know if your hair loss indicates a more serious problem.</p>
<p>Changes in your hair may not simply be a case of age or how you’ve been styling it. There are many patterns of hair growth and loss to be aware of. Take heed of any differences noticed by you, or your hairdresser.</p><img src="https://counter.theconversation.com/content/224774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Baumgardt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many diseases can alter the quality and appearance of your hair.Dan Baumgardt, Senior Lecturer, School of Physiology, Pharmacology and Neuroscience, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2151102023-10-12T16:37:24Z2023-10-12T16:37:24ZThe ‘male menopause’ – what you need to know<p><a href="https://www.itv.com/news/central/2023-10-04/nhs-trust-to-give-staff-paid-leave-for-male-menopause">East Midlands Ambulance Service</a> is reportedly giving men up to a year of paid leave for “<a href="https://www.nhsemployers.org/system/files/2021-06/East%20Midland%20Ambulance%20Service%20andropause%20in%20the%20workplace%20guidance.pdf">andropause related issues</a>”, which some are calling the “male menopause”.</p>
<p>This move has <a href="https://www.thetimes.co.uk/article/mariella-frostrup-men-get-your-hands-off-our-menopause-zccdh78hg">angered some commentators</a> who question whether there really is such a thing as the male menopause or “manopause”.</p>
<p>The andropause is not a condition that was recently invented. The medical establishment has been talking about it since <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/#:%7E:text=%E2%80%9CAndras%E2%80%9D%20in%20Greek%20means%20human,of%20testosterone%20in%20older%20man">the 1940s</a> when it was known as the “male climacteric”. Symptoms of this condition include a lack of energy, weight gain (including “man boobs”), sexual difficulties, sleep problems, anxiety, irritability, depression and even hot flushes.</p>
<p>While many private clinics recognise and treat andropause, it is not recognised as a syndrome by the <a href="https://www.nhs.uk/conditions/male-menopause/">NHS</a>, nor is it usually caused by a radical drop in “male hormones”, such as testosterone. Testosterone levels do naturally decline in men, but the average decrease is around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/#:%7E:text=%E2%80%9CAndras%E2%80%9D%20in%20Greek%20means%20human,of%20testosterone%20in%20older%20man">1% per year</a> after <a href="https://health.clevelandclinic.org/declining-testosterone-levels/#:%7E:text=The%20average%20drop%20is%20about,1987%2C%201995%20and%202002.">the age of 30</a>. </p>
<p>Less common – only seen in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/#:%7E:text=%E2%80%9CAndras%E2%80%9D%20in%20Greek%20means%20human,of%20testosterone%20in%20older%20man">6% of adult men under 80</a> – are chronically low levels of testosterone, also known as androgen deficiency. This may result from accidents affecting their testes, experiencing severe illness, or treatment for prostate cancer. </p>
<p>The natural drop in testosterone can be worsened by obesity, extreme stress and some medications or diseases, including drinking too much alcohol. So the andropause is probably more of a lifestyle symptom and therefore should be tackled as such.</p>
<p>The recent media <a>spotlight</a> on female menopause has highlighted just how badly women can be affected by midlife reduction in hormone levels. So much so that the <a href="https://www.theguardian.com/society/2022/apr/24/sajid-javid-appoint-hrt-tsar-acute-shortages-menopause">UK government</a> had to appoint a dedicated “menopause tsar” to deal with the resulting shortage of oestrogel, a popular <a href="https://www.fertifa.com/post/hrt-shortage-and-how-to-get-hrt">form of HRT</a>, as more and more women seek menopause treatment.</p>
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Read more:
<a href="https://theconversation.com/menopausal-women-often-turn-to-doctors-who-know-little-about-the-symptoms-heres-what-needs-to-change-207450">Menopausal women often turn to doctors who know little about the symptoms – here's what needs to change</a>
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<p>The East Midlands Ambulance Service is commendable in wanting to support men in making mid-life lifestyle changes, but calling it the “male menopause” undermines the magnitude of the physiological changes women experience as part of female menopause. </p>
<p>For men, lifestyle <a href="https://www.emerald.com/insight/content/doi/10.1108/WWOP-12-2016-0036/full/html">changes</a> can have huge benefits. Taking care of heart health, exercise and healthy diets <a href="https://pubmed.ncbi.nlm.nih.gov/36697895/">in midlife</a> are known to be good for brain function and can help prevent dementia and heart disease later on.</p>
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<img alt="Middle-aged man stretching in a park." src="https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553480/original/file-20231012-15-y9c82z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Exercise can stave off some of the effects of declining male hormones.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/staying-active-after-retirement-happy-joyful-2131333251">Evgeny Atamanenko/Shutterstock</a></span>
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<h2>Hormone replacement</h2>
<p>While many women report that taking sex hormones helps with brain problems, actual studies do not show overall long-term benefit of hormone treatment on <a>memory or mood</a>. There are also <a href="https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/benefits-and-risks-of-hormone-replacement-therapy-hrt/">small risks linked with taking hormone therapy</a>. </p>
<p>In contrast, for those who have had their ovaries or testes removed, or take hormone blockers because of cancers, a significant drop in memory and mood can occur and reduced testosterone has been associated with an increased risk for dementia, such as <a href="https://pubmed.ncbi.nlm.nih.gov/21696899/">Alzheimer’s disease</a> and heart disease – the two main causes of death in the UK. </p>
<p>However, it is unclear whether testosterone treatment helps to reduce this risk in men, as some studies showed an increased risk of heart disease, while others found testosterone treatment to be protective or have <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(22)00115-5/fulltext">no effect</a>.</p>
<p>In men with low testosterone levels, overall <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00169-1/fulltext#:%7E:text=We%20observed%20that%20testosterone%20treatment,testosterone%20but%20without%20classic%20hypogonadism">studies</a> suggest that taking testosterone reduced depression and improved erections and libido. There may also be benefits of oestrogen or <a href="https://www.ohsu.edu/sites/default/files/2019-09/CPD%20AMH919-Adams%20handouts.pdf">testosterone</a> gel on sexual function in women. </p>
<p>However, study results have been mixed and caution should always be taken with interpreting the results of research sponsored by the industries producing the treatments. Also, libido is not simply linked to hormones, and a dry vagina or limp penis can be influenced by factors such as relationship stress or work stress – or both.</p>
<h2>The stress effect</h2>
<p>Could andropause be a manifestation of midlife stress? Most likely. And this is not a matter of hormone change. Rather, while dips in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347230/">life satisfaction</a> are only seen in 10-20% of adults in middle age (and often not shown over time), this is probably the result of an evaluation of life at this important new stage.</p>
<p>Importantly, <a href="https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/men-and-mental-health">suicide risk</a> is highest in men between 40 and 49 and is the most common cause of death in men under 50. Many men may mask their depression with alcohol, drugs and overwork. This risk is highest in the poor.</p>
<p>We should applaud the East Midlands Ambulance Service for paying attention to men’s mental health, but maybe not because of the andropause. Rather, interventions that tackle <a href="https://www.glassdoor.co.uk/Salaries/emergency-ambulance-crew-salary-SRCH_KO0,24.htm">poor pay</a>, working conditions, job stress, <a href="https://aace.org.uk/vaa/#:%7E:text=Every%20day%20during%20the%202020,over%20the%20last%20five%20years">public harassment</a> and work-life satisfaction may help improve mental health more than framing these concerns as male menopause.</p>
<p>In the full statement by the East Midlands Ambulance Services, it was made clear that there is no separate or special leave policy for andropause with 12 months off on full pay. Instead, decisions are made on a case-to-case basis, trying to keep staff in work where possible and supporting them with their mental health in a wide variety of ways.</p><img src="https://counter.theconversation.com/content/215110/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eef Hogervorst received funding from the Alzheimer's Association and RIA to investigate sex hormone levels and dementia. She also received funding from the British Council Newton Trust to investigate soy and dementia risk. Eef reviewed evidence for dementia risk after taking menopausal HRT for NICE in 2022-2023. </span></em></p><p class="fine-print"><em><span>Emma D'Donnell and Gemma Witcomb do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Testosterone in men declines at a rate of around 1% a year from age 30. That doesn’t mean that men go through the ‘manopause’.Eef Hogervorst, Professor of Biological Psychology, Loughborough UniversityEmma D'Donnell, Senior Lecturer in Exercise Physiology, Loughborough UniversityGemma Witcomb, Senior Lecturer in Psychology, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2095162023-08-17T20:10:13Z2023-08-17T20:10:13ZDon’t believe the hype. Menopausal women don’t all need to check – or increase – their testosterone levels<figure><img src="https://images.theconversation.com/files/541661/original/file-20230808-29-wiyxrp.jpg?ixlib=rb-1.1.0&rect=17%2C80%2C5973%2C3907&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/worried-young-woman-covering-face-with-hand-6382634/">Pexels/Liza Summer</a></span></figcaption></figure><p>Ever heard “low testosterone” blamed for low mood, brain fog and loss of vitality? Despite all evidence to the contrary, social media influencers are increasingly promoting testosterone therapy as an elixir for women experiencing troubling symptoms of menopause. </p>
<p>In a series of documentaries and <a href="https://www.dailymail.co.uk/health/article-11792553/Davina-McCall-effect-sparks-menopause-testosterone-treatment-rush-putting-women-risk.html">social media posts</a> about menopause in 2021 and 2022, British TV presenter Davina McCall promoted the use of testosterone therapy in addition to standard <a href="https://www.menopause.org.au/hp/information-sheets/combined-menopausal-hormone-therapy-mht">menopausal hormone therapy</a>. The “<a href="https://www.telegraph.co.uk/news/2023/02/17/davina-effect-fuels-surge-menopausal-women-using-testosterone/#:%7E:text=Chelsea%20Magazine%20Company-,'Davina%20effect'%20fuels%20surge%20in%20menopausal%20women%20using%20testosterone,NHS%20prescriptions%20for%20the%20hormone">Davina effect</a>” has helped fuel a <a href="https://pharmaceutical-journal.com/article/news/nhs-testosterone-prescribing-in-women-rises-ten-fold-in-seven-years#:%7E:text=The%20number%20of%20women%20in,The%20Pharmaceutical%20Journal%20has%20revealed">ten-fold increase</a> in prescribing of testosterone for women in the United Kingdom since 2015. </p>
<p>Data isn’t available for Australia, but in my clinical practice, women are increasingly asking to have their testosterone level checked, and seeking testosterone to treat fatigue and brain fog.</p>
<p>But while testosterone continues to be an important hormone before and after menopause, this doesn’t mean women should be having a blood test to get their testosterone levels checked – or taking testosterone therapy. </p>
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<h2>What does testosterone do?</h2>
<p>Testosterone is an important hormone in women’s bodies, affecting the blood vessels, skin, muscle and bone, breast tissue and the brain. In both women and men, testosterone can act on its own or be converted into estrogen.</p>
<p>Before menopause, testosterone is made in the ovaries, where it helps developing eggs grow and aids in estrogen production. </p>
<p>The ovaries release both testosterone and estrogen into the bloodstream, and the levels of the two hormones in the blood peak around ovulation. </p>
<p>Some of the testosterone measured in blood is also produced outside the ovaries, such as in fat, where it is made from “pre-hormones” secreted by the adrenal glands. This source of production of testosterone takes over after menopause.</p>
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Read more:
<a href="https://theconversation.com/what-makes-you-a-man-or-a-woman-geneticist-jenny-graves-explains-102983">What makes you a man or a woman? Geneticist Jenny Graves explains</a>
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<h2>Do we have more testosterone before menopause?</h2>
<p>The claim is often made that pre-menopausal women have more testosterone in their bloodstream than estrogen, to justify the need for testosterone replacement after menopause. </p>
<p>But, when sex hormones have been measured with precision, studies have shown this is not true. <a href="https://pubmed.ncbi.nlm.nih.gov/31390028/">Our research</a> found estrogen levels are higher than testosterone levels at all stages of the menstrual cycle.</p>
<p>Blood testosterone levels <a href="https://pubmed.ncbi.nlm.nih.gov/31390028/">fall</a> by about 25% between the ages of 18 and 40 years in healthy women. The fall in testosterone coincides with the decline in eggs in the ovaries but whether this is a marker of the decline, a consequence, or a cause of the decline is not known.</p>
<p>From around 40, the rate of decline slows and blood testosterone levels don’t change when <a href="https://www.menopause.org.au/hp/information-sheets/what-is-menopause">menopause</a> occurs naturally. Studies have not shown testosterone levels change meaningfully during the menopause transition.</p>
<h2>Can blood tests detect ‘low testosterone’?</h2>
<p>Some influencers claim to have a condition called “testosterone deficiency syndrome” or low levels of testosterone detected in blood tests.</p>
<p>But there is no “normal” blood level below which a woman can be diagnosed as having “testosterone deficiency”. So there’s no such thing as having a testosterone deficiency or testosterone deficiency syndrome. </p>
<p>This is also in part, because women have very low testosterone concentrations compared with men, and most commercial methods used to measure testosterone cannot separate normal from low levels in women with any certainty. </p>
<p>Pre-menopausal women might also be told they have “low” testosterone if blood is drawn early in the menstrual cycle when it is normal for testosterone to be low. (However, it would only be clinically necessary to do this type of blood test to look for <em>high</em> testosterone, in someone with with excessive hair growth or severe acne, for example, not for <em>low</em> testosterone.) </p>
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<img alt="Woman has blood taken" src="https://images.theconversation.com/files/541839/original/file-20230809-27-vq6xq7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541839/original/file-20230809-27-vq6xq7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541839/original/file-20230809-27-vq6xq7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541839/original/file-20230809-27-vq6xq7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541839/original/file-20230809-27-vq6xq7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541839/original/file-20230809-27-vq6xq7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541839/original/file-20230809-27-vq6xq7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Blood tests can’t indicate you have low testosterone levels.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/nurse-wiping-the-arm-of-a-patient-8460349/">Pexels/Los Muertos Crew</a></span>
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<p>In post-menopausal women, much of the action of testosterone occurs in the tissues where it is made, after which testosterone is either converted to estrogen or broken down before it leaks back into the circulation. So blood testosterone concentrations are not a true reflection of tissue concentrations.</p>
<p>Further complicating the picture is the enormous variability in the effects of testosterone. At a given blood level of testosterone, some women might have oily skin, acne, increased body hair growth or balding, while others will have no such effects. </p>
<p>So, looking for a “low” blood testosterone in women is not helpful. </p>
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Read more:
<a href="https://theconversation.com/how-do-i-control-my-oily-skin-and-prevent-pimples-a-dermatologist-explains-120222">'How do I control my oily skin and prevent pimples?' A dermatologist explains</a>
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<h2>Can testosterone improve sexual desire? What about other conditions?</h2>
<p>There is sound evidence that testosterone therapy may improve sexual desire in post-menopausal women who have developed low sexual desire that bothers them. </p>
<p>This was <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">confirmed by</a> a <a href="https://pubmed.ncbi.nlm.nih.gov/31353194/">systematic review</a> of clinical trials comparing testosterone with a placebo or an alternative. These trials, all of which involved a treatment time of at least 12 weeks, showed testosterone therapy, overall, improved desire, arousal, orgasm and sexual satisfaction in post-menopausal women with low desire that caused them distress. </p>
<p>Treatment is only indicated for women who want an improvement in sexual desire (after excluding other factors such as depression or medication side effects) and its success can only be determined by each woman’s personal self-reported response.</p>
<p>But there is <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">not enough evidence</a> to show testosterone is beneficial for any other symptom or medical condition. The overall available data has shown no effect of testosterone on mood or cognition.</p>
<p>As such, testosterone therapy <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2019.1637079">should not be used</a> to treat symptoms such as fatigue, low mood, muscle weakness and poor memory, or to prevent bone loss, dementia or breast cancer.</p>
<p>However research continues to investigate these potential uses, including from my <a href="https://www.monash.edu/medicine/sphpm/units/womenshealth">research team</a>, which is investigating whether testosterone therapy can <a href="https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.534">protect against bone density loss and muscle loss after menopause</a>. </p>
<p><em>You can learn more about participating in one of our studies <a href="https://www.monash.edu/medicine/sphpm/units/womenshealth/join-a-study">here</a>.</em> </p>
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<strong>
Read more:
<a href="https://theconversation.com/hot-flushes-night-sweats-brain-fog-heres-what-we-know-about-phytoestrogens-for-menopausal-symptoms-204801">Hot flushes, night sweats, brain fog? Here's what we know about phytoestrogens for menopausal symptoms</a>
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<img src="https://counter.theconversation.com/content/209516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Davis is supported by the NHMRC, Grant no 2016627, and receives project funding from the NHMRC, MRFF and the Heart Foundation. She has consulted with Lawley Pharmaceuticals (most recently, in 2020) and the company has provided testosterone and matching placebo for her competitively funded clinical trials.</span></em></p>Women are increasingly seeking testosterone therapy to treat fatigue and brain fog. But there’s no evidence it improves symptoms of menopause.Susan Davis, Chair of Women's Health, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2077562023-07-18T14:32:17Z2023-07-18T14:32:17ZMale fertility crisis: what environmental contaminants have got to do with it<figure><img src="https://images.theconversation.com/files/537480/original/file-20230714-17-hkfcq9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7487%2C4976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are multiple causes of male infertility.</span> <span class="attribution"><span class="source">Jacob Lund/Shutterstock</span></span></figcaption></figure><p>The World Health Organisation (WHO) <a href="https://www.who.int/news-room/fact-sheets/detail/infertility">recently reported</a> that around one in six couples globally are affected by infertility. For many years people tended to blame women for a couple’s infertility – especially in <a href="https://academic.oup.com/humrep/article/27/5/1383/696393">African countries</a>. </p>
<p>But it’s now known that male factor infertility contributes about 50% of total cases. And men worldwide – <a href="https://www.ajol.info/index.php/ahs/article/view/158723">Africa included</a> – are experiencing a <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-023-01054-0">worrying trend</a> of decreased sperm count and quality. </p>
<p>There are multiple causes of male infertility. However, it is clear that <a href="https://www.tandfonline.com/doi/full/10.1016/j.aju.2017.12.004">environmental contaminants</a> play a large part in declining fertility worldwide. Concern is rising about substances such as per- and polyfluoroalkyl substances, nanomaterials and endocrine disrupting compounds. These substances are found everywhere in modern <a href="https://portal.ct.gov/DEEP/Remediation--Site-Clean-Up/Contaminants-of-Emerging-Concern/Contaminants-of-Emerging-Concern#:%7E:text=According%20to%20EPA%2C%20an%20emerging,a%20new%20pathway%20to%20humans.">everyday lives</a>. Most are present in personal-care products such as soaps, shampoos and hair sprays, as well as food wrap, water bottles and many other items. </p>
<p>Other contaminants that are <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969721036974?via%3Dihub">increasing</a> in prevalence and show signs of entering our food chain are pesticides and medication. Recent <a href="https://www.mdpi.com/2305-6304/11/4/330">research</a> in our laboratory found high traces of these in the nearshore marine environment of False Bay, as well as in rivers and air in agricultural areas of South Africa’s Western Cape province. </p>
<p>Our study suggests that these “contaminants of emerging concern” might be contributing to the male infertility crisis in surprising ways.</p>
<p>In our study, we described the effects of contaminants such as pharmaceuticals and pesticides on male reproduction. We propose that these can affect men’s reproductive fitness either by interacting with their brain, or by targeting the reproductive organs such as the testes directly.</p>
<p>The public needs to be aware of the effects of contaminants in the environment on reproductive health. Our research could assist in finding a possible cause of unexplained infertility. It may also lead to preventive treatments. </p>
<h2>Impact on male fertility</h2>
<p>Our research suggests that across animals, including humans, most contaminants of emerging concern interfere with hormone function. They target the hypothalamic-pituitary-gonadal axis. </p>
<p>The axis is the part of the <a href="https://www.epa.gov/endocrine-disruption/overview-endocrine-system#:%7E:text=The%20endocrine%20system%2C%20made%20up,the%20metabolism%20and%20blood%20sugar">endocrine system</a> that controls reproductive functions – the ability to produce sperm in men and eggs in women. When the axis is disrupted, reproductive hormones aren’t released as normal. This influences the rate and quality of sperm production.</p>
<p>We report that contaminants of emerging concern can also act directly on testicles by disrupting the blood-testis barrier. This physical barrier protects the developing sperm from harmful substances that may be present in the bloodstream. Once contaminants cross the barrier, these compounds move into the compartments of the testis where sperm are produced and can interact with the cells that are involved in sperm production. These cells also play important roles in regulating the production of hormones such as testosterone. Contaminants can either directly damage these cells or interfere with their function.</p>
<p>The contaminants can also directly damage the DNA in the sperm cells, leading to genetic changes that can affect the quality of the sperm and their ability to fertilise an egg. This can result in infertility or compromise the health of the resulting children.</p>
<h2>The legacy of fathers</h2>
<p>The way environmental factors affect fertility and cause effects over multiple generations may involve the <a href="https://pubmed.ncbi.nlm.nih.gov/23955672/#:%7E:text=The%20sperm%20epigenome%20is%20unique,be%20compacted%20and%20highly%20organized.">epigenome of sperm</a>. The mechanisms are far from being fully understood. But these epigenetic marks can affect how the genes within sperm work without changing the underlying <a href="https://www.mdpi.com/1422-0067/23/6/3350">DNA sequence</a>. </p>
<p>Yet, these changes can be passed down from a parent to their child. This can happen in two ways: when the germ cells that make sperm are exposed to contaminants of emerging concern, and when the sperm itself is affected. In both cases, epigenetic changes can be passed on to future generations who have not been directly exposed to the contaminants. </p>
<p>One category of compounds whose <a href="https://www.tandfonline.com/doi/full/10.1080/15287394.2020.1786483">impact</a> on epigenetic marks that has been <a href="https://onlinelibrary.wiley.com/doi/10.1002/tox.22819">extensively</a> <a href="https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-017-0376-9">studied</a> is nonsteroidal anti-inflammatory drugs such as paracetamol and ibuprofen. These drugs are used for managing pain and inflammation. </p>
<p>But our research suggests that they also have adverse effects on reproductive health in children. For example, exposure to these pharmaceuticals during pregnancy can lead to reduction in testosterone levels and changes in genes involved in neurodevelopment in boys. Further <a href="https://www.frontiersin.org/articles/10.3389/fgene.2022.929471/full">studies</a> have also <a href="https://academic.oup.com/eep/article/5/2/dvz008/5499083">suggested</a> that when adults were exposed to insecticides their sperm carried marks in genes involved in neurological functions including susceptibility to autism spectrum disorders, schizophrenia and bipolar disorder. </p>
<p>These effects may be particularly significant when exposure to contaminants of emerging concern is cumulative. And that’s often the case. These contaminants can accumulate in the environment and enter our bodies in various ways, through diet, drinking water, and exposure at work or in recreation. </p>
<p>But there might be solutions to limit their exposure.</p>
<h2>Taking charge</h2>
<p>The numerous pathways in which contaminants of emerging concern contaminate soil, water and air are apparent. But it’s not easy to detect and eradicate these contaminants. So how do we reduce our exposure to them?</p>
<p>Current control measures include regulatory frameworks to limit the use of certain <a href="https://www.foodfocus.co.za/home//Legislation/Food-Safety/AMENDMENT-TO-REGULATIONS-GOVERNING-THE-MAXIMUM-LIMITS-FOR-PESTICIDE-RESIDUES">pesticides</a> <a href="https://www.who.int/publications/i/item/9789240014770">or</a> <a href="https://www.oncotarget.com/article/12956/text/">pharmaceuticals</a>, and develop safer alternatives. There are personal protective measures to take, such as using air and water filters, and reducing the use of plastic products that may contain contaminants of emerging concern.</p>
<p>Public health campaigns could raise awareness about the risks of exposure, or the development of new technologies that can detect and quantify these contaminants in the environment more accurately.</p>
<p>Individuals, especially men, should be made aware of the rise in male infertility and how improving their own health and avoiding exposure to contaminants can increase their chances of fatherhood.</p><img src="https://counter.theconversation.com/content/207756/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For many years women were blamed for a couple’s infertility. But it’s now known that male factor infertility contributes to about 50% of total cases.Daniel Marcu, PhD Researcher in Reproduction and Genetics, University of East AngliaLiana Maree, Senior Lecturer, University of the Western CapeShannen Keyser, Lecturer, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2021882023-03-21T20:04:42Z2023-03-21T20:04:42ZHow world sport got into a mess over trans athletes – and how it can get out of it<p>World sport has been convulsed over the past few months – indeed years – by questions about trans athletes, especially trans women, competing in their acquired gender. </p>
<p>Most recently, World Athletics announced <a href="https://www.bbc.co.uk/sport/athletics/64373487">its “preferred option”</a> of a reduced 2.5nmol testosterone limit for trans women to compete, with a final decision due on March 23. </p>
<p>Other sporting bodies have proposed stricter eligibility rules, including Rugby Football Union, the Rugby Football League, <a href="https://www.eurosport.co.uk/triathlon/british-triathlon-creates-open-category-for-transgender-athletes-to-compete-after-fina-swimming-and-_sto9021687/story.shtml">British Triathlon</a> and <a href="https://www.skysports.com/athletics/news/12040/12802213/uk-athletics-urges-government-to-change-legislation-on-transgender-athletes">British Athletics</a>, based on excluding male advantage gained through puberty or “androgenisation” (the process leading to irreversible musculoskeletal and cardiovascular changes at puberty) from female competition. </p>
<p>Like British Athletics, British Triathlon <a href="https://www.eurosport.co.uk/triathlon/british-triathlon-creates-open-category-for-transgender-athletes-to-compete-after-fina-swimming-and-_sto9021687/story.shtml">said it wanted</a> an “open” category for “all individuals including male, [male and female] transgender and those non-binary who were male sex at birth”, while World Aquatics will make trans women athletes ineligible from competing in elite women’s swimming and diving, saying “fairness was non-negotiable”. </p>
<p>Tensions are still very apparent, but there are some signs, with these new policies, of a shift on global policy from one based on testosterone levels to one based on male advantage acquired at puberty. And it is clear that the terrain has been shifting from the terrain of science to the terrain of ethics. </p>
<p>One new development has been a sort of quietening on the scientific front. Although you still get the odd piece trying to make the claim that testosterone suppression can remove male advantage, most of the serious people in the debate have given up on this claim. A <a href="https://bjsm.bmj.com/content/55/15/865.abstract">systematic review of studies</a> showed that, even if hormone therapy reduces levels to those seen in women, strength, lean body mass and muscle area remained higher for at least three years. And we always knew that the skeletal advantages remained.</p>
<p>This has led to an attempt to re-engineer the idea of “fair competition” itself. Some tend to argue that, even though <a href="https://link.springer.com/article/10.1007/s40279-020-01389-3">trans women have residual male advantages</a>, it can still be reasonable for them to compete in the female category: something that proponents are now calling “meaningful competition”.</p>
<h2>Fair competition or ‘meaningful’ competition?</h2>
<p>Setting the new terrain here is the International Olympic Committee, which, following the researchers Joanna Harper and Yannis Pitsiladis, has given its blessing <a href="https://stillmed.olympics.com/media/Documents/Athletes/Medical-Scientific/Consensus-Statements/2023_BJSM-Framework-commentary.pdf">to the twin ideas</a> of “meaningful competition” and “disproportionate advantage” in its policy documents. The general idea is that, if the advantage held by trans women is sufficiently small, so that they won’t win all the time, then it is permissible - and “meaningful” - for them to compete in the female category.</p>
<p>But there are at least three big things wrong with this approach, or <a href="https://www.tandfonline.com/doi/full/10.1080/00948705.2023.2167720">so I’ve argued</a>. The first is that what matters about male advantage is not just its size but <em>the kind</em> of advantage it is. </p>
<p>There are two types of advantage in sport: <a href="https://www.tandfonline.com/doi/abs/10.1080/17461391.2021.1943715?journalCode=tejs20#:%7E:text=In%20sport%2C%20this%20process%20has,the%20basis%20of%20eligibility%20rules.">competition advantages and category advantages</a>. Competition advantages are the sorts of things that we let play out in sport: who is the most skilful, or fastest, or the best tactician? And, yes, sometimes, we are interested in who has the biggest genetic gifts, like the lung capacity of cyclist Miguel Indurain or the wingspan of swimmer Michael Phelps – and what they can do with it.</p>
<p>Category advantages, on the other hand, are those that we control for, through categories. Some of these are between sports – like between e-bikes, motor bikes and road bikes, or between different formulae in motor sport. The more obvious ones are age, weight and sex categories. These categories exclude certain sorts of advantages by definition. If you want to allow these advantages, you must do away with the category itself. You can change how you categorise. We could shift male advantage from being a category advantage, for example, to a competition advantage.</p>
<p>But, since few people want to do away with female sport (at least explicitly), male advantage must be excluded from it. The so-called “Phelps gambit” – the idea that Phelps’ natural body shape gave him “unfair” advantages within his category, and therefore we should accept the male advantages of trans women in the same way – doesn’t work, because we don’t classify for Phelps advantages; they are competition advantages. But male sex advantages are category advantages.</p>
<p>The second big mistake is that the IOC misunderstands fair competition. Fair competition doesn’t mean that no one ever dominates – think Indurain, Phelps, Martina Navratilova, and Usain Bolt. Of course, we could organise a handicap version of every sport to allow, as near as possible, everyone to cross the line at the same time, so that who wins turns out to be arbitrary and at the whim of the handicapper. But our standard understanding of fairness in sport is a matter of processes (a “level playing field”) not outcomes (a “photo-finish”).</p>
<p>The third mistake is about the place of self-identity in categorisation. The IOC’s medical and scientific director, Richard Budgett, has endorsed the slogan “trans women are women”. But you don’t need, for now, to make your mind up on whether the slogan is true or not, because, either way, the logic of the IOC approach is wrong. If the slogan is true, then trans women should be eligible for women’s sport without having to pass any further tests. But if the slogan is false, then it’s difficult to see what motivates testosterone limits and tests, whether 10nmol or 5nmol or 2.5nmol, for two years, or three years or more, because women’s sport should only be for women.</p>
<p>Having looked at the science – and worried about the logic – World Aquatics, World Rugby, British Triathlon and British Athletics have come to more or less the same conclusion. </p>
<p>Everyone should be welcome into sport, of course, and everyone must have a fair category in which to compete. This can be done with a female category – which excludes anyone with male advantage - and an inclusive, open category for anyone who wants to compete in it. With a few details to sort out, this is a solution for almost all athletic sports, which is maximally inclusive and fair to everyone.</p><img src="https://counter.theconversation.com/content/202188/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jon Pike is on part of the advisory group for Sex Matters.</span></em></p>Why some now talk about ‘meaningful’ rather than fair competition in elite sport.Jon Pike, Senior Lecturer in Philosophy, The Open UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1944282022-11-16T13:31:31Z2022-11-16T13:31:31ZAgeing: hormone could help predict men’s long-term health years in advance – new study<figure><img src="https://images.theconversation.com/files/495612/original/file-20221116-20-s91scs.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7935%2C5020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Who is likely to develop age-related disease could be predicted years in advance by looking at INSL3.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fulllength-photo-happy-senior-man-headphones-2040514991">Evgeny Atamanenko/ Shutterstock</a></span></figcaption></figure><p>We all age, but we don’t all age the same way. For some people, ageing means an increased risk of developing illnesses such as diabetes, cardiovascular disease, weak bones and cognitive decline.</p>
<p>It would be ideal if we could predict in early adulthood, while a person is still healthy, whether or not they are at risk of becoming ill or needing medical support when they are older. By then taking preventative measures, this would mean fewer people with health issues, fewer people in care, and considerably lower costs for the health system.</p>
<p>Our <a href="https://www.frontiersin.org/articles/10.3389/fendo.2022.1016107/full">latest study</a> suggests that predicting long-term health outcomes may be possible. We have found a novel insulin-like hormone in the blood, called insulin-like peptide 3 (INSL3), that may be able to predict long-term health, and whether a person is likely to develop age-related diseases – at least for men. </p>
<p>To conduct our study, we looked at data from one of the largest cohorts of ageing men, the <a href="https://academic.oup.com/ije/article/42/2/391/733095">European Male Ageing Study</a>. This had recruited 3,369 men between the ages of 40 and 79 from across Europe, including the UK, and followed them for four-to-five years. It was designed in part to assess whether the incidence of age-related disease in men can be explained by the decline of anabolic hormones such as testosterone, which is important for growth and development in the body. </p>
<p>Using data from the European Male Ageing Study, we looked for significant associations between INSL3 levels in stored blood samples that were taken at the beginning and end of the study, and the incidence of self-reported age-related illness. INSL3 was measured using a new testing method developed in our laboratory. We compared these results with the effects of other hormones such as testosterone, and also adjusted them for age, smoking status, and clinical parameters like obesity.</p>
<h2>Strong associations</h2>
<p>We were able to show that INSL3 levels can vary markedly from one person to another, and they were strongly associated with the incidence of illnesses such as cardiovascular disease, diabetes, loss of sexual function and bone weakness.</p>
<p>Men who had high INSL3 had lower risk of later becoming ill, while men with low INSL3 had a higher risk of developing age-related disease. Importantly, by looking at blood samples taken at both the beginning and end of the study, we showed that this relationship could be predicted several years in advance. </p>
<p>Although INSL3 is made in men exclusively by the same cells in the testes that make testosterone, the latter is highly variable. Testosterone levels can change markedly from hour to hour and day to day. This high variation makes it difficult to find statistically significant associations with other factors such as disease incidence. </p>
<p>Unlike testosterone, INSL3 levels remain amazingly consistent in a man’s bloodstream over long periods of time. This makes it possible to obtain similar values even when measured weeks, months or years apart. This allowed us to determine that low INSL3 was significantly linked with higher risk of age-related illness. </p>
<figure class="align-center ">
<img alt="Three young men walking together on a beach." src="https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495614/original/file-20221116-14-5bwen0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Differences in INSL3 levels appear to emerge in men as young as 18.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/summer-holidays-vacation-happy-people-concept-192589262">Ground Picture/ Shutterstock</a></span>
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</figure>
<p>In fact, <a href="https://doi.org/10.1111/andr.13001">previous research</a> from our group has shown that person-to-person variations in INSL3 levels can be seen in apparently healthy men as young as 18. Based on our findings, it seems that INSL3 levels remain similar throughout a man’s life. This means that we may be able to look at a man’s INSL3 levels when they are young and predict how likely they are to develop certain diseases when they get older.</p>
<p>It’s likely that INSL3 has functions in its own right, acting on different organs in the body. This will need to be confirmed by further research. What is clear is that the consistency of INSL3 throughout life makes it a much easier biomarker to observe when predicting age-related disease in men.</p>
<h2><strong>What’s behind these variations?</strong></h2>
<p>Our group in Nottingham is now focused on finding out what factors influence INSL3 levels in young men, and hence their capacity to make testosterone that could affect their later health.</p>
<p>Preliminary work from animal studies suggests that early-life nutrition may play a role, but many other factors including genetics or exposure to certain environmental factors (such as smoking) may also be involved. We need to confirm the predictive ability of INSL3 by studying men over a much longer period of time.</p>
<p>Of course, this work only relates to ageing men whose testes can function consistently into old age, only gradually declining in terms of sperm and hormone production. A woman’s physiology is much more radically modulated by ovarian function, which changes dramatically after the menopause. Hence we do not yet know of an equivalent to INSL3 for women when it comes to predicting ageing and disease.</p><img src="https://counter.theconversation.com/content/194428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ravinder Anand-Ivell received funding from University of Nottingham and DFG.</span></em></p><p class="fine-print"><em><span>Richard Ivell received funding for part of this study from the German Research Council (DFG) .</span></em></p>Our study found that low levels of INSL3 hormone were associated with greater risk of cardiovascular disease, diabetes and frailty in men.Ravinder Anand-Ivell, Associate Professor of Endocrinology and Reproductive Physiology, University of NottinghamRichard Ivell, Professor of Molecular Biology and Endocrinology, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1876722022-09-26T12:31:12Z2022-09-26T12:31:12ZTransgender men and nonbinary people are asked to stop testosterone therapy during pregnancy – but the evidence for this guidance is still murky<figure><img src="https://images.theconversation.com/files/486337/original/file-20220923-214-dia4h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2048%2C1020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Diane Rodríguez and her husband, Zack Elias, are a trans couple in Ecuador.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Diane_Rodr%C3%ADguez_abraza_a_su_esposo_embarazado_Zack_Elias_en_Guayaquil_-_alta_resolusi%C3%B3n.jpg">Chichicko/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>When I talk about our research team’s work on <a href="https://doi.org/10.1080/15532739.2020.1808554">pregnancy in transgender people</a>, people often recall <a href="https://people.com/tv/people-oprah-exclusive-the-pregnant-man-speaks-out/">Thomas Beatie</a>, a pregnant man who appeared on “Oprah” and in People magazine in 2008. The media focus on Beatie and his pregnancy provoked public fascination that tended to overshadow the everyday lived realities of being pregnant as a trans person. </p>
<p>Transgender people, as opposed to cisgender people, have a gender identity that is different from the gender they were assigned at birth. Some may go on hormone therapy to help align their body with their gender identity. Like most trans men, Beatie went off testosterone during his pregnancy because it was medically advised as standard practice. But <a href="https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy">testosterone therapy</a> is often essential to the mental and physical health of many trans men as well as some nonbinary people whose genders don’t fit within the categories of man or woman. What is the experience of pausing treatment like for them? Why do medical guidelines recommend going off testosterone?</p>
<p>As a <a href="https://scholar.google.com/citations?user=JF-zRXYAAAAJ&hl=en">sociologist</a> who studies sex, gender and sexuality, and trans experiences of family, health and well-being, these questions piqued my interest. I work with an <a href="https://transpregnancy.leeds.ac.uk">international team of researchers</a> on a project about trans men and nonbinary people’s experiences of pregnancy. We interviewed 70 trans and nonbinary people who were either currently or intending to become pregnant, as well as 22 health care providers specializing in working with these communities, across seven countries.</p>
<h2>Testosterone therapy</h2>
<p>While testosterone is widely considered a “male hormone,” <a href="https://www.medicalnewstoday.com/articles/323085">all people produce testosterone</a>. Physicians consider a <a href="https://doi.org/10.1210/endocr/bqaa014">wide range</a> of testosterone levels to be “normal.”</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Thomas Beatie holding his two children" src="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=878&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=878&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=878&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1103&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1103&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1103&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Thomas Beatie is a trans man who received widespread media attention during his pregnancies.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/thomas-beatie-with-his-daughter-susan-and-son-jensen-enjoy-news-photo/120564551">Christopher Hunt/TB via Getty Images</a></span>
</figcaption>
</figure>
<p>Many transgender and nonbinary people take <a href="https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy">testosterone</a> as part of their mental and physical health care. Testosterone therapy often results in a more masculine appearance through facial hair and muscle growth, fat redistribution and lowered vocal pitch.</p>
<p>In addition to physical changes, many of our study participants spoke of positive mental health improvements while on testosterone therapy, including feeling calmer, balanced and more fully themselves – sometimes for the first times in their lives. This is a <a href="https://theconversation.com/transgender-youth-on-puberty-blockers-and-gender-affirming-hormones-have-lower-rates-of-depression-and-suicidal-thoughts-a-new-study-finds-177812">common finding</a> across research on hormone therapy and trans and nonbinary people. </p>
<p>While there’s no universal dosing protocol for trans or nonbinary people undergoing testosterone therapy, the <a href="https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence">Endocrine Society’s treatment guidelines</a> recommend supplementing testosterone until blood ranges fall within those for cisgender men. By basing clinical standards on cisgender men, these guidelines can <a href="https://doi.org/10.3390%2Fjcm9061609">reproduce sex and gender binaries</a> that may not fit with actual desires of many trans and nonbinary people. Some resist this prescriptive medical model by <a href="https://www.sfaf.org/collections/beta/microdosing-hormones-expands-gender-affirming-care-options-for-non-binary-folks/">microdosing</a> testosterone, with or without health care provider support.</p>
<h2>Testosterone and pregnancy</h2>
<p>When my team and I analyzed our research interviews, we learned that the health care providers in our study typically told their trans patients to stop testosterone therapy either six months before trying to get pregnant or immediately upon becoming aware of pregnancy. They also advised continuing to withhold testosterone therapy until either after birth or stopping chestfeeding (nursing their babies). This could mean a pause in testosterone therapy for up to two years.</p>
<p>Why do doctors tell trans and nonbinary patients to stop testosterone therapy during pregnancy? </p>
<figure>
<iframe src="https://player.vimeo.com/video/691197437" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Trans artist Chella Man weighed the decision of stopping testosterone therapy during pregnancy in a 2022 performance piece.</span></figcaption>
</figure>
<p>The health care providers we interviewed expressed concerns about patients continuing testosterone while pregnant or chestfeeding. When we asked them what risks they were most concerned about, they often noted that there is either not enough or inconclusive research on using supplemental testosterone during pregnancy. Despite this, nearly all of the providers we interviewed routinely advised patients to pause testosterone therapy without reservation. </p>
<p>Some providers compared continuing testosterone therapy during pregnancy to illicit drug use during pregnancy, perceiving it as a future risk to the child. Others suggested that testosterone use during pregnancy is selfish because it prioritizes the parent’s own health and well-being in the present over the potential health and well-being of their child in the future. Some providers even suggested that trans and nonbinary patients shouldn’t have children if they are unwilling or unable to pause testosterone therapy during pregnancy. </p>
<p>In contrast, the trans men and nonbinary people we interviewed described grappling with difficult and weighty decisions around pausing testosterone during pregnancy. These decisions often involved choosing between their own mental health and well-being against the potential health and well-being of their child. As one participant described their experience going off testosterone during pregnancy:</p>
<blockquote>
<p>“My lows were miserable, depressed, to the point of suicidal. … I knew that going back on testosterone would help. I didn’t really know whether [my doctor] would be happy to re-prescribe me testosterone … and there was a fear there that it would be withheld from me … that they were going to say, ‘Well, sorry, you came off it, you’re not getting it back.’”</p>
</blockquote>
<h2>PCOS and producing ‘normal’ children</h2>
<p>Despite it being fairly standard medical advice, there remains relatively <a href="https://doi.org/10.1080/26895269.2022.2035883">scant empirical evidence</a> guiding the practice of pausing testosterone therapy for trans men and nonbinary people during pregnancy and chestfeeding. There is also currently no published work on microdosing testosterone during pregnancy.</p>
<p>Instead, much of the medical literature on the potential developmental effects of “excess androgen” exposure in the womb focuses on pregnant people with <a href="https://www.verywellfamily.com/what-is-polycystic-ovarian-syndrome-pcos-1959930">polycystic ovary syndrome</a> who have testosterone levels that generally <a href="https://doi.org/10.1210/jc.2010-1123">fall between those for cisgender women and men</a>. These studies center on the likelihood of the baby later developing <a href="https://doi.org/10.1210/en.2016-1801">intersex conditions</a>, or having biological traits that do not fit binary definitions of male or female characteristics; later self-identification as <a href="https://doi.org/10.1093/humupd/dmi013">lesbian</a> or <a href="https://doi.org/10.1093/humrep/del474">trans</a>; <a href="https://doi.org/10.1093/humrep/deab112">metabolic and cardiovascular dysfunction</a>, such as obesity; and <a href="https://doi.org/10.1038/s41398-021-01699-8">neuropsychiatric disorders</a>, such as autism and attention-deficit disorder. Most of these concerns have involved children categorized as female at birth.</p>
<p>People with polycystic ovary syndrome, however, are <a href="https://doi.org/10.1016/s0015-0282(01)02995-8">not routinely placed on testosterone blockers</a> during pregnancy or discouraged from feeding their infants milk they produce.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/bBbXpXnT8k8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Pursuing parenthood as a trans person in an anti-LGBTQ environment comes with many challenges.</span></figcaption>
</figure>
<p>In my review of our interviews and the medical literature, I became increasingly concerned that this focus on producing “<a href="https://theconversation.com/how-pregnancy-can-be-made-more-difficult-by-maternity-cares-notions-of-normal-117223">normal</a>” children fails to attend to both natural human diversity in cognitive processing, bodies and identities, and the mental health of trans and nonbinary parents. It may also echo <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">eugenicist policies</a> that attempt to eliminate human characteristics and communities that society deems inferior or bad. But <a href="https://autisticadvocacy.org/wp-content/uploads/2016/06/whitepaper-Increasing-Neurodiversity-in-Disability-and-Social-Justice-Advocacy-Groups.pdf">people</a> <a href="https://www.thetaskforce.org/">from these</a> <a href="https://naafa.org/">communities</a> have done a great deal of work over the past several decades to ensure they are granted equal rights and protections.</p>
<p>Paradoxically, the desire to protect offspring from testosterone exposure during pregnancy and chestfeeding may become a method to prevent the reproduction of some of the very same characteristics held by trans and nonbinary parents themselves. As one participant noted:</p>
<blockquote>
<p>“There’s a bunch of research around androgen exposure in utero and intersex conditions. … I did have complex feelings around working hard to not have an intersex child. … As someone who is a gender ‘other,’ to work hard to not create a different body that is a gender ‘other’ feels weird. It feels hypocritical.” </p>
</blockquote>
<h2>Moving beyond one-size-fits-all</h2>
<p>While concerns about “androgen excess” during pregnancy for trans men and nonbinary people parallel those for people with polycystic ovary syndrome, doctors treat these cases differently. This discrepancy in clinical approach indicates that there may be other pathways forward that don’t require stopping testosterone therapy completely. </p>
<p>I believe that careful attention to the physical and mental health and well-being of trans and nonbinary people before, during and after pregnancy is long overdue in medicine. Instead of approaching testosterone therapy during pregnancy as a binary yes/no question or a one-size-fits-all standard, investigating how various dosages of testosterone may affect all stages of pregnancy and chestfeeding could lead to better outcomes for both trans parents and their children.</p><img src="https://counter.theconversation.com/content/187672/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carla A. Pfeffer received funding from the Economic and Social Research Council for her work on the Transgender Pregnancy Project.
The Trans Pregnancy Project team includes: Sally Hines (PI), Ruth Pearce, Carla A. Pfeffer, Damien W. Riggs, Elisabetta Ruspini, and Francis Ray White.</span></em></p>Testosterone therapy is often essential for the health and well-being of transmasculine people. The choice to stop it to pursue pregnancy can be a difficult one.Carla A. Pfeffer, Associate Professor of Social Work, Affiliate Faculty in Sociology and the Center for Gender in Global Context, and Director of the Consortium for Sexual and Gender Minority Health, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1821852022-05-12T12:14:39Z2022-05-12T12:14:39ZTucker Carlson pulls from an old playbook as he stokes anxiety about a masculinity crisis<figure><img src="https://images.theconversation.com/files/462490/original/file-20220511-12-5fqd6.jpg?ixlib=rb-1.1.0&rect=16%2C8%2C2684%2C2036&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bodybuilder Charles Atlas sought to turn Americans from 'Chump to Champ.'</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/famous-body-builder-charles-atlas-flexing-his-biceps-news-photo/50777197?adppopup=true">Lee Lockwood/Getty Images</a></span></figcaption></figure><p>Promotions for “<a href="https://www.youtube.com/watch?v=IcxLQeh6J6A">The End of Men</a>,” Fox News host Tucker Carlson’s forthcoming documentary, lament “<a href="https://www.nytimes.com/2022/04/22/health/tucker-carlson-testosterone.html">The total collapse of testosterone levels</a> in American men.” </p>
<p>Carlson’s central premise is that modern society has devitalized American men. Strength, drive and aggression are no longer in vogue, and Americans, as a result, are become weaker. This, the film implies, has ramifications for the country itself.</p>
<p>The purported remedies – which include tanning one’s testicles – have been <a href="https://www.rollingstone.com/politics/politics-news/tucker-carlson-end-of-men-testicle-tanning-1338944/">easy fodder</a> <a href="https://www.lamag.com/citythinkblog/can-tucker-carlsons-end-of-men-doc-teaser-be-real/">for critics</a>. But as a <a href="https://link.springer.com/book/10.1007/978-3-030-63727-9">historian of physical culture</a>, I see Carlson’s claims as part of a rich heritage of skeptics shouting from the rooftops that American men are becoming devitalized, lazy and effeminate.</p>
<p>Over the past century, these hustlers and politicians have claimed that society is making men weaker. They’ve explained that physical weakness is indicative of moral rot and weakness of character. They have cited recent social problems as evidence. And their rallying cries often have stoked anxieties about some stronger, foreign enemy.</p>
<h2>Building ‘he-men’ after the Great Depression</h2>
<p>In the 1930s, fitness guru <a href="https://www.smithsonianmag.com/history/charles-atlas-muscle-man-34626921/">Charles Atlas</a> – whose real name was Angelo Siciliano – embarked on one of the most successful fitness campaigns of all time. </p>
<p>He released a cartoon advertisement titled “<a href="https://www.roguefitness.com/theindex/wp-content/uploads/2019/09/1G3uHXoTokw22s4kuYF6t8jpf8THTMnmz.jpg">The Insult that Made a Man Out of Mac</a>” that told the story of a “97-pound weakling” who is embarrassed at the beach by muscular bullies. Shamed, the boy goes home, builds muscle using Atlas’ workout course, and returns to defeat the bully.</p>
<p>The text accompanying these ads was equally inspirational. Atlas promised to build “he-men,” to make “weaklings into men” and to turn Americans from “Chump to Champ.” The ads appeared in comic books, pop culture magazines and fitness journals. For millions of young Americans, “Mac” was a part of their comic book reading experience. </p>
<p>Older Americans were also susceptible to this messaging.</p>
<p>When <a href="https://www.doi.org/10.1057/9780230101715_8">interviewed by the New York Post in 1942</a>, Atlas’ business partner, Charles Roman, noted that the Great Depression had been a boon for business, since working-age men tended to link unemployment to a lack of physical prowess. </p>
<p>In this regard, Atlas and Roman were not alone.</p>
<p>One of Atlas’ many fitness rivals during this time, a weightlifting coach and fitness writer named <a href="https://strongmanproject.com/search(resource:11629)?q=mark%20berry">Mark Berry</a>, professed that the Great Depression was spurred, in part, by the weakness of American men. </p>
<p>His solution? A diet and exercise regimen that centered on drinking at least a gallon of milk a day and squatting with a heavy weight draped <a href="https://www.ingentaconnect.com/content/intellect/ejac/2021/00000040/00000002/art00002">across the back at least 20 times</a>. Physical bulk and strength were, in Berry’s writings, among the primary ways men could protect their livelihoods and their country.</p>
<p>The rhetoric of Atlas, Roman and Berry, it should be noted, was relatively mild for this line of promotion.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fit man poses in briefs." src="https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=871&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=871&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=871&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1095&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1095&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462500/original/file-20220511-25-w1pfhx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1095&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bernarr Macfadden was inspired by trips to fascist Italy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/congratulated-on-anniversary-telegrams-and-letters-of-news-photo/514870404?adppopup=true">Bettmann/Getty Images</a></span>
</figcaption>
</figure>
<p>During that same period, fitness writer Bernarr Macfadden had <a href="https://doi.org/10.1080/17430437.2020.1865313">trained navy cadets</a> in fascist leader Benito Mussolini’s Italy and orphans in Portugal, which was then ruled by dictator <a href="https://www.britannica.com/biography/Antonio-de-Oliveira-Salazar">António de Oliveira Salazar</a>. Upon returning to the U.S., Macfadden contrasted the strength he claimed to see in fascist countries with what he saw as an atrophying American society.</p>
<p>Americans’ unwholesome diets and sedentary behaviors in the 1930s had, in Macfadden’s view, produced a pathetically weak male populace. The solution was strong government intervention in fitness, vegetarian diets and a strict regime of physical fitness in schools.</p>
<p>Much like one of Carlson’s interview subjects who promotes testicle tanning, Macfadden, in his widely read <a href="https://onlinebooks.library.upenn.edu/webbin/serial?id=physicalculture">Physical Culture magazine</a>, also pitched a bevy of alternative approaches to revitalize American men, ranging from fasting to all-milk diets. </p>
<h2>Fears of a stronger enemy</h2>
<p>The notion that American men were weak would eventually migrate to American politics. </p>
<p>During the 1930s, Germany’s Nazi Party began to <a href="https://www.degruyter.com/document/doi/10.7560/775879-007/html">invest heavily</a> in gymnastics and sports. Soon, images and videos of tanned athletic German citizens were broadcast around Europe and the United States.</p>
<p>Thus began a period of soul-searching in democratic countries. Was fascism producing physically stronger men and women? What would happen in the event of war? </p>
<p>In the U.K., politicians created state-run programs that <a href="https://books.google.com/books?hl=en&lr=&id=CdNTCgAAQBAJ&oi=fnd&pg=PA7&dq=charlotte+macdonald+strong+fit&ots=lIUDiDKZCl&sig=0QVWt3y4aDn3H708jmUUlKpWvq8">mimicked the fascist zeal for fitness</a>.</p>
<p>While calls for America to imitate the fitness regimen of the Nazis – and, to a lesser extent, the Italian fascists – <a href="https://doi.org/10.1080/17430437.2020.1865313">existed</a>, it wasn’t until the Cold War that politicians began to seriously implement policies aimed at truly addressing the nation’s fitness.</p>
<figure class="align-center ">
<img alt="Rows of shirtless men exercising in the snow." src="https://images.theconversation.com/files/462496/original/file-20220511-15-v5wk4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462496/original/file-20220511-15-v5wk4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462496/original/file-20220511-15-v5wk4s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462496/original/file-20220511-15-v5wk4s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462496/original/file-20220511-15-v5wk4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=660&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462496/original/file-20220511-15-v5wk4s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=660&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462496/original/file-20220511-15-v5wk4s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=660&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Russian soldiers perform calisthenics in a 1965 promotional photo for Soviet Army Navy Day.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/moscow-russia-this-picture-just-released-by-tass-official-news-photo/515180944?adppopup=true">Bettmann/Getty Images</a></span>
</figcaption>
</figure>
<p>In 1956, President Dwight Eisenhower created <a href="https://doi.org/10.1080/09523367.2011.586789">the President’s Council on Youth Fitness</a>. His reasons for doing so stemmed from medical reports that American children were physically weaker than their European counterparts and <a href="https://doi.org/10.1080/09523367.2011.586789">fears that the Soviet Union was physically fitter than America</a>. </p>
<p>Eisenhower’s successor, President John F. Kennedy, intensified fears about the nation’s declining vigor. Writing for Sports Illustrated in December 1960, then-President-elect Kennedy published an article titled “<a href="https://www.jfklibrary.org/asset-viewer/archives/JFKPOF/094/JFKPOF-094-003">The Soft American</a>” to encourage American citizens – in particular, men – to take their fitness seriously.</p>
<p>Sociologist Jeffrey Montez De Oca coined the term “<a href="https://doi.org/10.1111/j.1467-6443.2005.00253.x">muscle gap</a>” to describe this anxiety. Taking its name from the “<a href="https://www.theatlantic.com/magazine/archive/2013/08/what-missile-gap/309484/">missile gap</a>” – the perceived superiority of the USSR’s quantity and quality of missiles over America’s – it refers to the perceived weakness, and softness, of American men’s bodies compared to those of their communist counterparts. A soft body was indicative of a soft mind – and, worse yet, could even make one vulnerable to communist ideology.</p>
<h2>A different flavor of the same thing</h2>
<p>The Cold War may have ended, but fears that American men’s weaknesses pose a threat to the country have never gone away.</p>
<p>In 2019, the Centers for Disease Control and Prevention published a notice claiming that <a href="https://www.cdc.gov/physicalactivity/downloads/unfit-to-serve.pdf">obesity was threatening national security</a>. In November 2021, Republican Sen. Josh Hawley delivered a speech in which he argued that changing gender norms were <a href="https://www.hawley.senate.gov/senator-hawley-delivers-national-conservatism-keynote-lefts-attack-men-america">destabilizing men’s sense of purpose</a> – and were part of a broader project by “the Left” to “deconstruct” men.</p>
<p>The <a href="https://www.thenation.com/article/society/tucker-carlson-end-of-men/">social reasons</a> cited in Carlson’s documentary for the decline of men – poor food choices, overweight bodies, a disconnect from nature – form the latest evolution of masculinity crises. If anything, the new version has simply added a sprinkle of vaccine skepticism, fears of <a href="https://theconversation.com/the-dip-in-the-us-birthrate-isnt-a-crisis-but-the-fall-in-immigration-may-be-161169">declining birthrates</a> and anti-intellectualism. </p>
<p>That the documentary includes footage of JFK voicing his concerns about American children in the 1960s is proof of a much longer lineage. I wonder: Why does this story remain so powerful in the American psyche? Why is a subset of Americans so eager to believe that they, or their counterparts, are weak? </p>
<p>Given what we know of this history, perhaps the most pertinent question to ask is what golden standard the men of today are being compared with.</p><img src="https://counter.theconversation.com/content/182185/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Conor Heffernan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Fox News host’s forthcoming documentary ‘The End of Men’ is part of a rich heritage of hustlers and politicians claiming that American men are becoming devitalized, lazy and effeminate.Conor Heffernan, Assistant Professor of Physical Culture and Sport Studies, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1788722022-03-30T14:55:29Z2022-03-30T14:55:29ZScience shows that BPA and other endocrine disruptors are harmful to human health, which should incite tighter regulations<figure><img src="https://images.theconversation.com/files/452623/original/file-20220316-8334-1f833zv.jpg?ixlib=rb-1.1.0&rect=60%2C45%2C3253%2C2224&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">BPA is an industrial chemical used to make hard, clear plastic known as polycarbonate. It's also used in the lining of some cans. Many hard plastic bottles no longer contain BPA, and it's illegal to sell baby bottles with BPA in Canada.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span></figcaption></figure><p>More than two decades after the publication of <a href="https://www.penguinrandomhouse.ca/books/328770/our-stolen-future-by-theo-colborn/9780452274143"><em>Our Stolen Future</em></a>, what is the state of research on endocrine disruptors? Are those sneaky contaminants continue to interfere with our hormones?</p>
<p>In the book, scientists Theo Colborn and John Peterson Myers, along with journalist Dianne Dumanoski, shed light on the terrible effects that many environmental contaminants are having on the health of living things, as they interact with the hormonal system, also called the endocrine system. </p>
<p>These chemicals, called <a href="https://www.unep.org/explore-topics/chemicals-waste/what-we-do/emerging-issues/endocrine-disrupting-chemicals">endocrine disruptors</a>, can mimic or interfere with the body’s hormones, including thyroid hormones, estrogen, testosterone, etc. Endocrine disruptors can impair the development and proper functioning of the reproductive, nervous and immune systems in humans and animals, and can affect future generations.</p>
<p>One of us, Valérie, holds the Canada Research Chair in Ecotoxicogenomics and Endocrine Disruption. The other, Isabelle, studies the environmental causes of breast cancer. Together, we founded the <a href="https://www.ciape-iceda.ca/?lang=en">Intersectorial Centre for Endocrine Disruptor Analysis</a> (ICEDA) at the Institut national de la recherche scientifique.</p>
<p>Along with our colleagues, we recently published <a href="https://www.sciencedirect.com/journal/environmental-research/special-issue/10TZJBCC3C3">a collection of articles that review the scientific literature on endocrine disruptors</a> and their deleterious impacts on health. </p>
<h2>The origin of endocrine disruptors</h2>
<p><a href="https://www.trentu.ca/wqc/facultystaff/cmetcalfe">Chris Metcalfe</a>, professor emeritus in the environment school at Trent University, and his colleagues have <a href="https://doi.org/10.1016/j.envres.2021.112658">identified</a> several endocrine disruptors in the environment (water, soil, air, sediment), in food and consumer products. These include organochlorine pesticides, brominated flame retardants, per- and polyfluoroalkyl substances (used in non-stick coatings), alkylphenols (used in detergents), phthalates (used in cosmetics), bisphenol A and its analogues (used in plastics), organotins (used as anti-fouling agents) and others.</p>
<p><a href="https://www.canada.ca/en/health-canada/services/home-garden-safety/bisphenol-bpa.html">Bisphenol A</a> (or BPA) is a good example of an endocrine disruptor. Since 1960, it has been incorporated into most of the plastics we use every day, from plastic bottles and food containers to <a href="https://environmentaldefence.ca/2021/01/26/loblaw-costco-ban-toxic-bpa-bps-receipts/">cash register receipts</a> and canned goods.</p>
<p>BPA has a structure that resembles natural estrogen. Because of this, it was considered for use as a medication to treat menopausal women in the 1930s, <a href="https://doi.org/10.1016/j.dsx.2021.03.031">prior to its widespread use the production of plastics a few decades later</a>.</p>
<p>In the body, BPA binds to estrogen receptors in cells and induces inappropriate and untimely responses, such as increasing cell proliferation, <a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp.9282">which could promote the development of tumours</a>.</p>
<h2>Infertility in animal species</h2>
<p>A <a href="https://doi.org/10.1016/j.envres.2021.112584">literature review</a> led by <a href="https://www.sfu.ca/biology/people/faculty/vlm1.html">Vicki Marlatt</a>, an environmental toxicology researcher at Simon Fraser University, reveals a damning and widespread finding: many of these environmental contaminants impair reproduction in fish, amphibians, birds, mammals and humans, reducing their chances of producing viable offspring.</p>
<p>In humans and other animals, embryonic development and early life stages are the periods most susceptible to the effects of these contaminants.</p>
<p><a href="https://inrs.ca/en/research/professors/geraldine-delbes/">Géraldine Delbès</a>, a professor of reproductive toxicology at INRS, and her colleagues <a href="https://doi.org/10.1016/j.envres.2021.112040">have shown</a> that exposure to endocrine disruptors during this window of susceptibility leads to changes in testicular and ovarian programming. </p>
<p>For example, a decrease in androgens (testosterone and dihydrotestosterone) and an increase in estrogens can lead to a developmental disorder of the testes in children called <a href="https://doi.org/10.1093/humrep/16.5.972">testicular dysgenesis syndrome</a>, which has increased globally in the past 50 years.</p>
<h2>Fetal exposure can lead to adult disease</h2>
<p>Our research with <a href="https://inrs.ca/en/research/professors/cathy-vaillancourt/">Cathy Vaillancourt</a>, who studies pregnancy and toxicology at INRS, has shown that endocrine disruptors can interfere with <a href="https://doi.org/10.1016/j.envres.2021.112435">the hormones produced by the placenta, known for its robust defence barriers</a>, which can lead to health complications later in life. Chronic diseases such as diabetes and obesity have been associated with exposure to endocrine disruptors crossing the placental barrier during fetal development.</p>
<p>We also have <a href="https://doi.org/10.1016/j.envres.2021.112435">shown that early exposure to endocrine modulators</a> can affect the development of fetal mammary glands, and increase the risk of developing breast cancer in adulthood. These include BPA, brominated flame retardants and diethylstilbestrol (DES). Research by <a href="https://www.crchudequebec.ulaval.ca/en/research/researchers/etienne-audet-walsh/">Étienne Audet-Walsh</a>, who studies endocrinology and nephrology at Laval University, and his colleagues has suggested that <a href="https://pubmed.ncbi.nlm.nih.gov/34562481/">exposure to endocrine disruptors could be linked to the development prostate cancer</a>.</p>
<figure class="align-center ">
<img alt="A syringe, stethoscope and paper with the word 'Diabetes' written across the type of it." src="https://images.theconversation.com/files/452622/original/file-20220316-8416-l0hij2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452622/original/file-20220316-8416-l0hij2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452622/original/file-20220316-8416-l0hij2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452622/original/file-20220316-8416-l0hij2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452622/original/file-20220316-8416-l0hij2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452622/original/file-20220316-8416-l0hij2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452622/original/file-20220316-8416-l0hij2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some studies have found links between endocrine disruptors and the development of diabetes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Multiple physiological effects</h2>
<p>Endocrine disruptors can also alter other hormonal pathways, including those of the thyroid gland, which are also involved in stress control, immunity and metabolism.</p>
<p>With <a href="https://www.uvic.ca/science/biochem/people/faculty/profiles-new/helbing-caren.php">Caren Helbing</a>, a biochemist at the University of Victoria, we have developed an understanding of <a href="https://doi.org/10.1016/j.envres.2021.111906">the impacts altered thyroid hormone levels can have on other hormonal systems</a>. For example, when endocrine disruptors decrease levels of thyroid hormones, reproduction, stress and metabolism are also affected.</p>
<p><a href="https://www.vetmed.ufl.edu/profile/martyniuk-christopher/">Chris Martyniuk</a>, an animal physiologist at the University of Florida, and his team <a href="https://doi.org/10.1016/j.envres.2021.111904">have identified</a> new targets of endocrine modulators, such as glucocorticoids (corticosteroids). They cite two examples of studies in their work, including the link between high levels of BPA in urine and an increased risk of cardiovascular disease. Certain endocrine disruptors (arsenic, phthalates, organophosphate pesticides) can interfere with insulin and lead to obesity.</p>
<h2>From one generation to the next</h2>
<p>Endocrine disruptors may also have transgenerational effects. For example, when <a href="https://doi.org/10.1073/pnas.1811695115">fish are exposed to water contaminated with antidepressants</a>, the offspring of their offspring show an altered stress response, even if that generations was never exposed to these chemicals.</p>
<p><a href="https://www.mcgill.ca/robairelab/">Bernard Robaire</a>, a professor of reproduction, pharmacology and toxicology at McGill University, has attempted to explain how endocrine disruptors affect future generations. The data he and his team have compiled indicates that the <a href="https://doi.org/10.1016/j.envres.2021.112063">effects of these chemicals are not the result of changes in the genetic code</a>, but other cellular changes, including which genes are turned on or off, a mechanism called <a href="https://www.sciencedirect.com/topics/neuroscience/epigenetic-mechanism">epigenetics</a>.</p>
<p>The long-term extent of these consequences is not completely understood. Additional genetic and epigenetic research on the mechanisms underlying the action of endocrine disruptors will be needed, but we also need a better understanding the roles of social, metabolic and environmental stressors.</p>
<p>Globally, we believe that international collaboration and leadership are increasingly needed to advance the science of endocrine disruptors. We must move from the stage of research that characterizes the negative health effects of these chemicals to one that develops best practices for their regulation, which remains an important topic of discussion around the world.</p><img src="https://counter.theconversation.com/content/178872/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Valérie S. Langlois has received funding from the Natural Sciences and Engineering Research Council of Canada (NSERC) and Canada Research Chairs. She is the Director of the Intersectoral Center for the Analysis of Endocrine Disruptors (ICEDA), which is funded by the Institut national de la recherche scientifique (INRS).</span></em></p><p class="fine-print"><em><span>Isabelle Plante has received funding from the Natural Sciences and Engineering Research Council of Canada (NSERC), the Cancer Research Society (CRS) and the Fonds de recherche du Québec-Santé (FRQS). She is the co-director of the Intersectoral Centre for Endocrine Disruptors Analysis (CIAPE-ICEDA) which is funded by the Institut national de la recherche scientifique (INRS).</span></em></p>There is abundant evidence of the involvement of endocrine disruptors in reproductive dysfunction in several species, including humans.Valérie S. Langlois, Professor/Professeure titulaire, Institut national de la recherche scientifique (INRS)Isabelle Plante, Associate Professor, Institut national de la recherche scientifique (INRS)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722932022-02-04T13:09:35Z2022-02-04T13:09:35ZNot everyone is male or female – the growing controversy over sex designation<figure><img src="https://images.theconversation.com/files/441210/original/file-20220118-13-l32vzy.jpg?ixlib=rb-1.1.0&rect=0%2C26%2C5906%2C3904&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although the medical establishment is now recognizing that sex is not binary, society as a whole has been slow to embrace the concept.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/small-beautiful-child-lies-on-the-bed-on-his-royalty-free-image/1300384940?adppopup=true">Vera Livchak/Moment via Getty Images</a></span></figcaption></figure><p>Check out your birth certificate and surely you’ll see a designation for sex. When you were born, a doctor or clinician assigned you the “male” or “female” label based on a look at your genitalia. In the U.S., this has been <a href="https://doi.org/10.1056/nejmp2025974">standard practice for more than a century</a>. </p>
<p>But sex designation is not as simple as a glance and then a check of one box or another. Instead, the overwhelming evidence shows that <a href="https://doi.org/10.1002/ase.2002">sex is not binary</a>. To put it another way, the terms “male” and “female” don’t fully capture the complex biological, anatomical and chromosomal variations that occur in the human body. </p>
<p>That’s why calls are growing to remove sex designation from birth certificates, including <a href="https://thehill.com/changing-america/respect/equality/566767-ama-doctors-experts-recommend-removing-sex-designation-from">a recent recommendation</a> from the American Medical Association. </p>
<p>I am a <a href="https://www.bumc.bu.edu/busm/profile/carl-streed/">professor of medicine</a> who has worked extensively <a href="https://scholar.google.com.au/citations?user=Rv-dZJ4AAAAJ&hl=en">on lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) issues</a>. My co-author is a <a href="https://www.childrenshospital.org/directory/physicians/g/frances-grimstad">professor of gynecology</a> who is deeply involved in the health of people who are trans and intersex. </p>
<p>Our research and clinical experience show that sex designation is not something to take for granted. For those who don’t fit neatly into one of two categories – <a href="https://doi.org/10.1002/(sici)1520-6300(200003/04)12:2%3C151::aid-ajhb1%3E3.0.co;2-f">and there are millions</a> – an inappropriate classification on a birth certificate can have consequences that last a lifetime.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/n_5l2fwWGco?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What does intersex mean?</span></figcaption>
</figure>
<h2>The problems with sex designation</h2>
<p>Variations in genital anatomy happen more frequently than you might think; <a href="https://doi.org/10.1002/(sici)1520-6300(200003/04)12:2%3C151::aid-ajhb1%3E3.0.co;2-f">they occur in 0.1 to 0.2% of births annually</a>. In the U.S., that’s about 4,000 to 8,000 babies each year. </p>
<p>Other sex traits don’t necessarily help either. Doctors examining the reproductive organs <a href="https://doi.org/10.1038/518288a">can find people</a> born with both a vagina and testes, and also those born without any gonads. And when evaluating an individual’s estrogen and testosterone hormone levels, long defined as key determinants of female and male bodies, doctors find some people with vaginas still produce <a href="https://doi.org/10.1016/S0140-6736(12)60071-3">significant amounts of testosterone</a>. Because of this, testosterone is not a great indicator for defining sex; higher amounts of testosterone do not necessarily make someone male. </p>
<p>Even karyotyping – a laboratory procedure used since the 1950s to evaluate an individual’s number and type of chromosomes – doesn’t tell the whole story. While we typically expect people to either have XX or XY pairs of sex chromosomes, <a href="https://doi.org/10.1038/518288a">many people have variations</a> that <a href="https://dx.doi.org/10.1159%2F000499274">do not fit either category</a>. These include <a href="https://www.mayoclinic.org/diseases-conditions/turner-syndrome/symptoms-causes/syc-20360782#">Turner syndrome</a>, in which a person is born with a single X chromosome, and <a href="https://www.mayoclinic.org/diseases-conditions/klinefelter-syndrome/symptoms-causes/syc-20353949#">Kleinfelter syndrome</a>, which occurs when a person is born with a combination of XXY chromosomes. </p>
<p>In short, human diversity has demonstrated that the binary categories of male and female are incomplete and inaccurate. Sex designation, rather than “two sizes fit all,” <a href="https://doi.org/10.1089/lgbt.2021.0018">is on a spectrum</a>. Up to 1.7% of the U.S. population – that’s more than 5 million Americans – have an anatomy and physiology that present intersex traits.</p>
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<figcaption><span class="caption">What it’s like to be intersex.</span></figcaption>
</figure>
<h2>Binary designations can be damaging</h2>
<p>Those with intersex traits who <a href="https://doi.org/10.1371/journal.pone.0240088">are assigned at birth</a> to be female or male can <a href="https://www.amnesty.org/en/latest/campaigns/2017/05/intersex-rights/">experience medical care that harms them</a>, both physically and psychologically. </p>
<p>Sometimes physicians perform surgeries to align bodies into binary categories. For example, those born with a larger than typical clitoris <a href="https://doi.org/10.1089/lgbt.2021.0018">may have it reduced in size</a>. But some who have this childhood surgery suffer as adults from pain and difficulty having sex.</p>
<p>[<em><a href="https://memberservices.theconversation.com/newsletters?nl=science&source=inline-science-corona-important">Get The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p>
<p>Additionally, governments sometimes limit those with intersex traits from fully participating in society. For instance, in Australia, <a href="https://ihra.org.au/16808/annulment-marriage-due-intersex-marriage-falsely-called/">marriages have been annulled</a> because governments have previously ruled that an intersex person – someone not seen to be “100% man” or “100% woman” – cannot be legally married.</p>
<p><a href="https://stillmed.olympics.com/media/Documents/News/2021/11/IOC-Framework-Fairness-Inclusion-Non-discrimination-2021.pdf">Private entities</a> often do the same. The International Olympics Committee uses <a href="https://www.wired.com/story/caster-semenya-and-the-twisted-politics-of-testosterone/">cutoffs of hormone levels</a> to determine who plays in women’s sports. As a result, some athletes have been barred from participation. </p>
<p>And for those with a gender identity that differs from the sex designation on a government document, <a href="https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf">discrimination, harassment or violence</a> can result. </p>
<p>State governments have begun to acknowledge sex diversity. Some let gender-diverse people change their designation on birth certificates, <a href="https://www.lgbtmap.org/equality-maps/identity_document_laws/birth_certificate">although there are restrictions</a>. Medicine too <a href="https://doi.org/10.1089/lgbt.2021.0018">is changing</a>. For example, some pediatric centers have stopped performing surgeries on newborns with <a href="https://protect-us.mimecast.com/s/jNAuCVOrlMC8Dq3vuQEnoR?domain=them.us">differences in sex development</a>. Still, society at large <a href="https://www.cnn.com/2017/09/20/health/geas-gender-stereotypes-study/index.html">has been much slower to move beyond</a> the use of strictly binary categories. </p>
<p>As clinicians, we strive to be accurate. The evidence shows that using male and female as the only options on birth certificates is not consistent with scientific reality. Evidence shows that removing this designation will tell new parents that it’s not sex assignment that’s most important at birth but rather the celebration of a healthy and happy baby.</p><img src="https://counter.theconversation.com/content/172293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carl Streed receives funding from the National Heart, Lung, and Blood Institute and the American Heart Association. He is affiliated with the US Professional Association for Transgender Health and the American Medical Association. </span></em></p><p class="fine-print"><em><span>Frances Grimstad does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Millions of people do not fit neatly into male or female sex designations at birth, and wrong identification can set them up for a lifetime of physical and mental harm.Carl Streed Jr, Assistant Professor of Medicine, Boston UniversityFrances Grimstad, Assistant Professor of Gynecology, Harvard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1651312021-07-28T18:12:19Z2021-07-28T18:12:19ZDoes testosterone drive success in men? Not much, our research suggests<figure><img src="https://images.theconversation.com/files/413158/original/file-20210726-23-252qvb.jpg?ixlib=rb-1.1.0&rect=1%2C5%2C997%2C480&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not quite what the science says. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/playful-caucasian-business-people-work-place-1620124252">UfaBizPhoto/Shutterstock</a></span></figcaption></figure><p>There’s a widespread belief that your testosterone can affect where you end up in life. At least for men, there is some evidence for this claim: several studies have linked higher testosterone to socioeconomic success. But a link is different to a cause and using DNA, our new <a href="https://advances.sciencemag.org/lookup/doi/10.1126/sciadv.abf8257">research</a> suggests it may be much less important for life chances than previously claimed.</p>
<p>In previous studies, male <a href="https://pubmed.ncbi.nlm.nih.gov/26302434">executives</a> with higher testosterone have been found to have more subordinates, and financial traders with higher testosterone found to generate greater daily <a href="https://www.pnas.org/content/105/16/6167">profits</a>. Testosterone has been found to be higher among more highly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686046">educated</a> men, and among <a href="https://pubsonline.informs.org/doi/abs/10.1287/mnsc.2016.2664">self-employed</a> men, suggesting a link with entrepreneurship. Much less is known about these relationships in women, but one study suggested that for women, disadvantaged socioeconomic position in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4686046">childhood</a> was linked to higher testosterone later in life.</p>
<p>The beneficial influence of testosterone is thought to work by affecting behaviour: experiments suggest that testosterone can make a person more <a href="https://www.pnas.org/content/113/41/11633">aggressive</a> and more <a href="https://www.nature.com/articles/srep11206">risk tolerant</a>, and these traits can be rewarded in the labour market, for instance in wage negotiations. But none of these studies show definitively that testosterone influences these outcomes because there are other plausible explanations. </p>
<p>Rather than testosterone influencing a person’s socioeconomic position, it could be that having a more advantaged socioeconomic position raises your testosterone. In both cases, we would see a link between testosterone and social factors such as income, education and social class. </p>
<p>There are plausible mechanisms for this too. First, we know that socioeconomic disadvantage is stressful, and chronic stress can <a href="https://www.sciencedirect.com/science/article/pii/S0031938408000954?via%3Dihub">lower testosterone</a>. Second, how a person perceives their status relative to others in society might influence their testosterone: studies of sports matches, usually between men, have often found that testosterone <a href="https://pubmed.ncbi.nlm.nih.gov/27720891/">rises in the winner</a> compared to the loser.</p>
<figure class="align-center ">
<img alt="Older man holds head in front of a computer." src="https://images.theconversation.com/files/413159/original/file-20210726-21-197i1au.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413159/original/file-20210726-21-197i1au.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413159/original/file-20210726-21-197i1au.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413159/original/file-20210726-21-197i1au.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413159/original/file-20210726-21-197i1au.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413159/original/file-20210726-21-197i1au.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413159/original/file-20210726-21-197i1au.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic stress can lower your testosterone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-man-working-desk-busy-creative-130607537">Shutterstock</a></span>
</figcaption>
</figure>
<p>It’s also possible that some third factor is responsible for the associations seen in previous studies. For instance, higher testosterone in men is linked to good <a href="https://pubmed.ncbi.nlm.nih.gov/26846952/">health</a> – and good health may also help people succeed in their careers. A link in men between testosterone and socioeconomic position could therefore simply reflect an impact of health on both. (For women, higher testosterone is linked to <a href="https://pubmed.ncbi.nlm.nih.gov/20090761/">worse</a> health, so we would expect an association of higher testosterone and lower socioeconomic position.)</p>
<h2>Look at it this way</h2>
<p>It is very difficult to pick apart these processes and study just the effects of testosterone on other things. With this goal in mind, we applied a causal inference approach called “Mendelian randomisation”. This uses genetic information relevant to a single factor (here, testosterone) to isolate just the effect of that factor on one or more outcomes of interest (here, socioeconomic outcomes such as income and educational qualifications).</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="DNA visualisation with coloured bars" src="https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=462&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=462&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413160/original/file-20210726-22-8vvsyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=462&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">DNA can tell us a lot about our relationship with testosterone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/big-genomic-data-visualization-dna-test-1102537814">Zita/Shutterstock</a></span>
</figcaption>
</figure>
<p>A person’s circulating testosterone can be affected by environmental factors. Some, like the time of day, are straightforward to correct for. Others, like somebody’s health, are not. Crucially, socioeconomic circumstances could influence circulating testosterone. For this reason, even if we see an association between circulating testosterone and socioeconomic position, we cannot determine what is causing what. </p>
<p>This is why genetic information is powerful: your DNA is determined before birth and generally does not change during your lifetime (there are rare exceptions, such as changes which occur with cancer). Therefore, if we observe an association of socioeconomic position with genetic variants linked to testosterone, it strongly suggests that testosterone is causing the differences in socioeconomic outcomes. This is because influence on the variants of other factors is much less likely.</p>
<p>In more than 300,000 adult participants of the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a>, we identified genetic variants linked to higher testosterone levels, separately for men and women. We then explored how these variants were related to socioeconomic outcomes, including income, educational qualifications, employment status, and area-level deprivation, as well as self-reported risk-taking and overall health.</p>
<p>Similar to previous studies, we found that men with higher testosterone had higher household income, lived in less deprived areas, and were more likely to have a university degree and a skilled job. In women, higher testosterone was linked to lower socioeconomic position, including lower household income, living in a more deprived area, and lower chance of having a university degree. Consistent with previous evidence, higher testosterone was associated with better health for men and poorer health for women, and more risk-taking for men.</p>
<p>However, there was little evidence that genetic variation related to testosterone affected socioeconomic position at all. In both men and women we detected no effects of genetic variants related to testosterone on any aspect of socioeconomic position, or health, or risk-taking. </p>
<p>Because we identified fewer testosterone-linked genetic variants in women, our estimates for women were less precise than for men. Consequently, we could not rule out relatively small effects of testosterone on socioeconomic position for women. Future studies could examine associations in women using larger, female-specific samples.</p>
<p>But for men, our genetic results clearly suggest that previous studies may have been biased by the influence of additional factors, potentially including the impact of socioeconomic position on testosterone. And our results indicate that – despite the social mythology surrounding testosterone – it may be much less important for success and life chances than earlier studies have suggested.</p><img src="https://counter.theconversation.com/content/165131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Hughes receives funding from the Health Foundation and the Medical Research Council.</span></em></p><p class="fine-print"><em><span>Neil Davies works in a unit that receives support from the University of Bristol and the UK Medical Research Council, and NMD is also supported by a Norwegian Research Council Grant number and the Health Foundation. </span></em></p><p class="fine-print"><em><span>Sean Harrison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research suggests that despite the social mythology that surrounds testosterone in men, it may be much less important for life chances than previously thought.Amanda Hughes, Senior Research Associate in Epidemiology, University of BristolNeil Davies, Senior Research Fellow, University of BristolSean Harrison, Systematic Reviewer, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1329562021-07-11T12:28:42Z2021-07-11T12:28:42ZSex testing at the Olympics should be abolished once and for all<figure><img src="https://images.theconversation.com/files/409762/original/file-20210705-126479-1ab8by4.jpg?ixlib=rb-1.1.0&rect=24%2C24%2C2961%2C1725&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women's 800-metre silver medal winner Margaret Nyairera Wambui, left, shakes hands with gold medal winner Caster Semenya on the podium at the 2018 Commonwealth Games in Australia. Both runners have refused to take hormone-reducing drugs so they could compete at the Tokyo Olympics.</span> <span class="attribution"><span class="source">(AP Photo/Mark Schiefelbein)</span></span></figcaption></figure><iframe style="width: 100%; height: 250px; border: none; position: relative; z-index: 1;" src="https://narrations.ad-auris.com/widget/the-conversation-canada/sex-testing-at-the-olympics-should-be-abolished-once-and-for-al" width="100%" height="400"></iframe>
<p>Like the proverbial whack-a-mole, the Olympic sex test keeps coming back — with disastrous effects for women athletes across the globe — no matter how many times athletes and human rights’ advocates think they have abolished it.</p>
<p>The test was introduced in the 1930s to weed out <a href="https://books.google.ca/books?id=nT4bDAAAQBAJ&pg=PA24&lpg=PA24&dq=%E2%80%9Cathl%C3%A9tes+femmes+anormales%E2%80%9D&source=bl&ots=5ssYpczWUM&sig=ACfU3U0t-Xdxuxv2c_TFJPH_G4jF4gwoLg&hl=en&sa=X&ved=2ahUKEwj52u6izszxAhXYsZ4KHfAuBokQ6AEwAHoECAIQAw#v=onepage&q=%E2%80%9Cathl%C3%A9tes%20femmes%20anormales%E2%80%9D&f=false">“abnormal women athletes”</a> from the Olympics. The first test was a physical examination. </p>
<p>During the 1960s, when women began to object to the test’s <a href="https://olympics.time.com/2012/07/02/how-the-ioc-tests-for-gender/">“nude parades,”</a> the official response was not abolition, but replacement by chromosome analysis.</p>
<p>Feminists, athletes, geneticists, ethicists, and national governments protested, but it took until the 1990s when the International Amateur Athletic Federation (now known as World Athletics) and the International Olympic Committee ended the test. </p>
<h2>The ‘fine print’</h2>
<p>That turned out to be short lived. In the fine print of those decisions, the governing bodies reserved the right to resume the testing of <a href="https://www.washingtonpost.com/news/made-by-history/wp/2018/02/22/first-they-qualified-for-the-olympics-then-they-had-to-prove-their-sex/">“suspicious” women</a>. </p>
<p>After the triumph of South African middle distance runner Caster Semenya at the 2009 world championships in Berlin, World Athletics and the IOC <a href="https://www.worldathletics.org/news/iaaf-news/iaaf-to-introduce-eligibility-rules-for-femal-1">instituted a “hyperandrogenism” test</a> which set a limit of 10 nanomoles on the amount of natural testosterone a woman could possess to remain eligible.</p>
<p>In 2014, Indian sprinter Dutee Chand was singled out for the test and suspended just as she was finalizing her preparations for the Commonwealth Games in Glasgow. With the help of scholars Payoshni Mitra and Katrina Karkazis, the Sport Authority of India and Toronto lawyers Jim Bunting and Carlos Sayao, Chand appealed to the Court of Arbitration for Sport (CAS), sometimes called the supreme court of international sport. <a href="https://www.cbc.ca/radio/thecurrent/the-current-for-july-29-2015-1.3171969/dutee-chand-wins-case-for-high-testosterone-female-athletes-1.3171976">She won.</a></p>
<figure class="align-center ">
<img alt="Athlete, with an Indian flag draped around her shoulders, raises one arm to wave at the crowd." src="https://images.theconversation.com/files/409754/original/file-20210705-126479-1jetgly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409754/original/file-20210705-126479-1jetgly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409754/original/file-20210705-126479-1jetgly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409754/original/file-20210705-126479-1jetgly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409754/original/file-20210705-126479-1jetgly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409754/original/file-20210705-126479-1jetgly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409754/original/file-20210705-126479-1jetgly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">India’s Dutee Chand celebrates after her second-place finish in the women’s 100-metre final during at the 2018 Asian Games in Indonesia.</span>
<span class="attribution"><span class="source">(AP Photo/Ashley Landis)</span></span>
</figcaption>
</figure>
<p>The CAS overturned Chand’s suspension and the very policy itself on the grounds that the scientific evidence submitted by the athletics body was unconvincing. The IOC called off the test and both Chand and Semenya competed in the Rio Olympics, with Semenya again winning the 800 metres.</p>
<h2>Short-lived protection</h2>
<p>However, the optimism that the CAS would prove an effective protector of gender rights proved short-lived. In 2018, World Athletics imposed a revised threshold of five nanomoles of natural testosterone on the five events in which Semenya runs — ranging from 400 metres to the mile — and promptly suspended her. She, too, appealed to CAS, on the grounds that her human rights as a woman had been violated. </p>
<p>Semenya submitted extensive evidence that the test had driven many other women from the sport, stolen their livelihoods, subjected them to ridicule and harassment, and in a few frightening cases, forced them to undergo unnecessary, irreversible medical intervention, including surgery. Most of the affected athletes came from the Global South.</p>
<p>She was unsuccessful. While the CAS acknowledged the new regulation was discriminatory, it claimed that human rights were beyond the scope of its mandate. </p>
<p>Semenya has since appealed to the European Court of Human Rights, but no decision has been announced.</p>
<p>The ruling by World Athletics means Semenya could compete in the 5,000 metres event without undergoing treatment to reduce her natural testosterone. While she is the current 5,000 metre champion in South Africa, <a href="https://olympics.com/en/news/sthletics-caster-semenya-misses-5000m-olympic-qualifying-time-durban">she was unable to meet the Olympic qualifying standard</a>. This means she <a href="https://www.wsj.com/articles/caster-semenya-tokyo-olympics-11625159284">won’t compete in Tokyo</a>.</p>
<figure class="align-center ">
<img alt="Waist-up shot of Semenya in the middle of a pack of other runners, mid-stride." src="https://images.theconversation.com/files/409755/original/file-20210705-35872-1gfnvu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409755/original/file-20210705-35872-1gfnvu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=483&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409755/original/file-20210705-35872-1gfnvu4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=483&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409755/original/file-20210705-35872-1gfnvu4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=483&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409755/original/file-20210705-35872-1gfnvu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=607&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409755/original/file-20210705-35872-1gfnvu4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=607&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409755/original/file-20210705-35872-1gfnvu4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=607&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Caster Semenya on her way to winning the 5000-metres at the South African national championships in April. However, she was unable to meet the Olympic standard time in order to compete at the Tokyo Olympics.</span>
<span class="attribution"><span class="source">(AP Photo/Christiaan Kotze/File)</span></span>
</figcaption>
</figure>
<p>The persistence of the test, despite the condemnation of the <a href="https://undocs.org/en/A/HRC/44/26">United Nations High Commissioner for Human Rights</a>, <a href="https://www.nytimes.com/2020/12/04/sports/olympics/intersex-athletes-human-rights.html">Human Rights Watch</a>, <a href="https://www.wma.net/news-post/wma-reiterates-advice-to-physicians-not-to-implement-iaaf-rules-on-classifying-women-athletes/">the World Medical Association</a> and many scientific and academic bodies, painfully exposes the empty human rights rhetoric of the IOC. There is no scientific, legal, or ethical basis for such tests. </p>
<h2>A history of ignorance</h2>
<p>As the longtime athletics official and IOC member <a href="https://www.theglobeandmail.com/opinion/article-to-be-on-the-right-side-of-history-the-ioc-must-rule-out-sex-testing/">Arne Lundqvist acknowledged</a> at the CAS: “There has been a long history of ignorance.”</p>
<p>The way that such policies have been developed flies in the face of the international standard for arms-length vetting, evidence and consultation with those affected. </p>
<p>It is a stain on the Tokyo Olympics that Semenya, the two-time Olympic gold medallist and three-time world champion, one of the most charismatic athletes in the world, has been barred from defending her 800-metre title simply on the basis of unfounded stereotypes.</p>
<p>To empower unaccountable sports bodies, advised by self-selected physicians, to exclude some women on the basis of their personal perceptions of womanhood is both wrong-headed and unfair. The sex test should be abolished once and for all, and gender self-identification should become the basis for eligibility in women’s events at the Games.</p>
<h2>Focus on human rights</h2>
<p>How can the sex test be abolished? The most obvious solution is to follow Semenya’s lead and win women’s rights under the banner of human rights. Human Rights Watch has proposed that the <a href="https://www.hrw.org/report/2020/12/04/theyre-chasing-us-away-sport/human-rights-violations-sex-testing-elite-women">IOC adopt the UN Guiding Principles on Business and Human Rights</a>, which require a formal legal mechanism to hear and rule on complaints, and others have done the same. </p>
<p>While the <a href="https://olympics.com/ioc/news/the-olympic-charter">Olympic Charter proclaims</a> that “the practice of sport is a human right,” the IOC has failed to provide any mechanism to enforce human rights, claiming that as a private organization it enjoys the “autonomy of sport” from governments and human rights regimes. A growing body of scholarship disputes that claim. </p>
<p>The IOC does seem to be moving in the right direction, <a href="https://stillmed.olympic.org/media/Document%20Library/OlympicOrg/Documents/Olympic-Agenda-2020/Olympic-Agenda-2020-Recommendation-28-November-2016.pdf">floating the notion</a> of “responsible autonomy” and requiring that workers’ and citizens’ rights be protected in the staging of the 2024 Olympics in Paris and the 2028 Olympics in Los Angeles.</p>
<p>But it seems reluctant to impose any human rights requirements or protections upon Tokyo or the 2022 Winter Olympics in Beijing. It continues to restrict athletes’ rights to free speech in the recently announced revisions to Rule 50 that governs conduct at the Games. </p>
<p>I wish there was another way, but to end the sex test once and for all, we must first win the battle for Olympic human rights.</p><img src="https://counter.theconversation.com/content/132956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Kidd is an honorary member of the Canadian Olympic Committee. </span></em></p>Mandatory sex testing at the Olympics might have stopped in the 1990s, but the policing of high performance female athletes’ bodies is still ongoing.Bruce Kidd, Professor Emeritus of Kinesiology and Physical Education, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1600092021-05-13T19:55:30Z2021-05-13T19:55:30ZDo naturally high testosterone levels equal stronger female athletic performance? Not necessarily<figure><img src="https://images.theconversation.com/files/407613/original/file-20210622-19-q2w22h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-strong-girl-doing-pushups-on-617483096">Shutterstock</a></span></figcaption></figure><p>Testosterone is the major androgenic (male) hormone and one of <a href="https://www.wada-ama.org/sites/default/files/resources/files/2017_anti-doping_testing_figures_en_0.pdf">the most common doping agents</a>. Athletes who participate in strength and power-based sports, including bodybuilding, athletics, wrestling and cycling, have used testosterone for decades for its muscle-building properties.</p>
<p>Contemporary anti-doping tests can detect and distinguish between the presence of pharmaceutical (“exogenous”) testosterone and natural (“endogenous”) testosterone <a href="https://pubmed.ncbi.nlm.nih.gov/19117813/">with a high level of certainty</a>. The presence of exogenous testosterone is essential to return a positive result. </p>
<p>Meanwhile, some people, males and females, present with <a href="https://pubmed.ncbi.nlm.nih.gov/25587808/">high levels of natural testosterone</a> without having ever taken androgenic hormones. These people are called “hyperandrogenic”.</p>
<p>The common perception is that total testosterone levels directly determine athletic performance. But our <a href="https://www.nature.com/articles/s41598-021-89232-1">new research</a> challenges the assumption that naturally high testosterone levels are associated with stronger athletic performance in females.</p>
<h2>How does testosterone enhance performance?</h2>
<p>Testosterone acts on muscle cells by binding to a specific receptor protein, the androgen receptor. Upon testosterone binding, the androgen receptor signals to the muscle cell to activate the pathways that trigger an <a href="https://pubmed.ncbi.nlm.nih.gov/19650790/">increase in muscle mass</a>, called muscle hypertrophy. As a result, the muscle grows and becomes stronger.</p>
<p>But let’s look at what happens when testosterone can’t perform its job in the muscle. “Androgen receptor knockout mice” are genetically modified mice that do not produce this receptor. When compared to normal male mice, male androgen receptor knockout mice lose <a href="https://pubmed.ncbi.nlm.nih.gov/18390925/">up to 20%</a> of their muscle mass and strength. This makes sense since testosterone doesn’t have a receptor to bind to anymore. </p>
<p>Surprisingly though, this doesn’t happen in female mice. Female androgen receptor knockout mice are as strong and muscular as their control counterparts. This suggests testosterone may not be necessary to reach peak muscle mass and strength in females. </p>
<figure class="align-center ">
<img alt="A young man lifts a weight in the gym." src="https://images.theconversation.com/files/400453/original/file-20210513-15-15zxcnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400453/original/file-20210513-15-15zxcnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400453/original/file-20210513-15-15zxcnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400453/original/file-20210513-15-15zxcnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400453/original/file-20210513-15-15zxcnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400453/original/file-20210513-15-15zxcnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400453/original/file-20210513-15-15zxcnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Testosterone acts on muscle cells by binding to a specific receptor protein called the androgen receptor.</span>
<span class="attribution"><span class="source">Anastase Maragos/Unsplash</span></span>
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</figure>
<p>Our new <a href="https://www.nature.com/articles/s41598-021-89232-1">human data</a> align with this hypothesis. We used a large, publicly available database and showed total testosterone levels were not associated with muscle mass or strength in 716 pre-menopausal females. </p>
<p>This is in contrast to males, where higher testosterone concentrations <a href="https://pubmed.ncbi.nlm.nih.gov/27543675/">are associated with</a> increased muscle mass and strength. </p>
<p>We’re also doing experimental research on this topic. We’ve recruited 14 young female volunteers with natural testosterone levels along a spectrum from low to hyperandrogenic. </p>
<p>Although this part of our research is not yet published in a peer-reviewed journal, our results so far appear to confirm the findings from the epidemiological data. We’ve found testosterone levels don’t correlate with thigh muscle size, strength and power even after 12 weeks of resistance training aimed at maximising muscle mass and building strength.</p>
<p>Our laboratory-based study allows us to tightly control for external factors that may influence muscle mass and strength, such as diet, sleep, training status and menstrual cycle.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-and-sport-how-to-create-a-level-playing-field-112219">Sex and sport: how to create a level playing field</a>
</strong>
</em>
</p>
<hr>
<h2>Why mightn’t testosterone enhance athletic performance in females?</h2>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/17461391.2021.1921854">Previous research suggests</a> the female sex hormones oestrogen and progesterone may take over some of the muscle-building role of testosterone in young females. </p>
<p>Another important consideration is natural testosterone exists in two forms: “free” within the bloodstream, or “bound” to a protein that reduces its capacity to signal to the muscle. Our <a href="https://www.nature.com/articles/s41598-021-89232-1">research</a> suggests “free” testosterone has the greater role in regulating female muscle mass and performance. </p>
<figure class="align-center ">
<img alt="A woman in athletic gear standing in parkland." src="https://images.theconversation.com/files/400457/original/file-20210513-17-1heo1dn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400457/original/file-20210513-17-1heo1dn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400457/original/file-20210513-17-1heo1dn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400457/original/file-20210513-17-1heo1dn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400457/original/file-20210513-17-1heo1dn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400457/original/file-20210513-17-1heo1dn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400457/original/file-20210513-17-1heo1dn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We found higher natural testosterone levels weren’t associated with increased muscle mass or strength in more than 700 pre-menopausal females.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-shot-female-athlete-wearing-earphones-739058032">Shutterstock</a></span>
</figcaption>
</figure>
<p>It’s important to acknowledge that past a certain threshold, testosterone may have a different effect on female muscle physiology. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/31615775/">recent study</a> measuring the effects of pharmaceutical testosterone on physical performance in females found after ten weeks the volunteers receiving testosterone had gained more muscle mass and could run for longer on a treadmill before becoming exhausted compared to the volunteers who didn’t receive testosterone.</p>
<p>Surprisingly though, there was no between-group difference in muscle power, muscle strength, explosive power (sprinting) and the maximum rate of oxygen consumption measured during exercise, which is the best indicator of cardiorespiratory fitness. </p>
<p>These findings support our hypothesis that total testosterone isn’t a direct determinant of muscle strength and performance in females.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-what-you-need-to-know-about-testosterone-31687">Here's what you need to know about testosterone</a>
</strong>
</em>
</p>
<hr>
<p><em>Correction: this article previously discussed the World Athletics eligibility regulations for female athletes. In correspondence to The Conversation, World Athletics has said its regulations relate to females with 46-XY chromosomes. The subjects of the author’s research are females with 46-XX chromosomes. To account for this, all references to World Athletics regulations have been removed from this article.</em></p><img src="https://counter.theconversation.com/content/160009/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Severine Lamon receives funding from the Australian Research Council (ARC) and the International Olympic Committee (IOC). </span></em></p>Our research indicates the relationship between testosterone levels and athletic performance in females is not so simple.Severine Lamon, Associate professor, Nutrition and Exercise Physiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1572852021-04-16T12:36:36Z2021-04-16T12:36:36ZI’m a pediatrician who cares for transgender kids – here’s what you need to know about social support, puberty blockers and other medical options that improve lives of transgender youth<figure><img src="https://images.theconversation.com/files/394886/original/file-20210413-15-14mvcst.jpg?ixlib=rb-1.1.0&rect=0%2C240%2C4087%2C3476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Transgender medicine uses a multidisciplinary approach to help trans youth live happier lives. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/gender-transition-concept-royalty-free-illustration/499902638?adppopup=true">Sudowoodo/iStock via Getty Images Plus</a></span></figcaption></figure><p>When Charlie, a 10-year-old boy, came in for his first visit, he didn’t look at me or my colleague. Angry and crying, he insisted to us that he was <a href="https://genderspectrum.org/articles/language-of-gender">cisgender</a> – that he was a boy and had been born male. </p>
<p>A few months before Charlie came into our office, he handed a note to his mother with four simple words, “I am a boy.” Up until that point Charlie had been living in the world as female – the sex he was assigned at birth – though that was not how he felt inside. Charlie was suffering from severe <a href="https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria">gender dysphoria</a> – a sense of distress someone feels when their gender identity doesn’t match up with their assigned gender.</p>
<p>I am a <a href="https://www.bumc.bu.edu/busm/profile/mandy-coles/">pediatrician and adolescent medicine specialist</a> who has been caring for transgender youth for over a decade using what is called a <a href="https://doi.org/10.1159/000355235">gender-affirmative approach</a>. In this type of care, <a href="https://doi.org/10.1111/jcpp.12833">medical and mental health providers work side by side</a> to provide education to the patient and family, guide people to social support, address mental health issues and <a href="https://doi.org/10.1089/trgh.2016.0009">discuss medical interventions</a>.</p>
<h2>Getting on the same page</h2>
<p>The first thing our team does is make sure our patients and families understand what gender care is. We always begin initial visits in the same way. “Our goal is to support you and your family on this journey, whatever that may look like for you. My name is Mandy and I am one of the doctors at CATCH – the <a href="https://www.bmc.org/transgender-child-adolescent-center">Child and Adolescent Trans/Gender Center for Health program</a>. I use <a href="https://www.bumc.bu.edu/gms/2020/10/17/why-pronouns-matter/">she/her pronouns</a>.” Sharing pronouns helps transgender people <a href="https://doi.org/10.1097/JXX.0000000000000217">feel seen and validated</a>.</p>
<p>We then ask patients and families to share their gender journey so we can better understand where they are coming from and where they hope to go. Charlie’s story is one we often hear. A kid may not think much about gender until puberty but begins to experience worsening gender dysphoria when their body starts changing in what feels like the wrong way.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young transgender woman hugging her mother." src="https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/394888/original/file-20210413-23-1cfhrm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Support and acceptance from family has a huge impact on a transgender person’s mental health.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransgenderYouthPhotoEssay/57c38e24d8e045af82fe12fb1431c368/photo?Query=transgender%20AND%20youth&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=102&currentItemNo=4">AP Photo/Lynne Sladky</a></span>
</figcaption>
</figure>
<h2>Social transitions with family help</h2>
<p>Transgender and gender-diverse youth (those whose <a href="https://doi.org/10.1542/peds.2018-2162">gender identity doesn’t conform</a> to the norms expected of their assigned sex) may face transphobia and discrimination, and experience alarmingly <a href="https://doi.org/10.1016/j.jadohealth.2015.04.027">higher rates of depression, anxiety, self-harm and suicide</a> than their <a href="https://www.transequality.org/sites/default/files/docs/USTS-Executive-Summary-FINAL.PDF">cisgender peers</a>. One option can be to <a href="https://doi.org/10.1007/s10935-018-0508-9">socially transition to their identified gender</a>, both at home and in the outside world. </p>
<p>An important first step is to help <a href="https://doi.org/10.1016/j.jadohealth.2013.07.019">parents become allies and advocates</a>. Connecting parents with <a href="https://www.genderspectrum.org/audiences/parents-and-family">one-to-one as well as group support</a> can help facilitate education and acceptance, while helping families process their own experience. Charlie’s parents had been <a href="https://pflag.org/family">attending a local parent group</a> that helped them better understand gender dysphoria. </p>
<p>In addition to being accepted at home, young people often want to live in the world in their identified gender. This could include changing their name and pronouns and coming out to friends and family. It can also include using public spaces like schools and bathrooms, participating on single-gender sports teams and dressing or doing other things like <a href="http://www.ftmguide.org/binding.html">binding breasts</a> or <a href="https://www.chla.org/sites/default/files/atoms/files/Tucking%20English.pdf">tucking back male genitalia</a> to present more in line with their gender identity. Though <a href="https://doi.org/10.1097/MED.0000000000000236">more research needs to be done</a>, studies show that youth who socially transition have rates of depression <a href="https://doi.org/10.1542/peds.2018-2162">similar to cisgender peers</a>. </p>
<p>Many young people find that making a social transition can be an important step in affirming identity. For those that still struggle with depression, anxiety and managing societal transphobia, seeing a <a href="https://www.wpath.org/publications/soc">therapist who has knowledge of and experience with gender-diverse identities and gender dysphoria</a> can also be helpful.</p>
<p>However, most young people also need to make physical changes to their bodies as well to feel truly <a href="https://doi.org/10.11124/JBISRIR-2017-003869">comfortable</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A teenage transgender boy with his mother speaking with a doctor." src="https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395364/original/file-20210415-21-xtejfh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Medical options for transgender youth can include hormone blockers or hormone therapy as a first step.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransgenderTeenJourneyPart1/d8bc6e1f3b9b4169be30831e858dca28/photo?Query=transgender%20AND%20doctor&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=44&currentItemNo=0">AP Photo/Lynne Sladky</a></span>
</figcaption>
</figure>
<h2>Gender-affirming medical interventions</h2>
<p>When I first met Charlie, he had already socially transitioned but was still experiencing dysphoria. Charlie, like many people, wanted his physical body to match his gender identity, and this can be achieved only through medical interventions – namely, puberty blockers, hormonal medications or surgery.</p>
<p>For patients like Charlie who have started experiencing early female or male puberty, hormone blockers are typically the first option. These medications work like a pause button on the physical changes caused by puberty. They are well studied, safe and <a href="https://doi.org/10.1210/js.2019-00036">completely reversible</a>. If a person stops taking hormone blockers, their body will resume going through puberty as it would have. Blockers give people time to further explore gender and to develop social supports. Studies demonstrate that hormone blockers reduce <a href="https://doi.org/10.1111/jsm.13034">depression, anxiety</a> and <a href="https://doi.org/10.1542/peds.2019-1725">risk of suicide</a> among transgender youth.</p>
<p>Once a person has started or completed puberty, <a href="https://doi.org/10.1542/peds.2013-2958">taking prescribed hormones</a> can help people match their bodies with their gender identities. One of my patients, Zoe, is an 18-year-old transgender woman who has already completed male puberty. She is taking <a href="https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy">estrogen and a medication to block the effects of testosterone</a>. Together, these will help Zoe’s body develop breasts, reduce hair growth and have an overall more female shape. </p>
<p>Leo, another one of my patients, is a 16-year-old transgender man who <a href="https://transcare.ucsf.edu/guidelines/masculinizing-therapy">is using testosterone</a>. Testosterone will deepen Leo’s voice, help him grow facial hair and lead to a more male body shape. In addition to testosterone, transgender men can use an <a href="https://transcare.ucsf.edu/guidelines/youth">additional short-term medication</a> to <a href="https://doi.org/10.1111/soin.12355">stop menstruation</a>. For <a href="https://genderspectrum.org/articles/language-of-gender">nonbinary people</a> like my 15-year-old patient Ty, who is not exclusively masculine or feminine, my colleagues and I <a href="https://transcare.ucsf.edu/guidelines/gender-nonconforming">personalize their treatments to meet their specific need</a>.</p>
<p>The health risks from taking hormones are <a href="https://doi.org/10.1172/JCI142029">incredibly small</a> – not significantly different, in fact, than the risks a cisgender person faces from the hormones in their body. Some prescribed hormone effects are partially reversible, but others are more permanent, like voice deepening and growth of facial hair or breasts. Hormones can also <a href="https://doi.org/10.1093/humupd/dmz026">impact fertility</a>, so I always make sure that my patients and their families understand the process thoroughly.</p>
<p>The most permanent medical options available are gender-affirming surgeries. These operations can include changes to <a href="https://doi.org/10.21037/tau.2019.06.19">genitals</a>, <a href="https://doi.org/10.1016/j.cps.2018.03.010">chest or breasts</a> and <a href="https://doi.org/10.1016/j.cps.2018.03.005">facial structure</a>. Surgeries are not easily reversible, so my colleagues and I always make sure that patients fully understand this decision. Some people think gender-affirming surgeries go too far and that minors are <a href="https://abcnews.go.com/US/arkansas-state-legislature-overrides-governors-veto-transgender-health/story?id=76904369">too young to make such a big decision</a>. But based on <a href="https://doi.org/10.1001/jamapediatrics.2017.5440">available research</a> and my own experience, patients who get these surgeries experience improvements in their quality of life through a reduction in dysphoria. I have been told by patients that gender-affirming surgery “literally saved my life. I was free [from dysphoria].”</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<h2>Ongoing gender care</h2>
<p>In March 2021, nearly five years after our first visit, Charlie walked into my exam room. When we first met, he was struggling with his gender, anxiety and depression. This time, he immediately started talking about playing hockey, hanging out with friends and making the honor roll. He has been on hormone blockers for five years and testosterone for almost a year. With the help of a supportive family and a gender-competent therapist, Charlie is now thriving.</p>
<p>Being transgender is not something that goes away. It is something my patients live with for their entire lives. Our multidisciplinary care team continues to see patients like Charlie on a regular basis, often following them into young adulthood.</p>
<p>While more research is always needed, a gender-affirmative approach and evidence-based medicine allows young transgender people to live in the world as their authentic selves. This improves quality of life and saves lives, as one of our transgender patients <a href="https://development.bmc.org/our-impact/news-publications/inspire-fall-winter-20172018/">said about his experience receiving gender-affirming care</a>. “I honestly don’t think I would be here had I not been allowed to transition at that point. I’m not always 100%. But I have hope. I am happy to see tomorrow and I know I will achieve my dreams.”</p><img src="https://counter.theconversation.com/content/157285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mandy Coles does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Transgender youth have a number of research-backed medical options available to them. The multidisciplinary approach ranges from promoting family support to hormone treatments to surgery.Mandy Coles, Clinical Associate Professor of Pediatrics and co-director of the Child and Adolescent Trans/Gender Center for Health, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1577012021-03-29T11:54:57Z2021-03-29T11:54:57ZNofap: can giving up masturbation really boost men’s testosterone levels? An expert’s view<figure><img src="https://images.theconversation.com/files/392256/original/file-20210329-19-1rxi32a.jpg?ixlib=rb-1.1.0&rect=297%2C0%2C7051%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Testosterone levels can be affected by range of causes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bodybuilder-working-out-bumbbells-weights-gym-374999587">ESB Basic/Shutterstock</a></span></figcaption></figure><p><a href="https://www.bbc.co.uk/news/blogs-trending-40382766">Nofap</a> is a growing online movement devoted to giving up masturbation and even sex for extended periods – typically around 90 days. Starting as a spin-off from a 2011 thread on <a href="https://www.reddit.com">Reddit</a>, the organisation NoFap.com <a href="https://nofap.com/">describes itself</a> as a community-centred sexual health platform, designed to help people overcome porn addiction and compulsive sexual behaviour. </p>
<p>The <a href="https://www.bbc.co.uk/bbcthree/article/fa4340d8-3f9e-4b4e-9730-d582cfb1c7e5">claimed benefits</a>, however, have now extended the reach of nofap beyond the realms of porn addiction recovery and into mainstream health and lifestyle initiatives. Advocates of nofap are heralding an array of sexual, physical and mental improvements – including increased testosterone levels. But is there any evidence to back this up?</p>
<p>There are many movements that are similar to nofap, such as <a href="https://www.healthline.com/health/healthy-sex/semen-retention">semen retention</a>, and they all appear to be predominantly aimed at and practised by straight men, with only smaller pockets of <a href="https://www.theguardian.com/lifeandstyle/2019/sep/09/whats-causing-women-to-join-the-nofap-movement">women</a> and LGBTQIA+ people participating. It has <a href="https://www.vice.com/en/article/7xywwb/let-this-be-the-last-no-nut-november-nofap-meme-explained">also been</a> taken up by certain far-right and misogynist groups, such as <a href="https://theconversation.com/designating-the-proud-boys-a-terrorist-organization-wont-stop-hate-fuelled-violence-154709">Proud Boys</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/391189/original/file-20210323-15-d4u7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391189/original/file-20210323-15-d4u7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391189/original/file-20210323-15-d4u7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391189/original/file-20210323-15-d4u7c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391189/original/file-20210323-15-d4u7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391189/original/file-20210323-15-d4u7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391189/original/file-20210323-15-d4u7c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">NoFap table.</span>
<span class="attribution"><span class="source">Daniel Kelly</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Testosterone in men does indeed have profound effects on mood, being demonstrated to <a href="https://pubmed.ncbi.nlm.nih.gov/24047633/">improve depression</a>, <a href="https://howtoliveyounger.com/the-connection-between-testosterone-and-motivation/">happiness and motivation</a>. It is clearly linked to muscle growth and physical performance (that’s why it is <a href="https://theconversation.com/caster-semenya-how-much-testosterone-is-too-much-for-a-female-athlete-116391">a banned</a> supplementary substance in most sporting events). And many aspects of male sexual function are reliant on testosterone. So why wouldn’t we connect the dots between nofap and testosterone?</p>
<h2>The actual evidence</h2>
<p>Well, the main reason is the evidence. Two studies keep popping up when evidence is quoted to support benefits of sexual abstinence as a means to increase testosterone. In the first one, ten men <a href="https://pubmed.ncbi.nlm.nih.gov/11760788/">had their</a> testosterone levels measured twice (baseline) before masturbation and orgasm (several tests are more reliable than just one), and then in ten minute intervals after. </p>
<p>This was followed by a three-week period in which they were instructed to refrain from “any type of sexual activity”. After that period, the process was repeated. Testosterone was reported as being higher in the baseline measurements after abstinence.</p>
<p>Despite the conclusions of the research, the sample size of this study was tiny. And the increase in testosterone may have actually been due to the anticipation of sexual arousal in the second experiment after abstinence. What’s more, testosterone levels at the first baseline measurement were actually the same before and after abstinence, with the second measurement differing slightly. So without more data it is impossible to really say that abstinence increases testosterone at all.</p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/12659241/">second study</a> reported a 45% increase in testosterone levels after seven days of abstinence. But this was a temporary peak which then returned to the same levels as before, even with continued abstinence, and stayed that way. Such transient alterations in testosterone levels are unlikely to have any lasting effects on men’s health and may primarily serve as a regulator of the creation of new sperm.</p>
<p>A few studies, on the other hand, have shown either no effect of abstinence on testosterone or that testosterone levels were actually higher after masturbation or sex. Measuring testosterone before and directly after masturbation in 34 healthy young men found that <a href="https://pubmed.ncbi.nlm.nih.gov/135817/">testosterone levels increased</a> after self stimulation. But any longer term effects were not checked. At best, the evidence linking masturbation with changes in testosterone levels is limited and with mixed conclusions.</p>
<figure class="align-center ">
<img alt="Image of a test tube labelled " src="https://images.theconversation.com/files/391898/original/file-20210326-15-qmlso0.jpg?ixlib=rb-1.1.0&rect=9%2C37%2C3153%2C1911&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391898/original/file-20210326-15-qmlso0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391898/original/file-20210326-15-qmlso0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391898/original/file-20210326-15-qmlso0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391898/original/file-20210326-15-qmlso0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=465&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391898/original/file-20210326-15-qmlso0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=465&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391898/original/file-20210326-15-qmlso0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=465&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Psychological problems can cause a drop in testosterone.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abnormal-low-testosterone-hormone-test-result-1137684032">Jarun Ontakrai/Shutterstock</a></span>
</figcaption>
</figure>
<p>Countering the argument for nofap is the well-documented benefits of sexual activity, including masturbation, on health. The release of endorphins during orgasm leads to positive feelings. Masturbation can help relieve built-up stress and assist relaxation, improve sleep, boost mood, release sexual tension and cramps and even allow a better understanding of sexual wants and needs. And in men there may even be some <a href="https://www.sciencedirect.com/science/article/abs/pii/S2050052116000780?via%3Dihub">possible protection</a> against prostate cancer from regular ejaculation, although this relationship is not fully clear yet.</p>
<h2>Psychological reasons</h2>
<p>In fact, masturbation as such doesn’t appear to have any negative effects on sexual and general health, and particularly in relation to testosterone levels in men. The problem may lie in excessive masturbation and attitudes towards self pleasure.</p>
<p>Personal perceptions of masturbation can cause psychological effects that impact testosterone levels. A build-up of anxiety and depression can occur if someone has feelings of guilt following masturbation. This guilt could be based around feeling immoral, such as being unfaithful to a partner or having religious conflicts. A study <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145784/">investigating the motivation</a> for abstinence found that the reason was mostly due to attitudes, specifically the perception of masturbation as unhealthy or wrong.</p>
<p>This stress from prolonged guilt, anxiety and depression can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318487/">cause decreases</a> in testosterone levels and in these situations, abstinence may relieve such feelings and could then theoretically lead to a testosterone increase. Maybe, then, the argument shouldn’t be about changing the tendency or frequency of masturbation, but more about improving understanding and attitudes towards sexual behaviour.</p>
<p>That said, abstaining from masturbation could help people with destructive porn addictions. Taking a break from pornography, masturbation, or even sex altogether for an extended period of time could help break the cycle, or reboot from porn addiction. Beyond this, though, health benefits of nofap are anecdotal and evidence to show abstinence even alters testosterone at all is simply not there.</p>
<p>So for anyone embarking on a period of “fapstinence” as a health fad, there is no apparent harm in trying and there might even be perceived improvements in certain aspects of life. But bear in mind that there is no reason to believe that nofap will meaningfully boost your testosterone levels and you may be missing out on the many benefits of healthy masturbation.</p><img src="https://counter.theconversation.com/content/157701/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A growing online movement believes that giving up masturbation can make us happier and boost our testosterone levels.Daniel Kelly, Senior Lecturer in Biochemistry, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1513612020-12-22T13:35:07Z2020-12-22T13:35:07ZHow high school sports became the latest battleground over transgender rights<figure><img src="https://images.theconversation.com/files/375148/original/file-20201215-21-ylg7gh.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5734%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">High school athletes, including Terry Miller and Andraya Yearwood, both transgender girls, compete in New Haven, Connecticut, in 2019.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/home/search?query=Andraya%20yearwood&mediaType=photo&st=keyword">AP Photo/Pat Eaton-Robb</a></span></figcaption></figure><p>This year, 20 states proposed to ban <a href="https://transequality.org/issues/resources/understanding-transgender-people-the-basics">transgender girls</a> – meaning those assigned male at birth but who live and identify as girls – from competing on girls interscholastic sports teams. </p>
<p>The only bill to pass was in Idaho. That law <a href="https://www.nytimes.com/2020/04/01/sports/transgender-idaho-ban-sports.html?searchResultPosition=3">bars transgender athletes</a> from participating in high school and college sports. It also authorizes “sex testing” of athletes through genital exams and genetic and hormone testing. </p>
<p>The <a href="https://casetext.com/case/hecox-v-little">ACLU is challenging the law</a>, arguing that it violates civil rights, and a federal court has delayed its implementation. On Dec. 21, <a href="https://cdn.theconversation.com/static_files/files/1398/ECF-Stamped-Hecox-Amicus-12.21.2020.pdf?1608588131">over 60 women’s and LGBTQ rights groups</a> and <a href="https://cdn.theconversation.com/static_files/files/1399/athletes_in_womens_sports_amicus_brief_hecox_v._little.pdf?1608588187">nearly 200 women athletes</a>, including Billie Jean King, Megan Rapinoe and Candace Parker, filed legal briefs contesting the Idaho law and supporting the full inclusion of transgender athletes.</p>
<p>The right of girls and women to compete on sports teams has endured <a href="https://www2.ed.gov/about/offices/list/ocr/docs/tix_dis.html">50 years</a> of policy debate. With <a href="https://www.ucpress.edu/book/9780520275041/trans-kids">more young people</a> now identifying as transgender, whether transgender girls can compete on girls high school teams has risen to the forefront of these discussions. </p>
<p><a href="https://www.tandfonline.com/doi/abs/10.1080/21565503.2016.1268178">My research</a> helps explain why sports is a key venue for disputes over transgender equality today. The expansion of competitive sports for girls and women – both internationally and in the U.S. – has heightened scrutiny of who “belongs” on girls and women’s teams.</p>
<h2>A patchwork of rules</h2>
<p>Whether transgender youth can participate in athletics currently depends on <a href="https://www.transathlete.com/k-12">where they live</a>.</p>
<p><a href="https://13248aea-16f8-fc0a-cf26-a9339dd2a3f0.filesusr.com/ugd/2bc3fc_447f7b8e8a44c835e855c51087a5a6d9.pdf">Some states</a>, like Minnesota and Massachusetts, allow transgender athletes to compete on the teams that comport with their identity, regardless of medical interventions. Others, like Illinois and Virginia, <a href="https://13248aea-16f8-fc0a-cf26-a9339dd2a3f0.filesusr.com/ugd/2bc3fc_1d32e085305d4e51aad243797a80ea43.pdf">require a documented medical transition</a>, including disclosure of hormone therapies. In states such as Georgia and New Mexico, athletic eligibility is <a href="https://13248aea-16f8-fc0a-cf26-a9339dd2a3f0.filesusr.com/ugd/2bc3fc_32e4906881914e43b3bf20479c6f77bc.pdf">determined only by the sex designated</a> on a student’s birth certificate. Still others, like Pennsylvania, let <a href="https://13248aea-16f8-fc0a-cf26-a9339dd2a3f0.filesusr.com/ugd/2bc3fc_f8142bb6209a401e90a6b6c469ba5f60.pdf">local schools decide</a>. <a href="https://www.transathlete.com/k-12">Ten states</a> offer no statewide guidance for incorporating transgender athletes. </p>
<p>These eligibility rules are typically determined by state athletic associations, not state legislatures. However the recent spate of legislation suggests this could change.</p>
<p><iframe id="ZJpb8" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/ZJpb8/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Title IX and same-sex sports</h2>
<p><a href="https://uscode.house.gov/view.xhtml?req=20+USC+1681%3A+Sex&f=treesort&fq=true&num=10&hl=true&edition=prelim&granuleId=USC-prelim-title20-section1681">Title IX of the Education Amendments of 1972</a> is a federal law that bans sex discrimination at all levels of education. Every U.S. school must comply with the mandate. </p>
<p>Title IX has dramatically <a href="https://global.oup.com/academic/product/citizens-by-degree-9780190650957?cc=us&lang=en&">increased women’s access</a> to college education, graduate schools and athletics. Today, <a href="https://cdn.theconversation.com/static_files/files/1394/2018-19_participation_survey.pdf?1608515954">43% of high school athletes are girls</a>, as compared with 7% in 1971, the year before the bill became law.</p>
<p>After Title IX passed, policymakers had to decide how to increase women’s access to school-sponsored sports.</p>
<p>The National Organization for Women and other <a href="https://www.tandfonline.com/doi/abs/10.1080/21565503.2016.1268178">pro-integration activists argued</a> that coed teams would ultimately help secure women’s equal status and visibility as athletes. At the same time, they worried immediate sex integration might disadvantage women, given the previous lack of training, coaching and athletic competition for girls and women. So, starting in 1979, policymakers <a href="https://www2.ed.gov/about/offices/list/ocr/docs/t9interp.html">required schools</a> to expand access by creating new teams specifically for women and girls. </p>
<figure class="align-center ">
<img alt="Uniformed football player kicks ball in the air" src="https://images.theconversation.com/files/375727/original/file-20201217-23-3dcwg7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/375727/original/file-20201217-23-3dcwg7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/375727/original/file-20201217-23-3dcwg7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/375727/original/file-20201217-23-3dcwg7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/375727/original/file-20201217-23-3dcwg7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/375727/original/file-20201217-23-3dcwg7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/375727/original/file-20201217-23-3dcwg7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In 2020, Sarah Fuller of the Vanderbilt Commodores became the first woman to play in a Power Five college football game.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sarah-fuller-of-the-vanderbilt-commodores-warms-up-prior-to-news-photo/1229841716?adppopup=true">Missouri Athletics/Collegiate Images/Getty Images</a></span>
</figcaption>
</figure>
<p>Since then, women have <a href="https://www.npr.org/2020/11/28/939716026/sarah-fuller-makes-history-as-1st-woman-to-play-in-a-power-5-football-game">rarely competed</a> on men’s college or high school sports teams. Likewise, in 13 cases between 1971 and 2006, the <a href="https://doi.org/10.1177/0891243211398866">U.S. courts ruled</a> against <a href="https://theconversation.com/explainer-what-does-it-mean-to-be-cisgender-103159">cisgender boys and men</a> – those assigned male at birth and who live as boys and men – who wanted to play on teams for girls and women. <a href="https://doi.org/10.1177/0891243211398866">Research shows</a> that the legal reasoning in these cases advances the dubious notion that girls are inherently inferior athletes.</p>
<p>Despite <a href="https://global.oup.com/academic/product/playing-with-the-boys-9780195167566?cc=us&lang=en&">controversy around sex-segregated teams</a>, they remain the <a href="https://nyupress.org/9780814799659/getting-in-the-game/">norm for athletic competition</a> in the U.S.</p>
<p>Currently, transgender athletes are underrepresented at the high school level. One <a href="https://assets2.hrc.org/files/assets/resources/PlayToWin-FINAL.pdf?_ga=2.28099006.300407420.1582836585-1986322191.1582510625">report from the Human Rights Campaign</a> found that only 12% of transgender girls participate in organized sports, compared with 68% of young people overall.</p>
<p>Among the reasons for this is the lack of clarity in equity policy. <a href="https://www.politico.com/news/2020/08/26/court-yes-transgender-rights-gavin-grimm-bathroom-402532">Court cases establish</a> that public schools must affirm the gender of all students and protect them against exclusion under Title IX. However, the rights of transgender athletes to access high school sports teams are not specifically addressed in federal athletic policy guidelines. </p>
<h2>Transgender visibility and backlash</h2>
<p>Over the past three decades, the movement for transgender rights has made many <a href="https://www.press.umich.edu/9448956/remarkable_rise_of_transgender_rights">legislative and social gains</a>. These include increased public recognition, <a href="https://www.nytimes.com/2020/06/15/us/gay-transgender-workers-supreme-court.html">legal victories</a> and some <a href="https://www.lgbtmap.org/mapping-trans-equality">state-level protections</a> against discrimination at school. </p>
<p>But increased visibility for transgender people has also produced legislative backlash on issues like <a href="https://contexts.org/articles/bathroom-battlegrounds-and-penis-panics/">access to public restrooms</a>.</p>
<p>These “<a href="https://www.nytimes.com/2019/07/23/us/north-carolina-transgender-bathrooms.html">bathroom bills</a>” – which included attempts to deny transgender students access to sex-segregated bathrooms at school – provided a blueprint for current legislative proposals barring transgender athletes. They were premised on the idea that transgender people should not have the right to use sex-segregated spaces, like public restrooms and <a href="https://theconversation.com/better-locker-rooms-its-not-just-a-transgender-thing-74023">locker rooms</a>, that align with their gender identity.</p>
<p>Recent legislative proposals suggest that such bans should also apply to high school sports competition.</p>
<h2>International sports and sex testing</h2>
<p>Ongoing disputes in the international sporting environment are also relevant to the broader debate about who “belongs” in women’s sports. </p>
<p>The case of South African Olympic track star Caster Semenya drew significant attention to this question. Semenya is a cisgender woman – meaning she was assigned female at birth and lives as a woman – and an Olympic gold medalist in the women’s 800-meter event. After her first international championship in 2009, <a href="https://www.nytimes.com/2009/08/20/sports/20runner.html">several competitors challenged</a> her victory. <a href="https://www.newyorker.com/magazine/2009/11/30/eitheror">They suggested</a> that she was too fast, that her physical appearance was not sufficiently feminine, and that she was not “actually a woman.”</p>
<p>In a <a href="https://www.theguardian.com/sport/2019/may/01/how-caster-semenya-controversy-unfolded-since-2009-timeline">decadelong dispute</a>, the international governing agency for track and field <a href="https://www.nytimes.com/2016/07/03/magazine/the-humiliating-practice-of-sex-testing-female-athletes.html">fought to enact</a> a <a href="https://www.nytimes.com/2020/12/04/sports/olympics/intersex-athletes-human-rights.html">contested policy</a> that requires Semenya – and any other woman athlete whose gender is questioned – to submit to bodily and hormonal evaluations and possible medical treatments in order to remain eligible for particular running events. </p>
<p>The <a href="https://undocs.org/en/A/HRC/44/26">United Nations</a> and <a href="https://www.hrw.org/report/2020/12/04/theyre-chasing-us-away-sport/human-rights-violations-sex-testing-elite-women">Human Rights Watch</a> argue the policy has lasting negative impacts on the targeted athletes. Semenya <a href="https://www.nytimes.com/2020/09/08/sports/olympics/caster-semenya-court-ruling.html">refuses</a> to comply. </p>
<p>These <a href="https://www.press.uillinois.edu/books/catalog/85fcr3nh9780252040221.html">sex testing</a> policies, also known as gender verification, have long policed the elite women’s category and particularly <a href="https://muse.jhu.edu/article/702853/pdf">harm women of color</a>, who have been disproportionately scrutinized.</p>
<p>Idaho lawmakers envision enforcing their transgender ban on high school athletes in similarly invasive ways.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>Meanwhile, <a href="https://issues.org/science-sport-sex/">scientists are divided</a> on whether <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674725324">monitoring testosterone</a> – as both <a href="https://www.worldathletics.org/news/press-release/eligibility-regulations-for-female-classifica">international policy</a> and Idaho law now advocate – can identify any consistent athletic advantage. They <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674063518&content=reviews">continue to debate</a> <a href="https://www.basicbooks.com/titles/anne-fausto-sterling/sexing-the-body/9781541672895/">the meanings of gender</a> and the <a href="https://wwnorton.com/books/Delusions-of-Gender">impacts of sex difference</a>.</p>
<p>Yet as the 2021 legislative season begins, <a href="https://legiscan.com/TN/bill/HB0003/2021">some states</a> have already proposed additional transgender athlete bans. U.S. Rep. Tulsi Gabbard, Democrat of Hawaii, <a href="https://www.congress.gov/bill/116th-congress/house-bill/8932/text">introduced a bill</a> in Congress that would limit Title IX’s athletic equity protections only to girls and women assigned female at birth. A court case involving transgender athletes’ rights in <a href="https://www.washingtonpost.com/sports/2020/02/12/conn-high-school-girls-file-federal-suit-prevent-transgender-athletes-competing/">Connecticut</a> and the <a href="https://law.justia.com/cases/federal/district-courts/idaho/iddce/1:2020cv00184/45676/63/">Idaho case</a> remain ongoing.</p>
<p>As policymakers and elected officials debate the future of sports for girls and women, the rights of transgender athletes hang in the balance.</p><img src="https://counter.theconversation.com/content/151361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth A. Sharrow has received funding from the National Science Foundation, the Social Science Research Council, the American Association of University Women, the Gerald Ford Presidential Foundation, the Myra Sadker Foundation, the National Collegiate Athletic Association, the American Political Science Association, and the Massachusetts Historical Society. </span></em></p>New legislative proposals want to allow ‘sex testing’ of girl athletes through genital exams and genetic and hormone testing.Elizabeth A. Sharrow, Associate Professor of Public Policy and History, UMass AmherstLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1450672020-09-13T07:37:52Z2020-09-13T07:37:52ZHow false advertising misleads consumers in South Africa<figure><img src="https://images.theconversation.com/files/356050/original/file-20200902-14-1gehyru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Advertisers use images of muscular men and slender women to convince consumers to buy their products. </span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>The promise of health, losing weight, or increasing strength greets visitors to many health and supplement shops. Advertisers use images of muscular men and slender women, combined with carefully crafted text, to convince consumers to buy their products. </p>
<p>Words and shapes in bold and bright colours decorate the packaging of products that promise an increase in bulk and strength. Among the myriad of miracle promising products, you may find “testosterone boosting” supplements. A consumer can now buy a “legitimate” testosterone booster in South African retail stores. </p>
<p>In South Africa, <a href="https://www.gov.za/sites/default/files/gcis_document/201409/32975146.pdf">regulations</a> about labelling don’t allow advertisers to use pictures that are likely to create a false impression of the product. The <a href="https://www.gov.za/sites/default/files/gcis_document/201409/321864670.pdf">Consumer Protection Act</a> clearly states suppliers may not mislead consumers. The Act also bars suppliers from making false claims about a product. </p>
<p>But this has not stopped advertisers from making dubious claims. In a recent <a href="https://journals.assaf.org.za/index.php/sajsm/article/view/7426">article</a> I unpacked claims made in an advertisement for a testosterone boosting product. </p>
<p>The alleged active ingredient in some of these testosterone boosting products is <a href="https://www.rxlist.com/aspartates/supplements.htm">D-aspartic acid</a>. The main advertising claim is that a consumer’s testosterone level will increase after consuming a product containing this amino acid. The implied promise is that an increase in testosterone will provide a gain in muscle and strength. Stronger muscles, in turn, hold the promise of improving in sport. One such testosterone boosting product even claims to be based on science and that research was involved. </p>
<h2>Regulating advertising</h2>
<p>Claims that something is clinically proven, and that science and research are involved, require proof. The <a href="http://arb.org.za/">Advertising Regulatory Board</a> of South Africa, for example, requires that advertisers must hold the evidence for their advertising claims. Advertisements must be truthful and may not mislead consumers. Advertisers are not allowed to misuse and misrepresent research results. They are not allowed to make <a href="http://arb.org.za/assets/section02-(2020).pdf">science claims</a> for a product if it does not have such a basis. </p>
<p>My recent <a href="https://journals.assaf.org.za/index.php/sajsm/article/view/7426">article</a> shows how advertising claims about a testosterone boosting product mislead consumers.</p>
<p>The advertiser claimed that the supplement would boost a consumer’s testosterone levels. The advertiser referred to a <a href="https://rbej.biomedcentral.com/articles/10.1186/1477-7827-7-120">scientific paper</a> as the evidence for the product’s testosterone boosting ability. </p>
<p>A closer look at this research showed that a small group of 23 men received a daily dose for 12 days of a product containing D-aspartic acid. The control group of 20 men received a placebo. The group that received the D-aspartic acid showed an increase in total testosterone after 12 days. Their testosterone decreased three days after their last dose on day 12. </p>
<p>The group’s average level of total testosterone increased from 4.5 nanograms per millilitre at the start, to 6.4 nanograms per millilitre on day 12. The advertisers used the ratio of this increase on day 12 to claim that a 42% increase in testosterone is possible. </p>
<p>What they didn’t say is that the study took place at an infertility clinic. The participants had low testosterone levels at the start. The average increase of 1.9 nanograms per millilitre of testosterone appears remarkable if one looks at the percentage difference. This increase was, however, still within the normal testosterone range of men of that age. </p>
<p>Advertisers who use this scientific paper as the basis for their advertising claims misuse and misrepresent science. </p>
<p>There isn’t enough knowledge about D-aspartic acid and its effect on the increase in testosterone levels. The evidence from a <a href="http://journals.ssu.ac.ir/ijrmnew/article-1-794-en.html">few</a> small and short duration studies is not enough to conclude that D-aspartic acid can produce a clinically significant increase in testosterone levels. </p>
<p>Some advertisers also make misleading claims about supplements or weight-loss products. </p>
<p>In one <a href="http://arb.org.za/assets/biostrath---siebert-kruger---louis-fourie.pdf">case</a>, the Advertising Regulatory Board ruled that an advertisement was misleading when it promised improved academic performance. The advertiser was not able to provide adequate proof that the supplement would improve a child’s marks at school. In another <a href="http://arb.org.za/assets/usn---dr-harris-steinman.pdf">case</a>, the Advertising Regulator Board ruled that a well-known supplier of supplements misled consumers. The advertising claims were that the product was “thermogenic” (fat-burning) and that it would aid weight loss. The Advertising Regulatory Board ruled that the claims were without substance. </p>
<h2>Protecting consumers</h2>
<p>Science-based claims that a product is the result of research does not necessarily mean that it works or that it is safe. It also does not mean that the manufacturer tested their own product in a clinical trial. </p>
<p><a href="https://www.healthline.com/health/clinical-trial-phases#phase-iii">Clinical trials</a> are very expensive, go through several stages, and can take several years. The last stage of a clinical trial requires a manufacturer to include a large group of participants to see if the product works as planned.</p>
<p>An advertiser that makes direct or indirect claims that a supplement can boost testosterone, help with weight-loss, or improve school performance must have proof for these claims. Consumers are within their rights to ask advertisers to supply the evidence for their claims. </p>
<p>Scientific articles about ingredients in their products are not sufficient. The scientific evidence must be about the specific product that an advertiser promotes. The evidence must be objective and open for independent scrutiny.</p>
<p>Consumers can lodge a <a href="http://arb.org.za/complaints.html">complaint</a> with the Advertising Regulatory Board about advertisements that they regard as misleading. Alternatively, one can also approach the Consumer Goods and Services Ombud to <a href="http://www.cgso.org.za/what-we-can-deal-with/">complain</a> about misleading labelling.</p><img src="https://counter.theconversation.com/content/145067/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rudi de Lange does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Claims that a product can boost testosterone levels imply that this will lead to a gain in muscle and strength.Rudi de Lange, Associate Professor in Visual Communication, Tshwane University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1387672020-06-09T12:20:27Z2020-06-09T12:20:27ZCOVID-19’s deadliness for men is revealing why researchers should have been studying immune system sex differences years ago<figure><img src="https://images.theconversation.com/files/339316/original/file-20200602-133902-dka80w.jpg?ixlib=rb-1.1.0&rect=72%2C0%2C5613%2C3712&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reports show that the mortality rate among men with COVID-19 is higher than women. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/mattia-guarneri-lies-on-a-bed-in-coma-connected-to-a-news-photo/1219161924?adppopup=true">Marco Mantovani/Getty Images</a></span></figcaption></figure><p>When it comes to surviving critical cases of COVID-19, it appears that men draw the short straw. </p>
<p>Initial reports from China revealed the early evidence of increased male mortality associated with COVID. According to the <a href="https://globalhealth5050.org/covid19/sex-disaggregated-data-tracker/">Global Health 50/50 research initiative</a>, nearly every country is now reporting significantly higher COVID-19-related mortality rates in males than in females as of June 4. Yet, current data suggest similar infection rates for men and women. In other words, while men and women are being infected with COVID-19 at similar rates, a significantly higher proportion of men succumb to the disease than women, across groups of similar age. Why is it then that more men are dying from COVID-19? Or rather, should we be asking why are more women surviving? </p>
<p><a href="https://cvm.msu.edu/research/faculty-research/comparative-gastro-intestinal-research/moeser/gsbl-team">I am an immunologist</a>, and <a href="https://cvm.msu.edu/research/faculty-research/comparative-gastro-intestinal-research/moeser">I explore how stress and biological sex can impact a person’s vulnerability to immune-mediated disease</a>. I study a specific immune cell called the mast cell. Mast cells play a pivotal role in our immune systems as they act as first responders to pathogens and orchestrate immune responses that help clear the invading pathogens.</p>
<p>Our research shows that <a href="https://doi.org/10.1186/s13293-016-0113-7">mast cells from females are able to initiate a more active immune response</a>, which may help females fight off infectious diseases better than men. But the trade-off may be that <a href="https://theconversation.com/whos-stronger-an-immunological-battle-of-the-sexes-111334">women are at higher risk for allergic and inflammatory diseases</a>. Recent evidence indicates that mast cells are activated by SARS-CoV-2 which causes COVID-19.</p>
<p>Some clues to why females have higher survival rates may be found in our current understanding of differences in the <a href="https://theconversation.com/whos-stronger-an-immunological-battle-of-the-sexes-111334">immune systems of men versus women</a>. </p>
<h2>Could sex differences in immune system play a role?</h2>
<p>In general, females have a more robust immune response than men which may help females fight off infections better than males. This could be a result of genetic factors or sex hormones such as estrogen and testosterone. </p>
<p>Biological females have two copies of the X chromosome, which contains more immune genes. While the genes on one X chromosome are mostly inactive, some immune genes can escape this inactivation, leading to double the number of immune-related genes and thus double the quantity of certain immune proteins compared with biological men who have only one X chromosome. </p>
<p>Sex hormones such as estrogen and testosterone can also impact the immune response. In one study, researchers showed that <a href="https://doi.org/10.4049/jimmunol.1601896">activating the estrogen receptor in female mice provided them protection</a> against SARS-CoV. And there is an approved clinical trial that will examine the effects of <a href="https://clinicaltrials.gov/ct2/show/NCT04359329">estrogen patches on the severity of COVID-19 symptoms</a>. </p>
<p>It is, however, interesting that the current data showing that women have better survival rates than men applies to even men and women in the 80-plus age group, when hormone levels in both sexes equalize. This suggests that factors other than adult sex hormone levels are contributing to sex differences in COVID-19 mortality.</p>
<p>Androgens, a group of hormones - including testosterone - that are best known to stimulate the development of male characteristics and can cause hair loss, have also received recent attention as a risk factor for COVID-19 in males. In a study conducted in Italy, prostate cancer diagnosis increased the risk for COVID-19. However, prostate cancer patients who were receiving androgen-deprivation therapy (ADT), a treatment that suppresses the production of androgens which fuels prostate cancer cell growth, <a href="http://doi.org/10.1016/j.annonc.2020.04.479">had a significantly lower risk for SARS-CoV-2 infection</a>. This suggests that blocking androgens in men was protective against SARS-CoV-2 infection. </p>
<p>It is unknown how ADT works to reduce infection rates in men and whether this has been shown in other countries has yet to be determined. Testosterone, which is an androgen hormone has immune-suppressive effects so one explanation could be that ADT might boost the immune system to combat SARS-CoV-2 infection.</p>
<p>There is also evidence that males and females have different quantities of certain receptors that recognize pathogens or that serve as an invasion point for viruses like SARS-CoV-2. One example is the quantity of <a href="https://theconversation.com/what-is-the-ace2-receptor-how-is-it-connected-to-coronavirus-and-why-might-it-be-key-to-treating-covid-19-the-experts-explain-136928">angiotensin converting enzyme 2 (ACE2) receptors,</a> which SARS-CoV-2 binds to in order to infect cells. While there is currently no conclusive evidence for a role of ACE2 receptors impacting sex differences and the severity of COVID-19 disease, it remains a potential contributing factor. </p>
<h2>Gender, sex and COVID-19 risk</h2>
<p>A number of factors can interact with biological sex to increase or decrease one’s susceptibility to COVID-19. Another major factor is gender, which refers to social behaviors or cultural norms that society deems appropriate. <a href="http://doi.org/10.1186/s13293-020-00304-9">Males may be at increased risk for severe disease</a>, because in general, they tend to smoke and drink more, wash their hands less frequently and often delay seeking medical attention. All of these gender specific behaviors may put men at higher risk. While there is no current data yet on how gender plays a role in COVID-19, it will be a critically important factor to account for in order to understand sex differences in mortality.</p>
<p>Age, psychological stress level, coexisting conditions such as obesity, diabetes and cardiovascular disease can also interact with biological sex to increase disease.</p>
<p>While COVID-19 highlights the importance of biological sex in disease risk, sex biases in disease in general is not a new concept. COVID-19 is just another example of a disease that will be added to the growing list of diseases for which males or females are at increased risk. </p>
<h2>A history of male-biased research</h2>
<p>You might be wondering that if biological sex is so important, then why don’t we know what is causing disparities in disease prevalence between the sexes and why are there no sex-specific therapies? </p>
<p>One major reason is when it comes to being included in scientific research, it is mostly males who have been studied. </p>
<p>This disparity between biological sex differences in research has only recently been remedied. It has only been in the last five years that the National Institutes of Health <a href="https://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-102.html">has required sex difference data to be collected</a> for all newly funded preclinical research grants. </p>
<p>While there may be several reasons for choosing one sex over the other in research, the huge disparity that now exists is likely a major reason why we still know relatively little about sex differences in immunity, including the current COVID-19 pandemic. </p>
<p>This has clearly hindered advancement of women’s health, but also has negative consequences for men’s health. For example, given the biological differences between the sexes, it is very possible that drugs and therapies will have different effects in females than males. </p>
<p>Biological sex is clearly a major factor determining disease outcomes in COVID-19. Precisely how your biological sex makes you more or less resilient to diseases such as COVID-19 remains to be elucidated. Future basic research with animals and clinical trials in people need to consider biological sex as well as interactions with gender as an important variable. </p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/138767/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Moeser receives funding from The National Institutes of Health </span></em></p>Why does COVID-19 hit men harder than women? Is the disparity in mortality rates due to male hormones or an underlying difference in the male versus female immune system?Adam Moeser, Matilda R. Wilson Endowed Chair, Associate Professor of Large Animal Clinical Sciences, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1351582020-04-16T14:53:12Z2020-04-16T14:53:12ZCoronavirus: does testosterone really make infectious diseases worse in men?<figure><img src="https://images.theconversation.com/files/328359/original/file-20200416-192725-1jqreae.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5197%2C3462&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/middle-age-hoary-senior-man-wearing-1295474197">Krakenimages/Shutterstock</a></span></figcaption></figure><p>The COVID-19 pandemic has had a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7103991/">bigger toll on men</a> than <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingcovid19englandandwales/deathsoccurringinmarch2020#characteristics-of-those-dying-from-covid-19">it has on women</a>. There has been <a href="https://www.theguardian.com/world/2020/mar/26/men-are-much-more-likely-to-die-from-coronavirus-but-why">a lot of conjecture</a> about why this might be. <a href="https://www.dailymail.co.uk/health/article-8210435/Why-does-Covid-19-kill-men-women.html">One theory</a> is that the male sex hormone, testosterone, has a dampening effect on the immune system, making men more susceptible to the novel coronavirus. But just how plausible is this theory?</p>
<p>An overview of the scientific evidence suggests that oestrogen (the main female hormone) can improve the immune system and increase immune inflammation whereas testosterone (the male sex hormone) reduces or <a href="https://www.ncbi.nlm.nih.gov/pubmed/30210492">dampens the response</a>. As a result, women often have less severe infections than men and have significantly stronger immune responses to vaccinations (which are essentially less potent versions of a virus). Men with higher levels of testosterone may have weakened immunity and have been shown to produce the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24367114">lowest antibody responses</a> to annual flu vaccinations. </p>
<p>So is there a natural susceptibility of men to suffer more severely from viruses and bacterial infections as a result of testosterone? Such a conclusion is not so clear cut when you look a little deeper into the scientific evidence. </p>
<h2>Trade-offs</h2>
<p>Many of the studies that describe the suppressing effect of testosterone on the immune system have focused on a single immune function or individual immune cell types. But the immune system is a complex arrangement of many different cells, organs and tissues that direct an elaborate response to infections. It can broadly be sorted into two categories: innate immunity and adaptive immunity. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/PzunOgYHeyg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Innate and adaptive immune systems explained.</span></figcaption>
</figure>
<p>Innate immunity is rapid (within hours) and non-specific, meaning it is a frontline defence that is more generalised, targeting any invaders and slowing infection until adaptive immunity is developed. </p>
<p>Adaptive, or acquired immunity, is more complex. It takes a longer time (several days) to process and recognise a foreign invader before making specific antibodies to target it. After the threat has gone, the adaptive immune system “remembers” it, which makes future responses to the same pathogen faster, more efficient and powerful.</p>
<p>Adaptive immunity may also be thought of as more energetically demanding on the body. This means that in males with high testosterone, where energy-consuming actions such as increasing muscle strength, sexual appetite and risk-taking behaviour take precedence, adaptive immunity is not necessarily prioritised. Fitting in with this, when men have infections or illness, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075254/">their testosterone levels decrease</a>, possibly to move energy away from all those high-energy tasks to allow instead for most energy to go into strengthening the immune response. </p>
<p>A trade-off may also happen between different immune actions. When one part is highly effective, other functions may be turned down. In a normal situation, the ability to produce a quick response to local infection or tissue injury by activating the innate immune system is more useful in high-testosterone men. This is because, from an evolutionary perspective, they are more likely to experience trauma as a result of aggressive physical competition, roles in hunting and heavy manual or dangerous activities. So it’s not likely that testosterone would reduce all parts of immune function equally.</p>
<p>Despite its overall immune system suppressing effects, looking a little more closely at testosterone over a wide range of immune functions shows it can be immune system suppressing, strengthening and even sometimes have no effect on immune function at all. With such different effects in different investigations, it becomes clear that measuring only certain immune features in relation to testosterone does not truly reflect the overall immune capabilities of a man. </p>
<h2>Disease and age</h2>
<p>A major factor in how severe an infection may become is whether a person has underlying disease. While this is easy to understand, what is not so clear is the effect that the reduced levels of testosterone that happen during illness have on the likelihood of the infection developing into something more severe in men. It has been recently shown that COVID-19 reduces testosterone levels in men by <a href="https://www.medrxiv.org/content/10.1101/2020.03.21.20037267v2">altering the functioning of the gonads</a>. So could the increased severity of the disease in men be due to lowered testosterone?</p>
<p>Complicating things further is the influence of age. We know that the occurrence of additional diseases <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890129/">increases with age</a>. Age is a major risk factor for COVID-19 <a href="https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7">in both genders</a>. As men age, their testosterone levels decrease, offering the possibility that increased severity of infections in elderly men may be due to lower levels of testosterone rather than simply the presence of testosterone. For example, men with lower levels of testosterone who had chronic kidney disease <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733882/">were more likely to have to go to hospital because of infections</a> than men with higher levels. What may be relevant here to COVID-19 is that most of these infections were respiratory infections.</p>
<p>To find out how it influences the immune system, it would be necessary to look at testosterone effects on various functions of both innate and adaptive immunity in a variety of men with different health statuses and ages. Such investigations don’t exist at the moment. So for now, it would be wise to conclude that testosterone <em>can</em> modulate the immune system. But the way it does this and the outcome it has depends on many other factors that influence whether there may be a negative or a beneficial effect on the severity of infectious diseases, such as COVID-19, in men.</p><img src="https://counter.theconversation.com/content/135158/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniel Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The science is not so clear cut.Daniel Kelly, Lecturer in Biochemistry, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1228722019-09-09T16:16:14Z2019-09-09T16:16:14ZDoes extra testosterone reduce your empathy?<figure><img src="https://images.theconversation.com/files/291337/original/file-20190906-175705-hcx8as.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/509354542?src=-1-0&size=medium_jpg">Marc Bruxelle/Shutterstock</a></span></figcaption></figure><p>Cognitive empathy is the ability to recognise what another person is thinking or feeling, and one way it can be assessed in the lab is by using the “<a href="https://depts.washington.edu/uwcssc/sites/default/files/hw00/d40/uwcssc/sites/default/files/Mind%20in%20the%20Eyes%20Scale_0.pdf">reading the mind in the eyes test</a>” – or “eyes test”, for short. This involves looking at photos of a person’s eyes and picking which word best describes what the person in the photo is thinking or feeling.</p>
<p>Many studies, including our own, have shown a link between elevated testosterone and reduced cognitive empathy. But a <a href="https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2019.1062">new study</a> led by Amos Nadler, a visiting professor of economics at the University of Toronto, found that administering testosterone to men does not reduce their empathy, as measured by this test. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/291245/original/file-20190906-175673-1hd5s76.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/291245/original/file-20190906-175673-1hd5s76.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/291245/original/file-20190906-175673-1hd5s76.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/291245/original/file-20190906-175673-1hd5s76.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/291245/original/file-20190906-175673-1hd5s76.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=453&fit=crop&dpr=1 754w, https://images.theconversation.com/files/291245/original/file-20190906-175673-1hd5s76.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=453&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/291245/original/file-20190906-175673-1hd5s76.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=453&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Reading the mind in the eyes test.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Nadler and colleagues also measured digit ratio. The ratio between the length of a person’s index and ring finger is thought to be an indicator of how much testosterone they were exposed to in the womb (prenatal testosterone levels), and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044405/">has also been tied</a> to a lack of empathy. Nadler and colleagues’ study found that digit ratios were not related to empathy scores.</p>
<p>From these findings, they draw two conclusions: first, that this disproves a <a href="https://www.pnas.org/content/108/8/3448">previous study</a> by Jack van Honk and colleagues in which administering testosterone to women reduced their empathy. And second, that prenatal testosterone levels do not affect later empathy.</p>
<h2>Challenging the conclusions</h2>
<p>We would challenge both these conclusions, on two grounds. First, Nadler’s study only included men whereas van Honk’s study only included women. So while we agree that administering extra testosterone to men does not appear to reduce their empathy, Nadler’s study cannot be regarded as an attempt at replicating the van Honk study. A large-scale study of women would be needed for that.</p>
<p>And perhaps giving women extra testosterone does reduce their empathy (as van Honk found) while giving men extra testosterone does not. This could be because women on average score higher on the eyes test than men do, so there is more room for their scores to decrease. Also, on average, women have lower circulating testosterone levels than men, so large changes in their testosterone levels may have bigger effects on empathy. </p>
<p>In Nadler’s study, the testosterone levels of male participants were elevated two or threefold. In contrast, in the van Honk study, the testosterone levels of female participants were elevated at least tenfold. It is possible, then, that a higher dose of testosterone <em>would</em> have affected empathy in men. </p>
<p>Second, digit ratio may not be a good proxy of how much testosterone someone was exposed to in the womb, as <a href="https://www.ncbi.nlm.nih.gov/pubmed/15113628">other factors</a> may affect this ratio. To properly study prenatal testosterone, it should be measured directly, using prenatal samples.</p>
<p>Of course, measuring prenatal hormone levels in the womb is very difficult, but it is essential because testosterone exerts many of its programming effects during a critical time window when the brain is developing. </p>
<p>That is why we measured prenatal testosterone levels in the amniotic fluid surrounding the developing foetus in women who opted to have an <a href="https://www.nhs.uk/conditions/amniocentesis/">amniocentesis</a> during pregnancy and then following up the child years later to see how they developed. We <a href="https://www.ncbi.nlm.nih.gov/pubmed/18633782">confirmed</a> that the higher the level of prenatal testosterone, the lower their scores on the eyes test of empathy when tested at age six to eight years.</p>
<h2>Extreme male brain</h2>
<p>In their <a href="https://penntoday.upenn.edu/news/largest-study-its-kind-no-evidence-testosterone-reduces-cognitive-empathy">press release</a>, Nadler and colleagues argue that their new data challenges the “extreme male brain” (EMB) theory of autism. But Nadler’s study has little to do with the EMB theory. </p>
<p>The EMB theory makes no predictions about what will happen to a person’s empathy if you give them more testosterone. The EMB theory simply states that, on tests of empathy, typical females will on average score higher than typical males, and autistic people will on average score lower than typical males. </p>
<p>The EMB theory also states that on tests of systemising – the drive to analyse or construct systems in terms of rules – typical males will on average score higher than typical females, and that autistic people will on average score higher than typical males. </p>
<p>The EMB theory was recently confirmed in the largest test of sex differences in empathy and systemising among 600,000 people, and in the <a href="https://www.pnas.org/content/115/48/12152">largest study of autism</a>, among 36,000 autistic people. </p>
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Read more:
<a href="https://theconversation.com/extreme-male-brain-theory-of-autism-confirmed-in-large-new-study-and-no-it-doesnt-mean-autistic-people-lack-empathy-or-are-more-male-106800">Extreme male brain theory of autism confirmed in large new study – and no, it doesn't mean autistic people lack empathy or are more 'male'</a>
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<p>And in other recent studies, we showed that several prenatal sex steroid hormones, such as testosterone and oestrogen, are elevated in the <a href="https://www.nature.com/articles/s41380-019-0454-9">amniotic fluid of autistic boys</a>, demonstrating the importance of prenatal sex steroid hormones in changing brain development.</p>
<p>So, while the Nadler study is impressive for its scale, we now need a direct replication study of testosterone effects on women’s cognitive empathy. Finally, it is important to separately study the effects of testosterone on the prenatal brain, compared to the effects of the same hormone on the adult brain.</p><img src="https://counter.theconversation.com/content/122872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The link between testosterone and empathy is complicated. We don’t have all the answers yet.Simon Baron-Cohen, Professor of Developmental Psychopathology, University of CambridgeAlexandros Tsompanidis, PhD Candidate in Autism, University of CambridgeRichard Bethlehem, Research Associate in Autism, University of CambridgeTanya Procyshyn, Doctoral Scientist, Autism Research Centre, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1227642019-09-03T13:40:36Z2019-09-03T13:40:36ZStop calling it a choice: Biological factors drive homosexuality<figure><img src="https://images.theconversation.com/files/290563/original/file-20190902-175705-15kuqu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Biological factors shape sexual preference.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lgbt-lesbian-couple-moments-happiness-concept-575079754?src=-1-53">Rawpixel.com/SHutterstock.com</a></span></figcaption></figure><p><a href="https://doi.org/10.1126/science.aat7693">Across cultures, 2% to 10% of people report having same-sex relations</a>. In the U.S., <a href="https://www.statista.com/topics/1249/homosexuality/">1% to 2.2% of women and men</a>, respectively, identify as gay. Despite these numbers, <a href="https://www.pewresearch.org/global/2013/06/04/the-global-divide-on-homosexuality/">many people still consider homosexual behavior to be an anomalous choice</a>. However, biologists have <a href="https://us.macmillan.com/books/9780312253776">documented homosexual behavior in more than 450 species</a>, arguing that same-sex behavior is not an unnatural choice, and may in fact play a vital role within populations.</p>
<p>In <a href="https://doi.org/10.1126/science.aat7693">a 2019 issue of Science magazine</a>, geneticist Andrea Ganna at the Broad Institute of MIT and Harvard, and colleagues, described the largest survey to date for genes associated with same-sex behavior. By analyzing the DNA of nearly half a million people from the U.S. and the U.K., they concluded that genes account for between 8% and 25% of same-sex behavior. </p>
<p><a href="https://www.nature.com/news/sex-redefined-1.16943">Numerous studies have established that sex is not just male or female</a>. Rather, it is a continuum that emerges from a person’s genetic makeup. Nonetheless, misconceptions persist that same-sex attraction is a choice that warrants condemnation or <a href="https://www.apa.org/pi/lgbt/resources/just-the-facts">conversion</a>, and leads to discrimination and persecution.</p>
<p><a href="https://wjsulliv.wixsite.com/sullivanlab">I am a molecular biologist</a> and am interested in this new study as it further illuminates the genetic contribution to human behavior. As the author of the book, <a href="https://www.penguinrandomhouse.com/books/608709/pleased-to-meet-me-by-bill-sullivan/9781426220555/">“Pleased to Meet Me: Genes, Germs, and the Curious Forces That Make Us Who We Are,”</a> I have done extensive research into the biological forces that conspire to shape human personality and behavior, including the factors influencing sexual attraction.</p>
<h2>The hunt for ‘gay genes’</h2>
<p>The new finding is consistent with multiple earlier studies of twins that indicated same-sex attraction is a heritable trait.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1200&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1200&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1200&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290580/original/file-20190902-175663-baya3w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A new study suggests that genes are responsible for between 8% and 25% of same-sex preference.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/dna-multi-color-isolated-on-white-717211195?src=-1-47">Guru 3D</a></span>
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<p>The 2019 study is the latest in a hunt for “gay genes” that began in 1993, when Dean Hamer <a href="https://doi.org/10.1126/science.8332896">linked male homosexuality to a section of the X chromosome</a>. As the ease and affordability of genome sequencing increased, additional gene candidates have emerged with potential links to homosexual behavior. So-called <a href="https://doi.org/10.1038/s41598-017-15736-4">genome-wide association studies identified a gene called <em>SLITRK6</em></a>, which is active in a brain region called the diencephalon that differs in size between people who are homosexual or heterosexual.</p>
<p>Genetic studies in mice have uncovered additional gene candidates that could influence sexual preference. A 2010 study <a href="https://doi.org/10.1186/1471-2156-11-62">linked sexual preference to a gene called fucose mutarotase</a>. When the gene was deleted in female mice, they were attracted to female odors and preferred to mount females rather than males. </p>
<p>Other studies have shown that <a href="https://doi.org/10.1038/nature06089">disruption of a gene called <em>TRPC2</em></a> can cause female mice to act like males. <a href="https://doi.org/10.1126/science.1069259">Male mice lacking <em>TRPC2</em></a> no longer display male-male aggression, and they initiate sexual behaviors toward both males and females. Expressed in the brain, <em>TRPC2</em> functions in the recognition of pheromones, chemicals that are released by one member of a species to elicit a response in another.</p>
<p>With multiple gene candidates being linked to homosexuality, it seemed highly unlikely that a single “gay” gene exists. This idea is further supported by <a href="https://doi.org/10.1126/science.aat7693">the new study</a>, which identified five new genetic loci (fixed positions on chromosomes) correlating with same-sex activity: two that appeared in men and women, two only in men, and one only in women.</p>
<h2>How might these genes influence same-sex behavior?</h2>
<p>I find it intriguing that some of the genes from men identified in Ganna’s study are associated with olfactory systems, a finding that has parallels to the work in mice. Ganna’s group found other gene variants that may be linked with sex hormone regulation, which other scientists have previously suggested plays a large role in shaping the brain in ways that influence sexual behavior. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=846&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=846&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=846&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1063&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1063&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290575/original/file-20190902-175691-1l5i9pk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1063&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Conditions in the uterus during pregnancy are thought to influence the sexual preferences of the child.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beautiful-pregnant-woman-shopping-bags-outdoors-503149633?src=-1-18">Anna Om/Shutterstock.com</a></span>
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<p>Males with a genetic condition called <a href="https://ghr.nlm.nih.gov/condition/androgen-insensitivity-syndrome">androgen insensitivity syndrome</a> can develop female genitalia and are usually brought up as girls, despite being genetically male – with an X and Y chromosome – and they are attracted to men. This suggests that testosterone is needed to “masculinize” a prenatal brain; if that doesn’t happen, the child will grow up to desire men. </p>
<p>Similarly, girls who have a genetic condition called <a href="https://www.nichd.nih.gov/health/topics/cah">congenital adrenal hyperplasia</a> are exposed to unusually high levels of male hormones like testosterone while in the womb, which may masculinize their brain and increase the odds of lesbianism. </p>
<p>It’s also possible that hormonal shifts during pregnancy could affect how a fetus’ brain is configured. In rats, <a href="https://doi.org/10.1210/en.2011-0277">manipulation of hormones during pregnancy</a> produces offspring that exhibit homosexual behavior.</p>
<h2>Why does homosexual behavior exist?</h2>
<p>Several hypotheses have been advanced to explain how homosexuality can be beneficial in perpetuating familial genes. One idea involves the concept of kin selection, whereby people work to ensure the passage of their family’s genes into subsequent generations. Gay uncles and aunts, for example, are “<a href="https://doi.org/10.1177/0956797609359623">helpers in the nest</a>” that help raise other family members’ children to nurture the family tree.</p>
<p>Another idea suggests that homosexuality is a “trade-off trait.” For example, certain genes in women help increase their fertility, but <a href="https://doi.org/10.1111/j.1743-6109.2008.00944.x">if these genes are expressed in a male</a>, they predispose him toward homosexuality.</p>
<p>Sexual behavior is widely diverse and governed by sophisticated mechanisms throughout the animal kingdom. As with other complex behaviors, it is not possible to predict sexuality by gazing into a DNA sequence as if it were a crystal ball. Such behaviors emerge from constellations of hundreds, perhaps thousands, of genes, and how they are regulated by the environment.</p>
<p>While there is no single “gay gene,” there is overwhelming evidence of a biological basis for sexual orientation that is programmed into the brain before birth based on a mix of genetics and prenatal conditions, none of which the fetus chooses.</p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/122764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study of nearly 500,000 individuals finds that many genes affect same-sex behavior, including newly identified candidates that may regulate smell and sex hormones.Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164482019-05-09T20:07:52Z2019-05-09T20:07:52ZTen ethical flaws in the Caster Semenya decision on intersex in sport<figure><img src="https://images.theconversation.com/files/273417/original/file-20190508-183103-1eva5jd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caster Semenya is legally female, was from birth raised as female and identifies as a female.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ciamabue/7968832970/in/photolist-d9bmpU-6WYxJP-gbWqNq-faB1Ei-d2L35o-QYHomP-aciLfF-X6bjAG-27BHwNd-doMJTN-cT2bCb-RNztaz-cTaov7-74mBHV-cUT2rq-dXYK7q-cRCJDY-cQ9hZQ-RoFRBk-24xxRw2-8RuT7h-cUSVzh-dyUu74-dyUuRP-o4j6Zs-d6XYyN-74qwom-cUT6A5-d6XYpL-dyZXuN-6Rdv6M-d6XYw5-a9coyA-6YGtw4-dyZZsS-dyUuyt-d6XYdN-dyUuKK-25Xb6zb-dyZXsq-dyUuWM-25Xb5Zd-dyZXKL-dyZY9s-dyZXvw-dyZYfL-dyZXES-dyUtKa-dyZXq7-dyZXLW">Jon Connell on flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p><em>This essay is part of our occasional series <a href="https://theconversation.com/au/topics/zoom-out-51632">Zoom Out</a>, where authors explore key ideas in science and technology in the broader context of society and humanity.</em></p>
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<p>Middle-distance runner Caster Semenya will need to take hormone-lowering agents, or have surgery, if she wishes to continue her career in her chosen athletic events.</p>
<p>The Court of Arbitration in Sport (<a href="https://www.tas-cas.org/en/index.html">CAS</a>) <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">decided last week</a> to uphold a rule requiring athletes with certain forms of what they call “disorders of sex development” (DSD) – more commonly called “intersex” conditions – to lower their testosterone levels in order to still be eligible to compete as women in certain elite races. </p>
<p>The case was brought to CAS by Semenya, as <a href="https://theconversation.com/caster-semenyas-impossible-situation-testosterone-gets-special-scrutiny-but-doesnt-necessarily-make-her-faster-116407">she argued discrimination</a> linked to a 2018 decision preventing some women, including herself, from competing in some female events. </p>
<p>This ruling is flawed. On the basis of <a href="https://www.ncbi.nlm.nih.gov/pubmed/20702382">science and ethical reasoning</a>, there are ten reasons CAS’s decision does not stand up. </p>
<p>But first let’s take a quick look at the biology involved.</p>
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Read more:
<a href="https://theconversation.com/caster-semenya-how-much-testosterone-is-too-much-for-a-female-athlete-116391">Caster Semenya: how much testosterone is too much for a female athlete?</a>
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<p><a href="https://www.bbc.co.uk/sport/athletics/48128682">Semenya underwent medical testing in 2009</a>: at the time she was told it was a doping test. The results are confidential, but it has been widely reported that she does have an intersex condition. It seems reasonable to assume she has XY chromosomes, as she is covered by the CAS ruling. Her testosterone levels have not been disclosed, but since the ruling applies to her, they must almost certainly be in what they classify as the “male range”.</p>
<p>According to CAS, the DSD regulations require athletes who want to compete in some female events, who have XY chromosomes and in whom testosterone has a biological effect to reduce their natural testosterone levels to an agreed concentration (below 5 nmol/L). </p>
<p>In women referred to as “46 XY DSD” – the most common intersex condition among female athletes – the presence of a Y chromosome causes the development of testes. These do not descend from the abdomen but do produce testosterone. However the receptors for testosterone are abnormal, with the result that the individual develops as female with a vagina, but no ovaries or uterus. Circulating testosterone may have no biological effect in the case of complete androgen insensitivity syndrome (AIS), or some effect in partial AIS.</p>
<p>Now let’s consider what’s wrong with the ruling. </p>
<h2>1. It confuses sex with gender</h2>
<p>Sex refers to biology, and gender refers to social role or self-identification. In sport, the definition of male and female used to be based solely on sex. <a href="https://bjsm.bmj.com/content/39/10/695.info">This was assessed anatomically in the 1960s</a>, then by biological tests such as the presence of a structure called a “Barr body” in cells (found only in genetic females), or the gene for testicular development. </p>
<p>Sex determination was abandoned in the 1990s in favour of gender. From the 2000 Sydney Olympics forwards, <a href="https://bjsm.bmj.com/content/39/10/695.info">there were no tests of gender other than self-identification</a>. </p>
<p>Caster Semenya’s gender is uncontroversially female. She is legally female, was from birth raised as female and identifies as a female. So, on the current definition, Semenya is a female. Indeed, there has been no question of her gender.</p>
<p>Sex determination itself is not simple, with chromosomal, gonadal (presence of ovaries or testes), or secondary sex characteristics (physical) all possible definitions that would include or exclude different groups. </p>
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Read more:
<a href="https://theconversation.com/what-makes-you-a-man-or-a-woman-geneticist-jenny-graves-explains-102983">What makes you a man or a woman? Geneticist Jenny Graves explains</a>
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<p>The CAS decision relates to “XY females with disorders of sexual development.” XY denotes the male sex chromosomes. This reverts back to the old biological categories. Behind this ruling is the view that Semenya is really a man competing in the women’s category. This view is embodied beautifully in an article entitled “<a href="https://quillette.com/2019/05/03/a-victory-for-female-athletes-everywhere/">A victory for female athletes everywhere</a>.” </p>
<p>But Semenya is a female by the rules used by the International Association of Athletics Federations (<a href="https://www.iaaf.org/home">IAAF</a>) – so she should be allowed to compete to the best of her potential in her category.</p>
<p>An alternative is to retreat to the old sex-based definition based on the presence of a Y chromosome. But that carries its own questions on definitions, and also comes at great political and individual cost. It would imply that Semenya is a male with a disorder of sexual development. </p>
<h2>2. It discriminates against some forms of hyperandrogenism</h2>
<p>Hyperandrogenism is a term used to describe high levels of testosterone. </p>
<p>But the CAS decision does not cover all forms of hyperandrogenism. It only refers to women who have XY chromosomes, such as <a href="https://www.nhs.uk/conditions/androgen-insensitivity-syndrome/">partial androgen insensitivity syndrome (AIS)</a>. </p>
<p>It does not cover a condition called <a href="https://rarediseases.info.nih.gov/diseases/1467/congenital-adrenal-hyperplasia">congenital adrenal hyperplasia</a>, which can cause elevated levels of testosterone in women with XX chromosomes. </p>
<p>The implication is that XX females are real women, while those with XY chromosomes are not. </p>
<h2>3. It’s based on inadequate science</h2>
<p>The significant problem in partial AIS is that although testosterone is elevated in the blood, the receptors for testosterone do not respond to the hormone in the usual way. That is why these individuals have typical external female physical characteristics. </p>
<p>While the testosterone may have some impact on how the body works, it is impossible to quantify how much effect it is having. For example, the difference testosterone makes between males and females in all events is estimated to be <a href="https://sportsscientists.com/2019/05/on-dsds-the-theory-of-testosterone-performance-the-cas-ruling-on-caster-semenya/">up to 12% (all other items being equal)</a>. But Semenya’s best time is only <a href="https://shows.pippa.io/the-science-of-sport-podcast/episodes/the-caster-semenya-decision-explained">2% faster than her competitors</a>. It is not possible to determine how much of this 2% is due to testosterone, and how much due to other factors about her as an athlete, or her psychology.</p>
<p>The study on which the current decision is based contains only correlations and is flawed in several ways, with a call for its <a href="https://doi.org/10.1007/s40318-019-00143-w">retraction on scientific grounds</a>. It is a single study, conducted by the IAAF and the full data have not been released for independent replication. The sole ground for the claim that Semenya derives “material androgenizing effect” (that is, biological impact) appears to be the “statistical over-representation of female athletes with 46 XY DSD” in the relevant events, as documented in this single, poorly conducted study.</p>
<p>Even if Semenya’s times were to drop after the reduction of testosterone, this could be a side-effect of the drugs used to reduce testosterone, or a function of reductions in mental or physical functions which are themselves legitimate entitlements of the athlete. </p>
<p>Her body has grown up in the presence of a certain level of testosterone of uncertain function. Our bodies are complex, and still poorly understood. A change of this kind may lead to unexpected results. Some of these reductions in functions may be unjust. </p>
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Read more:
<a href="https://theconversation.com/testosterone-why-defining-a-normal-level-is-hard-to-do-113587">Testosterone: why defining a 'normal' level is hard to do</a>
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<p>No one has given a complete description of the role of testosterone in someone like Semenya, nor how much it ought to be reduced to achieve a supposedly fair outcome. The comparisons are only with XX chromosome women, who have a very different physiology and normal functioning testosterone receptors. </p>
<p>Put simply, a level of 5 nMol/L testosterone is meaningless in Semenya’s case because the receptors are not responding in the usual way. It does not achieve a “<a href="https://www.ncbi.nlm.nih.gov/pubmed/20702382">level hormonal playing field</a>”. </p>
<p>This is an example of “decimal point science smokescreen.” There is the impression of much greater confidence and sensitivity than the science warrants by appealing to figures with multiple decimal points. The science around testosterone in intersex conditions is poorly understood, let alone as it applies to individuals. This is a level chosen for convenience, not a level that will negate any perceived advantage, but go no further.</p>
<h2>4. It’s inconsistent with values of sport and human rights</h2>
<p>The self-professed values of sport include the <a href="https://www.wada-ama.org/sites/default/files/resources/files/wada_ethicspanel_setofnorms_oct2017_en.pdf">development of one’s own talent</a> . </p>
<p>Yet Semenya is asked to cobble her natural potential as a female competitor. She must take risky biological interventions to reduce her performance. </p>
<p>The United Nations Human Rights Council has stated that the regulations <a href="https://theconversation.com/its-not-clear-where-human-rights-fit-in-the-legal-ruling-on-athlete-caster-semenya-116417">contravene human rights</a> “including the right to equality and non-discrimination […] and full respect for the dignity, bodily integrity and bodily autonomy of the person”. </p>
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Read more:
<a href="https://theconversation.com/its-not-clear-where-human-rights-fit-in-the-legal-ruling-on-athlete-caster-semenya-116417">It's not clear where human rights fit in the legal ruling on athlete Caster Semenya</a>
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<h2>5. It’s inconsistent with treatment of other athletes</h2>
<p>Other women with disorders resulting in higher than expected levels of testosterone, such as congenital adrenal hyperplasia, are not required to reduce their biological advantage.</p>
<p>Competitors with genetic mutations causing increases in red blood cell mass, and who experience enhanced oxygen-carrying capacity as a result, are not required to reduce their biological levels. </p>
<p>The Finnish skier Eero Mäntyranta had a genetic mutation that boosted his red blood cell count by 25-50% (he produced more blood hormone erythropoetin, or EPO). He and won several Olympic medals with this <a href="https://bjsm.bmj.com/content/bjsports/37/3/192.full.pdf">natural form of doping</a>. </p>
<h2>6. It’s unjust</h2>
<p>The decision is unjust in several ways. </p>
<p>Firstly, it was the IAAF which moved from sex to gender definition of female in 1990s. Semenya has entered competition, trained and competed fairly under the rules. To change them now will be undermine her capacity to compete, work and live, after a lifetime of investment. </p>
<p>If the rules are to be changed, they should not affect athletes who agreed to the current rules, but future athletes. There should be a “grandmother clause” for current athletes, like Semenya or else they are unfairly burdened by the bungles of the IAAF. Even if these rules could be considered justified, they should apply to future athletes as soon as possible after puberty.</p>
<p>Secondly, justice is about giving priority to the worst off in our society – but this ruling adds disadvantage to the worst off. Those with intersex conditions are already stigmatised, discriminated against, in many cases cannot bear children even if they want to. They are the socially disadvantaged. This ruling adds further discrimination and disadvantage.</p>
<p>Thirdly, it sets back integration of intersex people, by stigmatising and marginalising them. We have told them: be yourself, society will accept you. But this sends the message: you are really male, we don’t accept you, you should be castrated.</p>
<h2>7. It is an inappropriate reaction to fear of a ‘slippery slope’</h2>
<p>At the heart of this decision is the fear of displacement of cisgender women on the podia by increasing debate over transgender athletes. <a href="https://quillette.com/2019/05/03/a-victory-for-female-athletes-everywhere/">The concern is</a> that if “XY females” are allowed to compete in the female category, formerly male transgender females will follow and rob cisgender women of their medals. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-does-it-mean-to-be-cisgender-103159">Explainer: what does it mean to be 'cisgender'?</a>
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<p>This is a separate issue. Transgender athletes have normal testosterone receptors and would have grown up in the presence of male levels of testosterone acting on normal receptors. Intersex athletes have not grown up in this way and are typically raised as female.</p>
<p>The perceived problem of transgender domination of female sports can be dealt with by separate rules that do not disadvantage existing intersex athletes, though they will raise contentious issues of their own. </p>
<h2>8. It is disproportionate and unreasonable</h2>
<p>All methods of reducing testosterone involve some risk. For example, the administration of <a href="https://www.ncbi.nlm.nih.gov/pubmed/2960241">high-dose birth control medication</a> involves risk of clots, including fatal lung clots. </p>
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Read more:
<a href="https://theconversation.com/how-to-choose-the-right-contraceptive-pill-for-you-87614">How to choose the right contraceptive pill for you</a>
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<p>These interventions interfere with a normally functioning organism for highly uncertain benefits to other people. This is disproportionate and unreasonable.</p>
<h2>9. It can’t be implemented</h2>
<p>The World Medical Association has advised doctors <a href="https://www.wma.net/news-post/wma-reiterates-advice-to-physicians-not-to-implement-iaaf-rules-on-classifying-women-athletes/">not to administer</a> testosterone-lowering interventions, describing the regulation as “<a href="https://www.wma.net/news-post/wma-urges-physicians-not-to-implement-iaaf-rules-on-classifying-women-athletes/">contrary to international medical ethics and human rights standards</a>”. </p>
<p>Their use would be “off label” and is for purposes other than the athlete’s health. The rules involve “strict liability” which means the athlete is responsible for any failure to comply, even if unintentional and outside of the athlete’s control.</p>
<h2>10. There are fairer, safer alternatives</h2>
<p>I have argued athletes <a href="https://www.bmj.com/content/347/bmj.f6150">should be able take performance-enhancing substances</a> within the normal physiological range. This would mean cisgender female athletes could take testosterone up to 5 nMol/L. This would reduce any advantage Semenya may have.</p>
<p>It would also deal with the problem that <a href="https://link.springer.com/article/10.1007/s40279-014-0247-x">up to 40%</a> of elite athletes are currently doping anyway. Semenya received the <a href="https://www.olympic.org/london-2012/athletics/800m-women">London 2012 800m gold medal</a> after the <a href="https://www.reuters.com/article/us-doping-russia-savinova/savinova-stripped-of-london-games-800m-gold-for-doping-idUSKBN15P1EO">original winner was disqualified for doping</a>. It is highly likely that some of her current competitors are also doping.</p>
<p>No doubt part of the resistance to allowing Semenya to “naturally dope” is that it will encourage other athletes to engage in doping. But they already are, and a better approach to “de-enhancing” Semenya is to <a href="https://www.bmj.com/content/347/bmj.f6150">regulate and monitor the enhancement of other athletes</a>. </p>
<h2>Spectacular fail</h2>
<p>Rarely does a public policy fail so spectacularly on so many ethical grounds. </p>
<p><a href="https://www.tas-cas.org/fileadmin/user_upload/Media_Release_Semenya_ASA_IAAF_decision.pdf">CAS acknowledged</a> that its decision constituted discrimination: </p>
<p>“The panel found that the DSD Regulations are discriminatory but the majority of the panel found that, on the basis of the evidence submitted by the parties, such discrimination is a necessary, reasonable and proportionate means of achieving the IAAF’s aim of preserving the integrity of female athletics in the restricted events.”</p>
<p>The UNHRC <a href="https://documents-dds-ny.un.org/doc/UNDOC/LTD/G19/072/46/PDF/G1907246.pdf?OpenElement">has refuted this claim of proportionality</a>: “there is no clear relationship of proportionality between the aim of the regulations and the proposed measures and their impact”.</p>
<p>This ruling is neither necessary, reasonable nor proportionate. It is simply unjust discrimination.</p>
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Read more:
<a href="https://theconversation.com/caster-semenyas-impossible-situation-testosterone-gets-special-scrutiny-but-doesnt-necessarily-make-her-faster-116407">Caster Semenya's impossible situation: Testosterone gets special scrutiny but doesn't necessarily make her faster</a>
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<p><em>Thanks to Michelle Telfer and Ken Pang for comments</em></p>
<p><em>This article builds on arguments presented in the paper <a href="https://www.ncbi.nlm.nih.gov/pubmed/20702382">Time to re-evaluate gender segregation in athletics?</a>.</em></p><img src="https://counter.theconversation.com/content/116448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Savulescu receives funding from Uehiro Foundation on Ethics and Education and the Wellcome Trust. </span></em></p>Athlete Caster Semenya will need to take hormone-lowering agents, or have surgery, if she wishes to continue her career in her chosen events. But the decision to ban her is flawed on many grounds.Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children's Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164072019-05-06T10:37:45Z2019-05-06T10:37:45ZCaster Semenya’s impossible situation: Testosterone gets special scrutiny but doesn’t necessarily make her faster<figure><img src="https://images.theconversation.com/files/272560/original/file-20190503-103063-57i6mw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An arbitration court ruled that the 28-year-old runner must lower her testosterone levels in order to compete.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Czech-Republic-Athletics-Continental-Cup/a76d9a3a2be74b81bb27078e493a789a/27/0">AP Photo/Petr David Josek</a></span></figcaption></figure><p>A yearslong saga between a middle-distance runner and her sport’s ruling body may be nearing something that resembles a conclusion.</p>
<p>In 2018, the International Association of Athletics Federations <a href="https://www.iaaf.org/news/press-release/eligibility-regulations-for-female-classifica">dictated</a> that female runners with naturally occurring high testosterone levels and specific “<a href="https://www.ncbi.nlm.nih.gov/pubmed/24337131">differences of sex development</a>” must lower their testosterone in order to compete in events ranging from 400 meters to one mile.</p>
<p>Two-time Olympic champion Caster Semenya challenged the 2018 policy. It was discriminatory, <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">she argued</a>, lacked scientific grounding and did “irreparable harm to affected female athletes.”</p>
<p>But on May 1, in a blow to Semenya and an untold number of other women, the Court of Arbitration for Sport upheld the regulations. The policy is now set to go into effect <a href="https://www.iaaf.org/news/press-release/cas-female-eligibility-regulations">on May 8</a> </p>
<p>As a scholar who studies <a href="https://global.oup.com/academic/product/womens-sports-9780190657703?cc=us&lang=en&">women’s sports</a> I’ve been following this story closely. At the heart of the conflict is how to define “femaleness” for the purpose of athletic competitions. Since sports are segregated by sex, what criteria – if any – should we use to distinguish female from male? </p>
<h2>How we got here</h2>
<p>Monitoring testosterone is the latest version of “sex testing” in women’s sport, <a href="https://www.press.uillinois.edu/books/catalog/85fcr3nh9780252040221.html">a practice that began in the 1930s</a>. </p>
<p>Originally, athletes presented affidavits from their personal and team physicians confirming that they were, in fact, women. In the 1960s, athletic administrators turned to gynecological examinations, visual inspections and chromosomal analyses. In the 1990s, they implemented genetic testing.</p>
<p>By the 21st century, most systematic testing had been discontinued, <a href="https://www.doi.org/10.1080/00336297.2011.10483678">unless someone “challenged” a female athlete’s sex</a>. This happened to Semenya at the <a href="https://www.theguardian.com/sport/2009/aug/19/caster-semenya-800m-world-athletics-championships-gender">2009 Track and Field World Championships</a>. Someone apparently issued such a challenge and the press caught wind of it. The International Association of Athletics Federations confirmed that she was undergoing “gender verification” procedures, just before she cruised to victory in the 800-meter race. </p>
<p>Although her test results were never made public, the IAAF <a href="https://www.press.uillinois.edu/books/catalog/58ctr3rx9780252038167.html">subsequently issued a new policy</a> for women with hyperandrogenism, or high testosterone. Arguing that high testosterone gave these athletes an unfair advantage, hyperandrogenic female athletes had two choices: suppress their testosterone or drop out of the sport.</p>
<p>Indian sprinter <a href="https://www.iaaf.org/athletes/india/dutee-chand-275950">Dutee Chand</a> refused to do either. In 2014, the Sports Authority of India diagnosed her as hyperandrogenic and disqualified her from competition. Chand challenged that disqualification in the Court of Arbitration for Sport, <a href="https://www.tas-cas.org/fileadmin/user_upload/award_internet.pdf">where adjudicators ruled</a> the IAAF had “insufficient evidence” to enforce its policy. The decision gave the organization two years to find evidence that associated enhanced performance with naturally high levels of testosterone. If not, the policy would be invalidated.</p>
<p>As the 2017 deadline approached, researchers affiliated with the IAAF <a href="https://bjsm.bmj.com/content/51/17/1309">published a study</a> that claimed women with high testosterone performed as much as 3% better than those with lower testosterone in a handful of events. </p>
<p>Undeterred by <a href="https://doi.org/10.1007/s40318-019-00143-w">those who exposed the study’s methodological flaws</a>, <a href="https://theconversation.com/a-sexist-policy-may-end-the-career-of-one-of-the-commonwealths-greatest-female-runners-94390">the organization plowed ahead with its regulations</a>, prompting Semenya’s challenge. </p>
<h2>‘Necessary’ discrimination?</h2>
<p>Although it rejected Semenya’s claims, the Court of Arbitration for Sport’s panel <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">conceded</a> that the regulations are “discriminatory” but “necessary” to preserve “the integrity of female athletics.” The regulations are additionally discriminatory, panel members noted, because they “do not impose any equivalent restrictions on male athletes.” </p>
<p>This is something that critics of the policy <a href="https://www.theguardian.com/commentisfree/2018/apr/26/testosterone-ruling-women-athletes-caster-semanya-global-south">have charged from the beginning</a>.</p>
<p>No one is concerned about male athletes with unusually high, naturally occurring testosterone. Taking hormones out of the equation, there are a host of biological advantages that some athletes enjoy over others. Nordic skier Eero Mäntyranta, for example, had a <a href="https://www.penguinrandomhouse.com/books/309105/the-sports-gene-by-david-epstein/9781617230127/">genetic condition</a> that caused the excessive production of red blood cells, giving him an advantage in endurance events. Michael Phelps’ <a href="https://www.businessinsider.com/michael-phelps-rio-olympics-body-swimming-2016-8">unique and optimally shaped swimming body</a> allows him to cut through the water with remarkable speed and efficiency. No one suggests these men should muzzle their assets. </p>
<p>This is because we don’t divide sport into categories based on hemoglobin or foot size, regardless of the advantages each confers. </p>
<p>We do, however, carve sport into male and female categories, and for good reason. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761733/">Studies show</a> that elite male athletes tend to outperform elite female athletes by about 10%. Segregating men and women in most elite sports gives women more opportunities to compete and succeed.</p>
<p>Here’s where it gets tricky. If we insist on sexual segregation in sport, how do we decide who’s a female and who’s a male? Do those criteria influence sport performance? And what happens when athletes do not fit neatly into sport’s definition of femaleness?</p>
<p>This is precisely what the new regulations attempt to address, albeit in a clumsy and confounding way. Specifically, the policy is aimed at women who are legally recognized as women but who are diagnosed with specific differences of sex disorders and have high levels of functional testosterone. The IAAF explains that these disorders involve male-typical sex chromosomes and the presence of testes or testicular development. The threshold for women’s testosterone is below the “normal” male range but more than two times higher than the upper limit of the “normal” female range.</p>
<p>Semenya and her supporters argue that since the women affected by the policy are, in fact, women, they should be allowed to compete without restriction. </p>
<p>“I just want to run naturally, the way I was born,” <a href="https://www.telegraph.co.uk/athletics/2018/06/18/caster-semenya-files-legal-case-against-new-testosterone-rule/">she said</a>. “It is not fair that I am told I must change.”</p>
<p>It’s worth noting that although Semenya is the top athlete in her class, her times don’t come anywhere near the times of elite male runners – despite allegedly having “male levels” of testosterone.</p>
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<a href="https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/272571/original/file-20190503-103057-7epr2a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Semenya blows away her female competitors, but her times wouldn’t allow her to compete against the top male runners.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Monaco-Athletics-Diamond-League/174e6fadd6e74e6e94dc77fd571091e1/32/0">AP Photo/Claude Paris</a></span>
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<h2>Sporting rights versus human rights</h2>
<p>The controversy has divided activists for sporting rights and human rights. </p>
<p>The IAAF <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">regards women’s sport</a> as a “protected class” and insists that it must “place conditions” on the female category in order “to ensure fair and meaningful competition.”</p>
<p>Human rights activists disagree. If an athlete is legally a woman, that should be good enough. In fact, the United Nations Human Rights Council <a href="https://ilga.org/downloads/Elimination_of_discrimination_against_women_and_girls_in_sport.pdf">resolved</a> that the new regulations “may not be compatible with international human rights norms and standards.” <a href="https://www.sport24.co.za/OtherSport/Athletics/sas-sports-scientist-tucker-not-enough-evidence-to-curb-caster-20190502">Citing the assertions of esteemed scientists</a> and <a href="https://ewn.co.za/2019/02/21/testosterone-expert-karkazis-says-iaaf-has-no-evidence-to-back-its-claims">bioethicists</a>, the council criticized the “lack of legitimate and justifiable evidence for the regulations.” Put differently, there is no conclusive, incontrovertible correlation between high natural testosterone and better performance. Without such evidence, they argued, the IAAF’s regulations shouldn’t be enforced. </p>
<p>The Court of Arbitration panel members <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">did note</a> that they’re concerned about how the IAAF’s regulations will be practically applied. In addition, the IAAF regards the regulations as a “living document,” which means that it can and probably will change as time goes on. </p>
<p>Will the testosterone restrictions expand to additional track and field events? </p>
<p>Meanwhile, the International Olympic Committee <a href="https://www.cnn.com/2019/05/01/sport/caster-semenya-cas-hearing-spt-intl/index.html">is reportedly working on guidelines</a> to help international federations devise their own policies regarding “gender identity and sex characteristics.” In other words, we can expect to see policies similar to the IAAF’s in other sports.</p>
<p>Semenya has 30 days to appeal the arbitration ruling to the Swiss Federal Tribunal. If this appeal fails, she and countless other women must reduce their testosterone, probably with medication, to keep competing in women’s events. What will this do to their bodies? To the sport? To issues of fairness and human rights? </p>
<p>The Court of Arbitration decision is just one leg in what looks to be a never-ending and perhaps futile relay to establish “fairness” in women’s sports.</p><img src="https://counter.theconversation.com/content/116407/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaime Schultz does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sports are segregated by sex. But what happens when athletes don’t fit neatly into sport’s definition of gender?Jaime Schultz, Associate Professor of Kinesiology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164952019-05-03T21:02:27Z2019-05-03T21:02:27ZThe demonization of Caster Semenya continues<figure><img src="https://images.theconversation.com/files/272567/original/file-20190503-103068-1hdwfh2.jpg?ixlib=rb-1.1.0&rect=0%2C270%2C5472%2C3366&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">South Africa's Caster Semenya in the moments before the women's 800-meter final during the Diamond League athletics event in Doha, Qatar on May 3. The world champion easily won the race, but her future remains in doubt.</span> <span class="attribution"><span class="source">(AP Photo/Kamran Jebreili)</span></span></figcaption></figure><p>Caster Semenya, one of the world’s greatest female middle-distance runners, may be forced to quit the event she has dominated for a decade. After easily winning the 800-metre race at an international meet in Doha on May 3, the South African athlete was defiant in saying she won’t comply with new restrictions that will be placed on her at future competitions.</p>
<p>“No man, or any other human, can stop me from running,” she said after the race, her first — and possibly last — competition since a controversial ruling by the supreme court of international sport.</p>
<p>Her defiant words were in reaction to <a href="https://www.tas-cas.org/fileadmin/user_upload/Media_Release_Semenya_ASA_IAAF_decision.pdf">a horrible ruling by the Court of Arbitration for Sport</a>, which denied an appeal by Semenya against the policy of track and field’s international governing body.</p>
<p>The International Association of Athletics Federations (IAAF) had previously ruled that female athletes like Semenya who have naturally high levels of testosterone must now take hormone-suppressing drugs to compete in any event between 400 metres and one mile. (There are five such events at the international level.) The court decision means the IAAF rules go into effect May 8.</p>
<p>The IAAF policy is based on bad science, flies in the face of best practice in policy making, overrides human rights and will cause tremendous anxiety and even harm among the female athletes in the world, particularly those in the Global South.</p>
<h2>Rules could cause harm</h2>
<p>Even the Court of Arbitration for Sport cautions that there are serious problems with the IAAF policy, including the potential for harmful side effects that hormonal treatment could cause for the athletes who must now take the medication to compete.</p>
<p>The Canadian Centre for Ethics in Sports, which directs Canada’s anti-doping program, the Canadian Association for the Advancement of Women and Sports and AthletesCAN, the association of Canadian national team athletes, <a href="https://cces.ca/news/cces-caaws-and-athletescan-very-concerned-cas-ruling-iaafs-eligibility-regulations-female">have condemned the decision</a>. Athletics Canada has said <a href="https://athletics.ca/athletics-canada-statement-on-iaaf-female-eligibility-regulations/">it won’t implement the policy in Canada</a>.</p>
<p>Before the judgment was rendered, independent experts for the UN Human Rights group <a href="https://www.ohchr.org/_layouts/15/WopiFrame.aspx?sourcedoc=/Documents/Issues/Health/Letter_IAAF_Sept2018.pdf&action=default&DefaultItemOpen=1">wrote the IAAF urging it to cancel the policy</a>. But some track and field athletes came out to support the policy, insisting that <a href="https://www.insidethegames.biz/articles/1077368/isinbayeva-backs-iaaf-and-says-female-athletes-with-high-testosterone-have-colossal-advantage">female athletes with high levels of testosterone have a “colossal” advantage</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/272569/original/file-20190503-103063-1nba6ah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/272569/original/file-20190503-103063-1nba6ah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/272569/original/file-20190503-103063-1nba6ah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/272569/original/file-20190503-103063-1nba6ah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/272569/original/file-20190503-103063-1nba6ah.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=518&fit=crop&dpr=1 754w, https://images.theconversation.com/files/272569/original/file-20190503-103063-1nba6ah.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=518&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/272569/original/file-20190503-103063-1nba6ah.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=518&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Semenya flexes her muscles after winning the gold medal in the women’s 800-metre at the 2016 Summer Olympics in Rio de Janeiro.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
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<p>Why has Semenya been so demonized?</p>
<p>As a professor of kinesiology and physical education who competed in athletics at the 1964 Olympics, it’s my view the explanation is to be found in a misunderstanding of natural testosterone, a narrow misreading of the Olympic values, the distrust engendered by almost century of sex testing in international sports and a failure of leadership on the part of the IAAF.</p>
<p>Synthetic testosterone is justly banned from Canadian and international sports (except for approved therapeutic purposes). If taken carefully, at the time of hard training, it can enable significant strength and speed gains and reduce the risk of injury.</p>
<h2>Not a reliable measure</h2>
<p>But natural testosterone is not the same thing. It may aid performance, but it may not. <a href="https://science.sciencemag.org/content/348/6237/858.full">As Yale University researcher Katrina Karkazis has argued</a>, there is no predictable relationship between natural testosterone and improved performance. Even in the same person, testosterone levels can change over time, depending on a range of factors. It’s not a reliable measure, and it will be very difficult, if not impossible, to monitor without frequent, invasive testing. </p>
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<p>Then there’s the ethical question. On what basis do you exclude athletes because of who they are? Natural testosterone is a human condition. When I used to urge athletes against doping, I often said “play with your own chemicals.” Now the IAAF is banning female athletes who play with their own chemicals. The Court of Arbitration for Sport emphasized that Semenya was not cheating, and that she should be admired for her athleticism and courage.</p>
<p>High natural testosterone occurs from a genetic mutation, not unlike the <a href="https://www.propublica.org/article/muscular-dystrophy-patient-olympic-medalist-same-genetic-mutation">hundreds of other genetic mutations that confer advantage in sports</a>, such as exceptional height, reach and ability to draw oxygen into the blood stream. Virtually every top athlete has at least one of these inherent advantages. The Olympic spirit is to rejoice in the diversity of humankind.</p>
<h2>Fairness? Let’s address these issues</h2>
<p>If the concern is really the fairness of condition, those who fear Semenya should address the huge international differences in personal and national income, the most consistent factor determining athletic performance because of the advantages it can buy in better training facilities, nutrition, coaching, medical assistance and so on.</p>
<p>Why is no effort made to balance out these other factors? Would Canadians who support the IAAF against Semenya like it if they were required to train under the same conditions as their competitors from the Global South? Of course not. </p>
<p>Sadly, Semenya has not been the first highly successful female athlete to be accused of masculine qualities and to face banning from sports. In fact, from the very beginning of high-level women’s sport, <a href="https://slate.com/technology/2019/05/caster-semenya-testosterone-gender-appeal-ruling.html">the best athletes have been so vilified.</a></p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/fOGXvBAmTsY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Kathrine Switzer, the first woman to compete in the Boston Marathon in 1967, was told women were too delicate to run long distances.</span></figcaption>
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<h2>Sex testing started decades ago</h2>
<p>In the 1930s, the men who controlled sports claimed that such women were “abnormal” and introduced “gender verification” to police them. In the 1960s, when women from the Soviet Union and the newly independent nations of the Global South, many of whom didn’t look like western women, began to win many of the medals, the test was made universal.</p>
<p>Every female athlete I know can recount the stress of “gender verification” and hundreds suffered from the stigma of false positives. <a href="https://www.theglobeandmail.com/sports/gender-testing-at-olympics-abolished-at-last/article25459571/">Worldwide opposition led to the abolition of the universal sex test in 1999</a>, but the very same people who administered it tried again when Semenya raced onto the scene. The legacy of this history continues to pit women against women and poison the sport.</p>
<p>What’s most troubling is the way the IAAF leadership has aggressively campaigned for this test. Instead of standing up for Semenya, admiring her and conducting an educational campaign to clarify the issues, IAAF president Sebastian Coe has made it his personal crusade to chase her from the sport. </p>
<p>But history is on Semenya’s side. As the Court of Arbitration for Sport’s decision acknowledges, there are so many problems with the IAAF policy that no doubt another legal challenge will be mounted before long. </p>
<p>Let’s hope that the next time, gender policing in sports will be abolished once and for all. And let’s hope that more track and field athletes will recognize the justice of Semenya’s cause and support her.</p><img src="https://counter.theconversation.com/content/116495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Kidd does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The great South African runner Caster Semenya may have competed in her last 800-metre race. She has been demonized for more than a decade, like many other female athletes before her.Bruce Kidd, Professor of Kinesiology, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164172019-05-02T22:22:54Z2019-05-02T22:22:54ZIt’s not clear where human rights fit in the legal ruling on athlete Caster Semenya<p>On May 1 the Court of Arbitration for Sport (<a href="https://www.tas-cas.org/en/index.html">CAS</a>) issued a highly anticipated ruling involving athlete Caster Semenya and Athletics South Africa as claimants, and the International Association of Athletics Federations (<a href="https://www.iaaf.org/home">IAAF</a>). </p>
<p>The <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">ruling</a> upheld the IAAF’s eligibility regulation that restricted female athletes, including Semenya, with “differences of sex development” – broadly taken to mean high levels of testosterone – from entering certain international athletic events. </p>
<p>It means Semenya <a href="https://theconversation.com/caster-semenya-how-much-testosterone-is-too-much-for-a-female-athlete-116391">will have to take medication</a> to lower her testosterone levels if she wishes to continue competing internationally in running events.</p>
<p>This decision is within the sports law decision-making framework. But what about Semenya’s human rights? <a href="http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/40/L.10/Rev.1">Recent publications</a> from the United Nations Human Rights Council (<a href="https://www.ohchr.org/en/hrbodies/hrc/pages/home.aspx">UNHRC</a>) criticise the “discriminatory regulations” relating to lowering testosterone in female athletes. </p>
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Read more:
<a href="https://theconversation.com/caster-semenya-how-much-testosterone-is-too-much-for-a-female-athlete-116391">Caster Semenya: how much testosterone is too much for a female athlete?</a>
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<p>Semenya’s case shows the challenges in balancing a range of interests in maintaining fair competition. On the one hand, the IAAF’s claim of a “legitimate, necessary and proportionate” method to ensure a level playing field in competitive sport. On the other, the rights of those with hyperandrogenism (a condition where the body produces relatively high levels of testosterone) in competing against females with so-called “normal” testosterone levels.</p>
<h2>Who is Caster Semenya?</h2>
<p>As an athlete competing in IAAF events, 28-year-old Semenya is well known for her athletic prowess in her chosen sport. </p>
<p>The public scrutiny <a href="https://www.theguardian.com/sport/2019/may/01/how-caster-semenya-controversy-unfolded-since-2009-timeline">Semenya endured in 2009</a> when subject to gender testing increased public attention on her physical attributes. </p>
<p>After being cleared to run again, Semenya’s domination continued to raise <a href="https://academic.oup.com/jcem/article/97/11/3902/2836438">controversy</a> about perceived unfairness of being included in female classified events. Others described her physical advantage akin to an adult competing against a child in the <a href="https://www.abc.net.au/news/2018-06-19/caster-semenya-to-challenge-iaaf-female-classification-rule/9884762">same competition</a>.</p>
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Read more:
<a href="https://theconversation.com/testosterone-why-defining-a-normal-level-is-hard-to-do-113587">Testosterone: why defining a 'normal' level is hard to do</a>
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<h2>The IAAF sets the rules</h2>
<p>The IAAF is the legitimate rule-maker in the world of athletics. Athletes agree to be bound by the IAAF rules if they want to compete.</p>
<p>In April 2018 the “Eligibility Regulations for Female Classification (Athletes with Differences of Sex Development)” – known as the <a href="https://www.iaaf.org/news/press-release/eligibility-regulations-for-female-classifica">DSD regulations</a> – were set out. </p>
<p>These established the criteria for women to compete in the female classification of the 400m, 800m and 1500m races and apply to athletes who are <a href="https://academic.oup.com/jcem/article/97/11/3902/2836438">female (or have intersex characteristics)</a> with naturally occurring testosterone levels of above 5 nanomole/L (a measure of concentration) and who experience a “material androgenising effect” (that is, the testosterone has a <a href="https://www.sportsintegrityinitiative.com/caster-semenyas-challenge-to-the-dsd-regulations-its-complicated/">biological effect</a>). </p>
<p>Affected female athletes are required to reduce natural testosterone levels to within the normal female range (i.e. to a level below 5 nanomole/L) by using medication, and maintain that reduced level for at least six months to remain eligible to compete. </p>
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Read more:
<a href="https://theconversation.com/what-makes-you-a-man-or-a-woman-geneticist-jenny-graves-explains-102983">What makes you a man or a woman? Geneticist Jenny Graves explains</a>
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<h2>The role of CAS</h2>
<p>The CAS determines sports-related disputes and bases its rulings on the evidence presented to it and the submissions presented by the parties. The authority of the CAS operates via a series of interlocking arrangements that cascade down through the global governance of sport, and are binding on athletes. </p>
<p>In June 2018, Semenya and Athletics South Africa filed <a href="https://www.lawinsport.com/sports-law-news/item/semenya-asa-and-iaaf-decision?tmpl=component&print=1">arbitration proceedings</a> challenging the validity of the DSD Regulations as <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">“discriminatory, unnecessary, unreliable and disproportionate”</a>. They claimed that the DSD regulations would cause “grave unjustified and irreparable harm” and questioned the scientific soundness, a concern raised by <a href="https://sportsscientists.com/2018/08/letter-to-bjsm-reinforcing-call-for-retraction-of-iaaf-research-on-testosterone-in-women/">others</a>. </p>
<p>The IAAF disagreed and claimed the DSD regulations were necessary to pursue “the legitimate aim of safeguarding fair competition and protecting the ability of female athletes to <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">compete on a level playing field</a>”. It claimed the DSD regulations were based on the “best available science” and did not discriminate. </p>
<p>On May 1 the CAS Panel upheld the validity of the DSD regulations and considered the DSD Regulations as a “necessary, reasonable and proportionate means of achieving the IAAF’s aim of preserving the <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">integrity of female athletics</a>” </p>
<p>Semenya and Athletics South Africa have thirty days to appeal to the Swiss Federal Tribunal. The IAAF issued a <a href="https://www.iaaf.org/news/press-release/cas-female-eligibility-regulations">media release</a> advising the DSD Regulations effective on 8 May 2019, and calling on affected athletes to consult their medical teams and initiate suppressive treatment.</p>
<h2>It’s also about human rights</h2>
<p>So what are the wider implications of the Semenya case? </p>
<p>In March 2019, the IAAF was criticised by the United Nations Human Rights Council (<a href="https://www.ohchr.org/en/hrbodies/hrc/pages/home.aspx">UNHRC</a>) over <a href="http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/40/L.10/Rev.1">concerns that</a> their “discriminatory regulations […] to medically reduce blood testosterone levels contravene international human rights […] including the right to equality and non-discrimination…and full respect for the dignity, bodily integrity and bodily autonomy of the person”.</p>
<p>With specific reference to the IAAF’s DSD Regulations, the UNHRC <a href="http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/40/L.10/Rev.1">called upon states</a> to “ensure that sporting associations […] refrain from developing and enforcing policies […] that force, coerce or otherwise pressure […] athletes into undergoing unnecessary, humiliating and harmful medical procedures”. </p>
<p>The UNHRC also requested the UN High Commissioner to <a href="http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/40/L.10/Rev.1">prepare a report</a> on the intersection of gender discrimination in sports and human rights to present to the Human Rights Council at its forty-fourth session (likely to be <a href="https://www.ohchr.org/EN/HRBodies/HRC/Pages/Sessions.aspx">held June 2020</a>). </p>
<p>Sport is a special domain, but it is not that special to be immune from the law and human rights. Indeed, Sport Australia <a href="https://www.sportaus.gov.au/integrity_in_sport/inclusive_sport">promotes inclusive sport</a> based on the principle that “every Australian […] should be able to participate in sport […] in a welcoming and inclusive way”.</p>
<p>So the questions remain whether states will take heed of the UNHRC call to action, and how to reconcile this with the IAAF’s stand on gender characteristics falling outside the “normal” range.</p><img src="https://counter.theconversation.com/content/116417/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annette Greenhow does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sport is a special domain, but it is not immune from the law and human rights. We’re yet to see if the United Nations Human Rights Council will take steps following a new ruling on testosterone.Annette Greenhow, Assistant Professor, Faculty of Law, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.